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The aim of this literature review is to critically analyse and synthesise relevant studies pertinent to the quality and standards of the current protocols on Preoperative fasting for elective surgical patients

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´╗┐Module ? SHN 3017 Preoperative Fasting Cohort ? M10 Group B2 Student Number ? 558211 Personal Tutor ? Megan Rosser Submission Date ? 16/07/2012 Word Count ? 3824 ________________ Contents Introduction 3-4 Rationale 4-5 Research strategy 5-6 Themes Identified 6-15 Conclusion 15-16 Reference list 17-21 Introduction The aim of this literature review is to critically analyse and synthesise relevant studies pertinent to the quality and standards of the current protocols on Pre-operative fasting for elective surgical patients. Whilst the introduction offers a brief synopsis of a literature review, it also comprises of the methodology, and provides a rationale, research strategies and critically analyses all relevant research within the main body, finally it will conclude all the literature and outline implications for change which will then lead on to form the basis for the management of change assignment in module eight. Parahoo (2006) suggests that a literature review should detail the time frame within which the literature was selected, as well as the methods used to evaluate and synthesize findings of the studies in question. This consequently allows us to identify and critically evaluate all the literature on the chosen topic. The framework chosen to critique the primary research articles was The Critical Appraisal Skills Programme (CASP); the purpose of CASP is to help provide the skills necessary for finding and critically evaluating the best scientific evidence on which to base health care decisions (CASP 1993). From undertaking the literature review several themes became apparent, the three most significant themes that were identified will be discussed in the main body of the assignment; 1, Understanding the cause of aspiration for patients fasting prior to surgery, 2,the on-going debate for how long the patient should be nil by mouth and 3, barriers in implementing change. Not only are these themes emphasized within the current evidence-based literature but are further accentuated by personal observation within the hospital environment When caring for patients it is essential for nurses to use the current best practice and is able to read research critically. ...read more.


Similarly a small scale randomised controlled trial demonstrated how a group of patients who were given a light breakfast consisting of a slice of toast and a cup of tea two to three hours before their surgery did not display significantly different residual gastric volumes or pH when stomach contents were aspirated, compare to a control group who were fasted overnight (Miller et al 1983). However this could not be proven as the orogastric tube used for the aspiration was so fine that any large fragments of toast could be left in the stomach, so the validity of this study must be questioned. Furthermore the research does not state any health problems the patients may be suffering. There are some elective patients where a significant delayed gastric emptying must be suspected. These include patients with gastrointestinal obstruction of any form, diabetes, or cancer in the upper gastrointestinal tract. In patients with systemic disease, the extent of gastric slowing may be highly variable depending on the severity of the disease (Read 1989, and Horowitz et al 2002). To what extent diabetic patients should be nil by mouth after midnight to secure gastric content in the normal range is still not known, therefore more research is needed to address this on-going problem. Additionally In 2003, a systematic review of twenty two randomized controlled trials found that patients who drank clear liquids up to ninety minutes before surgery were at no greater risk of vomiting, aspiration or related morbidity during anaesthesia; regardless of the volume of clear liquids they consumed (Brady et al 2003). Again the validity of this study has to be questioned as the number of participants was only twenty two and they have failed to address the conditions of the patients prior to surgery. It has also been discovered that taking oral fluids until two or three hours prior to surgery could have long-term benefits. ...read more.


Another example of the delay in current practice was expressed by a group of surgeons with regard to the modernization of fasting guidelines (McLeod et al 2005). They reviewed the recent Cochrane analysis on preoperative fasting in adult to prevent Perioperative complications (Brady et al 2003). They conclude that there was no evidence of increased risk with modern fasting guidelines. Despite these facts, their impression was the of the ASA guidelines a standard fast of NPO after midnight remain the standard practice in the majority of institutions. They believe the old NPO routine allows for a more flexible operating team. Conclusion In conclusion preoperative fasting remains a confusing concept for patients and practitioners. Anaesthesia care providers, surgeons, and nurses must collaborate to create and enforce policies that are safe for patients undergoing surgery (Woodhouse 2006., Stuart 2006.,Baril and Portman 2007 and Anderson 2009). There are a number of ways in which nurses can improve and implement future nursing practice. It is clear prolonged fasting negatively impacts on patients? health and well-being. Nurses should provide coping strategies to patients who are experiencing a dry mouth and who are thirsty due to prolonged fasting, (such as brushing teeth, rinsing the mouth etc) (Simini 1999). There are barriers to changing practice, including systemic constraints, resistance to change, lack of knowledge and/or the confidence to question existing practice. As nurses we are accountable for the care we give to the patients, so it should be our priority to make preoperative fasting less hazardous and more bearable to patients. To protect the patients? well-being, hospital nursing staff must be mindful of what information is being given to patients preoperatively, and give clear and concise information of the importance of preoperative fasting. If fasting practices are to be based on evidence rather than custom, nurses and physicians must work together to ensure that fasting instructions are congruent with ASA guidelines and that patients? understand them. Although the data published needs updating, the general consensus of the research demonstrates that the benefits of shortening the fasting period outweighs the risk to the patients. ...read more.

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