Introduction In 2009, the NPSA issued a report alerting healthcare providers to the potential risk of harm from using oral bowel cleansing agents (OBCA). Recently published consensus guidelines recommend pre-assessing patients undergoing colonoscopy before the use of OBCA. First, to determine whether pre-assessment improved the quality of bowel preparation for patients undergoing colonoscopy at our unit. Secondly whether pre-assessment helps to prevent deterioration in renal function in CKD patients. Thirdly, to define risk stratifying criteria for poor bowel preparation and use these to deploy resources to patients who are most at risk of poor bowel preparation.
Methods Data was collected prospectively over of 12 months. Patients were stratified to one of three risk groups based on the presence of risk factors for poor bowel preparation taking ‘at risk’ medication and those with significant co-morbidities. Group 1 patients had no risk factors and group 3 consisted of patients with 2 or more risk factors for poor bowel preparation. Data was analysed using SPSS.
Results 1840 colonoscopies were carried out during the time period. Total number analysed was 1704. Mean age was 61.7 years with a range of 16–94. 404 patients were pre assessed. Pre-assessment has significantly increased the quality of bowel preparation across all groups (OR = 1.605, p = 0.002). In groups 1 and 2 the odds of good quality bowel preparation was 80% and 72% higher respectively in patients who had been pre-assessed however these improvements were not statistically significant. Patients stratified into group 3 were 52% more likely to have good bowel preparation (p = 0.039) compared to those who were not pre-assessed. 88 patients had eGFR <60 ml/min. They had eGFR checked before and after administration of OBCA. There was a significant difference in the percentage change in eGFR between those patients that had Pre-assessment (Median = 7.7%) compared with those who did not (Median= -6.6%) (p = .006, Mann-Whitney).
Conclusion Face-to-face pre-assessment improved the quality of bowel preparation for patients undergoing colonoscopy. It helps to minimise the risk of renal injury in patients with CKD. Those stratified to group 3 saw a significant improvement in the quality of their bowel preparation. We conclude pre-assessment is a pre-requisite for patients who are at risk of poor bowel preparation and with significant co-morbidities.
Reference Rapid Response Report NPSA/2009/RRR012. Reducing risk of harm from oral bowel cleansing solution. February 2009. National Patient Safety Agency.
Disclosure of Interest None Declared.
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