Transcript Document

Fasting Pre Surgery
Minimising Unnecessary Starving
21 May 2014
Andrew Jones
Quality Improvement Specialist
Waitemata District Health Board
Background
• Patients reported to fast for extended
periods of time
• Unclear processes for changes to
procedure schedule
• Results in deconditioning and malnutrition
Scope of Project
ERAS & #NOF
Pathway
Preoperative
Fasting
Nutrition &
Hydration
Essentials of Care
Policies
• For surgical patients:
– 6 hours fasting
– 2 hours nil by mouth
– or midnight/7am for electives
• Also range of time frames for wide
range of procedures
Initial Scoping
• 6 & 2 Time frames confirmed by
Anaesthesia Clinical Director
• Awaiting responses from other CDs
• Snap shot of current practice on
wards
Stocktake
• Three wards
• Audit on 52
patients over
three weeks
Fasting Time
Pie Chart of Guidelines Met
C ategory
No
Unk nown
Yes
15.4%
15.4%
69.2%
Fasting Time
N = 14
Average NBM HRS
11.6
N = 31
Average NBM HRS
14.3
Fasting Time
• 10% of surgeries were postponed
• One patient:
–Surgery postponed 3 times
–16 hours of fasting time each time
• The average NBM time for postponed
patients:
–13 hours
Next Steps
• Prospective review of NBM cases
• Identify flexibility of Trendcare for
recording:
– Actual time last food
– Actual time last oral fluids
• Agreement on fasting/NBM times
for all procedures
Next Steps
• Target one clinical environment
• Test innovative process changes!
Thank You
Any Questions?