Pre-operative fasting practice die hard!

[kikisand83]

'Nil by mouth 12 midnight' is still the standard order for pre-operative fasting, although there are guidelines to advocate shorter fasting hours for elective surgeries.

Anesthetists concern about inflexible operation schedule and patients unable to be brought forward for surgery because of shortened fasting hours.

The operation schedule is not available to ward nurses, which makes shortened pre-op fasting even difficult. Nurses won't know when should be the last drink to serve to patient, but have to keep patient fasted in order not to miss the operation time.

I have personally experienced this lousy fasting system.

Anyone can help me on the issue?

[SaoirseRN]

For add-ons (that is, urgent cases that are added on to the end of a pre-existing OR slate) our surgeons often let them start their NPO at 0700 instead of midnight.

[kikisand83]

Thanks for sharing. Our anesthetists have same practice. But there are 80% of afternoon scheduled patients are fasted from midnight from a local survey.

Have u started practicing 2-3 hours fluids fasting for elective surgery patients?

Do u have system in place to check the operation schedule, so that lengthy fasting can be avoided?

[SaoirseRN]

Thanks for sharing. Our anesthetists have same practice. But there are 80% of afternoon scheduled patients are fasted from midnight from a local survey.

Have u started practicing 2-3 hours fluids fasting for elective surgery patients?

Do u have system in place to check the operation schedule, so that lengthy fasting can be avoided?

Most of our scheduled pre-ops start through a different department and I am unsure, but I believe the bigger surgeries are NPO midnight, but are always occupy the earliest three spots for each OR. Day surgery/minor procedures allow clear fluids up until 4-6 hours pre-op in most cases, and they always go after the bigger procedures.

Med/Surg has access to the day's schedule but don't know how on-schedule the cases are. Day surgery is the sending department for all scheduled major surgeries except OBS, as well as day surgeries and are in close communication with the OR.

[meanmaryjean, DNP, RN]

I did some work on this topic in grad school. The study I examined looked at pediatric patients, but a four hour fast was determined to be sufficient.

Our own trauma/ neuro ICU is conducting a study to do away with NPO status pre-operatively in all of our trans-pylorically fed patients. It evolved out of our EBP class- and I'm hearing really exciting news from the nurse researcher.

[kikisand83]

It is great to hear that. How did your Trauma /Neuro ICU implement the shortened preoperative fasting practice? How to coordinate between wards and OT for operation schedule? Only the information communicated is accurate and timely, the shorted fasting practice can be achieved.

[kikisand83]

Most of our scheduled pre-ops start through a different department and I am unsure, but I believe the bigger surgeries are NPO midnight, but are always occupy the earliest three spots for each OR. Day surgery/minor procedures allow clear fluids up until 4-6 hours pre-op in most cases, and they always go after the bigger procedures.

Med/Surg has access to the day's schedule but don't know how on-schedule the cases are. Day surgery is the sending department for all scheduled major surgeries except OBS, as well as day surgeries and are in close communication with the OR.

Major surgery go first then followed by elective surgery. This is the same as my hospital practice.

But the schedule control is much more strict compare to yours. The OT matron holds information about op schedule, who disseminates info to her nurses. Then OT nurses will communicate to departments on schedule. The problem is the change of op schedule is only made known to matron first, then disseminated to others. Med/Surg nurses will not be able to get first hand info (a delay in knowing actual op time), which make nurse hesitate to serve patient clear fluids on op day.

Will it be good if there is an electronic op schedule update board, that make info instantly available to all relevant deparment?

[SaoirseRN]

Our slate is electronic, but it is finalized the night before, so add-ons are not included if they have been added after hours or same-day, and any delays are verbally communicated. The day surgery department who sends all planned surgeries and many add-ons have the most up to date info on delays, generally because the OR calls for patients later than expected.