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Appreciating the benefits of nil by mouth education for patients

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VOL: 100, ISSUE: 50, PAGE NO: 43

Catherine Abou-Zaid, RGN, DipCoun, is nurse supervisor and in-service education coordinator, Mohamed Bin Khalifa Bin Salman Al Khalifa Cardiac Centre, Kingdom of Bahrain

This article caught my attention because of my concern over the length of time patients are expected to fast before...

This article caught my attention because of my concern over the length of time patients are expected to fast before some procedures. The article highlights studies that show that despite recommended guidelines, patients are often being asked to fast for longer periods than necessary.

In my specialist area, which is cardiac care, I feel patients are asked to fast for some procedures with no real background checks being carried out. Also, patients' understanding of the reason for fasting is not explained and can be greatly misunderstood.

Patients are routinely asked to fast from midnight, but most of our cardiac patients have diabetes and should be treated differently from elective cases.

The timing of angiogram listings must also be considered. This is where a cardiac liaison nurse would be of great advantage to our cardiac centre. She or he could be responsible for all preoperative preparation including the nil-by-mouth details.

The learning objectives of the article especially caught my eye, and I intend to follow these up in detail by closely monitoring the nurses' attitudes towards patients being nil by mouth. I will try to make sure the nurses understand the timings of elective angiograms and special blood tests.

In my nursing career I have come across patients who are told to fast from midnight without really understanding why because the medical jargon is too confusing. They will follow the directions of the health care professionals because they assume the staff know better than they do.

These patients can sometimes fast for 14 hours and may experience disorders connected with fasting such as dehydration and hypoglycaemia.

Good information should be given by the nurses together with the doctor and dietitian. Written instructions should be available as per procedure and there should be a thorough explanation of any adjustment to a patient's medication. Small leaflets should be made available and nurses should be prepared to educate patients on nil by mouth, the fasting period, the reasons for fasting and how long their procedure will take. The article recommends that written instructions to patients on nil by mouth should:

- Reassure patients to continue their oral intake until instructed to stop;

- Provide patients with oral comfort during fasting;

- Provide details of when patients can commence eating and drinking after their procedures.

I intend to issue a questionnaire similar to the one in the article to all patients following their procedures. Staff will be made more aware of when a patient is to be nil by mouth so they know the timing involved and any problems associated with this.

Organising postoperative snacks and advice on what to eat needs to be addressed as the timing of procedures may not coincide with mealtimes. Snacks and sandwiches must be available at ward level and there should be flexibility as ordering snacks from the hospital kitchen can take time.

These points need to be addressed by organising lectures and educational sessions on the importance of fasting and making sure that people are aware of the consequences of fasting inappropriately.

I feel strongly about this subject. I will try to encourage understanding and more attention to patient detail with patient questionnaires and in-service education. The article will also be discussed at our monthly supervisors' journal club.

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