537 A Simple Step for Better Prep: The Impact of Nurse Driven Telephone Education on Colonoscopy Bowel Prep

Abstract

INTRODUCTION: Bowel preparation affects the completeness, duration, and safety of colonoscopy, as well as the detection of neoplastic lesions. Guidelines have proposed a goal of >85% to achieve adequate bowel cleansing during colonoscopy. However there remain challenges to achieve this metric, as factors including patient health literacy, socioeconomic status, language barriers, and complex instruction tools can influence the quality of bowel prep. Recognizing a period of time when the adequacy of bowel prep at our institution was <85%, a nurse driven telephone education protocol was developed to improve bowel prep at the Phoenix VA Health Care System. METHODS: The nurse education team assigned a GI nurse to call patients one week prior to their colonoscopy. During this phone visit, patients were educated to eat a low residue diet one week prior to their procedure. They were further instructed to maintain a clear liquid diet the day prior to the colonoscopy. During the phone encounter, education was given regarding the timing of the bowel prep. Prior to our education initiative, to prevent confusion all patients were instructed to take the first dose of MoviPrep at 6 pm the evening before the exam, and the 2nd dose at midnight the day of the colonoscopy. With the nurse driven telephone education protocol patients received individualized plans for split dose prep, with the 1st dose at 6pm the evening prior to the colonoscopy and the 2nd dose four hours before the colonoscopy. We evaluated the quality of bowel prep seven months prior to and six months after our quality improvement initiative, and collected data on overall impression of bowel prep deemed by the performing gastroenterologist. Statistics were performed with univariate analysis and statistical significance was set at P < 0.05. RESULTS: For the preceding seven months prior to our quality improvement initiative, 2115 out of 2569 (82%) colonoscopies achieved adequate quality bowel prep. Following implementation of a nurse driven telephone education initiative, 2271 out of 2384 (95%) colonoscopies achieved adequate prep. This improvement from 82% to 95% was statistically significant (P = 0.0001). CONCLUSION: We demonstrate improved bowel prep through nurse driven telephone education. Where resources allow, this can be a simple yet effective tool to improve bowel prep, in turn reducing cost. Further studies are needed to determine the precise cost effectiveness of such interventions, as well the role other ancillary staff may play in education.