NU298 Unit 10 Capstone Paper Example

Shortening Fasting Before Procedures on a Medical Unit, Proposed but Not Yet Tested: A Capstone Paper Assembling Problem, Evidence and an Eight-Week Pilot Plan Into One Argument, With a Full Section on Its Limitations

[Student Name]

Purdue University Global

NU298: Capstone

Unit 10 Capstone Paper

[Instructor Name]

[Date]

The unit, baseline data and projections are composite and bracketed; nothing was changed on any unit, and the paper is a student capstone proposal.

Abstract

Hospitalized adults on a composite 30-bed medical unit were kept without clear liquids for a median of [13.5] hours before procedures that began, on average, after [1300]. Evidence suggests that fasting orders on medical services are frequent and often longer than needed, and that letting patients take clear fluids up to two hours ahead of planned procedures has not been shown to increase aspiration. This capstone proposes a three-part bundle, a fasting order check at the morning huddle, a call to confirm procedure times and clear liquids until two hours before for eligible patients, to be tested in an eight-week pilot. No change was made; results are projected, not observed.

Introduction and Problem

Fasting orders protect patients from aspiration during sedation, but when written from midnight for procedures in the afternoon, or for procedures that do not happen, they cause thirst, hunger, distress and sometimes low blood pressure. On the composite unit, [19] percent of fasts ended with the procedure postponed or canceled. Published studies of medical inpatients report similar patterns (Sorita et al., 2015, 2017).

Methods in Brief

CINAHL Complete and PubMed were searched for studies of fasting orders and fasting duration in hospitalized adults, with gray literature counted separately. Of [386] records, [11] were appraised and leveled using the Johns Hopkins approach (Dang et al., 2022). Full details appear in the search summary and annotated bibliography; this paper presents the conclusions.

What the Evidence Supports

1. On medical services, fasting orders are frequent and frequently overlong. Strength: moderate.

2. Trials in elective surgery found no rise in aspiration with shorter fluid fasts, and the current anesthesia guideline permits clear fluids up to two hours ahead (Brady et al., 2003; Joshi et al., 2023). Strength: strong in the surgical setting, more tentative for medical inpatients.

3. Long fasts cause psychological distress and physiological strain (Hepper et al., 2024). Strength: moderate for distress.

4. No study in the set tested a nurse-led change of this kind on a medical floor. Strength: weak.

The evidence is strong where it is least needed, in surgical trials, and weak where the unit most needs it, in whether nurses on a medical floor can make the change stick.

The Proposed Change

The bundle attaches to existing routines: the 0700 huddle reviews every fasting order, a [0900] call confirms procedure times, and an approved order set allows clear liquids until two hours before for patients without exclusions such as dysphagia, bowel obstruction, delayed gastric emptying or general anesthesia. The revised Iowa Model guides the sequence, with an eight-week pilot and then a team decision on whether to keep, change or drop the bundle (Iowa Model Collaborative, 2017).

Measures and Projected Results

Outcome: median clear-liquid fasting time and a thirst rating. Process: percent of fasting orders reviewed, confirmed and acted on. Balancing: delays or cancellations due to insufficient fasting and any aspiration events. If the bundle were delivered for about [80] percent of eligible patients, the projected median fast would fall to about [5] hours, based on typical procedure times. These are projections, not results.

Stakeholders and Their Concerns

Each group the change touches has a concern the proposal must answer. Providers worry about canceled procedures if patients drink too close to the time; the confirmed time and the two-hour rule address that. Procedure areas worry about extra phone calls; the call replaces the transport call they already receive. Nurses worry about workload; the huddle question adds about a minute per patient. Patients worry about whether drinking is safe; the bedside card explains the rule in plain words. Anesthesia worries about patients outside the guideline; the exclusions keep those patients on individual orders.

