Dear Editor,

Chambers, Whiteman, Stephens, Goodloe, and Kirsteen (2016) in their recently published article, "Improving Inpatient Colonoscopy Preparation in a University Hospital: Evidence-Based Practice Project," showed evidence that if colonoscopy preparation orders were clear and prepared by an electronic order set along with actual training for the nurses administering the preparation, the occurrence of repeated colonoscopies decreased. Although this study highlighted a hospital inpatient population, the changes implemented could have positive implications for outpatient procedures as well. This study could be the beginning of a comprehensive strategy for explaining and teaching colonoscopy preparation instructions. Improving colon preparation orders is the first step and then training the nurses, who instruct the patients, is the second step. The process then should continue on to make improvements in the tools used to actually enhance the understanding for the patient.

Taking into account the patient's ability to understand the instructions and how people learn could be an additional piece of the puzzle for a clean colon preparation. For example, Chen, Athilingam, Saloum, and Brady (2015) in their evidence-based literature review on "Enhancing Bowel Preparation for Screening Colonoscopy: An Evidence-Based Literature Review" stated that repeating the initial instructions by a phone call follow-up along with cartoon visual aids increased the number of adequate bowel preparations. Also, in a study published in 2011 in The American Journal of Gastroenterology, "Development and Validation of a Novel Patient Educational Booklet to Enhance Colonoscopy Preparation," Spiegel et al. (2011) found the use of a visual booklet with colorful examples of how a clear liquid actually looks improved the success of the colon preparation. Even an instructional video enhanced the overall quality of colon cleansing precolonoscopy as shown by Prakash et al. (2013) in their research published in a 2013 article, "Improving the Quality of Colonoscopy Bowel Preparation Using an Educational Video." Nurses and patients would benefit from reinforced directions and easy-to-understand instructions that are colorful and visually presented.

The article "Improving Inpatient Colonoscopy Preparation in a University Hospital: An Evidence-Based Practice Project" showed that a change in the way the preparation is ordered and education of the nurses are a strategy that helps with the success of a cleansed colon. Adding visual components such as the colorful instruction booklet and a video plus a reminder phone call are the reasonable next steps in improving the occurrence of adequate colonoscopy preparation.

Sincerely,

Kimberly M. Cato, RN, SGNA Member

Durham, NC

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