No Longer Nothing After Midnight: An Integrated Evidence-Based Practice Proposal for Clear Liquids and a Carbohydrate Drink Before Elective Surgery, Organized by the Revised Iowa Model
[Student Name]
University of Phoenix
DNP/710: Evidence-Based Practice Measurement and Clinical Inquiry
Week 8 Assignment
[Instructor Name]
[Date]
The hospital and project are composites written for a model paper.
This proposal asks the perioperative practice council to approve a pilot that retires our midnight fasting rule for eligible adult elective patients at the same-day surgery center, letting them drink clear liquids into the morning and finish a carbohydrate drink shortly before their scheduled time. It integrates the work of the past seven weeks, organized by the revised Iowa Model.
The Model
The model's authors (Iowa Model Collaborative, 2017) revised it based on a survey of 431 users, 88% of whom reported using the model and identified the most problematic steps as topic priority, critique, piloting and instituting change. The revision expanded piloting, implementation, patient engagement and sustaining change and was validated by participants at a national conference as a practical guide for the evidence-based practice process across settings.
Trigger
The trigger is a problem identified through patient reports and confirmed with data: the Week 1 audit showed that the typical patient went more than eleven hours without a drink and more than fourteen without food, and that close to half described their thirst as severe, despite national guidelines that allow clear liquids until 2 hours before anesthesia.
Is This a Priority?
Roughly six thousand patients a year pass through these instructions; the issue aligns with our hospital's patient experience goals and has national guidance, making it a priority. The chief anesthesiologist and the perioperative director have agreed to sponsor the work.
Team
The team includes me as project lead, two preoperative nurses, a follow-up nurse, an anesthesiologist, a surgeon, a scheduler, a pharmacist for drink selection, the quality analyst and a patient advisor who had surgery at our center last year.
Question
The PICOT question developed in Week 2 asks whether, for eligible nondiabetic adults, a sugared clear drink shortly before surgery plus liberal clear fluids beforehand lowers thirst and hunger and improves next-day recovery compared with fasting from midnight.
The proposal asks the council for twelve weeks and a drink; the evidence and the audit explain why that is a small request.
Evidence
A documented search of four databases yielded 9 studies. The anchor Cochrane review pooled 27 trials and reported a modest shortening of hospital stay, an unchanged complication rate and no aspiration pneumonitis in either arm (Smith et al., 2014). Individual trials showed less thirst, hunger and anxiety. Structured appraisal identified risk of bias, mainly from lack of blinding.
Synthesis and Recommendation
Rated with GRADE, evidence for comfort and safety is moderate certainty, and evidence for recovery is low certainty. Joshi et al. (2023), updating the national fasting guidelines, support carbohydrate-containing clear liquids up to 2 hours before elective procedures in healthy adults. The recommendation is conditional: implement with exclusions and monitoring.
Pilot Design
A 12-week before-and-after pilot in the same-day surgery center will include about 70 eligible patients per week. Patients with diabetes, severe obesity, known slow stomach emptying, obstruction, pregnancy or drugs that slow gastric emptying will keep standard fasting. The anesthesiologist on the team will review exclusions with staff.
Training
Every preoperative and follow-up nurse will complete a 15-minute session with practice scripts before the pilot begins, and champions on each shift will answer questions during the first two weeks.
Measures
Structure: updated bilingual instructions, drink supply, training completion. Process: new instructions given, drink consumed in the window, fasting duration. Outcomes: thirst and hunger on 0-to-10 scales, QoR-15 at next-day call. Balancing: aspiration events, cases delayed or canceled. Data are collected by preoperative and follow-up nurses in new record fields and reviewed weekly on run charts.
Communication Plan
Surgeons' offices will receive the new instructions and a one-page explanation, since many patients hear fasting advice first from their surgeon. Schedulers will be trained to answer common questions. The preadmission telephone script will include the new instructions and a teach-back question: "What time will you finish your drink?" Consistent messages from every contact prevent the confusion that sustained the old practice.
Staff Readiness
A brief survey of preoperative nurses found that most supported the change but worried about schedule changes. The plan to have anesthesia assess patients moved earlier addresses that concern directly.
