P49
PERIOPERATIVE FASTING IN ELECTIVE PAEDIATRIC SURGERY ADMISSIONS AT PILGRIM HOSPITAL
K. Roser1, J. Sampath2, J. O’Hagan2, W. Adeboye2
1Northumbria Healthcare NHS Foundation Trust, UK
2United Lincolnshire Hospitals NHS Trust, Boston, UK
Background
Following the 2018 consensus statement on clear fluid fasting for elective paediatric general anaesthesia(1), an internationally accepted regimen was agreed upon, as detailed in Table 1.
Despite this, during their pre-operative anaesthetic assessment, it had been noted that children who were undergoing elective surgeries at Pilgrim Hospital had experienced fasting times that exceeded recommendations by a considerable degree. This prompted concern regarding the unnecessary nature of such lengthy fasting periods, and the deleterious physiological, emotional and behavioural impacts that fasting to such a degree may have on the child.
Problem
Children who were admitted for elective surgery at Pilgrim Hospital across a 6-week period in early 2023 were fasted from solids for an average of 14 hours 23 minutes, and from clear fluids for an average of 9 hours 35 minutes.
A separate quality improvement project conducted within the trust during the same time period demonstrated that the excessive fasting times experienced by children had impacted on the satisfaction of their parents and caregivers.(2)
Strategy for Change
It was our aim to improve the quality of pre-operative fasting information provided to parents and caregivers. Current practice consists of an instruction within the surgery booking letter, requesting that a telephone call be made to the paediatric inpatient ward in order to obtain fasting instructions.
To improve the reliability of the information provided, we authored a letter to be distributed to parents and caregivers. This letter contains clear instructions for fasting times, depending on whether the child’s surgery is due to take place in the morning or afternoon. Initial feedback was sought through dissemination within the trust’s anaesthetic department. Following this, it is now in the latter stages of approval prior to being distributed to parents and caregivers alongside the surgery booking letter.
Measure of Improvement
Once distribution of the letter is established in the coming months, it is our intention to re-audit the perioperative fasting times experienced by children who are admitted for elective surgeries at Pilgrim Hospital.
Lessons Learnt
Children who undergo elective surgery at Pilgrim Hospital are subjected to unnecessarily lengthy periods of fasting. Firstly, this practice is not in line with current recommendations, and furthermore it has a tangible impact on patient satisfaction scores provided by parents and caregivers.
Message for Others
Care should always be taken when issuing pre-operative instructions to parents and caregivers, the quality of which becomes particularly important in the absence of a paediatric pre-assessment service.
References:
- Thomas M, Morrison C, Newton R, Schindler E. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Pediatr Anesth. 2018;28:411–414. https://doi.org/10.1111/pan.13370
- Taylor K, Sampath J. Audit on Paediatric Patient Satisfaction. Presented at Pilgrim Hospital, ULHT; 2023 Jun 6.