What Would Count as Failure

The pilot would be judged unsuccessful if fasting times did not fall, if process measures stayed below [50] percent after four weeks, or if any balancing measure showed harm. Any aspiration event during sedation in a patient who had clear liquids would stop the pilot for review, whatever the other results. Naming failure in advance protects patients and keeps the team from explaining away poor results after the fact.

Sustaining the Change if It Works

If the pilot succeeds, sustainment would rely on the order set default, a monthly audit of fasting times reported at the staff meeting and inclusion of the bundle in new-nurse orientation. Without these, changes that depend on habit tend to fade within months.

Limitations

The evidence leans on observational studies and quality improvement reports for the questions closest to this unit, and on older surgical trials for safety. Definitions vary: some studies measure total fasting, others only food or only fluids, which makes comparison difficult. The baseline is from four weeks of records on one composite unit and may not reflect other months. Results are projected rather than measured, so the paper cannot say whether the bundle works. The exclusions, chosen for safety, also limit how many patients benefit. Finally, the change depends on a provider group and procedure areas the student does not control; without their agreement, the bundle cannot run (Sparling & Yeh, 2023).

Recommendations, Graded by Evidence

Strong: allow clear liquids until two hours before elective sedated procedures for patients who meet guideline criteria. Moderate: review every fasting order daily for need and timing. Weak, to be tested: nurse-driven confirmation calls and order-set defaults as the way to deliver the change on a medical unit.

What I Learned Doing This Project

The project changed how I read orders. Before it, "NPO after midnight" looked like a clinical decision; now I see it as a default that may or may not fit the patient in front of me. I also learned that the hardest part of evidence-based practice is not finding evidence but matching it to a setting it was not studied in, and saying honestly where it stops. Writing the limitations section took longer than any other, and it is the section I would most want a nurse manager to read before approving a pilot.

Conclusion

The problem is real, measurable and partly within nursing's reach. The evidence supports the direction of change and leaves open whether this unit can deliver it. A short, measured pilot is the next honest step.

References

Brady, M. C., Kinn, S., Stuart, P., & Ness, V. (2003). Preoperative fasting for adults to prevent perioperative complications. Cochrane Database of Systematic Reviews, 2003(4), Article CD004423. https://doi.org/10.1002/14651858.CD004423

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Hepper, E. C., Wilson, J., Drinnan, M., & Patterson, J. M. (2024). Psychosocial impacts of being nil-by-mouth as an adult: A scoping review. Journal of Advanced Nursing, 80(9), 3499-3515. https://doi.org/10.1111/jan.16100

Iowa Model Collaborative. (2017). Iowa Model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Harbell, M. W., Kuo, C. I., Soriano, S. G., Stricker, P. A., Tipton, T., Grant, M. D., Marbella, A. M., Agarkar, M., Blanck, J. F., & Domino, K. B. (2023). 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: Carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration: A modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 138(2), 132-151. https://doi.org/10.1097/ALN.0000000000004381

Sorita, A., Thongprayoon, C., Ahmed, A., Bates, R. E., Ratelle, J. T., Rieck, K. M., Devalapalli, A. P., Issa, M., Shah, R. M., Lalama, M. A., Wang, Z., Murad, M. H., & Kashiwagi, D. T. (2015). Frequency and appropriateness of fasting orders in the hospital. Mayo Clinic Proceedings, 90(9), 1225-1232. https://doi.org/10.1016/j.mayocp.2015.07.013

Sorita, A., Thongprayoon, C., Ratelle, J. T., Bates, R. E., Rieck, K. M., Devalapalli, A. P., Ahmed, A., & Kashiwagi, D. T. (2017). Characteristics and outcomes of fasting orders among medical inpatients. Journal of Hospital Medicine, 12(1), 36-39. https://doi.org/10.1002/jhm.2674

Sparling, J. L., & Yeh, D. D. (2023). Hungry for change: How best to implement and sustain reduced fasting times in hospitalized surgical patients? The Joint Commission Journal on Quality and Patient Safety, 49(11), 579-580. https://doi.org/10.1016/j.jcjq.2023.07.001