Photo (l to r): Older Persons and Rehabilitation nurse manager Belinda Macfie, with clinical nurse manager Rupia Proebstel and registered nurse Sharleen Baird.
Fasting before surgery is often a requirement for patients – but when they are older or frail going without food and water can have a bigger impact and must be carefully monitored.
At Waikato’s Older Persons and Rehabilitation, staff and families were concerned about the amount of time patients were fasting, especially if surgery was postponed and rescheduled for the next day.
“Older people have very little reserves to cope with repeated fasting cycles,” explains clinical nurse manager for Ward OPR2 Rupia Proebstel.
Her nurse manager Belinda Macfie investigated what other hospitals had done to solve the problem, and came up with concept of a fasting clock developed in Wollongong Hospital, Australia. It gives everyone – patients, families, nurses and other staff – a visual tool to monitor fasting times.
The clock is a poster that goes on the wall above the patient’s bed. It uses a traffic light colour scheme to show what intake of liquid and food is allowed in the hours prior to the scheduled surgery.
Belinda Macfie says the aim is minimise the amount of time a person is fasting. “If the surgery is rescheduled, the clock is reset and this prevents an older person going without nourishment for too long.”
The benefits, she says, are patients who are better able to handle surgery when they go in, and can recover more quickly when they come out.
With Rupia leading the development of the Waikato version, the fasting clock was first tested on Ward OPR2 in October last year and is now used in all the Older Persons and Rehabilitation wards, with much success.
“Staff were involved right from the start and really supported the idea,” Rupia notes. “That made implementation faster and easier.”
Nurse Sharleen Baird, the high performer nurse in OPR2, is leading out the implementation of the fasting clock. Currently she is using two formats of the clock, one for patients with surgery schedule for the morning, and the other for the afternoon. However she is working on a more flexible design that can be manually adjusted to better reflect a change in scheduled surgery times.
“Feedback from patients and families is wonderful,” she says. “It has become an important part of patient care.”
Note: Fasting before surgery is important to reduce the risk of a patient under anaesthesia inhaling stomach contents into their lungs, or vomiting and choking. When you are going under anaesthesia your body and all its functions are “put to sleep” making normal reactions, like swallowing or controlling the reflex to vomit, impossible.