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Table 6 Summary of impact with examples

From: A pragmatic cluster randomised trial evaluating three implementation interventions

Impact

Description

Policy changes and development

Some trusts participating in the study had no Trust fasting policy. Some had fasting policies that were not consistent with guideline recommendations. For these trusts, the intervention period included the development of a policy (which in one Trust took six months to complete), and amending existing policy to ensure it was with the guideline recommendations.

Changes to information given to patients pre-operatively

Some trusts either developed or amended their patient information, including information provided in the letters that were sent to patients’ pre-operatively to make it clear what time individual patients could eat and drink up to (i.e., a move away from traditional block fasting rules), and what exactly terms such as ‘clear fluids’ meant.

Introducing new approaches to communicating individual fasting times

Examples of different practical approaches to making patients and staff aware of the individual fasting times were reported. For example, the use of various tools to mark/record individual patient fasting times, such as paper cups, white boards and drug charts. Other practices included taking a more active approach to encouraging patients to drink up to two hours before anaesthesia.

Improved communication

Some staff reported that there had been improved communication between staff, and staff and patients about fasting times (although communication was also highlighted as a barrier to changing practice in some trusts).

Management of lists

In some trusts it was reported that there had been a review of operational list management to attempt to facilitate more individualised fasting times.

Raising awareness of fasting

It was reported that the project raised practitioners’ awareness of fasting practice in their units through informal and formal education sessions, meetings, web-based resources, data collection, role modelling.

Development of individuals

A number of staff reported personal and professional development as a result of taking on key contact and facilitator of PDSA roles.