Criteria for clinical audit
Possible objectives for an audit
- To ensure that the management of perioperative fasting follows evidence-based guideline recommendations.
People that could be included in an audit
- All patients undergoing elective surgery
- All staff and carers who work or have close associations with patients undergoing planned elective surgery.
Measures that could be used as a basis for a clinical audit
- The Guideline Development Group and RCN staff have developed essential question areas that form a broad basis for the development of audit criteria.
| Criterion | Exception | Definition |
|---|---|---|
| 1. Water (clear fluid) is taken up to two hours before induction of anaesthesia. | The higher-risk patient that the anaesthetic team treats differently. Contra-indications. |
Higher risk of regurgitation and aspiration; patients include those with obesity, gastro-oesophageal reflux and diabetes. |
| 2. Breast milk is taken up to four hours preoperatively | The higher-risk patient that the anaesthetic team treats differently. Contra-indications. |
Higher risk of regurgitation and aspiration; patients include those with obesity, gastro-oesophageal reflux and diabetes. |
| 3. The patient fasts from solids, formula milk, cows' milk and milk-containing drinks for at least six hours preoperatively. | The higher-risk patient that the anaesthetic team treats differently. Contra-indications. |
Higher risk of regurgitation and aspiration; patients include those with obesity, gastro-oesophageal reflux and diabetes. |
| 4. The anaesthetic team gives the higher-risk patient further interventions. | Healthy patients. | Healthy - ASA I-II without gastrointestinal disorders. Further interventions such as H2 -receptor antagonists, sodium citrate, gastrokinetic agents and proton pump inhibitors, together with rapid sequence induction, tracheal intubation and nasogastric tube. |
| 5. a) Postoperatively, oral fluids are offered to healthy patients when they are fully awake. b) The child is not required to drink as part of the discharge criteria. |
Non-routine, complicated surgery. Gastrointestinal or major abdominal surgery. Contra-indications. |
Some useful general information about and support for clinical audit is available on the Healthcare Quality Improvement Partnership (HQIP) website.
For more helpful information go to: Service improvement tools