Doctors fault starving of KNH surgery patients

KNH's administration block. 24th Feb, 2014. Photo/Jonah Onyango.

Doctors at the Kenyatta National Hospital (KNH) have faulted the starving of patients slated for operations for long hours, saying the practice is unnecessary and out of step with modern medicine.

Patients at the country's largest referral hospital are required to go without food for up to 22 hours before an operation. This is contrary to international guidelines that approve of patients enjoying a normal meal even eight hours to surgery.

At midnight, a nurse sweeps through wards at KNH, warning surgery patients not to eat anything until after their procedures. This triggers a starvation marathon that sometimes runs for up to 22 hours in a practice referred to as Preoperative Fasting (POF).

But an in-house team set up to review the practice at KNH says POF was replaced by progressive international guidelines in 1999. The revised guidelines say no patient should fast for more than eight hours.

The guidelines allow the consumption of clear liquids up to two hours before elective surgery, a light breakfast six hours before the procedure, and a normal meal eight hours beforehand.

The KNH-sponsored in-house team was mandated with assessing whether or not the facility had stepped into this realm of modern medicine.

The team comprising George Njoroge, Lucy Kivuti-Bitok and Samuel Kimani of the School of Nursing Sciences, University of Nairobi, and KNH, found the hospital was unnecessarily over-starving their surgery patients.

The team's report was published in the International Scholarly Research Notices on April 12. It found that 77 per cent of patients fasted for about 15 hours while about 30 per cent did not eat for up to 22 hours.

GLOBAL GUIDELINES

According to the team, these findings are not consistent with the reviewed and acceptable global guidelines.

"This may be due to lack of flexibility and adaptability by the institution to the global trends and development."

The team was especially surprised that elective surgery patients could not have clear fluids when thirsty.

"This finding portends lack of knowledge and the inconsistencies associated with the fasting guidelines since clear liquids are permissible up to two hours before surgery," they said.

The doctors said the shortened starving period increases patient comfort after surgery, reduces stress and improves how the body responds to the hormone insulin.

The researchers investigated 65 pre-surgery patients in the hospital's surgical wards between April and July 2015.

The team regretted what it called "resistance to change" at the country's leading training hospital, saying that was likely to influence medical practice across the country.

The doctors want the midnight "no-food" bulk calls replaced with an approach where patients are advised about their fasting schedules individually.