Thursday, July 12, 2007
This presentation is part of : Leading Toward EBN Utilization
Adherence to the preoperative fasting guideline
Nanda Meents, MSc, Clinical epidemiology, biostatistics and bioinformatics, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands, Hester Vermeulen, PhD, Amsterdam Center for Evidence Based Practice, Academic Medical Center to the University of Amsterdam, Amsterdam, Netherlands, and Dirk T. Ubbink, MD, PhD, Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center to the University of Amsterdam, Amsterdam, Netherlands.
Learning Objective #1: become aware that actual fasting policies still not agree with the evidence-based guideline
Learning Objective #2: extract suggestions to improve implementation of the current preoperative fasting guideline

In 1999 the American Society of Anaesthesiologists recommended to replace the traditional preoperative ‘fasting from midnight’ regimen by a more tolerant approach. Their evidence-based guideline permits unrestricted clear fluid intake up to 2h, breast-feeding up to 4h, and a light-breakfast up to 6h before surgery. However, the actual widespread variations in fasting instructions and available literature on actual fasting times reveal inadequate guideline implementation, possibly resulting in patient discomfort and a preoperative hypoglycaemic state in surgical patients.
We studied the extent of variation in preoperative fasting policies among anaesthesiologists, surgeons and nurses in a university teaching hospital. We also studied possible barriers to comply with the guideline. Both to improve implementation of the guideline.
Questionnaires about professionals’ fasting policies were sent to 25 anaesthesiologists, 44 surgeons, and 126 nurses of five different paediatric and surgical wards of a university teaching hospital. Besides, 100 adult patients, 10 children, and 10 parents of hospitalised infants were interviewed about their fasting periods.
Adult and paediatric surgical patients were subjected to preoperative fasting times approximately three to four times longer than advised by the guideline. Adult patients reported hunger (13%) and thirst (32%). Contrary to other patients, infants fasted according to the guideline. Only 27.4% of the nurses adhered to the guideline, which was significantly less than anaesthesiologists (57.1%) and surgeons (56.7%). Most patients received instructions on preoperative fasting from a nurse. Guideline implementation barriers were: changes in the operating schedule, operation indications, and lack of research awareness. Nurses prefer receiving information through a form in the nursing dossier, clinical lessons and a pocket card.

Current practice still shows prolonged and variable fasting times. Because patients mainly depend on the nurses’ fasting instructions, nurses should be educated about the negative effects of prolonged fasting in order to improve guideline adherence.