Browsing by Author "Kotlowitz, Jessica Rose"
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- ItemAssessment of the implementation of the peri-operative nutrition ERAS guidelines in elective colorectal surgery patients in a tertiary hospital in South Africa(Stellenbosch : Stellenbosch University, 2017-03) Kotlowitz, Jessica Rose; Visser, Janicke; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Introduction: The ERAS (enhanced recovery after surgery) guidelines recommend a set of perioperative nutritional interventions which optimize recovery and reduce surgical stress. However, traditional perioperative nutritional practices still persist in many settings worldwide, many of which can be detrimental to patient recovery. The extent of compliance with the ERAS guidelines in South Africa has not been studied. Implementation of the guidelines locally has the potential to decrease morbidity, mortality and length of hospital stay, thereby lowering health care costs. This study aimed to evaluate the current practices and barriers to implementation of the ERAS guidelines in South Africa. Methods: An observational descriptive cohort study with an analytical component was conducted at a tertiary academic hospital in South Africa. Thirty adult colorectal surgery patients were observed throughout their surgical journey. Patients completed an interviewer-administered questionnaire to determine pre- and post-operative fasting times and experiences of current fasting practices. Nutritional risk of patients was determined using the NRS-2002 screening tool. A total of 58 health care professionals (HCPs) (29 professional nurses, 13 registered dietitians, three GIT surgery consultants and 13 anaesthesiology consultants) completed a self-administered questionnaire in order to assess knowledge, attitudes, practices and barriers to the implementation of the ERAS guidelines. Results: Twenty-seven percent of patients were nutritionally at risk on admission and 70% were weighed on admission to the ward. In contrast to the ERAS guidelines, patients were fasted preoperatively from solids and liquids for a mean of 19.5 hours (SD 13.2) and 14.92 hours (SD 7.8) respectively. None of the participants received a carbohydrate loading drink preoperatively. The first enteral feed after surgery was commenced at a mean of 13.64 hours (SD 8.6) postoperatively. Knowledge regarding the ERAS guidelines was poor, with HCPs scoring a mean of 36% (SD 27.7). The attitude questionnaire showed good awareness of the importance of nutrition with 93% of HCPs agreeing with the importance of patients being well nourished before surgery. Seventy one percent of HCPs indicated that they did not intend to order a preoperative carbohydrate drink for their patients. Participants reported advising patients to fast from solids and liquids for a mean of 9.59 hours (SD 5.69) and 4.30 hours (SD 4.31), respectively. Postoperatively, 75% of HCPs reported advising their patients to fast for between four and 24 hours, while 91% reported progressing patients slowly to a full oral diet. Lack of co-operation of the multidisciplinary team, resistance to change, the lack of a formal ERAS policy, the unpredictability of the surgical schedule and the lack of education regarding the ERAS guidelines amongst HCPs were identified as major barriers to ERAS implementation. Conclusion: Implementation of the ERAS guidelines in a tertiary hospital in South Africa was found to be poor and traditional perioperative nutrition practices were still largely used. This study provided further motivation for the implementation of ERAS guidelines and an insight into the barriers of such implementation in public hospitals in South Africa. Stakeholders should engage with these identified barriers in order to develop targeted strategies for successful ERAS implementation.