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Fasting Pre SurgeryMinimising Unnecessary Starving
21 May 2014
Andrew Jones
Quality Improvement SpecialistWaitemata District Health Board
Background• Patients reported to fast for extended
periods of time• Unclear processes for changes to
procedure schedule• Results in deconditioning and malnutrition
Scope of Project
Essentials of CareNutrition & Hydration
ERAS & #NOF Pathway Preoperative
Fasting
Policies• For surgical patients:
– 6 hours fasting– 2 hours nil by mouth– or midnight/7am for electives
• Also range of time frames for wide range of procedures
Initial Scoping• 6 & 2 Time frames confirmed by
Anaesthesia Clinical Director• Awaiting responses from other CDs• Snap shot of current practice on
wards
Stocktake• Three wards• Audit on 52
patients over three weeks
Fasting Time
NoUnknownYes
Category
15.4%
15.4%
69.2%
Pie Chart of Guidelines Met
Fasting TimeN = 14
N = 31
Average NBM HRS 11.6
Average NBM HRS 14.3
Fasting Time• 10% of surgeries were postponed• One patient:
–Surgery postponed 3 times –16 hours of fasting time each time
• The average NBM time for postponed patients:–13 hours
Next Steps• Prospective review of NBM cases• Identify flexibility of Trendcare for
recording:– Actual time last food– Actual time last oral fluids
• Agreement on fasting/NBM times for all procedures
Next Steps• Target one clinical environment• Test innovative process changes!
Thank You
Any Questions?