Læknablaðið - 01.06.2016, Síða 28

288 LÆKNAblaðið 2016/102
R A N N S Ó K N
ENGLISH SUMMARY
Introduction: Fasting is an important safety precaution for patients
before surgery but studies indicate that excessive fasting is common.
Explanations for this, including patient education related factors, are not
well known. The aim of this study was to explore how long patients fast
before surgery and what instructions they received, one year after the
introduction of new guidelines for patients and professionals.
Material and methods: This descriptive study was undertaken in a
national, 660-bed university hospital in 2011. Data was collected from
patient records and with questionnaires. Included were adult surgical
patients having anaesthesia during a 5day period.
Results: The sample consisted of 193 patients: 83% were scheduled
for elective surgery and 86% returned questionnaires. Average fasting
time was 13,6 (±3.0) hours for solid food and 8,8 (±4.5) hours for clear
fluids. A quarter (27%) had received instructions according to guidelines
and 45% were instructed to fast from midnight. Information was either
written (18%), verbal (37%) or both (45%) and 46% of patients received
information on the importance of fasting. Patients scheduled for morn-
ing surgery fasted for a shorter time than afternoon patients (p<0.05).
Patients who received both verbal and written information fasted shorter
on clear fluids (p<0.001) than others.
Conclusions: The fasting of surgical patients before their operation
is unnecessarily long and they do not get uniform instructions. This
warrants further exploration. There is a need for staff to coordinate
instructional practices, to involve patients more in their own care with
consistent information and comprehensive education and assist them in
reducing fasting on clear fluids after hospital admission.
Preoperative fasting: Instructions to patients and length of fasting – a prospective, descriptive survey
Brynja Ingadottir1,2, Anna Maria Olafsdottir1, Herdis Sveinsdottir1,2, Lara Borg Asmundsdottir1, Lilja Asgeirsdottir1, Margret Sjofn Torp1, Elin J.G. Hafsteinsdottir3
1Landspitali University Hospital, Surgical services, 2Faculty of Nursing, School of Health Sciences, University of Iceland, 3Landspitali University Hospital Department of Research and
Development.
Key words: preoperative fasting, patient education, surgery, surgical patients.
Correspondence: Brynja Ingadóttir, brynjain@landspitali.is
Heimildir
1. Stuart PC. The evidence base behind modern fasting
guidelines. Best Pract Res Anaesthesiol 2006; 20: 457-69.
2. Levy DM. Pre-operative fasting—60 years on from
Mendelson. Contin Educ Anaesthesia, Crit Care Pain 2006;
6: 215-8.
3. American Society of Anaesthesiology (ASA). Practice
guidelines for preoperative fasting and the use of
pharmacologic agents to reduce the risk of pulmonary
aspiration: Application to healthy patients undergoing
elective procedures. Anesthesiology 2011; 114: 495-511.
4. Crenshaw JT. Preoperative fasting: will the evidence ever
be put into practice? Am J Nurs 2011; 111: 38-43.
5. Crenshaw JT, Winslow EH. Preoperative fasting duration
and medication instruction: are we improving? AORN J
2008; 88: 963-76.
6. Rycroft-Malone J. Implementing evidence-based practice
in the reality of clinical practice. Worldviews Evid Based
Nurs 2012; 9: 1.
7. Falconer R, Skouras C, Carter T, Greenway L, Paisley
AM. Preoperative fasting: Current practice and areas for
improvement. Updates Surg 2014; 66: 31-9.
8. Roberts S. Preoperative fasting: a clinical audit. J Perioper
Pr 2013; 23: 11-6.
9. Castillo-Zamora C, Castillo-Peralta LA, Nava-Ocampo
AA. Randomized trial comparing overnight preoperative
fasting period Vs oral administration of apple juice at
06:00-06:30 am in pediatric orthopedic surgical patients.
Paediatr Anaesth 2005; 15: 638-42.
10. Tosun B, Yava A, Açikel C, Açıkel C. Evaluating the effects
of preoperative fasting and fluid limitation. Int J Nurs
Pract 2015; 21: 156-65.
