Service implications of implementing guidance for oral bowel cleansing agents in colonoscopy.

INTRODUCTION: Bowel preparation has led to serious adverse events. Consequently, regulatory and advisory bodies have issued guidance,including a risk stratification of patients,aiming to minimise this risk.

AIMS: To determine the impact of the new guidance on our current practice of Picolax used in colonoscopy with regard to patient stratification,compliance and service implementation.

METHODS: Patients listed for day case colonoscopy during October 2009 were audited using data from the hospital and endoscopy databases. A follow-up, structured patient telephone interview evaluated side effects, the assessment process and patient experience.

RESULTS: Of the participating 112 patients, 97.4% were clinically reviewed before colonoscopy,98.3% received written instructions and 70% verbal instructions. None had their preparation dispensed by a regulated professional. Although 62% of patients were retrospectively identified as 'at risk' (elderly, with congestive cardiac failure, cirrhosis or chronic kidney disease or on angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics or non-steroidal anti-inflammatory drugs), none were identified before their procedure. Significant events (postural hypotension, collapse, dizziness, palpitations, faint) were seen in 4.4%, all of whom could potentially be identified as 'at risk' using a stratification of low epidermal growth factor receptor with relevant co-morbidity (congestive cardiac failure or cirrhosis).

CONCLUSIONS: Given the difficulties with compliance and the high prevalence of 'at risk' patients, the implementation will be challenging and require significant service redesign.