1. Minimising Unnecessary Starving
Fasting Pre Surgery
Minimising Unnecessary Starving
21 May 2014
Andrew Jones
Quality Improvement Specialist Waitemata District Health Board

2. Background Patients reported to fast for extended periods of time
Unclear processes for changes to procedure schedule
Results in deconditioning and malnutrition

3. Scope of Project Preoperative Fasting Essentials of Care
ERAS & #NOF Pathway
Preoperative Fasting
Essentials of Care
Nutrition & Hydration

4. 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

5. Initial Scoping
6 & 2 Time frames confirmed by Anaesthesia Clinical Director
Awaiting responses from other CDs
Snap shot of current practice on wards

6. Stocktake
Three wards
Audit on 52 patients over three weeks

7. Fasting Time

8. Fasting Time
N = 14
Average NBM HRS 11.6
N = 31
Average NBM HRS 14.3

9. 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

10. 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

11. Next Steps Target one clinical environment
Test innovative process changes!

12. Thank You
Any Questions?