Abstract
Introduction
This quality improvement (QI) project aimed to enhance patient experience and safety by reducing fluid fasting times by embedding the recently introduced "Sip til Send" policy in our acute orthopaedic trauma unit.
Our concern was that older patients with hip fractures, who are often living with frailty and at high risk of complications, were being kept Nil by Mouth (NBM) for extended periods before operative intervention
The "Sip Til Send" policy supports eligible patients in consuming clear fluids (170 mL/hour) until transfer to theatre with a reduction in distress, thirst, nausea and headache experienced in the peri-operative period
Method
Using QI methodology, we assessed baseline practice through a staff survey and observational data. Three Plan-Do-Study-Act (PDSA) cycles were conducted. Process measures to demonstrate adherence to the policy included: staff knowledge and patient understanding, documentation of pre-operative care instructions, correct bedside signage, water within patient reach, oral intake documented on fluid balance charts.
Interventions included interdisciplinary teaching sessions, guideline promotion and dissemination via email and poster displays, daily trauma meeting discussions, and the introduction of a standardised template for recording pre-operative instructions.
Results
Results showed marked improvement across all measures:
- Adherence to the policy rose from an average of 27% (Sept 2024) to 88% (Feb 2025)
- Staff confidence increased from 3.43/5 to 4.77/5
- Patient understanding improved from 0% to 75%
- Correct bedside signage rose from 40% to 90%
- Documented trauma meeting pre-operative care instructions increased from 20% to 100%
- Water within patient reach improved from 40% to 100%
- Oral fluid balance documentation rose from 1% to 60%
Conclusion
We successfully embedded a “Sip til Send” approach in our acute orthopaedic unit, changing the long-standing culture of prolonged fasting. Key enablers included small group teaching for all staff, clear bedside signs, patient education, and improving trauma meeting documentation.