Unrestricted drinking before procedural sedation using fasting cards: a prospective observational quality improvement study

International guidelines recommend clear liquid fasting for 2 hours before procedural sedation—but in practice this fasting time is usually exceeded, often significantly. We aimed to align actual liquid fasting times with these guidelines by implementing 'unrestricted drinking using fasting cards' for patients undergoing procedural sedation. In a prospective, observational, quality improvement study, we implemented 'unrestricted drinking before procedural sedation using fasting cards' in two ‘Plan-Do-Study-Act’ cycles. Our patient population included those scheduled for elective procedures with sedation in gastroenterology, pulmonary, and cardiology. The introduction of 'drink until called' and subsequent education, including fasting cards, increased the proportion of patients who were aware they could drink before sedation to 81%. The awareness about permission to drink before procedural sedation correlated with significantly shorter median [interquartile range] clear liquid fasting times of 1.2 [0.7-2.5] hours compared to those who were not informed (11.3 [4.1-12.7] hours; p<0.00001) and a higher median cumulative preoperative drinking volume on the day of sedation: 300 [200-500] ml versus 50 [50-100] ml; p<0.00001). Additionally, patients informed about their drinking permission experienced less thirst (71.6% vs. 42.1%; p<0.05) and were more likely to take morning medication (72.8% vs. 52.6%; p<0.05). Our results demonstrate the importance of aligning clinical practice with established guidelines to improve patient safety and comfort. Future efforts should focus on overcoming institutional and cultural barriers to enable widespread adoption of such quality improvement measures.