Cargando…

Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia

BACKGROUND: Despite well-defined recommendations, prolonged fasting times for clear fluids and solids are still common before elective surgery in adults. Extended fasting times may lead to discomfort, thirst, hunger and physiological dysfunctions. Previous studies have shown that prolonged fasting t...

Descripción completa

Detalles Bibliográficos
Autores principales: Witt, Lars, Lehmann, Barbara, Sümpelmann, Robert, Dennhardt, Nils, Beck, Christiane E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547037/
https://www.ncbi.nlm.nih.gov/pubmed/34702191
http://dx.doi.org/10.1186/s12871-021-01468-6
_version_ 1784590307120119808
author Witt, Lars
Lehmann, Barbara
Sümpelmann, Robert
Dennhardt, Nils
Beck, Christiane E.
author_facet Witt, Lars
Lehmann, Barbara
Sümpelmann, Robert
Dennhardt, Nils
Beck, Christiane E.
author_sort Witt, Lars
collection PubMed
description BACKGROUND: Despite well-defined recommendations, prolonged fasting times for clear fluids and solids are still common before elective surgery in adults. Extended fasting times may lead to discomfort, thirst, hunger and physiological dysfunctions. Previous studies have shown that prolonged fasting times are frequently caused by patients being misinformed as well as inadequate implementation of the current guidelines by medical staff. This study aimed to explore how long elective surgery patients fast in a German secondary care hospital before and after the introduction of an educational note for patients and re-training for the medical staff. METHODS: A total of 1002 patients were enrolled in this prospective, non-randomised interventional study. According to the power calculation, in the first part of the study actual fasting times for clear fluids and solids were documented in 502 consecutive patients, verbally instructed as usual regarding the recommended fasting times for clear fluids (2 h) and solids (6 h). Subsequently, we implemented additionally to the verbal instruction a written educational note for the patients, including the recommended fasting times. Furthermore, the medical staff was re-trained regarding the fasting times using emails, newsletters and employee meetings. Thereafter, another 500 patients were included in the study. We hypothesised, that after these quality improvement procedures, actual fasting times for clear fluids and solids would be more accurate on time. RESULTS: Actual fasting times for clear fluids were in the median 11.3 (interquartile range 6.8–14.3; range 1.5–25.5) h pre-intervention, and were significantly reduced to 5.0 (3.0–7.2; 1.5–19.8) h after the intervention (median difference (95%CI) − 5.5 (− 6.0 to − 5.0) h). The actual fasting times for solids also decreased significantly, but only from 14.5 (12.1–17.2; 5.4–48.0) h to 14.0 (12.0–16.3; 5.4–32.0) h after the interventions (median difference (95%CI) − 0.52 (− 1.0 to − 0.07) h). CONCLUSIONS: The study showed considerably extended actual fasting times in elective adult surgical patients, which were significantly reduced by simple educational/training interventions. However, the actual fasting times still remained considerably longer than defined in recommended guidelines, meaning further process optimisations like obligatory fluid intake in the early morning are necessary to improve patient comfort and safety in future. TRIAL REGISTRATION: German registry of clinical studies (DRKS-ID: DRKS 00020530, retrospectively registered).
format Online
Article
Text
id pubmed-8547037
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-85470372021-10-26 Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia Witt, Lars Lehmann, Barbara Sümpelmann, Robert Dennhardt, Nils Beck, Christiane E. BMC Anesthesiol Research BACKGROUND: Despite well-defined recommendations, prolonged fasting times for clear fluids and solids are still common before elective surgery in adults. Extended fasting times may lead to discomfort, thirst, hunger and physiological dysfunctions. Previous studies have shown that prolonged fasting times are frequently caused by patients being misinformed as well as inadequate implementation of the current guidelines by medical staff. This study aimed to explore how long elective surgery patients fast in a German secondary care hospital before and after the introduction of an educational note for patients and re-training for the medical staff. METHODS: A total of 1002 patients were enrolled in this prospective, non-randomised interventional study. According to the power calculation, in the first part of the study actual fasting times for clear fluids and solids were documented in 502 consecutive patients, verbally instructed as usual regarding the recommended fasting times for clear fluids (2 h) and solids (6 h). Subsequently, we implemented additionally to the verbal instruction a written educational note for the patients, including the recommended fasting times. Furthermore, the medical staff was re-trained regarding the fasting times using emails, newsletters and employee meetings. Thereafter, another 500 patients were included in the study. We hypothesised, that after these quality improvement procedures, actual fasting times for clear fluids and solids would be more accurate on time. RESULTS: Actual fasting times for clear fluids were in the median 11.3 (interquartile range 6.8–14.3; range 1.5–25.5) h pre-intervention, and were significantly reduced to 5.0 (3.0–7.2; 1.5–19.8) h after the intervention (median difference (95%CI) − 5.5 (− 6.0 to − 5.0) h). The actual fasting times for solids also decreased significantly, but only from 14.5 (12.1–17.2; 5.4–48.0) h to 14.0 (12.0–16.3; 5.4–32.0) h after the interventions (median difference (95%CI) − 0.52 (− 1.0 to − 0.07) h). CONCLUSIONS: The study showed considerably extended actual fasting times in elective adult surgical patients, which were significantly reduced by simple educational/training interventions. However, the actual fasting times still remained considerably longer than defined in recommended guidelines, meaning further process optimisations like obligatory fluid intake in the early morning are necessary to improve patient comfort and safety in future. TRIAL REGISTRATION: German registry of clinical studies (DRKS-ID: DRKS 00020530, retrospectively registered). BioMed Central 2021-10-26 /pmc/articles/PMC8547037/ /pubmed/34702191 http://dx.doi.org/10.1186/s12871-021-01468-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Witt, Lars
Lehmann, Barbara
Sümpelmann, Robert
Dennhardt, Nils
Beck, Christiane E.
Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia
title Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia
title_full Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia
title_fullStr Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia
title_full_unstemmed Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia
title_short Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia
title_sort quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547037/
https://www.ncbi.nlm.nih.gov/pubmed/34702191
http://dx.doi.org/10.1186/s12871-021-01468-6
work_keys_str_mv AT wittlars qualityimprovementprojecttoreduceactualfastingtimesforfluidsandsolidsbeforeinductionofanaesthesia
AT lehmannbarbara qualityimprovementprojecttoreduceactualfastingtimesforfluidsandsolidsbeforeinductionofanaesthesia
AT sumpelmannrobert qualityimprovementprojecttoreduceactualfastingtimesforfluidsandsolidsbeforeinductionofanaesthesia
AT dennhardtnils qualityimprovementprojecttoreduceactualfastingtimesforfluidsandsolidsbeforeinductionofanaesthesia
AT beckchristianee qualityimprovementprojecttoreduceactualfastingtimesforfluidsandsolidsbeforeinductionofanaesthesia