AAAHC Colonoscopy Best Practices
A new report from the Accreditation Association for Ambulatory Health Care (AAAHC) Institute for Quality Improvement (IQI) shows compliance with national recommendations on colonoscopies can improve the safety of the procedure and increase patient satisfaction.
The report is the fifth in a series of best practices studies undertaken by the Performance Measurement Initiative of the IQI and was performed during July through December 2015. The authors explained that keeping the period to no more than 6 months helped avoid possible distorted results from new developments in the healthcare industry, such as changing technology. Researchers collected data from 54 ambulatory healthcare organizations, for a total of 1,419 routine colonoscopy cases. Using self-reported data from patients, ages 16-86, the authors identified the following as best practices for improvement in colonoscopy procedures at ambulatory care organizations:
- Follow Guidelines for Testing Fluids Used for Sterilization or High-Level Disinfection
- Existing national guidelines recommend sterilization (for critical use cases) or, if that is not possible, high-level disinfection (HLD) of GI endoscopes, and sterilization of cutting instruments that break the mucosal barrier before use. Of the organizations in the study, 2% reported using only sterilization, 79% said they used only HLD, and 19% reported using both.
- The authors also recommend providing steps for testing fluids used for scope sterilization or HLD, yet only 85% of the ambulatory organizations surveyed report indicated that they follow all of the steps.
- Follow Guidelines for Pre-sterilization Equipment Cleaning
- A 96% self-reported compliance rate was found among the participating organizations but feedback on specific reprocessing practices for fluid testing and equipment cleaning suggested that not all participating organizations were fully adhering to national guidelines.
- The study’s authors insist focus on adequate, ongoing training and assessment of reprocessing colonoscopes and cleaning equipment is essential to ensuring optimal patient safety. They suggest organizations perform annual competency testing for all staff who reprocess endoscopes, as well as provide instructions when guidelines or manufacturers’ instructions change.
- The authors also recommend opting for disposable rather than reusable cutting instruments. “For those few organizations still using reusable cutting instruments, compliance with manual precleaning recommendations shows opportunities for improvement,” Kuznets said.
- Educate Patients on Proper Bowel Preparation
- Results showed that 25% of patients had more than “a little discomfort” during bowel preparation.
- “Poor patient compliance with directions for bowel preparation can mean cancellation and rescheduling of the procedure, because the endoscopist can’t proceed or the endoscopist is not able to detect significant polyps — i.e., those greater than 5 millimeters in size,” Kuznets notes. “In the latter case, poor bowel prep may lead to a less effective colonoscopy and the need for a shorter interval between colonoscopies. Rescheduling and shorter intervals between colonoscopies are expensive for everyone involved. This is not just taking additional patient and GI center time, but it also increases the potential for missing significant polyps.”
One of the study’s researchers and IQI vice president and senior director Dr. Naomi Kuznets commented, “It is very positive that almost all patients find the procedure itself to be comfortable and would recommend it to a friend. At the same time, we need this to be as safe a procedure as possible and this includes, but is not limited to, being vigilant with regard to compliance with national and manufacturers’ recommendations on colonoscope and instrument reprocessing. We also need the procedure to be as effective as possible, and that means good bowel prep.”