4CPS-195 Mastering the colonoscopy bowel preparation of patients: a multidisciplinary healthcare approach

BACKGROUND: The diagnostic accuracy of colonoscopy requires a perfect visualisation of the colonic mucosa, making bowel preparation a fundamental requisite of the procedure. Failure to adequately cleanse the bowel for colonoscopy results in an increase in costs and risks for patients, such as failed detection of neoplastic lesions, prolonged procedure duration and repetition of the examination. Due to recurrent failures observed in our hospital settings, a problem-solving approach was undertaken. PURPOSE: The aim of this study was to evaluate the quality of the pre-colonoscopy process of in- and outpatients (IOP) and identify potential dysfunctions. MATERIAL AND METHODS: In a 411-bed general hospital performing on average 90 colonoscopies per month, the colonoscopy reports of IOP from 1 January to 31 March 2017 were analysed. The rating of bowel preparation quality was determined according to the Boston Bowel Preparation Scale (BBPS). The laxative treatments used and the therapeutic indications were also recorded. A multidisciplinary team (MT) composed of a gastroenterologist, pharmacist, anaesthetist, nurse, senior nurse, endoscopist, dietetician and nurse-assistant met regularly for 6 months to assess the process, identify failure factors, create value-added flow and propose solutions to improve it. To compare the two groups, Student’s t or X (2) tests were used for continuous or dichotomous variables, respectively. RESULTS: Two hundred and ninety-seven colonoscopy reports corresponding to 284 patients were analysed (13 patients repeated the examination). Eighty patients (28%) experienced an inadequate bowel preparation (BBPS ≤6 or annotation on report). The most widely used laxative was polyethylene glycol. The number of failures was significantly higher among inpatients compared to outpatients (p