Standard surgical preparation has always called for patients to fast before their procedure, but a group of Parkview nurses conducted a research study that showed that letting some patients eat resulted in no negative impacts and instead improved their overall satisfaction.
Their study, published in the American Journal of Critical Care in January, is helping change the way Parkview heart catheterization patients prepare for their procedure.
Parkview Heart Institute (PHI) registered nurses Carri Woods, Michelle Wood and Angela Boylan launched the research project after approaching their leaders to address a common problem with the cardiac surgery patients they see – hungry tummies. Patients undergoing cardiac catheterization procedures are ordered to fast – no food or drink except sips of water if taking medication -- after midnight the night before their procedure.
Depending on the schedule for their procedure, that can turn into a very long fast.
“People who are hungry can be grumpy and then you add on top of that delays in procedures for various reasons, then it’s just longer and longer before they can eat,” said Woods, nursing services manager with the PHI coronary procedural intensive care unit. “Nurses were getting the brunt of that frustration, so we asked, ‘Why are we doing this? What’s the research behind it?’”
The answer to that question turned out to be that the fasting requirement was a recommendation of anesthesiologists, but the nurses couldn’t find much data to back up the requirement. So the Parkview team designed its own trial to investigate whether fasting had tangible benefits.
The randomized controlled study sampled just under 200 patients undergoing elective cardiac catheter procedures and divided patients into two groups. The control group followed typical fasting requirements while patients in the study group were allowed to eat a heart-healthy, low- acid meal prior to their procedure.
The results of the study showed no negative impacts between the two groups, but did show increased satisfaction for study group patients. Data showed no difference in fatigue, glucose levels or gastrointestinal issues between groups, but patients who were allowed to eat reported less hunger and thirst and greater satisfaction than those in the fasting group. Diabetic patients also reported lower anxiety about possible hypoglycemic events when allowed to eat before their procedure.
After the study was completed and presented to PHI leaders, the change was quickly adopted and put into use for new patients undergoing cardiac catheterization procedures.
“It usually takes many, many years to integrate study into practice, but Parkview reviewed our results and implemented the change nearly next day,” said Wood.
“Our Parkview Heart Institute leaders allowed us to do it, were on board with us, supported us and let us run with it,” added Boylan.
“This is just one example of the culture of innovation that we’ve built here at Parkview,” said Dr. Roy Robertson, president of the Parkview Heart Institute and specialty service lines. “Research is important to the evolution of medicine, and we encourage our caregivers to speak up and share their ideas when they see opportunities to improve.”
Their research was confined to only cardiac catheter procedures, which use conscious sedation and not general anesthesia, but the results have generated interest with other Parkview departments and other health systems conducting similar procedures as to whether pre- procedure guidelines could be updated.
“Our nurses saw an opportunity to serve their patients better and followed through with an excellent study that allowed Parkview to evolve its guidance prior to cardiac catheterization procedures,” said study co-author Dr. Jan Powers, director of nursing research and EBP, Parkview Regional Medical Center. “Future patients will benefit with a more convenient, more satisfying experience because of the insight and dedication of our heart institute nurses. It’s just one of many examples of how Parkview strives every day to make the healthcare better for our patients.”
The Parkview Heart Institute is a dedicated cardiac care hospital located on the Parkview Regional Medical Center campus. The heart institute provides a one-stop location for cardiology care, genetics counseling, surgery and rehabilitation services, offering numerous specialists, advanced technology and emerging medicines and protocols to serve patients with high-quality heart care. The heart institute is also allied with the Cleveland Clinic Heart, Vascular and Thoracic Institute, one of the nation’s top cardiac care facilities, offering local physicians and patients additional support and resources.
To view Parkview’s study, “Fasting Versus a Heart-Healthy Diet Before Cardiac Catheterization: A Randomized Controlled Trial,” in full, read online at the American Journal of Critical Care.
