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Author Sue Sendelbach responds: My experience in translating research into practice is reflected in the conclusions of Jo Rycroft-Malone, PhD, RN, and Christopher Burton, DPhil, RN, who've found that "there is a growing body of research to support the assertion that using evidence in practice is a complex and multi-factorial process (not event)."1


My colleagues and I had explored changing the policy for both fluids and solids, but the complexity of scheduling patients for cardiovascular procedures includes changes in the timing of these procedures. It's not unusual to reschedule a procedure for earlier in the day, and, if the patient has eaten solid foods, this can lead to a delay. I agree with Dr. Winslow and Ms. Crenshaw that changing our liquid policy was the first step in the process.


Part of the challenge in changing the preoperative fasting policy was that Abbott Northwestern is a tertiary care center, which means that it receives many referrals. Presently, more than 40 centers refer their patients to our facility for cardiovascular procedures. When we changed the preoperative fasting policy, we worked with each of these centers to ensure that all patients received the same preoperative instructions: they are not to eat solid foods after midnight the day of the procedure but may drink clear liquids (water, clear fruit juices, carbonated beverages, clear tea, black coffee; no alcohol) up to one hour before they're scheduled to arrive for the procedure.


We've not asked patients if these are, indeed, the instructions they received. However, on admission, all patients are asked when they've last had fluids, and their responses consistently indicate that they've followed the preoperative instructions.




1. Rycroft-Malone J, Burton C. Paying attention to complexity in implementation research. Worldviews Evid Based Nurs;7(3):121-2. [Context Link]