Development and validation of a nurse-assessed patient comfort score for colonoscopy

Rostom, Alaa; Ross, Erin; Dubé, Catherine; Rutter, Matthew D.; Lee, Thomas; Valori, Roland; Bridges, Ronald; Pontifex, Darlene; Webbink, Veronica; Rees, Colin; Brown, C. Titus; Whetter, D.; Kelsey, Susan G.; Hilsden, Robert J.

doi:10.1016/j.gie.2012.10.003

Cited by 62 publications

(45 citation statements)

References 12 publications

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“…Validation of scores is variable. One well-validated score exists: the Nurse Assessed Patient Comfort Score, an international study192 in which 300 patients undergoing colonoscopy and their endoscopy nurses rated comfort levels. Even in this validated scoring system, there was discrepancy between the patient-reported levels of comfort and the clinician-reported levels, with lower levels of comfort reported by patients.…”

Section: The Standardsmentioning

confidence: 99%

Expert opinions and scientific evidence for colonoscopy key performance indicators

Rees

Bevan

Zimmermann-Fraedrich

et al. 2016

Gut

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Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.

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Section: The Standardsmentioning

confidence: 99%

Expert opinions and scientific evidence for colonoscopy key performance indicators

Rees

Bevan

Zimmermann-Fraedrich

et al. 2016

Gut

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“…In contrast during nurse administered moderate sedation any adverse hemodynamic or respiratory events will result in interruption and possibly a discontinuation of a procedure, or alternately a patient may be more awake or experience more pain due to limitations of medication available for moderate sedation. Specific to gastroenterology, the Nurse-Assessed Patient Comfort Score (NAPCOMS) 43 and Patient Satisfaction with Sedation Instrument (PSSI) 44 have been described. The PROSAS differs from these tools as it directly assess patient report unlike NAPCOMS and is brief and can be reliably administered in the procedural recovery area, unlike the PSSI.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of the PROcedural Sedation Assessment Survey (PROSAS) for assessment of procedural sedation quality

Leffler

Bukoye

Sawhney

et al. 2015

Gastrointestinal Endoscopy

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Background Over 20 million invasive procedures are performed annually in the United States. The vast majority are performed with moderate sedation or deep sedation yet there is limited understanding of drivers of sedation quality and patient satisfaction. Currently, the major gap in quality assurance for invasive procedures is the lack of procedural sedation quality measures. Objective To develop and validate a robust, patient-centered measure of procedural sedation quality, the PROcedural Sedation Assessment Survey (PROSAS). Design Through a series of interviews with patients, proceduralists, nurses and anesthesiologists, and an interactive patient focus group, major domains influencing procedural sedation quality were used to create a multipart survey. The pilot survey was administered and revised in sequential cohorts of adults receiving moderate sedation for GI endoscopy. After revision, the PROSAS was administered to a validation cohort. Setting GI endoscopy unit. Patients A expert panel of proceduralists, nurses and anesthesiologists, an initial survey development cohort of 40 patients, and a validation cohort of 858 patients undergoing sedation for outpatient GI endoscopy with additional surveys completed by the gastroenterologist, procedure nurse and recovery nurse. Main Outcomes and Measures Survey characteristics of the PROSAS. Results Patients were able to independently complete the PROSAS after procedural sedation before discharge. 91.6% of patients reported minimal discomfort; however, 8.4% of patients reported significant discomfort and 2.4% of patients experienced hemodynamic and/or respiratory instability. There was a high correlation between patient reported intraprocedure discomfort and both clinician assessments of procedural discomfort and patient recall of procedural pain 24 to 48 hours postprocedure (p<0.001 for all), suggesting high external validity. Limitations Single-center study, variability of sedation technique between providers, inclusion of patients with chronic pain on analgesics Conclusions The PROSAS is a clinically relevant, patient-centered, easily administered instrument that allows for standardized evaluation of procedural sedation quality. The PROSAS may be useful in both research and clinical settings.

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“…The duration of colonoscopy, patient comfort (measured by the Nurse Administered Patient Comfort Score assessed throughout the colonoscopy), bowel preparation quality (measured by the Aronchick Scale), and the amount and type of sedation used was recorded 27 . A bowel motility scale was introduced after 45 patients were enrolled.…”

Section: Methodsmentioning

confidence: 99%

“…Bowel motility was assessed with a 5-point bowel spasm scale, adapted from previous studies 28 . Other secondary outcomes included the withdrawal time, sedation type and dose, quality of bowel preparation via the Aronchick Scale, and patient comfort by the validated Nurse-assessed Patient Comfort Score (NAPCOMS) 27 31 . …”

Section: Methodsmentioning

confidence: 99%

Use of warm carbon dioxide insufflators does not affect intra-colonic gas temperature and has no effect on polyp detection rate during colonoscopy – a randomized controlled trial

et al. 2017

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Background and study aims Methods to improve polyp detection during colonoscopy have been investigated, with conflicting results for warm water irrigation. Carbon Dioxide (CO 2) warmed to 37 °C may have similar or more pronounced effects on bowel motility. This study aimed to assess whether warmed CO 2 would improve polyp detection compared to room temperature air insufflation. Patients and methods This was a double-blind, randomized controlled trial that enrolled 204 patients undergoing screening or surveillance outpatient colonoscopy. The primary outcome was polyp per patient detection rate. Secondary outcomes included adenoma per patient detection rates, bowel spasm, and patient comfort. Results The trial was terminated after an interim analysis determined futility. Between the warmed CO 2 and room air groups, no significant differences were found in the per-colonoscopy polyp detection rate ( P = 0.57); overall polyp detection rate ( P = 0.69); or adenoma detection rates ( P = 0.74). More patients in the room temperature group had lower spasm scores (p = 0.02); however, there was a trend towards greater patient comfort in the warmed CO 2 group ( P = 0.054). An ex-vivo study showed a significant difference between exiting CO 2 temperature at the insufflator end vs. delivered CO 2 temperature at the colonoscope tip end. The temperature of insufflation at the tip of the colonoscope was not different when using warmed vs. unwarmed insufflation ( P = 0.62). Conclusion When compared with room air insufflation, warmed CO 2 insufflation did not affect polyp detection rates.

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Development and validation of a nurse-assessed patient comfort score for colonoscopy

Cited by 62 publications

References 12 publications

Expert opinions and scientific evidence for colonoscopy key performance indicators

Expert opinions and scientific evidence for colonoscopy key performance indicators

Development and validation of the PROcedural Sedation Assessment Survey (PROSAS) for assessment of procedural sedation quality

Use of warm carbon dioxide insufflators does not affect intra-colonic gas temperature and has no effect on polyp detection rate during colonoscopy – a randomized controlled trial

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