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Preoperative fasting in children: An audit and its implications in a tertiary care hospital
1Department of Anaesthesiology Critical Care and Pain, Christian Medical College, Vellore, Tamilnadu, India.
Insights
Prolonged preoperative fasting in children is common, but simple interventions like nurse education and improved communication significantly reduced fasting times. Adherence to guidelines for clear fluids, breast milk, and solids in pediatric patients is crucial.
Area of Science:
- Pediatric Anesthesiology
- Surgical Patient Care
- Healthcare Auditing
Background:
- Prolonged preoperative fasting in children is a prevalent issue in high-volume surgical centers.
- International guidelines recommend specific fasting durations (2h clear fluids, 4h breast milk, 6h solids), but adherence is often poor.
- Current practices frequently exceed recommended preoperative fasting times for pediatric patients.
Purpose of the Study:
- To audit and determine the length of preoperative fasting in children undergoing elective surgery.
- To identify the primary causes of prolonged preoperative fasting in pediatric surgical patients.
- To evaluate the impact of an educational intervention and improved coordination on fasting times.
Main Methods:
- A cross-sectional audit involving 50 children under 15 years undergoing elective surgery.
- Initial audit data collected on preoperative fasting times and causes.
- Post-intervention reaudit conducted 6 months after implementing nurse education and enhanced communication protocols.
Main Results:
- Initial audit showed mean fasting times of 11.25h for solids and 9.25h for water, significantly exceeding guidelines.
- Key causes identified were incorrect nursing orders (74%) and surgical schedule changes (32%).
- Reaudit demonstrated reduced mean fasting times to 9h for solids and 4h for water, with schedule changes (30%) as the main remaining cause.
Conclusions:
- Educating ward nurses on international preoperative fasting guidelines is effective.
- Enhanced coordination between anesthesiologists, surgeons, and nurses can significantly decrease unnecessary preoperative starvation in children.
- Implementing simple system changes can improve adherence to pediatric preoperative fasting recommendations.
Background:
Prolonged preoperative fasting in children is a common problem, especially in highvolume centers. All international professional society guidelines for preoperative fasting recommend 2 h for clear fluids, 4 h for breast milk and 6 h for solids, nonhuman and formula milk in children. These guidelines are rarely adhered to in practice.
Aims:
An audit was undertaken to determine the length of preoperative fasting time in children and its causes.
Settings And Design:
Cross-sectional study of 50 children below 15 years posted for elective surgeries.
Materials And Methods:
An initial audit was performed at our institution on preoperative fasting time in 50 children below 15 years of age for elective surgeries. The mean preoperative fasting times were found to be much longer than the recommended times. Ward nurses were then educated about internationally recommended preoperative fasting guidelines in children. Anesthesiologists started coordinating with surgeons and ward nurses to prescribe water for children waiting for more than 2 h based on changes in surgery schedule by instructing ward nurses through telephone on the day of surgery. A reaudit was done 6 months after the initial audit.
Statistical Analysis Used:
SPSS 16 software.
Results:
The initial audit revealed a mean preoperative fasting time of 11.25 h and 9.25 h for solids and water, respectively. Incorrect orders by ward nurses (74%) and change in the surgical schedule (32%) were important causes. After changing the preoperative system, mean preoperative fasting times in children decreased to 9 h and 4 h for solids and water, respectively in reaudit. Change in surgical schedule (30%) was the major cause for prolonged preoperative fasting in reaudit.
Conclusions:
Simple steps such as education of ward nurses and better coordination among the anesthesiologists, surgeons and nurses can greatly reduce unnecessary preoperative starvation in children.
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