Heartbeat: A simple sip saves lives

March 20, 2019

Can a picture of a glass of water make a difference to patients’ lives? Well the answer is yes.

When City Hospital’s anaesthesia team entered the weLearn competition to demonstrate change they had successfully implemented, their entry ‘Think Drink’ – a campaign to nudge patients away from fasting before operations – came out the winner.

Now the team, led by Consultant in Anaesthesia and Critical Care, Dr Santhana Kannan, is enjoying success which has won them £5,000, but more importantly better patient experience and satisfaction.

The poster shows a glass of water with the headline ‘Think Drink’ and the message ‘Patients allowed sips of water until surgery’.

Dr Kannan explained that the guideline stipulating pre-operative fasting safety limits (six hours for solids and two hours for fluids) has been in place for more than three decades. However, repeated audits have shown that patients were fasting for much longer unnecessarily (up to seven hours on average for fluids in our organisation). This was due to a combination of perceived risks and also practical constraints in terms of monitoring patient fluid intake.

Recent research has shown that allowing patients to drink water before surgery is safe. It reduces the risk of dehydration, reduces post-operative vomiting and improves clinical stability during the procedure. There is enough evidence from inside and outside the UK to show this works.

Dr Kannan – alongside fellow doctors Christopher Horner and Ahmed Gilani – modified the pre-operative fasting policy that allowed patients to have unlimited sips of water in the run-up to their surgery, using a ‘0-2-6’ approach – ‘0’ for the sips of water until being called into theatre, ‘2’ for fizzy drinks, milk, tea or coffee up to two hours before and ‘6’ meaning solids up to six hours before.

Dr Kannan said: “Following the implementation of the ‘Think Drink Project’, we re-audited and the average fasting time for fluids had come down to two hours. There was a huge improvement. Ward colleagues reported that patients came back with fewer headaches – most likely due to better hydration.

“This is a step change in practice. We now need to try and ensure that all patients are aware of this option and we extend this to emergency surgery as well.”

The team aims to do this by modifying their letters to patients to make them aware of the revised guideline well in advance.

All the results from the campaign were put into an infographic poster that was submitted for the weLearn competition and won the £5,000 – which Dr Kannan and the team now have to spend. Fortunately, they have some ideas.

He said: “The prize money will be shared between myself, Dr Horner and Dr Gilani. I am not sure what their spending plans are but a proportion of my share will go to charity and quality improvement activity within the department. I am happy that our initiative won the prize. The resultant publicity will aid colleague awareness. I am grateful to all my department colleagues for their support in this venture.”