MacDougall Katarzyna A R, Bushra Shahnoor E S, Kannan Santhana G
Oxford University Hospitals, NHS Foundation Trust Nuffield Orthopedic Center, Buckinghamshire, UK.
Korean J Anesthesiol. 2025 Jun;78(3):272-278. doi: 10.4097/kja.24489. Epub 2025 Mar 31.
Fasting guidelines have long recommended that patients can have clear fluids until 2 h prior to surgery. Multiple audits in our institution showed that patients had prolonged fluid fasting duration, despite being given preoperative instructions. This paper presents the results of audits in our institution relating to fasting since 2004 and the outcome of interventions undertaken.
Audits conducted in 2004, 2008, 2018, 2021, and 2022 were reviewed, with a focus on fasting duration for clear fluids. Interventions that led to significant improvements were identified.
The median fasting duration for clear fluids was 8 h, 8 h 42 min, and 7 h 42 min in 2004, 2008, and January 2018, respectively. The approach of giving patients a 'welcome drink' of water and allowing sips of water up to the time of being called upon to the theater was introduced in 2018 (Think Drink). This resulted in dramatic reduction of fasting duration to 2 h 15 min. However, repeat audit in 2021 showed slippage requiring additional interventions in the form of staff education for newcomers and reinforcement at staff huddles that reduced the fasting duration down to 2 h. There were no instances of aspiration or regurgitation after the introduction of Think Drink.
Allowing sips of water until being called to the theater with a Think Drink approach successfully reduced unnecessary fasting by patients. Staff and patient education were also required to sustain success. Fasting duration should be considered a 'Quality of Service Indicator' and periodic audit should be mandated.
长期以来，禁食指南一直建议患者在手术前2小时可以饮用清液。我们机构的多次审核表明，尽管已给予术前指导，但患者的液体禁食时间仍延长。本文介绍了自2004年以来我们机构与禁食相关的审核结果以及所采取干预措施的结果。
回顾了2004年、2008年、2018年、2021年和2022年进行的审核，重点关注清液的禁食时间。确定了导致显著改善的干预措施。
2004年、2008年和2018年1月清液的中位禁食时间分别为8小时、8小时42分钟和7小时42分钟。2018年引入了给患者一杯“欢迎饮品”水并允许其在被召唤到手术室之前小口喝水的方法（“想喝就喝”）。这使得禁食时间大幅缩短至2小时15分钟。然而，2021年的再次审核显示出现了下滑，需要采取额外的干预措施，即对新员工进行人员培训，并在员工会议上进行强化，这将禁食时间缩短至2小时。引入“想喝就喝”方法后没有发生误吸或反流的情况。
采用“想喝就喝”的方法允许患者在被召唤到手术室之前小口喝水，成功减少了患者不必要的禁食时间。还需要对工作人员和患者进行教育以维持这一成果。禁食时间应被视为一项“服务质量指标”，并应定期进行审核。
