S461 Single Center Initiative to Standardize and Correct Discrepancies in Bowel Preparation Administration for Inpatient Colonoscopy

Introduction: Inpatient colonoscopy has diagnostic and therapeutic utility in a wide array of pathologies. Optimal visualization is crucial for evaluation of underlying abnormalities, while poor visualization leads to delayed or repeated procedures resulting in increased hospital costs, resource utilization, and delay of patient care. The purpose of our quality improvement study was to identify and overcome barriers to inpatient colonoscopy preparation administration to improve overall visualization quality. Methods: This is a single center study consisting of a pre-intervention phase evaluating nursing practices and inpatient colonoscopy quality over a 3-month period (January 2, 2024-March 29, 2024) followed by the creation of an Epic Order-Set to clarify preparation timing and a 3-month post-intervention analysis (February 1, 2025-April 30, 2025). Primary outcomes include quality of colonoscopy preparation as measured via Boston Bowel Preparation Score (BBPS) of the total colon and right colon. Secondary outcomes include the rates at which the cecum is reached, the need for additional preparation on the day of the procedure, the need for multi-day preparation, and the need for repeat inpatient colonoscopy. Outcomes between the pre- and post-intervention phases were compared utilizing Pearson chi-square. Results: There was a total of 209 patients included in the study, 113 in the pre-intervention phase and 95 in the post-intervention phase. Thirty nurses responded to the pre-intervention survey with 83.3% stating that they do not currently administer preparation past midnight. There were no statistically significant differences amongst the pre- and post-intervention groups when comparing total colonoscopy BBPS (P= 0.995), right colon BBPS (P= 0.290), rates of cecum being reached (P= 0.621), frequency at which more bowel preparation was required in the morning (P= 0.983), frequency at which repeat inpatient colonoscopies were required (P= 0.647) or frequency at which patients required multi-day preparation (P= 0.284). Conclusion: Though our study did not reveal statistically significant differences amongst the pre- and post-intervention patients, we found that several other factors may be impacting preparation administration, including patient refusal, intolerability of large volume, variance in which instructions to follow for bowel preparation administration and more. Eliminating additional modifiable factors may contribute to improvement in administration preparation, and additional prospective studies are needed for further evaluation.