OBJECTIVES: We applied quality improvement (QI) methodology to identify the different aspects of why children fasted for prolonged periods in our institution. Our aim was for 75% of all children to be fasted for clear fluid for less than 4 hours. BACKGROUND: Prolonged fasting in children can increase thirst and irritability and have adverse effects on haemodynamic stability on induction. By reducing this, children may be less irritable, more comfortable and more physiologically stable, improving the preoperative experience for both children and carers. METHODS: We conducted a QI project from January 2014 until August 2016 at a large tertiary pediatric teaching hospital. Baseline data and the magnitude of the problem were obtained from pilot studies. This allowed us to build a key driver diagram, a process map and conduct a failure mode and effects analysis. Using a framework of Plan-Do-Study-Act cycles our key interventions primarily focused on reducing confusion over procedure start times, giving parents accurate information, empowering staff and reducing variation by allowing children to drink on arrival (up to one hour) before surgery. RESULTS: Prior to this project, using the 6,4,2 fasting rule for solids, breast milk, and clear fluids, respectively, 19% of children were fasted for fluid for less than 4 hours, mean fluid fasting time was 6.3 hours (SD 4.48). At the conclusion 72% of patients received a drink within 4 hours, mean fluid fasting reduced to 3.1 hours (SD 2.33). The secondary measures of aspiration (4.14:10 000) and cancellations have not increased since starting this project. CONCLUSIONS: By using established QI methodology we reduced the mean fluid fasting time for day admissions at our hospital to 3.1 hours and increased the proportion of children fasting for less than 4 hours from 19% to 72%.
OBJECTIVES: We applied quality improvement (QI) methodology to identify the different aspects of why children fasted for prolonged periods in our institution. Our aim was for 75% of all children to be fasted for clear fluid for less than 4 hours. BACKGROUND: Prolonged fasting in children can increase thirst and irritability and have adverse effects on haemodynamic stability on induction. By reducing this, children may be less irritable, more comfortable and more physiologically stable, improving the preoperative experience for both children and carers. METHODS: We conducted a QI project from January 2014 until August 2016 at a large tertiary pediatric teaching hospital. Baseline data and the magnitude of the problem were obtained from pilot studies. This allowed us to build a key driver diagram, a process map and conduct a failure mode and effects analysis. Using a framework of Plan-Do-Study-Act cycles our key interventions primarily focused on reducing confusion over procedure start times, giving parents accurate information, empowering staff and reducing variation by allowing children to drink on arrival (up to one hour) before surgery. RESULTS: Prior to this project, using the 6,4,2 fasting rule for solids, breast milk, and clear fluids, respectively, 19% of children were fasted for fluid for less than 4 hours, mean fluid fasting time was 6.3 hours (SD 4.48). At the conclusion 72% of patients received a drink within 4 hours, mean fluid fasting reduced to 3.1 hours (SD 2.33). The secondary measures of aspiration (4.14:10 000) and cancellations have not increased since starting this project. CONCLUSIONS: By using established QI methodology we reduced the mean fluid fasting time for day admissions at our hospital to 3.1 hours and increased the proportion of children fasting for less than 4 hours from 19% to 72%.
Authors: Alison R Carroll; Allison B McCoy; Katharina Modes; Marni Krehnbrink; Lauren S Starnes; Patricia A Frost; David P Johnson Journal: J Hosp Med Date: 2022-02-14 Impact factor: 2.899
Authors: Adriana S Gandolfo; Priscilla F N Cardoso; Izabel M Buscatti; Manoel Carlos P Velhote; Maria Aparecida C Bonfim; Alberto C Helito Journal: Clinics (Sao Paulo) Date: 2021-08-04 Impact factor: 2.365
Authors: Lars Witt; Barbara Lehmann; Robert Sümpelmann; Nils Dennhardt; Christiane E Beck Journal: BMC Anesthesiol Date: 2021-10-26 Impact factor: 2.217
Authors: Ahmed M El-Sharkawy; Prita Daliya; Christopher Lewis-Lloyd; Alfred Adiamah; Francesca L Malcolm; Hannah Boyd-Carson; Daniel Couch; Philip J J Herrod; Tanvir Hossain; Jennifer Couch; Panchali B Sarmah; Tanvir S Sian; Dileep N Lobo Journal: Clin Nutr Date: 2020-09-05 Impact factor: 7.324