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?