82 Adequate bowel preparation leading to succesful colonoscopy procedure and accurate diagnosis

Background Colonoscopy is a diagnostic and therapeutic procedure carried out in the outpatient department at Al Khor hospital and adequate bowel preparation is required to carry out the procedure efficiently.¹ Inadequate bowel preparation results in delay in provision of diagnosis, rescheduling of the procedure, patient dissatisfaction, and increased healthcare costs.² A retrospective review of Endoscopy unit data at Al Khor Hospital showed that in Q2 2020 only 77% of the patients had adequate bowel preparation on the Boston Bowel Preparation Scale (BBPS Score >6) set by the European Society of Gastrointestinal Endoscopy.³ This quality Improvement project aimed to corroborate effective and tolerable bowel preparation to secure quality of colonoscopy procedure, to reduce repeating colonoscopy procedures to save resources, to ensure timely provision of correct and accurate diagnosis, and to safeguard patient satisfaction and improve patient flow.

Methods The project was conducted using the QI methodology. The project aimed to increase the rate of adequate bowel preparation (BBPS Score >6) among Outpatients for Colonoscopy from 77% in June 2019 to 90% in June 2020 and 95% in June 2021. Many PDSA cycles were conducted, formulated from the change ideas of driver diagrams to monitor improvement. Proper patient education on pre-procedural preparation, providing individual kits for each patient, staff awareness, and telephonic follow-up of the patient two to three days before the procedure (figure 2) were the action plans. Due to the COVID-19 pandemic the project was held twice.

Results The project achieved 100% bowel preparation (figure 1) for more than 10 months consecutively (May 2021 to June 2022) and during this period, no procedure was cancelled due to inadequate preparation. This helps in easy diagnosis and intervention of the procedure without delay.

Conclusion Efforts directed towards adequate bowel preparation before colonoscopy procedure improve patient outcome, staff and patient satisfaction, decreases waiting time, and are cost-effective.

References

1. Hassan C, East J, Radaelli F, Spada C, Benamouzig R, Bisschops R, Dumonceau JM. Bowel preparation for colonoscopy: European society of gastrointestinal endoscopy (ESGE) guideline - update 2019. Endoscopy 2019;51(8):775–794. https://doi.org/10.1055/a-0959-0505

2. Sharma P, Burke CA, Johnson DA, Cash BD. The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention. Endoscopy International Open [Internet] 2020 May 1;8(5):E673–83. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165013/

3. Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointestinal Endoscopy 2009;69(3 Pt 2):620–625. https://doi.org/10.1016/j.gie.2008.05.057

Disclosures and Acknowledgments The presented abstract summarises the findings of a Quality Improvement (QI) initiative carried out at Al Khor Hospital Daycare and Endoscopy Unit, Nursing Department, Al Khor Hospital, Qatar. While every effort was made to accurately depict outcomes, the abstract only provides a brief summary and may not cover all project details.

We extend gratitude to the leaders and team members (Fatma Moh’d A.S.Al-Komah, Gihan Saadawy, Chandu Kuttathiparambil Ambujakshan, Kristine Bella Fleur Soriano Espero, Sunitha Thomas), other healthcare professionals, and patients at Al Khor Hospital for their vital roles in the successful implementation of this project. Additionally, appreciation is expressed to the hospital administration for their guidance and support throughout the project.