Audit of knowledge of pre operative fasting guidelines
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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?. Patients are kept fasted for unnecessarily long periods prior to surgery

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Audit of knowledge of pre operative fasting guidelines l.jpg

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 l.jpg
Why do this audit?

Patients are kept fasted for unnecessarily long periods prior to surgery

Patients are denied medication prior to surgery

Patients are incorrectly given oral fluids prior to surgery


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Background

  • Fasting from midnight was thought to reduce risk of pulmonary aspiration [1]

  • Preventing dehydration can reduce peri-operative complications [2,3]

    • Dry mouth

    • Hunger

    • Confusion

    • Headache

    • Nausea and vomiting

    • Hypovolaemia

    • Hypoglycaemia

    • Ketoacidosis in diabetics


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Guidelines

AAGBI4, ASA5 & RCN6 recommend:


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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


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Method

  • Approval sought from MSGH audit department

  • Questionnaire

    • 1. Fasting times prior to different food stuffs

    • 2. Fasting times prior to spinal

    • 3. Fasting times prior to sedation

    • 4. What constitutes as a clear fluid

  • Distributed to doctors and nursing staff working in the acute medical and surgical departments:

    • Surgery, Medicine, A&E, EAU, CCU, paediatrics, Day Ward

  • Excluded anaesthetists, Elderly care, Obstetrics


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    Results

    • 52 Questionnaires

      • 26 nursing staff, 26 doctors

    • Specialty of staff




    Answers given for question 2 l.jpg
    Answers given for question 2

    • Fasting prior to spinal should be:

      • Longer 0

      • The same 23 (44%)

      • Shorter 12 (23%)

      • No fasting 16 (30%)


    Answers given for question 3 l.jpg
    Answers given for question 3

    • Fasting prior to sedation for a procedure in theatre:

      • Longer 3 (6%)

      • The same 31 (60%)

      • Shorter 13 (25%)

      • No fasting 5 (10%)


    Q4 definition of clear fluids l.jpg
    Q4. Definition of clear fluids

    Water 51 (98%)

    Squash 22 (42%)

    Lemonade 9 (17%)

    Milk 0

    Black tea/coffee 21 (40%)

    Tea coffee with milk 0



    Total scores for questionnaire l.jpg
    Total Scores for Questionnaire

    Number of people

    Score /15


    Conclusion l.jpg
    Conclusion

    All healthcare workers should score 100% on a pre-operative fasting guideline questionnaire

    Nobody scored 100%

    Average score for healthcare workers was 49% (Mean Score 7.4, Range 4-14)


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    Limitations

    Small sample size

    Large number of FY1’s included in study


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    Suggestions for improvement

    • Need to spread the word:

      • E-mail guidelines to everyone (Participants were keen to find out the answers)

      • Approach teaching sessions eg FY1 / nurse study days, or at hospital induction

      • Flyer/ small poster for wards

      • Poster of audit results to be displayed in theatre


    References l.jpg
    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