Sip Til Send at JHH Adult Medicine Grand Rounds

We are pleased to announce that the John Hunter Hospital and John Hunter Children's Hospital will be implementing the "Sip Til Send" initiative starting on 3rd September 2024.

This initiative is led by anaesthetist Dr Lynn Chan and Geriatrician/Perioperative physician Dr Erica Epstein from the John Hunter Hospital and is supported by the HNELHD executive and the NSW Clinical Excellence Commission.

Please share this news with you colleagues.
For JHH/JCHC staff, if you have any questions, please do not hesitate to contact Erica.Epstein@health.nsw.gov.au or Anaesthetist Dr Lynn Chan at Phui.Chan@health.nsw.gov.au.

For all other HNELHD locations please contact the Anaesthetics department or the Sip Til Send Champion(s).

What is Sip Til Send

This protocol began in Tayside, Scotland, and has now been used in many locations in the United Kingdom and at other large hospital networks in Australia including the Royal Adelaide Hospital.

The initiative promises to be safe, simple, and kind, enhancing the overall patient experience.
Audits of thousands of patients show no increased risk of aspiration.
We anticipate that it will also help reduce the need for IV fluids, particularly given the current shortage.

What do you need to know?

What you need to know:

The instructions for solid fasting remain unchanged, with a fasting period of six hours for solids.
Patients are allowed to sip clear fluids (mainly water or clear apple juice) up to 200 ml every hour for adults until they are called to theatre.

Paediatric patients are allowed to sip 3 ml/kg/hour up to a maximum of 200 ml per hour until they are called to theatre.

Clear fluids include:

Water
Clear apple juice
Diluted cordial and electrolyte solutions
Black tea/coffee (no milk)
Ice or lemonade ice-blocks

Clear fluids ARE NOT

Clear fluids do NOT include: Thickened fluids Broths/clear soups Jelly Sweets/lollies (even if sucked) or chewing gum

Avoid using the term Nil By Mouth (NBM)

Documenting fasting instructions:
Please avoid using the term Nil By Mouth (NBM) unless clinically indicated for medical/surgical reasons.

Please instead use terminology such as in the following examples:

"No solid food for 6 hours, can Sip Til Send"
“No solid food from 2am, can Sip Til Send”
“Fast from solids, can Sip Til Send”

Sip Til Send

Sip Til Send presentations

30 May 2024

Dr Erica Epstein - Staff Specialist, Geriatrics.
Dr Lynn Chan - Staff Specialist, Anaesthetist

hipcast HipCast - Podcast Sip Til Send: Minimising fluid fasting times for our patients

Australian and New Zealand College of Anaesthetists; Faculty of Pain Medicine:
PG07(A) Guideline on pre-anaesthesia consultation and patient preparation Appendix 1 2023

Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia, British Journal of Anaesthesia. 2011;106(5):617-31.

Harnett, Colleen et al. Evaluation of the 'Sip Til Send' regimen before elective caesarean delivery using bedside gastric ultrasound: A paired cohort pragmatic study European journal of anaesthesiology vol. 41,2 (2024): 129-135. doi:10.1097/EJA.0000000000001926

Rüggeberg, Anne et al. Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives BJA open vol. 10 100282. 5 May. 2024, doi:10.1016/j.bjao.2024.100282.

Wiles, M D, and A Macdonald. The effect of a Sip til Send; policy on patient satisfaction: a quality improvement project Anaesthesia reports vol. 12,1 e12271. 6 Jan. 2024, doi:10.1002/anr3.12271.

Goyal, Raj K et al. Advances in the physiology of gastric emptying Neurogastroenterology and motility vol. 31,4 (2019): e13546. doi:10.1111/nmo.13546.

Back

News & Updates

Sip Til Send launch news item

News Update 25.10

Education

Nursing Staff Education Package: PowerPoint presentation version 4.0

Education Package: PowerPoint Presentation Version 3.0 (Incl. more detail eg. history of fasting, local fasting audit data)

If you require the Power Point presentations, please contact the team. When using the resources amend to suit the locations including Sip Til Send champion's contact information.