1. Audit of Knowledge of Pre-operative Fasting Guidelines Jennifer Thorburn FY2 City Hospital, Birmingham Awini Gunasekera ST3 New Cross Hospital, Wolverhampton

2. 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

3. 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

4. Guidelines  AAGBI 4, ASA 5 & RCN 6 recommend: Ingested material Minimum fast Clear fluids2 hours Breast milk4 hours Infant formula6 hours Non-human milk6 hours Light meal6 hours

5. 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

6. 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

7. Results  52 Questionnaires 26 nursing staff, 26 doctors  Specialty of staff

8. Answers given for Question 1 FoodstuffRange (hours) No. correct answers Large meal4 - 2416 (31%) Slice of toast4 - 2423 (44%) Tea / Coffee with milk0 - 2421 (40%) Breast milk0 - 1213 (25%) Clear fluids0 - 1226 (50%) Tablets with water0 - 1219 (37%) Chewing gum0 - 248 (15%)

9. Individual scores for Q1 (out of 7)

10. Answers given for question 2  Fasting prior to spinal should be: Longer0 The same23 (44%) Shorter12 (23%) No fasting16 (30%)

11. Answers given for question 3  Fasting prior to sedation for a procedure in theatre: Longer 3(6%) The same 31(60%) Shorter13(25%) No fasting5(10%)

12. Q4. Definition of clear fluids Water51 (98%) Squash22(42%) Lemonade9(17%) Milk0 Black tea/coffee21(40%) Tea coffee with milk0

13. Scores given for Question 4 ScoreNumber% 1/600 2/600 3/62242 4/61937 5/61121 6/600

14. Total Scores for Questionnaire Score /15 Number of people

15. 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)

16. Limitations  Small sample size  Large number of FY1’s included in study

17. 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

18. 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