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Adopting preoperative fasting guidelines.
Megan Anderson1, Rhonda Comrie
1Western Anesthesiology Associates, St Louis, MO, USA.
AORN Journal
|July 8, 2009
Summary
Preoperative fasting guidelines are often ignored, with "NPO after midnight" used universally. Rogers' Theory of Diffusion of Innovations can guide changes in provider beliefs for better adherence to evidence-based fasting protocols.
Area of Science:
- Anesthesiology
- Healthcare Management
- Behavioral Science
Background:
- The American Society of Anesthesiologists established preoperative fasting guidelines in 1999.
- Current guidelines recommend healthy, non-pregnant patients fast for six hours from solids and two hours from liquids.
- Provider adherence to these guidelines is inconsistent, with a prevalent use of the 'NPO after midnight' rule regardless of patient or procedure specifics.
Purpose of the Study:
- To explore the application of Rogers' Theory of Diffusion of Innovations to improve adherence to evidence-based preoperative fasting guidelines.
- To analyze the benefits and disadvantages of proposed changes to fasting orders.
- To facilitate the initiation of local protocols for preoperative fasting.
Main Methods:
- Utilizing Rogers' Theory of Diffusion of Innovations as a framework.
- Analyzing provider beliefs and practices regarding preoperative fasting.
- Identifying barriers and facilitators to adopting updated fasting protocols.
Main Results:
- Provider adoption of evidence-based fasting guidelines is suboptimal.
- A blanket 'NPO after midnight' approach persists despite established guidelines.
- Theoretical frameworks can aid in understanding and influencing provider behavior change.
Conclusions:
- Rogers' Theory of Diffusion of Innovations offers a valuable model for understanding and implementing changes in clinical practice.
- Addressing provider beliefs is crucial for successful adoption of updated preoperative fasting guidelines.
- Developing and implementing local protocols can improve adherence and patient care.
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