A pilot study to evaluate the feasibility of implementing a split-dose bowel preparation for inpatient colonoscopy: A single-center experience

Objectives: Feasibility of using split-dose bowel preparation in an inpatient setting has not been extensively studied. We conducted a single-centre multiphase study to (1) understand the perceived barriers to split-dose administration among nursing and providers, (2) develop and implement a split-dose electronic order set and (3) evaluate the use and impact of split-dose administration on 100 consecutive colonoscopies. Methods: Nurse/provider interviews were conducted to understand perceived concerns and potential barriers to split-dose preparation. Next, an order set containing specific nursing instructions was developed, disseminated and implemented into the electronic health record as the default order set for inpatient colonoscopies. Finally, 100 consecutive inpatients undergoing colonoscopy were interviewed to determine prep consumption, tolerability and rate of procedural delays due to inadequate preparation. Results: Survey results indicated perceived concerns about inpatients' ability to tolerate and complete the preparation, insufficient nursing support and complexity of preparation administration. Based on this, prep orders were adjusted to accommodate nursing concerns prior to implementation. 54% of inpatients actually completed the bowel preparation in split doses (SPLIT group); the remainder had the conventional full dose preparation (NON-SPLIT). Less procedural delay and a lower rate of additional laxatives use (13% vs 30.4%) were seen in the SPLIT versus NON-SPLIT group. Splitdose preparation was well tolerated among inpatients. Conclusions: Split-dose bowel preparation can be implemented for inpatients undergoing colonoscopy. This multiphase study demonstrates the steps used to implement split-dose preparation at our institution and may provide others with strategies that they could use at their institutions.