Implementation of the American Society of Anesthesiology's guidelines to reduce prolonged fasting times in pediatric preoperative patients: a best practice implementation project.

Abstract

The American Society of Anesthesiology (ASA) guidelines for pediatric preoperative fasting have been a standard for well over a decade. However, use of protocols involving an excessive fasting duration exposes patients to the physiological impacts of fluid volume loss. The current project aimed to improve fluid supplementation during presurgical fasting in pediatric patients at an academic medical center. Specific objectives were to increase clinical staff knowledge regarding ASA fasting standards and implement them in specific pediatric patient populations. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice tools were used. A baseline audit assessed compliance with best practice criteria regarding staff education, patient/family instruction and preoperative fasting times. Intervention outcomes were evaluated in a post implementation criteria audit. Although compliance with fasting less than 12 hours more than doubled, only half of these patients/parents adhered to the guidelines. No excessive fasting events were attributed to a language barrier. There were no insufficient fasting events. Moderate success with fasting compliance was demonstrated when patients/parents were taught the multi-step ASA non per os (nothing by mouth) instructions. This complexity may have contributed to non-compliance and pointed to the need for enhanced teaching strategies. No operative start delays related to insufficient fasting indicated surgical scheduling flexibility was not at risk, and anesthesia providers had adopted the guidelines. Interdisciplinary engagement in this project was significantly impacted by director level communication which will be a key strategy for future implementations.