Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-16-2025

Graduate Advisor

Dr. Elizabeth Segura

Committee

Keri Jupka

Dr. Candace Frye

Abstract

Prolonged nil per os (NPO) status for geriatric patients in the emergency department is a critical safety issue, leading to increased rates of delirium, hypoglycemia, and perioperative complications. A quality improvement project was designed to address this problem through a targeted, nurse-driven intervention. In geriatric patients (age ≥70) in a geriatric emergency department, this project aimed to determine if implementing an electronic health record (EHR)-prompted nursing workflow to obtain a diet order would reduce the length of time patients were kept NPO compared with standard practice. An EHR documentation tool was designed and implemented along with targeted nursing education sessions at a large Northeastern hospital. A prospective chart review was conducted over a four-week post-implementation period. Outcomes included the time from provider assignment to diet order and the rate of missed diet orders. Data were analyzed using Interrupted Time Series Analysis (ITSA) for time-based outcomes and Chi-square analysis for categorical data. Nurses utilized the new workflow for 294 patients, representing a 37.9% adoption rate. The intervention resulted in a statistically significant immediate reduction of 65.5 minutes in the time from provider assignment to diet order (p = .002, 95% CI [−106.06, −24.95]). Furthermore, missed diet orders decreased significantly by 6.2% (p = .001, 95% CI [37.3%, 44.4%]). The implementation of a nurse-driven, EHR-prompted workflow successfully reduced prolonged NPO status and missed diet orders in a clinically meaningful way. This evidence-based project demonstrates that nurse-led, technology-supported interventions can significantly improve the safety and quality of nutritional management for geriatric patients in the emergency setting.

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