Targeting Incomplete Bowel Preparations for Inpatient Colonoscopies

Student Researcher:
Amanda Lee

Supervisor / Principle Investigator:
Dr. Ali Kohansal

Additional Authors:
Dr. Lindsey Russell
Hannah Rempel
Donna Perez
Pam Mathura
Dr. Narmin Kassam

MD Class of 2021


At the University of Alberta Hospital (UAH), patients admitted to the gastroenterology wards may require an urgent colonoscopy for diagnosis and treatment. Prior to the colonoscopy, patients are required to drink a laxative to clean out the colon and ensure good visualization. However, the quality of the bowel preps is complicated by factors such as poor taste, large volume and medical comorbidities. In turn, poor bowel preps result in poorer health outcomes, higher health care costs and diminished patient experience. The aim of this quality improvement (QI) project was to reduce the number of incomplete inpatient colonoscopies by 30% over 2.5 months. To do so, the “Model for Improvement” provided the quality framework. QI tools were used to identify opportunities for change in the inpatient bowel prep process, and interventions targeting these gaps were developed and tested using Plan-Do-Study-Act (PDSA) cycles. The gaps identified included bowel prep order variability, education, intolerance, lack of tracking and communication between units. The interventions included a standard bowel prep order label, an instructional patient placemat and a nursing ‘tip sheet’ containing strategies for when a patient is not tolerating the prep. The PDSA cycle demonstrated a reduction of incomplete colonoscopies over 2.5 months, a 59% rate of use of the standardized label and a 70% rate of standard bowel prep education. Patients were satisfied by the placemat, with 59% saying that the placement would help with future bowel preps. As well, it is anticipated that the interventions developed here can be easily adopted by other units. As a result, this QI project was able to, and has the potential to further, improve the patient experience.