The Preoperative Fasting Conundrum: An Audit of Practice in a Tertiary Care Children's Hospital
Sujata Shivlal Rawlani1, Nandini Malay Dave1, Priyanka Pradeep Karnik1
1Department of Paediatric Anaesthesia, NH-SRCC Children's Hospital, Mumbai, India.
Insights
Preoperative fasting times in children were significantly reduced after implementing educational interventions and improving teamwork. These changes optimized fasting duration and enhanced the preoperative experience for pediatric surgical patients.
Area of Science:
- Pediatric Anesthesiology
- Surgical Patient Care
- Healthcare Quality Improvement
Background:
- Current preoperative fasting guidelines for pediatric elective surgery are often not followed.
- Prolonged fasting times can negatively impact children's well-being and increase perioperative risks.
- Understanding adherence barriers is crucial for optimizing patient care.
Purpose of the Study:
- To assess preoperative fasting durations in children undergoing elective surgery.
- To evaluate the effectiveness of interventions aimed at improving adherence to fasting guidelines.
- To analyze healthcare staff's knowledge and practices regarding pediatric preoperative fasting.
Main Methods:
- An initial audit surveyed 85 children (up to 15 years) and assessed staff knowledge via questionnaires.
- Interventions focused on raising awareness of current preoperative fasting guidelines.
- A re-audit was conducted 4 months post-intervention to measure changes.
Main Results:
- Initial audits showed mean fasting times for solids (9.43 hours) and water (6.64 hours) exceeded recommendations.
- Staff cited incorrect orders and lack of guideline awareness as key non-adherence causes.
- Post-intervention, mean fasting times decreased to 7.7 hours for solids and 2.6 hours for water.
Conclusions:
- Simple educational measures and multidisciplinary collaboration effectively reduce pediatric preoperative fasting times.
- Optimizing fasting duration improves the preoperative experience for children.
- Evidence-based guidelines and teamwork are essential for safe and effective pediatric surgical care.
Objective:
This article aimed to study preoperative fasting times in children undergoing elective surgery and to analyze the effect of active interventions conducted to promote compliance with current fasting guidelines.
Methods:
An initial audit was performed in which 85 children up to 15 years of age posted for elective surgeries were surveyed. A question- naire was circulated among nurses, resident medical officers, and surgeons to assess their knowledge regarding recent fasting guidelines and its importance. The mean preoperative fasting times were found to be much longer than the recommended guidelines. Interventions were carried out to spread awareness about recent preoperative fasting guidelines. A re-audit was done 4 months after the initial audit.
Results:
The initial audit revealed a mean preoperative fasting time for solids and water to be 9.43 hours and 6.64 hours, respectively. About 43.6% of hospital staff believed "fasting from midnight" regimen is the best method to prevent pulmonary aspiration. Incorrect orders by doctors (47%) and ward nurses (38%) were found to be important causes of non-adherence. After the intervention, mean preoperative fasting times for solids and water decreased to 7.7 hours and 2.6 hours, respectively.
Conclusion:
Adopting simple measures such as education and multidisciplinary teamwork can optimize fasting duration and children's experi- ences preoperatively.
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