Resources
The drink costs about $3 per patient, or roughly $10,000 per year at full implementation. Staff training requires 15 minutes per nurse. Record changes require about 20 hours of analyst time. No new staff are needed.
Risks and Mitigation
The main clinical risk is aspiration in a patient who should have been excluded. Mitigations are clear exclusions, anesthesia review and a stopping rule: any aspiration event triggers immediate review. The main operational risk is schedule changes; instructions will specify drinking 2 hours before the scheduled time, and patients moved earlier will be assessed by anesthesia.
Alignment With Hospital Goals
The change supports three hospital goals: patient experience scores, which include questions on comfort; efficiency, through fewer difficult intravenous starts; and evidence-based care, a priority for our Magnet redesignation. Linking the pilot to these goals strengthens the case for resources.
Patient Engagement
The patient advisor reviewed the instructions, recommending simpler wording and a picture of permitted liquids, both adopted.
Equity
Instructions will be provided in English and Spanish with pictures, and the drink will be given free at the preadmission visit rather than purchased, so that cost and language do not decide who benefits. Results will be examined by language and age to check that the change reaches all eligible patients.
Evaluation and Decision
After 12 weeks, the team will review the data. If thirst and hunger improve, adherence is adequate and no safety signal appears, we will recommend adoption across all surgical areas.
If the Pilot Fails
If thirst does not improve or adherence is poor, the team will examine process data to find the cause before abandoning the change. If a safety signal appears, the pilot stops and the council receives a full review.
Sustaining the Change
Sustainment steps include incorporating new instructions into the scheduling system, adding the drink to the preadmission workflow, monitoring run charts monthly for a year and including fasting education in orientation.
What Success Looks Like
Success at 12 weeks means median fasting from liquids below 4 hours, at least 70% of eligible patients drinking the carbohydrate drink in the window, a reduction of at least 2 points in mean thirst and no aspiration events. Stating these targets in advance lets the council judge the pilot against clear criteria.
Dissemination
Results will be shared with the council, at a regional perioperative nursing conference and, if appropriate, in a manuscript structured by SQUIRE 2.0.
Conclusion
Following the revised Iowa Model from trigger to sustainment, this proposal integrates local data, a focused question, a documented search, appraisal and GRADE synthesis, validated measures and an evaluation plan. It asks the council for a 12-week pilot of the new instructions for eligible adults, with safeguards and a clear decision point.
References
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Harbell, M. W., Kuo, C. I., Soriano, S. G., Stricker, P. A., Tipton, T., Grant, M. D., Marbella, A. M., Agarkar, M., Blanck, J. F., & Domino, K. B. (2023). 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: Carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration: A modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 138(2), 132-151. https://doi.org/10.1097/ALN.0000000000004381
Smith, M. D., McCall, J., Plank, L., Herbison, G. P., Soop, M., & Nygren, J. (2014). Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database of Systematic Reviews, 2014(8), Article CD009161. https://doi.org/10.1002/14651858.CD009161.pub2
How this DNP 710 Week 8 example is structured
The DNP/710 Week 8 work usually closes with an integrated evidence-based practice proposal. This paper follows the steps of an established EBP model, summarizes the work of each earlier week in its place and adds the elements a decision body needs: team, pilot design, resources, risks and sustainment. Students search this week as DNP 710 Week 8, DNP710 Wk 8 or DNP/710 Wk 8; all three are the same assignment.
DNP/710 Week 8 questions, answered
What does DNP/710 Week 8 usually ask for?
Many sections close with an integrated evidence-based practice proposal that combines the problem, question, evidence, recommendation, measures and evaluation plan into one document.
What is the Iowa Model?
A widely used, application-oriented model guiding clinicians through the evidence-based practice process, from identifying a trigger and forming a team through piloting, implementing, evaluating and sustaining a change; it was revised in 2017 based on user feedback.
Why pilot before full implementation?
A pilot tests feasibility and effects on a small scale, reveals problems that can be fixed and provides local evidence that helps persuade stakeholders before the change is adopted system-wide.
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