Transcript Audit of Knowledge on Pre-operative Fasting Guidelines

Audit of Knowledge of
Pre-operative Fasting
Guidelines
Jennifer Thorburn FY2
City Hospital, Birmingham
Awini Gunasekera ST3
New Cross Hospital, Wolverhampton
Why do this audit?
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Patients are kept fasted for unnecessarily
long periods prior to surgery
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Patients are denied medication prior to
surgery
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Patients are incorrectly given oral fluids
prior to surgery
Background
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Fasting from midnight was thought to
reduce risk of pulmonary aspiration [1]
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Preventing dehydration can reduce perioperative complications [2,3]
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Dry mouth
Hunger
Confusion
Headache
Nausea and vomiting
Hypovolaemia
Hypoglycaemia
Ketoacidosis in diabetics
Guidelines
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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
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Approval sought from MSGH audit department
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Questionnaire
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1.
2.
3.
4.
Fasting times prior to different food stuffs
Fasting times prior to spinal
Fasting times prior to sedation
What constitutes as a clear fluid
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Distributed to doctors and nursing staff working in the
acute medical and surgical departments:
 Surgery, Medicine, A&E, EAU, CCU, paediatrics, Day
Ward
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Excluded anaesthetists, Elderly care, Obstetrics
Results
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52 Questionnaires
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26 nursing staff, 26 doctors
Specialty of staff
Answers given for Question 1
Foodstuff
Range
(hours)
No. correct
answers
Large meal
4 - 24
16 (31%)
Slice of toast
Tea / Coffee with milk
4 - 24
0 - 24
23 (44%)
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
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Fasting prior to spinal should be:
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Longer
The same
Shorter
No fasting
0
23 (44%)
12 (23%)
16 (30%)
Answers given for question 3
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Fasting prior to sedation for a procedure in
theatre:
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Longer
The same
Shorter
No fasting
3
31
13
5
(6%)
(60%)
(25%)
(10%)
Q4. Definition of clear fluids
Water
Squash
Lemonade
Milk
Black tea/coffee
Tea coffee with milk
51
22
9
0
21
0
(98%)
(42%)
(17%)
(40%)
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
14
12
Number
of
people
10
8
6
4
2
0
4
5
6
7
8
9
Score
/15
10
11
12
13
14
15
Conclusion
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All healthcare workers should score 100%
on a pre-operative fasting guideline
questionnaire
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Nobody scored 100%
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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
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Suggestions for improvement
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Need to spread the word:
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E-mail guidelines to everyone (Participants were
keen to find out the answers)
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Approach teaching sessions eg FY1 / nurse study
days, or at hospital induction
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Flyer/ small poster for wards
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Poster of audit results to be displayed in theatre
References
1
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