11. Pimenta GP, de Aguilar-Nascimento JE. Prolonged
Preoperative Fasting in Elective Surgical Patients: Why
Should We Reduce It? Nutr Clin Pract 2013; 29: 22-8.
12. Ali Abdelhamid Y, Chapman MJ, Deane AM. Peri-
operative nutrition. Anaesthesia 2016; 71 Suppl.:9-18.
13. Faria MS, de Aguilar-Nascimento JE, Pimenta OS,
Alvarenga Jr LC, Dock-Nascimento DB, Slhessarenko
N. Preoperative fasting of 2 hours minimizes insulin
resistance and organic response to trauma after video-
cholecystectomy: a randomized, controlled, clinical trial.
World J Surg 2009; 33: 1158-64.
14. Braga M, Ljungquist O, Soeters P, Fearon K, Weimann A,
Bozzetti F. ESPEN Guidelines on Parenteral Nutrition :
Surgery. Clin Nutr 2009; 28: 378-86.
15. Baril P, Portman H. Preoperative fasting: knowledge and
perceptions. AORN J 2007; 86: 609-17.
16. Breuer JP, Bosse G, Seifert S, Prochnow L, Martin J,
Schleppers A, et al. Pre-operative fasting: a nationwide
survey of German anaesthesia departments. Acta
Anaesthesiol Scand 2010; 54: 313-20.
17. Gunawardhana AI. Knowledge, attitudes and practice of
preoperative fasting guidelines in the National Hospital of
Sri Lanka. Sri Lankan J Anaesthesiol 2012; 20: 1-4.
18. Redman. BK. Advances in Patient Education. Springer
Publishing Company; New York 2004.
19. Ólafsdóttir AM, Ásgeirsdóttir L. Fasta fyrir skurðaðgerð:
"ekkert eftir miðnætti" er gömul klisja. In: Sveinsdóttir H,
Blöndal K, Ingadóttir B, editors. Aðgerðasjúklingar liggja
ekki aðgerðalausir II : um hjúkrun sjúklinga á skurð-
deildum [rafbók]. Rannsóknastofnun í hjúkrunarfræði
við Háskóla Íslands og Landspítala Háskólasjúkrahús,
Reykjavík 2009: 23-36.
20. Ólafsdóttir AM, Ásgeirsdóttir L. Fasta fyrir skurðaðgerð
“ekkert eftir miðnætti” - gömul klisja. Tímarit hjúkrunar-
fræðinga 2010; 4: 34-6.
21. Karadağ M, İşeri ÖP. Determining Health Personnel’s
Application Trends of New Guidelines for Preoperative
Fasting: Findings From a Survey. J Peri Anesthesia Nurs
2014; 29: 175-84.
22. Rycroft-Malone J, Seers K, Crichton N, Chandler J,
Hawkes CA, Allen C, et al. A pragmatic cluster randomis-
ed trial evaluating three implementation interventions.
Implement Sci 2012; 7: 80.
23. Fredericks S, Guruge S, Sidani S, Wan T. Postoperative
patient education: A systematic review. Clin Nurs Res
2010; 19: 144-64.
24. Friedman AJ, Cosby R, Boyko S, Hatton-Bauer J, Turnbull
G. Effective teaching strategies and methods of delivery
for patient education: A systematic review and practice
guideline recommendations. J Cancer Educ 2011; 26:
12-21.
25. Khoyratty S, Din AH, Spendlove R, Teehan M, Arhi C,
Modi BN, et al. The impact of discussing preoperative
fasting with patients. J Perioper Pract 2011; 21: 284-6.

gefa þeim kolvetnaríka drykki þar til tveir tímar eru til aðgerðar.
Áhugavert væri að fylgja þessari rannsókn eftir með því að kanna
hvaða leiðbeiningar sjúklingar fá í dag, hversu mikið seinkun á
aðgerðaráætlun skýrir langa föstu og hvaða skýringar sjúklingar
gefa varðandi lengd föstunnar.
Þakkir
Sjúklingum sem tóku þátt í þessari rannsókn eru færðar bestu
þakkir svo og starfsfólki skurðlækningasviðs Landspítala sem
aðstoðaði við gagnasöfnun, og Jeannette T. Crenshaw sem veitti
ráðgjöf við gerð spurningalistans.