Bowel preparation for inpatient colonoscopy: a quality evaluation

Abstract

Background: Adequate bowel preparation is a prerequisite for colonoscopy. Good preparation improves adenoma detection and caecal intubation rates, and poor preparation can increase complications, cancellations, rebookings, and overall hospital stay. Methods: A retrospective descriptive study of all inpatient colonoscopies within inclusion criteria at Vall d'Hebron University Hospital from June 2016 to June 2017. This assessed the quality of bowel preparation using the simple, reliable Boston Bowel Preparation Scale (BBPS) and collected data on demographics and the referring unit. Results: Of 10 643 diagnostic and therapeutic colonoscopies performed, 854 (8%) were in inpatient studies, and 126 of these (14.8 %) were excluded. Of 728 patients included in the final analysis, bowel preparation was excellent in 18%, good in 45%, regular in 18% and poor in 19%. Of the 37% with inadequate preparation, 15% had to be repeated. Conclusions: Overall, hospital bowel preparations were insufficient. Proposals for improving the quality of bowel preparation included: recommending a waste-free diet for all new inpatients expected to undergo diagnostic colonoscopy; introducing a more tolerable polyethylene glycol laxative solution; and developing learning materials, such as simple written instructions for inpatients, a training plan for ward nurses and an infographic on the prerequisites for endoscopy.