Authors (including presenting author) :
Tang CM (RN), Lau TL(APN), Leung WH(WM)
Affiliation :
Endoscopy Center, Yan Chai Hospital
Introduction :
With a rapid growing population and the impacts of COVID pandemic, health care system is being challenged. Workload of healthcare staff and hospital beds continues to endure heavy stress. In this regard, it should consider relieving the burden on overstretched healthcare system is of paramount importance. “Home Bowel Preparation” is a prevalent method for patients to have a home-based bowel preparation prior to the day of colonoscopy. Patients consume the bowel preparation solution at home and check the clearance of bowel preparation by themselves. On the day of exanimation, they come to day center as day cases. After the procedure, they rest for about 2 hours then can be discharged home. The whole process reduces time, ward admission rate and manpower. A cleaned bowel before a procedure is crucial but it is not easy to tolerate 4 liters of unpalatable laxative fluid without the guidance of nurses. This program is aimed to provide patients incentives and supports to complete the full volume of the prep as prescribed.
Objectives :
To promote “Home Bowel Preparation” for patients undergo colonoscopy thereby reducing inpatient bed occupancy rate and relieving healthcare workload in relation to bowel preparation monitoring To increase the compliance of bowel preparation solution consumption at home by encouraging patients to follow instructions to complete the prep with the use of motivational water bottle in order to (i) enhance bowel preparation quality, (ii) increase the cecal intubation rate and (iii) reduce the default rate
Methodology :
-Eligible patients were recruited for “Home Bowel Preparation” program for colonoscopy from Specialist Outpatient Clinic of Surgical department. -Starting from 1/2021, a 1 liter of motivational water bottle was provided to the selected patient to have bowel preparation at home. The water bottle was funded by Yan Chai Hospital Medical Fund ($29.5 for each water bottle, with total 1694 water bottles were distributed). The motivational water bottle was a transparent plastic bottle printed with time markers and motivational quotes, which was designed by endoscopy nurses. The transparent appearance of the bottle facilitated the visualization of actual amount of bowel preparation solution taken. The time markers reminded patients when to start, have and finish bowel preparation solution. The motivational quotes were inspiring wordings that cheered up patient to finish the journey of bowel preparation solution consumption. (Fig.1) -On the day of colonoscopy, patients who have home bowel preparation were admitted as day cases in Endoscopy Centre. Marks were given to each patient who had colonoscopy to evaluate the quality of bowel preparation according to Boston Bowel Preparation Scale (BBPS). The uneventful patients were discharged home on the same day. -To evaluate the admission rate, default rate and the mean score of (BBPS) of “Home Bowel Preparation” patients with and without motivational water bowel.
Result & Outcome :
-From 9/2019 to 3/2022, 751 patients were recruited for “Home Bowel Preparation” program, which was 13.3% of total number of patients who have colonoscopy. This implies a reduction of ward admission due to colonoscopy, and lesser workload of healthcare staff in terms of monitoring bowel preparation status. - The default rate of patients under “Home Bowel Preparation” program is lower than that of non-participants. -In “Home Bowel Preparation” program, the mean score of BBPS was higher in patients with motivational water bottle. This signifies participants have better quality of bowel preparation with motivational water bottle. The motivational water bottle is useful to keep patients stay motivated to follow instructions to complete bowel preparation at home, so as to achieve better compliance and quality of bowel preparation.
