Although the patient is responsible for completing bowel prep before a colonoscopy, it is often up to a nurse to provide clear instructions and guidelines to the patient and their family about how to successfully complete the prep. As bowel prep can make or break a colonoscopy, many clinics are finding that standardization, enhanced staff education and improved patient education materials can facilitate improved prep, according to two new studies presented at the 2024 SGNA Annual Course.

Providing Education to Staff

Junabelle Gamble, DNP, MSN, BSN, RN, a gastroenterology nurse at Baylor St. Luke’s Medical Center, in Houston, tested St. Luke’s nurses before and after a bowel preparation education course based on the most recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines. She recruited participants from a variety of nursing units, including nurses working on different shifts and in different roles. A total of 134 participants completed the education course and the before-and-after tests.

Dr. Gamble found uniform results across the nine subtopic areas in the tests, which ranged from knowledge of types of bowel prep to understanding the repercussions of poor prep. Nurses scored consistently low before the education course but tested high after the course. To Dr. Gamble, the results confirmed that after proper education, the staff was able to recall and implement current bowel prep standards.


Providing Education to Patients

Like Dr. Gamble, Stephanie Rollo, BSN, RN, CGRN, a gastroenterology nurse at Glens Falls Hospital, in Queensbury, N.Y., has been working to improve bowel prep at her facility. Instead of staff education, her focus has been on standardizing bowel preparation practices since 2007 through patient and family education.

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In her work, she has found that the materials provided by hospitals and clinics were very limited and that patients often expressed to staff members that they were confused and anxious before the procedure. She and the Gastrointestinal Unit-Based Council at her facility have been developing materials that are clear and easy to understand for those involved in the prep. These materials are supplemental to the pre-procedure instructions given by physicians.

A good bowel prep educational pamphlet, Ms. Rollo said, must include medication instructions, duration of NPO (nothing by mouth) and scenarios that would prompt a patient to call the doctor.

According to Ms. Rollo, improved patient education can help endoscopy centers avoid two main groups of complications: administrative complications—such as scheduling challenges, delays in anesthesia, and staffing challenges—and procedural complications—such as limited exam visibility resulting in delayed or missed diagnoses and treatments, increased electrocautery risks, and prolonged procedure times.

“Patient compliance increases with education and understanding,” Ms. Rollo told GEN Priority Report. She said her goals for providing clear reference materials are to improve inpatient prep, decrease confusion, and improve communication and quality of care for everyone involved. Dr. Gamble also noted that education can benefit both the patient and the healthcare team by preventing prolonged hospital stays, decreasing patient anxiety, decreasing hospital costs and, with staff education, empowering staff.

Change Can Mean Challenges

Seth Gross, MD, the clinical chief of the Division of Gastroenterology and Hepatology at NYU Langone Health, in New York City, has found that the biggest challenge to implementing a standardized practice is implementing the change itself. “Changing the culture from what we are used to doing to a better and new way can be a hurdle that can be overcome,” he said.

He said he believes the best way to implement change is to support “champions” in the hospital to aid in implementing best practices. He said tools to implement change may include educational modules, routine knowledge check-ins (i.e., audits) and replication of standards of practice. Each healthcare organization has its own policies and practices, and it can be difficult to streamline a standard of practice for every organization, he said. However, one can replicate the successes of other organizations’ bowel prep standards by:

  • using current guidelines, such as referring to the ASGE guidelines to educate staff members;
  • developing instructions that are presented in both oral and written forms to those completing the prep; and
  • providing ongoing education that applies to a variety of staff and their differing shift times.

Follow the societies, Dr. Gross advised. “Strong medical evidence leads to medical societies educating their members on best practice,” he said, “which leads hospitals to adopt these standards.”

—Ronni Benson, RN, BSN

The sources reported no relevant financial disclosures. Dr. Gross is a member of the Gastroenterology & Endoscopy News editorial board.

This article is from the July 2024 Priority Report print issue.