How We Cleaned It Up: A Simple Method That Improved Our Practice’s Bowel Prep

Srisarajivakul, Nalinee; Chua, Dennis; Williams, Reneé; Leigh, Lyvia; Ou, Amy; Quarta, Giulio; Poles, Michael A.; Goodman, Adam

doi:10.1038/ajg.2016.148

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…Given its poor health literacy, there is concern that this population may be unable or unwilling to perform split-dose preparation. We have previously shown that a split-dose regimen increases the adequacy of bowel preparation [ 22 ]. A recent randomized controlled trial also found that a split-dose regimen increases the adenoma detection rate, making uptake of this regimen essential [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Split-dose preparation has been shown to increase the quality of cleansing and has been associated with greater patient compliance in two recent meta-analyses, explaining why split-dosing has become an attractive quality measure [ 20 , 21 ]. The implementation of a split-dose preparation regimen and associated educational materials has even been shown to increase preparation quality in this safety-net hospital population [ 22 ]. However, there are only limited data concerning the impact of split-dose preparation on patient tolerability.…”

Section: Introductionmentioning

confidence: 99%

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Split- versus single-dose preparation tolerability in a multiethnic population: decreased side effects but greater social barriers

Perreault

Goodman

Larion

et al. 2018

aog

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Background:This study was performed to compare patient-reported tolerability and its barriers in single- vs. split-dose 4-L polyethylene glycol (PEG) bowel preparation for colonoscopy in a large multiethnic, safety-net patient population.Methods:A cross-sectional, dual-center study using a multi-language survey was used to collect patient-reported demographic, medical, socioeconomic, and tolerability data from patients undergoing outpatient colonoscopy. Univariate and multivariate analyses were used to identify demographic and clinical factors significantly associated with patient-reported bowel preparation tolerability.Results:A total of 1023 complete surveys were included, of which 342 (33.4%) completed single-dose and 681 (66.6%) split-dose bowel preparation. Thirty-nine percent of the patients were Hispanic, 50% had Medicaid or no insurance, and 34% had limited English proficiency. Patients who underwent split-dose preparation were significantly more likely to report a tolerable preparation, with less severe symptoms, than were patients who underwent single-dose preparation. Multiple logistic regression revealed that male sex and instructions in the preferred language were associated with tolerability of the single-dose preparation, while male sex and concerns about medications were associated with tolerability of the split-dose preparation.Conclusions:In a large multiethnic safety-net population, split-dose bowel preparation was significantly more tolerable and associated with less severe gastrointestinal symptoms than single-dose preparation. The tolerability of split-dose bowel preparation was associated with social barriers, including concerns about interfering with other medications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Split- versus single-dose preparation tolerability in a multiethnic population: decreased side effects but greater social barriers

Perreault

Goodman

Larion

et al. 2018

aog

View full text Add to dashboard Cite

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“…Many studies have examined the efficacy between different bowel preparation regimens [12–16,29], yielding controversial results. While much attention has focused on safety and patient tolerance, several studies found that combined colon cleansing regimens had better patient acceptability than a traditional regimen [13,16,29].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there are concerns of nephrotoxicity and phosphate retention related to NaP use, hence, it is not favored for patients with renal insufficiency and/or heart disease [10,11]. The effectiveness of various cleansing regimens is controversial [12–16]. …”

Section: Introductionmentioning

confidence: 99%

A Modified Bowel Preparation Regimen for Colonoscopy Providing the Patients’ Satisfaction and Convenience

