Assessing preoperative fasting practice among adult patients at Kenyatta national hospital, surgical department.

Abstract

Background Patients scheduled for anesthesia and surgery should be fasted to reduce the stomach content as much as possible. Preoperative fasting aims to avoid gastric aspiration during anesthesia or surgery. Patients fasted from mid night of the day of surgery until induction of anesthesia may experience many hours of fasting if they are not first on the operating list. This practice results in prolonged fasting with resultant adverse effects. Objective The objective of this study was to assess the Preoperative fasting practice among adult patients at Kenyatta National Hospital, surgical department. Methods and materials This was a descriptive cross-sectional design study. Permission to carry out the study and presentation of findings was sought from the Kenyatta National Hospital/ University of Nairobi Ethics Regulation Committee (KNH/ UoN/ERC) which was granted on 16/04/2015. Permission from KNH surgical division was sought and granted on 29/04/2015. Consent was obtained from the participants; their rights were respected. Quantitative and qualitative approach to data collection was applied. Data was collected using self-administered questionnaire. A total of 276 subjects participated in the study, 65 patients and 211 medical personnel. Data was analyzed using Statistical Package on Social Science (SPSS) software version 20. Quantitative data was analyzed using descriptive statistics methods of Mean, Mode, Median and Standard Deviation (SD). Inferential statistics; Chi-square and fisher’s exact test were used to show the relationship between variables. The results were presented in tables, graphs and pie charts. Qualitative data was grouped in themes and similar information was deducted for final analysis. Results Most (47.7%, n=31) patients had knowledge deficit (I do not know) on reasons for fasting, they were followed by those who said it was to empty bowel 20% (13), then to avoid reaction with anesthesia 15.4% (10), then to prevent bleeding 10.8% (7) and then to prevent vomiting and aspiration 6.2% (4). There was a significant(χ2 = 30.973,df = 12,p = 0.002) relationship between level of education and reasons for preoperative fasting among patients. Patients who had low level of education were likely to report knowledge deficit on preoperative fasting.Majority 80.6% (n=170) of medical personnel were knowledgeable on preoperative fasting guidelines for adults before induction of anesthesia or surgery. Majority (80%, n=10) of the patients’ view were that, ward nurses gave preoperative fasting instruction, followed by anesthetist 15% (n=10) and then surgeon 5% (n=3) (Fig 4.5-1). There was a significant(χ2 = 6.164,df = 2,p = 0.046) relationship between who gave fasting instructions and complain of NPO among patients. Patients who reported that ward nurses gave fasting instructions were likely to complain of NPO. These results were not supported by response from the medical personnel; the relationship between who gave preoperative fasting instructions and complain of NPO was not statistically significant(χ2 = 11.600,df = 6,p = 0.072) Overall majority (58.5%, n=38) of the patients disagreed that preoperatively thirsty patients can take clear fluids, 26.1% (17) agreed while 15.4% (10) did not support either response. Most (24.2%, n=51) of the medical personnel reported to fast patients for 2 hours after taking clear liquids, 23.7% (n=50) fasted patients from mid night, 6 hours fasting was 20.9% (n=44), other responses (31.2%, n=66) did not yield much significance Regarding the outcomes, most (43.1%, n=28) of the patients ranked thirst as a moderate challenge, this was followed by ranking thirst as a severe challenge 36.9% (n=24), then none challenge 9.2% (n=6), then slight challenge 7.7% (n=5) and then mild challenge 3.1% (n=2). There was a significant(χ2 = 38.617,df = 16,p = 0.001) relationship between knowledge on consumption of fluid and perception of thirst among patients. Patients who reported to be less knowledgeable on consumption of fluid were likely to experience severe thirst. These results were different from the opinion of medical personnel (χ2 = 16.790,df = 16,p = 0.399) Conclusion Medical personnel were knowledgeable on preoperative fasting guidelines as stipulated by the 1999 American Society of Anesthesiologists. This study provided information that the practice of medical personnel was not as per the guidelines. The practice of Nil per Oral (NPO) from mid night was popular in the hospital to the comfort of medical personnel. The patients were uncomfortable with the practice and did not appreciate it. Majority of the patients were fasted after their last meals or from mid night. On average patients fasted for longer durations than recommended by the1999 American Society of Anesthesiologist guidelines of preoperative fasting practice. It is recommended that bulk fasting instructions from mid night should be discouraged and instead individualized care to be emphasized. Therefore the hypothesis of this study was approved; that preoperative fasting practices at Kenyatta National Hospital were not in tandem with the 1999 American Society of Anesthesiologist guidelines of preoperative fasting practice.