門診病人大腸鏡檢查腸道準備不完全改善專案

Project to Improving Outpatient Incomplete Bowel Preparation for Colonscopy

目的：大腸鏡檢查是確診大腸癌的重要利器，檢查前的腸道準備品質與檢查的成功率相關。於2012年2月調查發現門診大腸鏡檢查病人腸道準備不完全率高達52.2％，影響醫師確診及病人後續治療，因此成立專案小組，探討影響腸道準備不完全相關因素，藉以改善檢查前的腸道準備品質，提升大腸鏡檢查判讀的正確性。方法：經現況分析發現：無一致性的護理指導方式、大腸鏡檢查護理指導單張不適用、大腸鏡檢查護理指導輔助工具不足及無適當的護理指導空間，是腸道準備品質不佳的主因。專案小組擬定及改善對策包括：1.製訂大腸鏡護理指導手冊；2.製作大腸鏡護理指導光碟；3.增設瀉藥使用方法海報；4.建置大腸鏡檢查護理指導外部網頁；5.提供專屬護理指導場所等方法，改善檢查前的腸道準備品質。結果：透過改善對策的執行，大腸鏡檢查腸道準備不完全率由改善前的52.2％下降至8.6％；門診病人對大腸鏡檢查認知正確率由58.1％提升至90％。結論：本專案確實能有效降低門診病人大腸鏡檢查腸道準備不完全率，及提升病人對大腸鏡檢查的認知，並可提供日後臨床護理照護標準修訂及參考，以提高整體照護品質。

Purposes: Colonoscopy is an important examination to check for cancer or precancerous growths in the colon or rectum. The quality of bowel preparation before the examination is closely related to the successful rate of colonoscopy. Through a survey in February, 2012, we found that the incomplete rate of bowel preparation before colonoscopy in outpatients was up to 52.5%. This affects the accurate diagnosis and follow-up. The purpose of the project was to improve the incomplete rate of bowel preparation before colonoscopy. So as to improve the quality of bowel preparation before lifting colonoscopy interpretation is correct. Methods: Current state assessment revealed the following cause of the problem: Lack of consistency in nursing care guidelines, The nursing instruction leaflet of colonoscopy was not applicable, Inadequate teaching tools of nursing instruction, Lack of space for nursing care education. Team members then planned strategies for improvement : 1. Make a manual of colonoscopy nursing care guidelines, 2. Record a disc for colonoscopy nursing instructions, 3. Make posters for instructions of laxatives, 4. Build web pages for colonoscopy nursing instructions, 5. A plan to have nursing instruction independent space. Improve the quality of bowel preparation before colonoscopy examination. Results: After implementation of the improvement measures, the incomplete colon preparation rate dropped from 52.2% to 8.6%. The overall patient satisfaction of colonscopy examination increased from 58.1% to 90%. Conclusions: The project showed that the intervention indeed incomplete rate of bowel preparation before colonoscopy in outpatients and could be a potential guideline for improving the quality of colonscopy examination in outpatient setting.