WP7.3 - FAMiSH: FAsting prior to eMergency general Surgery in Hospital – Quality improvement project protocol

Abstract

Abstract This study was conducted to evaluate adherence to preoperative fasting guidelines at the RD&E hospital, focusing on safety and reducing prolonged fasting complications particularly in patients with extremes of age, diabetic or co-morbid. Data were gathered anonymously over 2 cycles for 4 weeks through patient records and questionnaire to access patient given instructions for fasting. All patients with planned procedures were included, excluding emergency operations (NCEPOD) 1 or 2a/2b classification. Issues such as inadequate communication, excessive fasting, insufficient monitoring, and medication mismanagement were addressed. Cycle one revealed 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 have missed their medications, as well as diabetic patients with prolonged hours of fasting. We have provided a session for junior doctors and nurses aiming education on ASA guidelines and encouraging individualised fasting plans for patients. Information leaflets were created to be distributed to patients planned for surgery. In the second cycle only 20% and 24% of patients didn’t follow fasting guidelines for solids and liquids respectively as compared to 68.75% of the patients receiving inappropriate instructions in 1st cycle, showing significant improvement in patient care. In our study at the RD&E we have noted an improvement in departmental focus on adherence to fasting guidelines, which focus on abstaining from solid foods up to 6 hours and drinks up to 2 hours prior to surgery, aiding patient safety and improvement of quality of care.