2017

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BackgroundA complete cleansing of the bowel is a critical factor that impacts the diagnostic accuracy of colonoscopies. However, the common bowel preparation regimen of two 45 mL doses of sodium phosphate (2×NaP) often leads to uncomfortable symptoms and subsequently lower patient adherence. To improve patient adherence and satisfaction, we proposed a modified regimen composed of two sennoside tablets and one bottle of NaP (S+NaP) and we then evaluated bowel preparation quality and patient satisfaction.Material/MethodsA total of 531 patients who underwent colonoscopies at the outpatient coloproctology clinic from January 2016 to December 2016 were retrospectively reviewed. Eligible patients were divided into two groups: S+NaP group (n=93) and 2×NaP group (n=60). We compared bowel preparation quality, adenoma detection rate (ADR), self-reported patient satisfaction scores, and adverse events among the two groups.ResultsRegarding high bowel preparation quality, our results showed that there was no significant difference among the two groups (p=0.775), as well as no significant differences in ADRs (p=0.187). However, a lower proportion of nausea was found in the S+NaP group compared to the 2×NaP group (24.7% versus 41.7%, respectively, p=0.028). In addition, patients in the S+NaP group were more likely to be very satisfied with the regimen compared with patients in the 2×NaP group (odds ratio: 5.58; 95% confidence interval: 2.36–13.213, p<0.001).ConclusionsOur modified bowel preparation regimen, S+NaP, yielded significantly higher patient satisfaction with less nausea while maintaining similar bowel preparation quality.

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“…The philosophy behind this method is that quality improvement can be effectively achieved only when it can be described as a process in which ameliorations are linked to indicators that can be measured. PDSA has already demonstrated its utility in optimizing bowel cleansing 13 14 18 , but without specifically addressing an increase in split-dose regimen adoption, and mainly in very selected cohorts.…”

Section: Introductionmentioning

confidence: 99%

IMPlementing split Regimen OVEr Single dose using a Plan-Do-Study-Act approach (IMPROVES study)

et al. 2019

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Background and aims A split-dose regimen for colonoscopy is recommended by international guidelines, but its adoption is still suboptimal. Our aim was to assess whether a Plan-Do-Study-Act approach (PDSA), a scientific method promoting quality improvement, would be able to improve adherence to a split-dose regimen, and to identify factors influencing its adoption. Methods This study consisted of three phases: Cycle 1: a cross-sectional assessment of split-dose adherence in consecutive outpatients/inpatients undergoing colonoscopies in 74 Italian centers; Educational intervention: regional meetings with literature review, analysis of Cycle 1 data, and discussion on corrective measures; local diffusion of educational material and tools for improvement; Cycle 2: reassessment of split-dose adherence after spontaneous local interventions. Demographic, clinical, and procedural variables were systematically collected. Multivariate logistic regression was used to identify predictors of split-dose adoption. Results In total, 8213 patients (mean age = 60.29 years (SD = 13.58), men = 54 %, outpatients = 88.4 %) were enrolled between 2013 and 2016 (Cycle 1 = 4189 patients and Cycle 2 = 4024 patients). Split-dose adoption rose from 29.1 % in Cycle 1 to 51.1 % in Cycle 2 ( P < 0.0001), and being enrolled in Cycle 2 independently predicted split-dose adherence (OR = 2.9; 95 %CI 2.6 – 3.3). The adoption improved in all time slots, including colonoscopies scheduled before 0930. The main corrective measures were: rescheduling of colonoscopies after 0930 (between 0930 and 1130: OR = 2.6; 95 %CI 2.3 – 3.1; after 1130: OR = 7; 95 %CI 5.9 – 8.4); the cleansing regimen communicated by the Endoscopy unit (via form: OR = 1.6; 95 %CI 1.3 – 1.9; via visit: OR = 2.1; 95 %CI 1.7 – 2.5); a decrease in the use of deep sedation (OR = 2; 95 %CI 1.7 – 2.5). Conclusions An educational intervention with observation-driven corrections through a PDSA approach was able to substantially increase the adoption of a split-dose regimen.

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How We Cleaned It Up: A Simple Method That Improved Our Practice’s Bowel Prep

Cited by 5 publications

References 9 publications

Split- versus single-dose preparation tolerability in a multiethnic population: decreased side effects but greater social barriers

Split- versus single-dose preparation tolerability in a multiethnic population: decreased side effects but greater social barriers

A Modified Bowel Preparation Regimen for Colonoscopy Providing the Patients’ Satisfaction and Convenience

IMPlementing split Regimen OVEr Single dose using a Plan-Do-Study-Act approach (IMPROVES study)

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