Educating Patients After Conscious Sedation for Gastrointestinal Procedures

Abstract

Medication for conscious sedation during gastrointestinal (GI) diagnostic procedures causes amnesia, thereby preventing patients from recalling postprocedure instructions or follow-up appointments. A serious complication after GI diagnostic procedures is bleeding, which can occur if patients take aspirin or nonsteroidal anti-inflammatory agents after the procedure. Past research revealed that 73% of patients did not remember instructions. The purpose of this randomized controlled trial was: (1) to determine if patients with wrist bands remember to read their postprocedure instructions, and (2) to determine what patient demographics are associated with failure to read postprocedure instructions. Sixty-one GI clinic outpatients participated in this Veterans Affairs Medical Center study, received routine written instructions before and after GI diagnostic procedures, and were randomly assigned to one of two groups: control group (standard care plus next-day phone call) or intervention group (wrist band plus standard care plus next-day phone call). A memory test evaluated patients' knowledge of procedure results, date of follow-up appointment, and medications. Results indicated no significant differences in the memory test between the groups (t = 0.9, p = .36). Patients 65 years of age and older had scores indicating memory problems, regardless of the wrist band (r = 0.19, p = .06). The wrist band was ineffective as a reminder to read instructions; rather, the next-day phone call served as the reminder.

An Investigation Into the Information Received by Patients Undergoing a Gastroscopy in a Large Teaching Hospital in Ireland

“…Previous research indicates a higher proportion of older patients undergoing a variety of endoscopy procedures (Hayes & Buffum, 2001;Ratanalert et al, 2003;van Vliet, Grypdonck, van Zuuren, Winnubst, & Kruitwagen, 2004). This study confirms these findings.…”

Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

“…Die Aufklärungen über die Verhaltensmaßnahmen für die Zeit nach der Untersuchung sollten dem Patienten schriftlich an die Hand gegeben werden[49,317]. Bei kritischen Prozeduren oder Patienten mit hoher Komorbidität war hier eine gezielte Nachfrage seitens der Klinik mittels Telefonanruf am nächsten Tag effektiver als eine schriftliche Aufforderung an den Patienten, seinerseits Rücksprache zu halten[327].Voraussetzung für eine Sedierung und/oder Analgesie ist ein permanenter intravenöser Zugang.AnmerkungDie Verabreichung von Sedativa erfordert prinzipiell einen peripher-venösen Zugang. In einer vergleichenden Studie von Smith et al[328] zur Funktionstüchtigkeit von Schmetterlingskanülen (Butterfly) und Venenverweilkanüle 1 Stunde nach erfolgter Endoskopie, also einem Zeitraum, in dem die Halbwertszeit der meisten Benzodiazepine und Opiate nicht einmal erreicht ist, waren nur noch 44 % der Schmetterlingskanülen, aber 98 % der Venenverweilkanülen noch funktionstüchtig.AnmerkungZwischenfälle, die auf eine Sedierung zurückzuführen sind, sind in erster Linie kardiopulmonale Ereignisse[319].…”

Is there a place for sedationless colonoscopy?

“…The rapid turn around of the unsedated patient minimizes recovery time. The amnesic effects of sedation 33 are obviated, and discharge planning is facilitated. Because of less manpower demand the service is more efficient.…”