Enhanced Recovery After Surgery (ERAS) guidelines recommend carbohydrate-rich clear fluids up to two hours before elective surgery to reduce peri-operative stress and improve patient outcomes [1]. Despite this, prolonged fasting remains common in routine practice. This audit aimed to improve compliance with pre-operative carbohydrate drink administration and documentation, and to reduce prolonged fasting in elective surgical patients.

Methods

A closed-loop quality improvement project was conducted over two cycles. Cycle one involved prospective data collection in 54 patients assessing carbohydrate drink administration, documentation compliance and prolonged fasting (>6 hours). Interventions included multidisciplinary staff education, reinforcement of ERAS guidance at pre-assessment, day-of-surgery reminder prompts and theatre briefing reinforcement. Cycle two re-audited the same parameters three months later in 63 patients.

Results

Baseline compliance with carbohydrate drink administration and documentation was 0%. Following intervention, administration increased to 60% and documentation to 50%. The proportion of patients fasting for more than six hours reduced from 80% to 43%, representing a clinically significant 37 percentage-point absolute reduction. No aspiration events or safety concerns were observed following implementation.

Discussion

Multidisciplinary interventions significantly improved adherence to ERAS carbohydrate drink guidance and reduced prolonged fasting without compromising patient safety. These findings demonstrate that simple, low-cost quality improvement strategies can effectively change clinical practice. Embedding reminder systems within peri-operative workflows is key to sustaining improvement.

Acknowledgements

We thank the anaesthesia and nursing teams for their contribution to data collection and implementation of practice changes.