Kenneth's story
Here is Kenneth's story as told by his son Ian.
Clinical context
As a health care professional, I have long understood the importance of underpinning clinical practice with evidence. Recently, my father was admitted for planned surgery, and I was interested to observe how the clinical team applied published evidence related to perioperative fasting. I was encouraged to hear how preoperative preparation had increased his understanding and enabled him to gain insight to what would happen on the day of surgery. I was delighted to see the use of white boards, indicating what fasting regime should be applied, with a ‘three and six’ rule clearly written, three hours for fluids (the evidence supports fluids up to two hours pre anaesthetic) and six hours for food.
Applying the evidence
Getting it right
While the clinical team understood the evidence, it was not applied at the bedside. In effect, my father was starved from midnight, having had fluids up to the time he slept the night before surgery. While the operative list indicated he was the third operation on the list, two large cases determined he was unlikely to go to theatre before 12.00 noon, the reality was 1.30pm. Personal involvement in supporting my mother and father did not allow me to fully expose the weakness in this experience, but I did take opportunity to point out to the clinical team that it was entirely reasonable and safe for my father to have had a light snack at 6.00am (toast) and a cup of tea. Clear fluids could have been enjoyed by my father until 10.00am.
Team thinking and effective evidence implementation
Traditional patterns to care, in this situation the management of the operation list, had a detrimental impact at two levels. Poor patient experience and a lack of evidence based care. The responsibility for this sits with the whole clinical team, and their ability to work and communicate effectively in making evidence based health care work, leading to a real improvement in patient experience. Personally, I feel that in this case, there was no excuse, Dad should have been fasted more effectively, shaped by contemporary evidence. Lets work together to improve the quality of patient care, and use the published evidence.