Improving Patient Bowel Preparation Quality and Colonoscopy Preparedness

Proper colonoscopy bowel preparation is critical for effective screening and surveillance of colon cancer and adenomas. Adhering to written multi-step, order-dependent bowel preparation instructions can be complex for patients with low health literacy. This quality improvement project aimed to demonstrate that offering written and video health literacy-directed colonoscopy instructions improves patients' understanding of bowel preparation, compliance, and subsequent bowel cleanliness, as evidenced by reduced phone calls to nursing staff, procedural times, and same-day procedure cancellations. Written instructions, targeted to a Flesch-Kincaid Grade Level 6.5, and an educational video were provided to 1,031 patients undergoing colonoscopy screening or surveillance over 12 weeks. The project resulted in an 83% reduction in phone calls to nursing staff requesting additional instruction. Same-day procedure cancellations increased minimally by 0.2%, but less-than-ideal bowel preparations (fair, poor/inadequate) had a relative decrease of 20%. Procedural times remained relatively unchanged (mean: 29.9; median: 28.5) post-intervention, with 59.9% of procedures completed within 30 minutes. Providing health literacy-directed multimedia instructions can be a convenient, practical, and cost-efficient approach to reducing nursing workflow interruptions, enhancing bowel preparation quality, and increasing patient confidence with colonoscopy preparations.