Duncan Stickle1, Stewart Cartmill1,2, Niranjali Yatiwelle1
1Dumfries & Galloway Royal Infirmary, Dumfries, United Kingdom. 2Queen Elizabeth University Hospital, Glasgow, United Kingdom
Introduction: Previous guidance has recommended a fluid fasting period of two hours or more for all patients undergoing surgery. This has been standard practice for a number of years, however controlling individual fasting times is extremely difficult, often well in excess of two hours. Prolonged fluid fasting is known to cause increased rates of post operative nausea and vomiting (PONV) and delirium, in addition to thirst and dehydration, with little evidence of benefit.
A number of NHS trusts have moved towards a policy of allowing patients to sip from a cup of water until sent for by theatre, without a significant increase in pulmonary aspiration events or other complications.
Methods: Around the time of introduction of a “sip til send” protocol in Dumfries & Galloway Royal Infirmary, staff education sessions were organised to raise awareness, alongside posters and updated patient information leaflets.
A snapshot patient satisfaction survey was undertaken before and after implementation to assess subjective experience of the different fasting approaches
Results: Following implementation, 76% of patients were sipping on water in the waiting area. Of those not actively sipping, average fasting time fell from 6 hours (range 1-14) to 2 (range 1-3). Subjective feelings of dehydration fell from 60% to 15%, with similar reductions in the rates of dry lips or mouths as well as reduced rates of patient anxiety about fasting. There were no reported aspiration events.
Conclusions: This new policy was universally liked by patients and resulted in great improvements in all subjective markers of dehydration.