title: Preoperative fasting in children: An audit and its implications in a tertiary care hospital.
abstract: BACKGROUND
  Prolonged preoperative fasting in children is a common problem, especially in highvolume centers. All international professional society guidelines for preoperative fasting recommend 2 h for clear fluids, 4 h for breast milk and 6 h for solids, nonhuman and formula milk in children. These guidelines are rarely adhered to in practice.
  
  
  OBJECTIVE
  An audit was undertaken to determine the length of preoperative fasting time in children and its causes.
  
  
  METHODS
  Cross-sectional study of 50 children below 15 years posted for elective surgeries.
  
  
  METHODS
  An initial audit was performed at our institution on preoperative fasting time in 50 children below 15 years of age for elective surgeries. The mean preoperative fasting times were found to be much longer than the recommended times. Ward nurses were then educated about internationally recommended preoperative fasting guidelines in children. Anesthesiologists started coordinating with surgeons and ward nurses to prescribe water for children waiting for more than 2 h based on changes in surgery schedule by instructing ward nurses through telephone on the day of surgery. A reaudit was done 6 months after the initial audit.
  
  
  METHODS
  SPSS 16 software.
  
  
  RESULTS
  The initial audit revealed a mean preoperative fasting time of 11.25 h and 9.25 h for solids and water, respectively. Incorrect orders by ward nurses (74%) and change in the surgical schedule (32%) were important causes. After changing the preoperative system, mean preoperative fasting times in children decreased to 9 h and 4 h for solids and water, respectively in reaudit. Change in surgical schedule (30%) was the major cause for prolonged preoperative fasting in reaudit.
  
  
  CONCLUSIONS
  Simple steps such as education of ward nurses and better coordination among the anesthesiologists, surgeons and nurses can greatly reduce unnecessary preoperative starvation in children.
authors.affiliation: Department of Anaesthesiology Critical Care and Pain, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: B G
authors.initials: BG
authors.lastname: Arun
authors.forename: Grace
authors.initials: G
authors.lastname: Korula
keywords: Audit; children; fasting guidelines; preoperative fasting