Audit of Knowledge of Pre-operative

Fasting GuidelinesJennifer Thorburn FY2

City Hospital, Birmingham

Awini Gunasekera ST3 New Cross Hospital, Wolverhampton

Why do this audit?

Patients are kept fasted for unnecessarily long periods prior to surgery

Patients are denied medication prior to surgery

Patients are incorrectly given oral fluids prior to surgery

Background

Fasting from midnight was thought to reduce risk of pulmonary aspiration [1]

Preventing dehydration can reduce peri-operative complications [2,3]

Dry mouth Hunger Confusion Headache Nausea and vomiting Hypovolaemia Hypoglycaemia Ketoacidosis in diabetics

Guidelines AAGBI4, ASA5 & RCN6 recommend:

Ingested material

Minimum fast

Clear fluids 2 hours

Breast milk 4 hours

Infant formula 6 hours

Non-human milk 6 hours

Light meal 6 hours

Standard

All doctors and nurses looking after patients going to theatre should know the pre-operative fasting guidelines Available on hospital intranet

All healthcare workers should score 100% on a pre-operative fasting guideline questionnaire

Method Approval sought from MSGH audit department

Questionnaire 1. Fasting times prior to different food stuffs 2. Fasting times prior to spinal 3. Fasting times prior to sedation 4. What constitutes as a clear fluid

Distributed to doctors and nursing staff working in the acute medical and surgical departments: Surgery, Medicine, A&E, EAU, CCU, paediatrics, Day Ward

Excluded anaesthetists, Elderly care, Obstetrics

Results

52 Questionnaires 26 nursing staff, 26 doctors

Specialty of staff

Answers given for Question 1Foodstuff Range

(hours)No. correct

answers

Large meal 4 - 24 16 (31%)

Slice of toast 4 - 24 23 (44%)

Tea / Coffee with milk 0 - 24 21 (40%)

Breast milk 0 - 12 13 (25%)

Clear fluids 0 - 12 26 (50%)

Tablets with water 0 - 12 19 (37%)

Chewing gum 0 - 24 8 (15%)

Individual scores for Q1 (out of 7)

Answers given for question 2 Fasting prior to spinal should be:

Longer 0 The same 23 (44%) Shorter 12 (23%) No fasting 16 (30%)

Answers given for question 3 Fasting prior to sedation for a procedure in

theatre:

Longer 3 (6%) The same 31 (60%) Shorter 13 (25%) No fasting 5 (10%)

Q4. Definition of clear fluids

Water 51 (98%)Squash 22 (42%)Lemonade 9 (17%)Milk 0Black tea/coffee 21 (40%)Tea coffee with milk 0

Scores given for Question 4

Score Number %

1/6 0 0

2/6 0 0

3/6 22 42

4/6 19 37

5/6 11 21

6/6 0 0

Total Scores for Questionnaire

0

2

4

6

8

10

12

14

4 5 6 7 8 9 10 11 12 13 14 15

Score /15

Number of people

Conclusion

All healthcare workers should score 100% on a pre-operative fasting guideline questionnaire

Nobody scored 100%

Average score for healthcare workers was 49% (Mean Score 7.4, Range 4-14)

Limitations

Small sample size Large number of FY1’s included in study

Suggestions for improvement Need to spread the word:

E-mail guidelines to everyone (Participants were keen to find out the answers)

Approach teaching sessions eg FY1 / nurse study days, or at hospital induction

Flyer/ small poster for wards

Poster of audit results to be displayed in theatre

References1 Lliungvist O. Review: Preoperative fasting. British Journal of Surgery 2003: 90 (4): 400-

406

2 Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database of Systematic Reviews 2003, Issue 4. Art No.: CD004423. DOI: 10.1002/1465

3 Rowe J. Preoperative fasting: is it time for a change? [Review] Nursing Times 2000; 96: 14-15

4 The Association of Anaesthetists of Great Britain and Ireland. Pre-operative Assessment: The Role of the Anaesthetist. Section 10: Fasting policies. Nov 2001: p.11

5 American Society of Anaesthesiologists Task Force. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. Anesthesiology 1999: 90(3): 896-905

6 Royal College of Nursing. Perioperative Fasting in Adults and Children: An RCN Guideline for the Multidisciplinary Team. 1.1 Preoperative fasting in healthy adults. November 2005: p.6