070 QUENCH: the quality‐improvement project to reduce pre‐operative dehydration times
Published Date: 01st May 2020
Publication Authors: Jones K
Pre‐operative fasting aims to minimise the risk of pulmonary aspiration during anaesthesia. Patients often fast for longer than the advised standard times of 6 h for food and 2 h for fluids [1], on a fluctuating emergency list, compromising optimal physiology and patient experience. Peri‐operative quality‐improvement programme (PQIP) data shows our Trust has a lower than average Bauer satisfaction score relating to peri‐operative thirst. Our objective was to reduce the dehydration time in patients listed for emergency surgery.
Methods
Over 1 week we conducted staff and patient surveys to assess knowledge and understanding of pre‐operative fasting rules. Dehydration times for patients having emergency surgery were recorded. Inconsistencies were identified and interventions implemented across the Trust to improve knowledge and increase communication between theatre and the wards. This included training, posters and a modification to our World Health Organization (WHO) checklist. Three months later, we repeated the assessment. Results were analysed using Student's t‐test.
Results
Staff knowledge was variable across the Trust, often defaulting to historical ‘fast from midnight’ advice to avoid errors, which could lead to operation cancellation. Wards reported lack of communication from theatre regarding list order. Published guidance regarding chewing gum was unknown [1]. Patient knowledge was universally poor. Twenty‐nine patient surveys were completed in QUENCH‐1 and 41 in QUENCH‐2; there was a statistically significant reduction in average fasting times for clear fluids from 9 h 32 min (SD = 3.75) to 7 h 18 min (SD = 4.93; p = 0.043) after interventions. Forty‐two per cent of patients reported feeling very or extremely thirsty in QUENCH‐1, which increased in QUENCH‐2 to 60% with 83% of patients rating thirst importance > 7/10.
Discussion
Despite significant work from the team, dehydration times have reduced only modesty and fasting knowledge appears unchanged. To further address this issue, we have revised our fasting policy and are moving to a ‘sip ’til we send’ approach [2]. This will be implemented across the Trust and will require publicity, staff education and a change in pre‐operative clinic advice and written communication to patients. Once embedded, we will complete a further cycle of assessment and address ongoing areas of deficit.
Miller, T; Jones, K et al. (2020). 070 QUENCH: the quality‐improvement project to reduce pre‐operative dehydration times. Anaesthesia. 75 (S2), 43.