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Parents' understanding of and compliance with fasting instruction for pediatric day case surgery
Steve Cantellow1, Jonathan Lightfoot, Helen Bould
1Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. cantellow@mac.com
Insights
Many parents misunderstand or fail to adhere to preoperative fasting guidelines for children, potentially increasing perioperative risks. Improving parental understanding of fasting instructions is crucial for patient safety.
Area of Science:
- Pediatric Anesthesiology
- Patient Safety
- Surgical Care
Background:
- Children undergo preoperative fasting to minimize aspiration risk.
- Aspiration of gastric contents can lead to serious complications.
- Fasting protocols are standard practice in pediatric surgery.
Purpose of the Study:
- To assess parental comprehension of preoperative fasting instructions.
- To evaluate parental adherence to fasting guidelines for children.
- To identify strategies for reducing perioperative complications due to fasting non-compliance.
Main Methods:
- A survey was administered to parents of children undergoing elective surgery.
- The survey assessed parents' understanding of fasting duration and purpose.
- Parents also indicated acceptable food/fluid intake during fasting periods.
Main Results:
- 13.5% of children were not fasted despite preoperative confirmation.
- Reported and actual fasting durations varied significantly.
- Parental understanding of fasting purpose was often limited to nausea prevention, not aspiration risk.
Conclusions:
- Preoperative fasting compliance in children is suboptimal.
- Parental recall and understanding significantly impact adherence to fasting advice.
- Deliberate misrepresentation of fasting status by parents may occur, necessitating improved communication.
Objective:
To determine whether parents understand and adhere to preoperative fasting instructions.
Aim:
To identify how we may reduce perioperative morbidity relating to failure to fast.
Background:
Children are routinely fasted preoperatively with the aim of reducing the risk of aspiration of gastric contents and its sequelae.
Methods:
Parents of children on the day case ward following elective surgery completed a survey asking: (i) For how long was your child asked to fast? (ii) How long did you ensure your child was fasted of food and clear fluids? (iii) What do you think is the purpose of fasting? We also asked the parents to complete a checklist of items they thought acceptable to consume when fasting.
Results:
Despite affirming fasting status in the preoperative check, 13.5% were not fasted. Parents reported advised fasting times of 1-24 h (median 6) for solids and 0.5-24 h (median 3) for fluids. Children were fasted of solids for 3-40 h (median 9.5) and of fluids for 0.5-24 h (median 5). Regarding the understanding of fasting, 9 referred to aspiration and 53 to the prevention of nausea or vomiting. Thirteen believed that fasting status altered the efficacy of anesthesia. During the fasting period, 4.9% would allow French fries, 22.3% toast/crackers, 17.5% cereal, 14.7% a sweet, 14.9% gum, and 12.6% tea with milk.
Conclusions:
Children we believe to be fasted may not be. Parents may deliberately misrepresent the actual fasting status of their child. Adherence to fasting advice may be affected by parents' recall and understanding of fasting advice.
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