Nil by Mouth No More? Rethinking Pre-Op Fasting in Nursing Practice

Balancing patient safety, comfort, and evidence in perioperative care.

Still telling patients ‘nil by mouth from midnight’? It’s time to rethink. This session unpacks the latest ANZCA fasting guidelines, explores the SipTilSend approach, and shows how nurses can improve safety, comfort, and recovery by moving beyond outdated fasting rules.”
CPD HOURS: 1
 Registration Year 2025/2026

Course Content

Australian hospitals are re-evaluating pre-operative fasting practices. Traditional “nil by mouth from midnight” approaches remain common, yet evidence and updated ANZCA guidelines support shorter fasting times. This paper compares the harms of prolonged fasting with the benefits of liberalised protocols and highlights the nurse’s role in implementing change.

Traditional fasting practices are outdated and unsupported by current evidence. Liberal fasting—particularly clear fluids up to two hours before surgery—improves comfort, hydration, and recovery without increasing aspiration risk. Nurses across all specialties (wards, ED, ICU, day surgery) must understand and apply ANZCA’s updated guidelines, and take an active role in closing the gap between evidence and practice to deliver safer, more patient-centred care.

This session unpacks the latest ANZCA fasting guidelines, explores the SipTilSend approach, and shows how nurses can improve safety, comfort, and recovery by moving beyond outdated fasting rules.”
This synopsis is my interpretation of the article and is not a reproduction of the original text.

Why this Session may be Relevant to your Work

This knowledge is relevant to your work as a nurse because understanding and applying evidence-based fasting guidelines helps you improve patient comfort, reduce complications, and ensure safe, high-quality perioperative care.

Learning Outcomes


  • Differentiate between traditional and liberal fasting practices and explain the evidence for updating pre-operative fasting times.
  • Identify the adverse outcomes associated with prolonged fasting, including patient discomfort, haemodynamic instability, and delayed recovery.
  • Describe the current ANZCA fasting guidelines, including the “six-four-one” and SipTilSend protocols, and their implications for patient safety and comfort.
  • Demonstrate an understanding of the nurse’s role in implementing, educating, and ensuring adherence to evidence-based fasting guidelines, including the use of implementation science to support practice change.

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Sue Walker

RN, BN, BN (ADMIN), MPHC, MACN

Sue is the Director and Co-Founder of Nurses for Nurses (NFNN), delivering national and international conferences, study tours and professional development programs for nurses and midwives. She is also a key contributor to Nursing CPD, an online education platform supporting nurses to meet NMBA Continuing Professional Development requirements through accessible, evidence-based learning that is firmly grounded in real-world practice.