DNP Final Report: An Evidence-Based Initiative to Improve Bowel Preparation Quality for Colonoscopy

Good colonic bowel preparation (CBP) is an important component of colonoscopy but is often inadequate. Improving CBP can help increase detection of precancerous polyps, prevent procedures from being canceled or repeated, and decrease medical expenses. A quality improvement project was implemented to increase adequate CBP rates at an ambulatory surgery center specializing in endoscopy. Several factors correlate with suboptimal CBP, but the practice question focused on patient education. The PICOT question guiding evidence synthesis was posed: In adult patients preparing for outpatient colonoscopy, how do revised instructions with visual aids compared to written instructions affect CBP adequacy and patient satisfaction? Instructions were revised to include visual aids, plain language, and new formatting and then implemented. Two measures used to assess change were CBP adequacy and patient satisfaction; post-intervention data collected was compared to baseline. Initial analysis of CBP adequacy ratings demonstrated a 0.7% decrease, so individual provider results were further investigated. Physicians from Clinic A saw a collective 1.2% improvement in CBP quality, while Clinic B saw a 6.6% reduction in adequate CBP. Survey respondents shared positive perceptions of the instructions, but there was no significant change in satisfaction. Sustainability of the project included adoption of the instructions and sharing with other clinics in the regional medical group. Future projects may include expansion to other scheduling groups utilized by physicians and evaluating effectiveness of different CBP regimens available.