An audit investigating the practice of preoperative fasting and the administration of medication to patients during the nil per mouth period in Metro East district hospitals

Abstract

Background: Fasting before anaesthesia is an important practice aimed at preventing the aspiration of gastric contents. However, extended fasting periods have been associated with adverse effects. Despite international guidelines, evidence suggests that patients often experience extended fasting times beyond these recommendations. This study evaluated preoperative fasting durations and medication administration practices within the Metro East Health District of Cape Town.

Methods: This descriptive study was conducted across four hospitals in the Cape Metro East Health District: Eerste River, Helderberg, Karl Bremer, and Khayelitsha. A total of 162 patients were enrolled. Eligible participants were aged 18 years or older, undergoing elective or urgent surgical procedures, and admitted more than six hours before surgery. Data on fasting duration, alignment with international fasting guidelines, and medication administration were collected using structured questionnaires. Statistical analysis included one-way ANOVA for fasting times and chi-square tests for categorical variables.

Results: The average fasting durations observed were 14.25 hours for solid foods and 13.10 hours for fluids, which significantly exceeded the recommended guidelines. There were no statistically significant differences in fasting durations between hospitals. Only 17.90% of patients’ fasting instructions conformed to the international guidelines. Correct fasting instructions correlated with a significant reduction in fasting time for solids. However, no decrease was observed for fluids. The reduced fasting time for solids still exceeded acceptable practice. Adherence to medication protocols during the nil per mouth (NPM) period was notably poor.

Conclusion: Metro East Health District patients experience prolonged fasting durations that exceed recommendations. Contributing factors include inaccurate fasting instructions by doctors and suboptimal medication administration by nursing staff during the NPM period. Research is needed to develop interventions to improve NPM fasting times and medication administration.