Implementation of Visual Instructional Cards Improve Patient Compliance on Colonoscopy Bowel Preparation

Background Our hospitals Digestive Medicine Centre has a diverse patient population including those who may not understand English and/or Chinese. Patients who come to our centre for colonoscopy arrangement require adequate and clear instructions of bowel preparation. As colorectal cancer is the second leading cause of death in Hong Kong and third leading cause of death in the world, it is our foremost priority to ensure that colonoscopy preparation is optimal to ensure complete and accurate examination of the whole colonic lining. Patients must follow a strict pre-endoscopy diet and bowel prep protocol. According to the literature, many patients reported experiencing unpleasant, difficult and disruptive care during the bowel preparation process for a colonoscopy. Up to 25% of patients are not given adequate bowel preparation instructions. A visual educational leaflet may increase patient understanding of the procedure and improve bowel preparation. Purpose and Problem Statement Currently, we provide written instructions for patients for patients who are undergoing colonoscopy. The PICO question is: Does the implementation of visual instructional cards improve patient compliance on bowel preparation for a colonoscopy? Design and Method By obtaining the bowel preparation results from the endoscopy report. It divided into four parts: Good, fair, poor and not mentioned. Using descriptive statistics to analyze pre and post data. Implementation Plan With the support from Hong Kong Sanatorium and Hospital medical group doctors, four visual instructional cards were implemented with simple Chinese and English wordings. The four visual instructional cards are: how to take Pico-Prep, how to take Klean-Prep, the ready of the stool color for colonoscopy and the importance of a clean colon. These instructional cards were used in three centres: Digestive Medicine Centre, Gastroenterology and Hepatology Centre and endoscopy centre as a trial. Results The results were collected from September 2018. A total of 91 cases were reviewed and surprisingly found that 86% cases have good bowel preparation while there is no report without mention how the bowel preparation is. To compare with the same period with 127 cases reviewed by not using the visual instructional cards for bowel preparation education, there are only 37% cases have good bowel preparation