Improving Quality and Safety in the Endoscopy Unit (On-Demand) | August 2023-04_ASGE Quality_Dominitz

04_ASGE Quality_Dominitz_Bowel Prep

Pdf Summary

In this document, Dr. Jason Dominitz discusses the importance of optimizing bowel preparation in endoscopy units and provides strategies for achieving better outcomes. Inadequate bowel preparation can lead to prolonged procedure times, decreased cecal intubation rates, repeat procedures, increased costs, and reduced detection of adenomas. Risk factors for poor prep include older age, male sex, higher body mass index, inpatient status, polypharmacy, and certain medications and conditions.<br /><br />There are various options for patient education, including educational booklets, videos, outsourcing, texting, smartphone apps, and robocalls. Multiple purgative options are available, including full volume and low volume preps, hyperosmotic low volume preps, and over-the-counter products. Personalized regimens can improve adherence and satisfaction.<br /><br />Split-dose preps have shown superiority in terms of satisfactory colon cleansing, decreased discontinuation rates, increased willingness to repeat the same prep, and reduced nausea. Same-day prep for afternoon cases can be effective and convenient, with a morning dose taken at approximately 6 a.m.<br /><br />The document recommends individualizing the choice of prep and using split-dose or same-day prep. It also suggests implementing low-residue or full liquid diets on the day prior to colonoscopy. Bowel prep quality adequacy is considered a recommended quality metric, with an aim for greater than 85% of outpatient examinations. Scoring systems such as the Boston Bowel Preparation Scale (BBPS) or Aronchick Scale can be used to assess prep quality.<br /><br />The document emphasizes the importance of monitoring and improving the adequacy of bowel prep rates, and it suggests considering patient factors when prescribing preps. Adherence to these recommendations can lead to improved outcomes and patient satisfaction.

Keywords

bowel preparation

endoscopy units

prolonged procedure times

cecal intubation rates

repeat procedures

patient education

split-dose preps

same-day prep

colonoscopy

improved outcomes