906 A Prospective Clinical Audit of Pre-Operative Fasting Practices at a Tertiary Care Hospital in India

Abstract

Abstract Aim Even in the face of evidence-based recommendations, the ‘nil by mouth from midnight’ regimen has persisted because it is easy to administer and allows for theatre flexibility. We aimed to audit preoperative fasting practices at Kasturba Medical College Hospital Attavar, India against the Indian Society of Anaesthesiologists (ISA) national guidelines. Method Prospective clinical audit involving ASA 1 and 2 patients undergoing elective, non-obstetric surgery under general/regional anaesthesia or sedation. Data were collected from patient notes and from an interview on the morning of surgery (at least one hour prior to induction of anaesthesia). Results Baseline Data (N = 100) Median fasting durations of 10 hours and 12.5 hours from clear fluids and solids, respectively. 99% of patients gave an incorrect reason or did not know at all the reason for preoperative fasting. Interventions:Patient information leaflets (in English and the local language) were made and distributed to every ward; to be shown to elective surgery patients on the day before surgery.Surgical trainees, anaesthesiology trainees and nurses were made aware of the audit findings. Re-Audit (N = 40) Median fasting duration of 3 hours and 11 hours respectively clear fluids and solids. Thirty-five percent of patients knew the correct reason for preoperative fasting. 50% gave an incorrect reason, while 15% did not know the reason. Conclusions Prolonged fasting was observed initially despite guidelines. Significant reduction in clear fluid fasting duration was achieved (10 hours to 3 hours) by creating awareness.