TH6.1 Fasting times and medication administration in ‘nil by mouth’ emergency surgery patients

Abstract

Aims 1) To determine whether ‘nil by mouth’ (NBM) emergency surgery patients are fasted for longer than the recommended 6 hours for food and 2 hours for clear fluids. 2) To establish whether oral medications are being correctly administered/omitted in these patients. Methods Fasting and medication administration data were collected prospectively on patients who received emergency surgery over a 2- week period. Drug administration decisions were categorised as ‘correct’ or ‘incorrect’ by comparison with local guidelines. Results A total of 65 patients were identified with the average preoperative fasting times being 24 hours for food and 14 hours for clear fluids. However, the range of fasting times exceeded 110 hours. Notably, only 16 (25%) patients had a drink while they were NBM and 29 (45%) patients were incorrectly administered medications, including several instances of omission of critical drugs. Conclusions Further work is needed to establish the cause of prolonged fasting periods. However, likely factors include; operation scheduling difficulties, lack of understanding of NBM guidelines, inadequate communication with patients, and patient choice. This is resulting in poor preoperative optimisation of patients (e.g. dehydration of patients), as well as a significant risk to patient safety with critical medications being omitted. In order to rectify the severe lack of adherence to the guidelines, we are introducing further NBM training for medical professionals in our trust, in addition to updating the current trust guideline to reflect a wider range of medications and keep up to date with current national guidance.