Bowel preparation

Quality statement 4

A patient booked for colonoscopy receives a bowel preparation product and dosing regimen individualised to their needs, co-morbidities, regular medicines and previous response to bowel preparation. The importance of good bowel preparation for a quality colonoscopy is discussed with the patient. They are provided with consumer-appropriate instructions on how to use the bowel  preparation product and their understanding is confirmed.

Purpose

To ensure that patients who present for colonoscopy have a clear bowel that enables a thorough examination.

For consumers

  • Before you have a colonoscopy, you need to make sure your bowel is as clear as possible. If your bowel is not clear, polyps or even cancers may be missed, or you may need to have the colonoscopy again. This means it is important for you to follow the instructions carefully and ask questions if you do not understand what to do.

  • To get your bowel ready for the colonoscopy, you will be told what (and what not) to eat and drink, including when to drink extra fluids to stop you from getting dehydrated. You will be given, or asked to buy, medicine to clear out your bowel by causing diarrhoea. Make sure you understand when to take the medicines, usually starting the day before the colonoscopy. Your doctor or nurse will explain how these medicines may affect you. You should tell them about any previous experience you have had with bowel preparation.

  • Preparation for colonoscopy can also affect your other health conditions or medicines, such as medicines for diabetes or medicines to prevent blood clots. You may need to change the way you take your other medicines or follow special instructions in the days before your colonoscopy. Your doctor will discuss any changes you need to make with you. Some people may need extra personal or health support during bowel preparation and a few may need an overnight stay in hospital. If at any time during the bowel preparation you are unsure what to do, ring your doctor or clinic to check.

For clinicians

Provide written and verbal consumer-appropriate information to patients preparing for colonoscopy, using interpreter services where necessary. Select an appropriate bowel preparation agent and ensure the patient knows how to obtain and use it, taking into account individual risks, co-morbidities, current medicines, and the patient’s previous experience with bowel-cleansing medicines. Clearly explain the purpose of bowel preparation, the importance of following the prescribed procedure, the regimen and the potential side effects of the bowel preparation products. Allow the patient appropriate time to ask questions and confirm that they understand what to do and its importance.

A split-dose regimen is recommended as this results in a higher quality colonoscopy examination compared with ingestion of the entire preparation on the day or evening before the colonoscopy, and has been associated with increased adenoma detection rates. Typically this involves splitting the standard dose of the bowel preparation between the day before and the morning of the colonoscopy (3-6 hours before the planned start of the procedure).

Ensure patients on diabetes medicines, anticoagulants, antiplatelets or other medicines are provided with individualised instructions about how to adjust their medicines and manage their condition as they undergo bowel preparation. Consider whether a patient with relevant co-morbidities needs specific health or personal support whilst undergoing bowel preparation, for example, overnight admission for patients who are unlikely to manage bowel preparation independently.

For health service organisations

Ensure that policies and procedures support best practice for bowel preparation. Support patients by enabling access to information about bowel preparation. For health service organisations with responsibility for providing bowel preparation and advice, provide clear, written patient information about the bowel preparation procedure and a telephone number for any inquiries patients may have as the bowel preparation proceeds; ensure interpreter services or translated materials are available. Ensure patient information is approved and periodically reviewed by clinical staff. Where relevant to the facility, ensure policies support the provision of extra assistance to patients who are unlikely to manage bowel preparation independently, including overnight admission if needed.

For consumers

  • Before you have a colonoscopy, you need to make sure your bowel is as clear as possible. If your bowel is not clear, polyps or even cancers may be missed, or you may need to have the colonoscopy again. This means it is important for you to follow the instructions carefully and ask questions if you do not understand what to do.

  • To get your bowel ready for the colonoscopy, you will be told what (and what not) to eat and drink, including when to drink extra fluids to stop you from getting dehydrated. You will be given, or asked to buy, medicine to clear out your bowel by causing diarrhoea. Make sure you understand when to take the medicines, usually starting the day before the colonoscopy. Your doctor or nurse will explain how these medicines may affect you. You should tell them about any previous experience you have had with bowel preparation.

  • Preparation for colonoscopy can also affect your other health conditions or medicines, such as medicines for diabetes or medicines to prevent blood clots. You may need to change the way you take your other medicines or follow special instructions in the days before your colonoscopy. Your doctor will discuss any changes you need to make with you. Some people may need extra personal or health support during bowel preparation and a few may need an overnight stay in hospital. If at any time during the bowel preparation you are unsure what to do, ring your doctor or clinic to check.

For clinicians

Provide written and verbal consumer-appropriate information to patients preparing for colonoscopy, using interpreter services where necessary. Select an appropriate bowel preparation agent and ensure the patient knows how to obtain and use it, taking into account individual risks, co-morbidities, current medicines, and the patient’s previous experience with bowel-cleansing medicines. Clearly explain the purpose of bowel preparation, the importance of following the prescribed procedure, the regimen and the potential side effects of the bowel preparation products. Allow the patient appropriate time to ask questions and confirm that they understand what to do and its importance.

A split-dose regimen is recommended as this results in a higher quality colonoscopy examination compared with ingestion of the entire preparation on the day or evening before the colonoscopy, and has been associated with increased adenoma detection rates. Typically this involves splitting the standard dose of the bowel preparation between the day before and the morning of the colonoscopy (3-6 hours before the planned start of the procedure).

Ensure patients on diabetes medicines, anticoagulants, antiplatelets or other medicines are provided with individualised instructions about how to adjust their medicines and manage their condition as they undergo bowel preparation. Consider whether a patient with relevant co-morbidities needs specific health or personal support whilst undergoing bowel preparation, for example, overnight admission for patients who are unlikely to manage bowel preparation independently.

For health service organisations

Ensure that policies and procedures support best practice for bowel preparation. Support patients by enabling access to information about bowel preparation. For health service organisations with responsibility for providing bowel preparation and advice, provide clear, written patient information about the bowel preparation procedure and a telephone number for any inquiries patients may have as the bowel preparation proceeds; ensure interpreter services or translated materials are available. Ensure patient information is approved and periodically reviewed by clinical staff. Where relevant to the facility, ensure policies support the provision of extra assistance to patients who are unlikely to manage bowel preparation independently, including overnight admission if needed.

Read Quality Statement 5 - Sedation