835 FAMiSH: Fasting Prior to Emergency General Surgery in Hospital – Quality Improvement Project Protocol

Abstract

Abstract Aim This study was conducted to evaluate adherence to preoperative fasting guidelines at the Royal Devon University Hospital, focusing on safety and reducing prolonged fasting particularly in geriatric, diabetic or co-morbid patients. Method Data were gathered anonymously over 2 cycles for 4 weeks through patient records and questionnaires to access patient given instructions for fasting to solids and fluids. All patients with emergency surgeries more than 6 hours later were included, excluding emergency operations (NCEPOD) 1 or 2a/2b classification. Issues such as inadequate communication, excessive fasting and medication mismanagement were addressed. Results Cycle one revealed that 25% of patients fasted for more than 6 hours, 56.25% did not consume liquids for more than 12 hours, and 25% abstained from drinking for more than 8 hours preoperatively. It was noted that guidelines were not thoroughly adhered to. Some patients missed medications, besides diabetics with prolonged hours of fasting. We have provided a session for junior doctors and nurses, educating on ASA guidelines, and encouraging individualised fasting plans for patients. Information leaflets were distributed to patients for surgery. In the second cycle only 20% and 24% of patients didn’t follow fasting guidelines for solids and liquids respectively compared to 68.75% of patients receiving inappropriate instructions in first cycle, showing significant improvement in care. Conclusions In our study we have noted improvement in departmental focus on adherence to fasting guidelines, which advise abstaining from solids up to 6 hours and drinks up to 2 hours prior to surgery, aiding patient safety and improvement of quality of care.