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Background: Traditional fasting rules for children prior to elective operations ("6‑4‑2 rule") often lead to prolonged fasting times with possible adverse events (discomfort, hypoglycemia, metabolic disorders, agitation/delirium). A new liberal fasting policy allowing children to drink clear fluids until being called to the operating room ("6‑4‑0") was established in our university hospital. This article describes our experiences and retrospectively examines the effects. Objective: Evaluation of real fasting times before and up to 6 months after the intervention (success and durability of changing fasting policy). Evaluation of impact on outcome parameters, such as patients' resp. parents' satisfaction as well as perioperative agitation, arterial hypotension after induction and postoperative nausea and vomiting (PONV). Material and methods: Retrospective evaluation of methods and interventions from 1 month before to 6 months after changing the fasting policy (June–December 2020). Statistical analysis using descriptive statistics, odds ratio and χ2-test. Results: Of 216 analyzed patients 44 were in the pre-change group and 172 in the post-change group. We could significantly reduce clear fluids fasting times over the 6 months after the intervention (median fasting time: from 6.1 h to 4.5 h; p = 0.034) and achieve our aim (fasting time for clear fluids less than or equal to 2h) in 47% of the patients. Fasting times became longer again reaching pre-change intervals in the 4th and 5th month, so reminder measures turned out to be necessary. By reminding the staff we could reduce fasting times again in the 6th month and restore patients' resp. parents' satisfaction. Satisfaction was improved by shorter fasting times (median school grade from 2.8 to 2.2; p = 0.004; odds ratio for better satisfaction 5.24, 2.1–13.2), and preoperative agitation was reduced (agitation modified PAED scale 1–2 in only 34.5% instead of 50%, p = 0.032). In the liberal fasting group, we observed a nonsignificant smaller incidence of hypotension after induction (7% vs. 14%, p = 0.26) while PONV was too rare in both groups for statistical purposes. Conclusion: With multiple interventions we could significantly reduce fasting times for clear fluids and improve patients' resp. parents' satisfaction as well as preoperative agitation. These interventions included regular presence in all staff meetings, a handout for both parents and staff, as well as a remark on the anesthesia protocol. Children who were operated on later in the day, benefited most from the new liberal fasting policy as they were allowed to drink until being called to the operating room. Following our experience, we consider simple and safe fasting rules for the whole staff as most important for change management. Nevertheless, we could not reduce the fasting intervals in all cases and had to remind the staff after 5 months to preserve this success. For enduring success, we suggest regular staff updates during the change process instead of one single kick-off information event. [ABSTRACT FROM AUTHOR]

Background: Parents of children with profound intellectual and multiple disability (PIMD), who use Augmentative and Alternative Communication (AAC), implemented AAC interventions at home already prior to the COVID-19 pandemic (Deliberato & Manzini, 2012). With respect to the implementation process for these options, they reported various challenges (McNaughton et al., 2008). Aims: The study investigates the goals that parents of children with PIMD set and pursue for their children under pandemic conditions and the ways in which practitioners support the parents in the pursuit of these goals. Methods: In a Reflexive Grounded Theory approach, five interviews with parents of children with complex disabilities were conducted by (video) telephone. Results: In AAC implementation at home, the parents' main goal is to enable their children to pursue their own intentions. To support parents in the implementation of AAC at home, professionals use digital communication tools and prepared forms of AAC. Conclusions: To implement AAC, conditions of the use and transfer of AAC, but also the support of the parents should be reflected in designing AAC interventions at home. [ABSTRACT FROM AUTHOR]