Optimizing Bowel Preparation Quality For Elective Colonoscopy

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Authors (including presenting author) :
Shum PY (1)(2), Lee KW (1), Luk KK (3)
Affiliation :
(1) Nursing Service Division, United Christian Hospital, (2) Medicine and Geriatrics Department, United Christian Hospital (3) Dietetic Department, United Christian Hospital
Introduction :
Colorectal cancer was the most popular cancer (16.6%, 5036 of all new cancer cases) diagnosed in Hong Kong in 2015 (Hospital Authority, 2017). And, colonoscopy is regarded as the most effective tool for colorectal cancer screening (Johnson, Barkun, Cohen, et al, 2014). Good bowel preparation (Including 2-days low residue diet, comply well with bowel cleansing agent) is essential for a successful colonoscopy examination. Inadequate preparation may lead to repeat or cancellation of the procedure, poor diagnostic accuracy and compromise patient safety. Through Observational survey: From Oct/2016 – March/2017, 8 cases were screened and reviewed in an acute medical ward. Only 38% (3 out of 8), elective colonoscopy cases had “Adequate or above” bowel preparation quality. The reasons of that may include: No detailed low-residue diet instruction provided in the existing colonoscopy instruction sheet; Low rate of compliance with the bowel preparation agents etc. In order to maximize the patient benefit and cost effectiveness, there was an urge to improve the quality of colonoscopy bowel preparation.
Objectives :
(1) Improving bowel preparation quality for elective colonoscopy, in terms of incidence with “Adequate or above” bowel preparation quality; (2) Enhancing patients’ compliance on the bowel preparation agents (Klean-Prep); (3) Facilitating nursing colleagues to provide bowel preparation education, and prepare patients for colonoscopy.
Methodology :
Methodology: (a) Hospital Dietitian team was invited to publish a low residue diet reference leaflet. Together with the existing colonoscopy instruction sheet, the leaflet was delivered and explained to patients who will re-admit for colonoscopy. (A low-residue diet limits the amount of fiber and other foods that increase bowel activity, result in slowing down bowel movements by reducing the size and frequency of stool (Bechtold et al., 2016).) (b) A colonoscopy preparation reminder was designed for nursing staffs, in order to facilitate the colonoscopy bowel preparation and patients’ education. (c) Colonoscopy education poster was designed and displayed in ward. (d) An A4-size reference card with stool and colonoscopy endoscopic photos, was used for patient education, that indicate good and poor bowel preparation.
Result & Outcome :
After the program was launched; From April/2017-Nov/2018, 31 cases were screened and reviewed. 74% (23 out of 31) had “Adequate or above” Bowel preparation quality; Patients receive more comprehensive bowel preparation education and thus complied better with the Klean-prep; Positive feedback was obtained from nursing colleagues (clear instruction, time saving, convenient etc.).

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