Ramadan 2010 staff guidance

6 August 2010

The Muslim holy month of Ramadan starts on Wednesday 11 August 10 and lasts either 29 or 30 days ending on or about 10 September. To mark the end of Ramadan, Eid-ul-Fitr, a celebration day will take place on either 9 or 10 September depending on the sighting of the new moon.

As well as being one of the focal points of the Muslim year, Ramadan is intended to make those who fast conscious of others. Through not eating, people are encouraged to think of the less fortunate who are often without food.
Religion and belief are one of the main strands of diversity, and festivals like Ramadan, as well as Easter, Yom Kippur, Vaisakhi and Diwali, and the other religious days and periods give us an opportunity not just to support those who observe them, but also to learn and understand more about the people we work with and serve.

During this time many Muslims will consider it an obligatory duty to fast from dawn to dusk. It is a total fast, with complete abstinence from food and drink.

There are only a few people who are exempt from fasting and these include pregnant and menstruating women, lactating women who have concerns about their own or their child’s health, children, the elderly, infirm, those who are ill and persons travelling long distances. However, in many cases, exempted persons and other people who may be vulnerable such as diabetics and the elderly will want to fast. It is a very special time where every Muslim will want to be part of this time of reflection and consideration.

Communications and the patient’s perspective

The importance of good communication with diverse patient groups including using tools such as Language Line, Pictorial Handbook , the Community Calendar 2010 and the Multi Lingual Phrasebooks, are identified as best practice for all NWAS health care professionals.

All managers and staff should be made aware of the impact of Ramadan, be sensitive towards and have consideration for our Muslim service users and colleagues, during this very special time.

Being equipped with the necessary information in relation to Ramadan supports the users of services in and helps clinical staff to have an additional communication aid when providing medical interventions, care, advice and respect for Muslim patients.

When approaching the issue with Muslim patients, it is important for healthcare professionals to provide an acknowledgement ofthe fast - for example,  “I understand that it is Ramadan. Are you fasting at the moment?  I would like to be able to… I believe this may/may not break your fast (where applicable)… are you comfortable with this?"

If Muslim patients refuse treatment, even though it may not break the fast, the patient’s choice should be respected and advice should be offered on medical grounds.

Fasting will have an impact on assessments

The fast will break when:

  • eating or drinking intentionally
  • taking oral medication
  • providing nourishing medication (also by intramuscular or intravenous injections)
  • smoking
  • using vaginal or rectal pessaries

Typical clinical interventions that would break the fast include (the list is not exhaustive):

  • using aspirin
  • glucogen (IM)
  • glucose drip (IV)
  • glucose drinks

 The fast will not break when:

  • administering injections (intravenous, intramuscular and subcutaneous)
  • taking bloods (thumb pricks or intravenous)
  • using puffers and inhalers or eye and ear drops
  • eating or drinking unintentionally

Typical clinical interventions that will not break the fast include (the list is not exhaustive):

  • GTN (Glycerin Tri Nitrate)
  • treating wounds
  • rectal Diazepam
  • nebulisers and oxygen
  • Ventolin sprays / Salbutamol
  • saline infusion (IV)
  • morphine (IV)
  • diazepam
  • adrenaline
  • penicillin

Other considerations for managers

Managers need to be aware that Ramadan is about ‘being part of’ and could lead to placing a different demand on Trust PES services in areas where there are high-density Muslim populations such as in Manchester and Bolton, the popular towns of East Lancashire, Preston and the Muslim Somali populations of Merseyside and Cheshire.

Managers will also need to consider the impact of Ramadan on staffing and ways to accommodate Muslim staff during this period. Consideration should be given to allowing breaks at different times of day to support Muslim staff.

 Other considerations managers should take into account will be to:

  • consider / sensitively any requests for annual leave or shift swaps for Eid-ul-Fitr on 9 and 10 September 2010,
  • consider flexible working or changing shift rotas to accommodate breaking the fast at the end of each day where this is possible
  • consider allowing extra time off to pray, especially at sunset
  • allowing meal breaks at different times, for example lunch break at dusk approx 8.45pm initially to coincide with breaking the fast. Avoid organising any social events during this time if Muslim staff are to be invited to the events.

However, all requests based on religious identity and practice should be considered and balanced against operational need. As a supportive employer and proactive service provider North West Ambulance Service NHS Trust recognises it is good practice to accommodate these requests wherever possible. Accommodating religious belief and practices, does not mean allowing extra time off – it is about being flexible about employees’ existing holiday entitlement, working patterns or break periods.

 Other useful guidelines are available on NHS Evidence:-

Fatwas and surgery: how and why a fatwa may inform a Muslim patient's surgical options

Drugs of porcine origin & clinical alternatives