Pre-surgical fasting of patients


Pre-surgical fasting of patientsWhat is pre-surgical fasting

For patients due to undergo a surgical procedure, it is recommended that they do not eat solid foods, milk products or anything other than clear fluids (e.g. water, clear soup, jelly) for six hours prior to their surgery. They may then only have clear fluids until two hours prior to surgery[1]. From two hours prior to surgery, the patient must fast - must not have anything to eat or drink until their surgery happens.

The reason for this is to prevent the patient from breathing any stomach contents into their lungs during their surgical procedure while they are under anaesthetic.

  1. BMJ Quality Improvement Programme: Pre-operative Fasting – a patient centered approach [http://qir.bmj.com/content/2/2/u605.w1252.full]

 

What are we doing?

If surgery is delayed, postponed or cancelled, patients may end up having to fast for an extended period of time or on multiple occasions. This is not good for patients as it can impact on their recovery.

We decided to work with our orthopaedic patients. The aim of this project is to make sure these patients only fast for the appropriate amount of time (generally six hours) and only on the day they are having surgery. We want to ensure that patients whose orthopaedic surgery is delayed, postponed or cancelled are given adequate nutrition and hydration without it impacting their ability to have surgery.

Patient Food DiaryTo make this happen, we need to ensure that our ward nurses, surgeons and theatre staff aware of:

  • where a patient is on the theatre list
  • the scheduled or anticipated theatre time
  • the length of fasting time

To understand how long our patients are fasting, we have developed a food diary and are asking our patients and their care givers to complete the diary. This will record their experience of the fasting process, what they are eating both before and after surgery. This food diary is also being used with the recovering faster from a broken hip (fractured neck of femur) [ERAS] project [view more about the ERAS project].


Where to from here?

Over the coming year we aim to:

  • identify opportunities for improving the fasting process
  • improve staff knowledge and skill around the fasting process
  • enable staff to identify the anticipated or scheduled theatre time for a patient and the length of time a patient has fasted
  • develop a process to manage a patient who has fasted for more than six hours
  • develop information for patients and their families / whānau around the fasting process to enable them to discuss any concerns with staff

We will report on progress in next year’s quality account.