The paediatric fluid fasting conundrum: a quality improvement initiative in Te Tai Tokerau (Northland, New Zealand)*

Fasting is necessary to minimise the risk of aspiration; however, prolonged paediatric fluid fasting is associated with negative peri-operative effects. We evaluated the effect of a collaboratively designed ice block intervention to improve paediatric fluid consumption in the pre-operative room. This project took place in Te Tai Tokerau (Northland, New Zealand). The intervention involved offering children an ice block on arrival in the pre-operative room. Audits were performed pre-intervention, 6 weeks and 18 months post-intervention. The primary outcome was the proportion of children consuming clear fluid in the pre-operative room. Secondary outcomes included fluid fasting times and children's pre-operative experiences. Datasets were analysed using ANOVA and the chi-squared test. Post-intervention, more children consumed clear fluid in the pre-operative room (13% versus 83% versus 95%; p = 0.002) due to more nurses offering (51% versus 87% versus 98%; p < 0.001) and fewer children declining clear fluid (56% versus 2% versus 3%; p = 0.007). The mean fluid fasting time decreased (10 h versus 3 h versus 2 h; p < 0.001), fewer children reported feeling hungry or thirsty (51% versus 15% versus 15%; p < 0.001) and more children reported feeling good or happy (2% versus 43% versus 30%; p < 0.001). This intervention increased clear fluid consumption in the pre-operative room, reduced fluid fasting time and optimised children's pre-operative experience, with sustained effect over 18 months. Future initiatives should focus on prehospital interventions to improve fluid consumption before leaving home on the day of surgery.