University of Arizona College of Medicine Phoenix, AZ, United States
Alcantar Daniel, MD1, Sakolwan Suchartlikitwong, MD1, Bridgette B. McNally, DO1, Yasmin Alishahi, MD2 1University of Arizona College of Medicine, Phoenix, AZ; 2Carl T. Hayden VA Medical Center, Phoenix, AZ
Introduction: Colonoscopy is an important diagnostic, screening and therapeutic tool. However, depending on the adequacy of bowel preparation, if poor, can cause significant pathology to be missed. Guidelines have proposed an overall goal of >85% to achieve adequate bowel cleansing during colonoscopy. In our institution, we provide split dose Golytely preparation, as it has been associated with higher compliance, increase quality of preparation and increased procedural completion. Unfortunately, we have not met the goal of >85% colonoscopy success. The purpose of this quality improvement project is to evaluate the current inpatient bowel preparation process and develop an intervention to the reach the goal of >85% adequacy.
Methods: To focus on areas of improvement for our inpatient colonoscopy preparation, a thorough investigation was performed. All potential stakeholders were interviewed, and potential problems/errors were discussed with all departments (e.g. nursing, endoscopy, patients) involved in the bowel preperation process. From our investigation we identified potential problems/errors from a physician, patient, and nursing standpoint. Because of such findings, the following interventions were performed: an order set was created to include all orders necessary for bowel preperaiton, split dose Goleytly (4L) was switched to split dose Moviprep (2L), and enhanced nursing/physician education was provided. Lastly, a retrospective chart review was performed from dates 11/01/2019-11/30/2020 for which adequacy of bowel preparation was recorded. Adequate bowel prep was defined as a Boston Bowel Prep Score of greater than or equal to 6.
Results: For the preceding 12 months prior to our quality improvement initiative, 93 out of 123 (75%) inpatient colonoscopies were deemed to have adequate quality bowel prep. This was below the recommended standard of 85%. Following implementation of our interventions, 8 of 9 (89%) inpatient colonoscopies achieved adequate preparation.
Discussion: Although our data collection post intervention is low, we currently demonstrate an improved bowel preparation with our intervention. Although our interventions were recently implemented (April 2021) we expect out bowel prep adequacy toimprove with further data. Furthermore, this intervention has the potential of reducing cost by re-preparation and hospital length of stay. Additional studies are needed to determine the precise cost effectiveness of such interventions.
Alcantar Daniel indicated no relevant financial relationships.
Sakolwan Suchartlikitwong indicated no relevant financial relationships.
Bridgette McNally indicated no relevant financial relationships.
Yasmin Alishahi indicated no relevant financial relationships.
Alcantar Daniel, MD1, Sakolwan Suchartlikitwong, MD1, Bridgette B. McNally, DO1, Yasmin Alishahi, MD2. P0147 - Optimizing Inpatient Bowel Preparation for Colonoscopy at the Phoenix, VA: A Quality Improvement Project, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.