Pre-operative fasting - a patient centered approach

Prolonged pre-operative fasting can be an unpleasant experience and result in serious medical complications. The Royal College of Nursing guidelines state a minimum fasting period of six hours for food and two hours for clear fluids, prior to elective anaesthesia or sedation in healthy patients. We audited the Moorfields South Pre-operative Assessment Unit fasting instruction policy to ensure it is clear and in accordance with national guidelines. A questionnaire assessing the clarity and accuracy of fasting instructions and patient hydration was employed to survey patients undergoing elective anaesthesia or sedation in July 2013 (first cycle) and September 2013 (second cycle). The fasting instruction policy and patient information leaflet were reviewed; they state "nothing to eat or drink from midnight" for morning surgery and "nothing to eat or drink from 7AM" for afternoon surgery. The 10 patients surveyed in the first cycle reported that the instructions they were given were clear. 70% expressed subjective dehydration and 40% showed clinical evidence of dehydration. The patients had not been encouraged to drink clear fluids up till two hours before surgery. Patients fasted for unnecessarily prolonged periods, the longest of which was 17 hours. Our interventions were: delivering a teaching session to update staff of current pre-operative fasting guidelines, producing a patient information leaflet that was correct, reader-friendly and comprehensive and displaying posters as a reminder of the updated fasting instruction policy. The 12 patients surveyed in the second cycle had been encouraged to drink clear fluids up till two hours before surgery. A dramatically reduced 25% expressed subjective dehydration and 25% showed clinical evidence of dehydration. The longest fasting period was reduced to eight hours. We encourage all hospitals to adopt a patient centered approach to pre-operative fasting, dispelling the "nil my mouth for eight hours" policy, to improve patient wellbeing and satisfaction.