Pre-operative Fasting Sofie Chaudhri Carol Gray Victoria Fraser

Outline Pre-operative fasting guidelines 1st audit cycle in RAH and VOL Changes to implementation of fasting guidelines 2nd audit cycle in RAH Plans for the future

GGC Fasting Guidelines am listpm list Solids including milky drinks and sweets Fast from 0230 (6 hours) Fast from 0730 (6 hours) Tea / coffee with max 2tsp milk Allow until 0430 (4 hours) Allow until 0930 (4 hours) Clear fluids Allow until 0630 (2 hours) Allow until 1130 (2 hours)

1st Audit Cycle RAH Jan 2012 n=96 VOL Nov 2012 n=86 Interviewed in theatre reception Asked about fasting times and what instructions they were given Asked about whether they had had IV fluids

Results Mean fasting times for solids were 15 hours 7 minutes (RAH) and 13 hours 4 minutes (VOL) Mean fasting times for liquids were 13 hours 54 minutes (RAH) and 12 hours 13 minutes (VOL)

Results RAH

Results VOL

Changes to implementation of guideline New guidance for wards encouraging 300mls water at 6am for all day / morning lists and 11am for afternoon lists New leaflet for pre-assessment Educating staff about GGC guidelines

Re-audit RAH Jan 2013

Results Mean fasting time for solids was 14 hours 57 minutes (p=0.713) Mean fasting time for liquids was 7 hours and 31 minutes (p<0.001)

What were patients told? RAH Cycle 1 RAH Cycle 2

Further improvements? Many conflicting sources of information about fasting for patients - not just pre- assessment and ward nurses Still work to do in pre-assessment and wards Patients allowed unlimited clear fluids up to 6am as well as encouraging 300mls Some patients still choosing not to have the recommended fluids

Plan for the future Feedback to wards and pre- assessment Look at other sources of information for patients - appointment letters, reception staff, medical staff on wards Encourage free fluids overnight in addition to 300mls in the morning