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Preoperative fasting in the department of plastic surgery
  1. Andrew Davies1,
  2. Wei Sheng Pang2,
  3. Timothy Fowler3,
  4. Ffion Dewi3,
  5. Thomas Wright3
  1. 1 Department of Orthopaedics, North Bristol NHS Trust, Bristol, UK
  2. 2 University of Bristol Medical School, Bristol, UK
  3. 3 Department of Plastic Surgery, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Andrew Davies; ardavies{at}doctors.org.uk

Abstract

Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patients on the plastic surgery trauma list. Adult inpatients awaiting surgery were asked to complete a preoperative assessment sheet. Questions included the length of preoperative fasting, clarity of instructions and wellness scores. Three cycles of data collection were performed over a 12-month period, patients who declined to participate or were unable to consent were excluded. The first cycle revealed the need for significant improvement. Interventions included staff education, patient information sheets, preoperative drinks, greater availability of ward snacks and improved communication between the ward staff and surgical team through our electronic trauma database. The initial audit of 15 patients revealed a mean fasting time of 16.3 hours for fluid (range 10–22) and a mean of 19.3 hours for solid food (range 10–24). The mean wellness score was 6/10 (10 being very well), 67% of patients felt they were given clear information. The final cycle demonstrated clear improvement in all domains. The mean fasting time declined to 5.1 hours for fluid (range 3–10 hours) and 13 hours for solid food (range 7.5–17 hours). The mean wellness score (10=very well) increased from 6 to 8, the mean thirst score declined from 6.1 to 5.1 and 100% patients felt they had been given clear information. Removal of the traditional ‘NBM from midnight’, patient education, a clear fasting routine with preoperative drinks and improved communication between the full multidisciplinary team has led to a reduction in the fasting times on our trauma list.

  • patient safety
  • patient satisfaction
  • quality improvement
  • surgery
  • teamwork

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors AD: Project design, data collection and analysis, implementation of interventions, writing and review of the manuscript. WSP: Data collection and analysis, writing and review of the manuscript. TF and FD: Data collection and analysis, implementation of interventions, manuscript review. TW: Project supervisor, implementation of interventions, manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study was registered with our Trust audit and research department. Formal ethical approval was not sought for this service improvement work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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