Improving Quality and Safety In Your Endoscopy Unit: Live and Virtual

06_Levin_Bowel Prep
Pdf Summary
This document discusses the importance of optimizing bowel preparation in an endoscopy unit for better outcomes. Inadequate bowel preparation can lead to prolonged procedure time, decreased cecal intubation rates, repeat procedures, reduced detection of adenomas, and increased costs.<br /><br />Risk factors for poor prep include older age, male sex, higher body mass index, inpatient status, polypharmacy, tricyclic antidepressants, narcotics, diabetes mellitus, and neurologic conditions associated with poor mobility.<br /><br />The document suggests various approaches to optimizing bowel prep, including the adoption of split-dose or same-day preps, personalized regimens to improve satisfaction and adherence, and the use of patient education tools such as standardization, booklets, videos, texting, smartphone apps, and robocalls.<br /><br />Different purgative options are discussed, including isosmotic full volume preps, isosmotic low volume preps, hyperosmotic low volume preps, and over-the-counter products. The selection of the prep should take into consideration factors such as taste, volume, and the presence of mental barriers.<br /><br />The document emphasizes the importance of using scoring systems to assess the quality of the bowel preparation. The Boston Bowel Preparation Scale (BBPS) and the Aronchick Scale are recommended for this purpose. Adequate preps, defined as those that allow for the use of recommended surveillance or screening intervals, should be achieved in more than 85% of outpatient examinations.<br /><br />The use of split-dose preps is promoted due to their demonstrated superiority and better patient compliance. The document also discusses the challenges and considerations associated with split-dosing, such as patient acceptance of sleep disturbance and compliance with pre-procedure fasting guidelines.<br /><br />Additionally, the document suggests that a clear liquid diet may not be necessary and that allowing a low residue diet on the day prior to colonoscopy yields similar prep quality without compromising results.<br /><br />Finally, the document highlights the importance of addressing inadequate prep through various approaches, such as rescheduling, prescribing a more intensive regimen, or considering alternative screening modalities.<br /><br />In conclusion, optimizing bowel preparation in an endoscopy unit is crucial for better outcomes. Using split-dose preps, personalized regimens, patient education tools, and appropriate scoring systems can help achieve adequate preps and improve patient experience.
Keywords
bowel preparation
endoscopy unit
procedure time
cecal intubation rates
repeat procedures
detection of adenomas
costs
split-dose preps
patient education tools
adequate preps