Bowel preparation for colonoscopy

Project completed as part of the 2023-4 Northampton General Hospital NHS Trust Green Team Competition.

Team members

· Sue Broughall - Endoscopy Compliance manager

· Theresa Passmore - Endoscopy Manager

· Patricia Ojo - Endoscopy Junior Sister

Setting / patent group: Endoscopy

Issue:

The quality of bowel preparation pre-endoscopy is crucial because inadequate or incomplete bowel preparation can lower screening effectiveness and increase health care expenses due to longer or aborted procedures. Our service has historically prescribed Moviprep, requiring a patient to drink 2 litres of a laxative solution that has a poor taste. Patients would be required to drink an additional 2 litres of water, making a total of 4 litres of fluid. It was therefore a concern that some patients attend for colonoscopy and have their procedure abandoned, cancelled on the day and rebooked due to poor bowel prep while some will not attend citing inability to tolerate high volume bowel preparation and poor taste.

Intervention:

A novel low-volume bowel preparation regimen, Plenvu (Norgine) is polyethylene glycol [PEG] laxative designed for oral bowel preparation use before an elective colonoscopy procedure in adults. Plenvu can be administered in 1 litre, as a 1 day or 2 day regimen has recently emerged. This could offer the potential for enhanced compliance and potentially improved bowel preparation outcomes. A recent (2021) study in London demonstrates that Plenvu is a low volume (1 litre) polyethylene glycol (PEG) plus ascorbate-based bowel preparation which has demonstrated a superior cleansing and equal safety and tolerability profile compared with standard agents (7). Plenvu met the low volume, effective, palatability and convenience criteria on the Boston Bowel Preparation Scale (BBPS) scores.

Outcomes:

We have switched to routine use of Plenvu in 90% cases, saving £29,284 per year as Plenvu is cheaper than Moviprep.

While our service has a low rate of failed colonoscopies (2.7%) exceeding UK JAG performance indicators, we hope to see further reductions in failed procedures over the coming 12 months. We hope to see reduced rates of DNA procedures.

We require 12 months to evaluate the impact of the change, with predicted outcomes below based on an assumption that 59% (78/132) failed colonoscopies, and 50% DNA and cancellations per year can be prevented from this change.

Environmental: Saving of 1,361.5kgCO2e, equivalent to driving 4,027.43 miles in an average car.

Financial: Additional income of £72,226 per year from replacing failed procedures and wasted slots from cancellations/DNAs with successful procedures.

Social impact: 62% staff agreed poor bowel prep is a frequent problem in our unit and 50% felt Plenvu would support this problem

Staff comment “If the prep works right then there would be less patients being rebooked and less waste”

Key learning

The elements that contributed to the success and learning in this study is the QI training, support, information resources and organisational process support received and links to patients benefit and clinical outcomes alongside environmental and financial benefits.