the two groups, bed management (ERAS) pilot and highlighted the would also stand to gain from better importance of sustained oral intake. estimates of anticipated hospital bed On the day of surgery, we actively usage, which could easily be encouraged mothers to drink clear calculated in advance. fluids up to 2 hours of their expected theatre arrival time. References Methods State of the health system Beds in the NHS: Scotland. British Prospective data collection was Medical Association. 2017. undertaken for mothers admitted for GMC Hot Topics Guidance; elective caesarean delivery from September 2016-January 2017. All mothers were asked 1) when did she Surgical Outcome Risk Tool. have her last meal? 2) when did she University College London have clear fluid to drink? After team briefing before starting the elective list, mothers expected to have surgery later that day were provided with clear Not too fast? Service evaluation fluids and encouraged to take them after introducing change to improve until 2 hours before theatre arrival fasting time for elective caesarean time. Data was analysed with excel delivery spreadsheet and z ratio for significant difference of proportions for all U Ikram, K Litchfield, H Elliot, A Clark mothers fasted for 4 hours or less Princess Royal Maternity, Glasgow (pragmatic cut off agreed). Royal Infirmary, Glasgow, UK Results Introduction Data was collected for 115 parturients. AAGBI guideline suggests minimum of Mean fasting time for food was 15 2 hours fasting for clear fluid before hours (range 10-24). Mean fasting time general elective surgery.1 In for clear fluids was 4 hours (range obstetrics, the ASA obstetric task force a reduction from mean of 10.5 recommends a similar period.2 Fasting hours in 2014. When comparing for longer duration can cause mothers fasted for 4 hours or less in significant dehydration, ketosis and 2014 audit vs. recent data results were maternal dissatisfaction.3 Our previous significantly different: 15% vs. 60% audit4 showed that parturients were with a z score of 5.4 and 2 tailed p fasting for a prolonged period of time value of <0.0002. before elective caesarean delivery. We engaged mothers at an antenatal Discussion education class as part of our enhanced recovery after surgery
the two groups, bed management would also stand to gain from better estimates of anticipated hospital bed usage, which could easily be calculated in advance. References State of the health system Beds in the NHS: Scotland. British Medical Association. 2017. GMC Hot Topics Guidance; Surgical Outcome Risk Tool. University College London Not too fast? Service evaluation after introducing change to improve fasting time for elective caesarean delivery U Ikram, K Litchfield, H Elliot, A Clark Princess Royal Maternity, Glasgow Royal Infirmary, Glasgow, UK Introduction AAGBI guideline suggests minimum of 2 hours fasting for clear fluid before general elective surgery.1 In obstetrics, the ASA obstetric task force recommends a similar period.2 Fasting for longer duration can cause significant dehydration, ketosis and maternal dissatisfaction.3 Our previous audit4 showed that parturients were fasting for a prolonged period of time before elective caesarean delivery. We engaged mothers at an antenatal education class as part of our enhanced recovery after surgery (ERAS) pilot and highlighted the importance of sustained oral intake. On the day of surgery, we actively encouraged mothers to drink clear fluids up to 2 hours of their expected theatre arrival time. Methods Prospective data collection was undertaken for mothers admitted for elective caesarean delivery from September 2016-January 2017. All mothers were asked 1) when did she have her last meal? 2) when did she have clear fluid to drink? After team briefing before starting the elective list, mothers expected to have surgery later that day were provided with clear fluids and encouraged to take them until 2 hours before theatre arrival time. Data was analysed with excel spreadsheet and z ratio for significant difference of proportions for all mothers fasted for 4 hours or less (pragmatic cut off agreed). Results Data was collected for 115 parturients. Mean fasting time for food was 15 hours (range 10-24). Mean fasting time for clear fluids was 4 hours (range a reduction from mean of 10.5 hours in 2014. When comparing mothers fasted for 4 hours or less in 2014 audit vs. recent data results were significantly different: 15% vs. 60% with a z score of 5.4 and 2 tailed p value of <0.0002. Discussion