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Sa1151 Development and Prospective Evaluation of a Nurse Assessed Patient Comfort Scale (NAPCOMS) for Colonoscopy
Sa1151 Development and Prospective Evaluation of a Nurse Assessed Patient Comfort Scale (NAPCOMS) for Colonoscopy Erin Ross, Catherine Dube, Robert J. Hilsden, Veronica Webbink, Breanna Gillett, Tom J. Lee, Matthew D. Rutter, Alaa Rostom Background: Comfort is an essential measure of endoscopy quality and safety. Studies have looked at validating comfort scores, but have either focused on patients who did not receive sedation or have shown poor agreement between nurse comfort scores and patient reported comfort. Objective: The purpose of this study is to develop and validate a Nurse Assessed Patient Comfort Scale (NAPCOMS) to provide an objective assessment of patient comfort during outpatient colonoscopy with moderate sedation use. Methods: Seven endoscopists and four nurses from the United Kingdom and Canada utilized a Modified Delphi approach to modify the Gloucester Comfort Score and create a new scale with appropriate face validity. The elements in this comfort scale include the intensity, frequency, and duration of pain, the level of consciousness of the patient, and the overall tolerability of the procedure. A sample size of 300 patients was required to allow for a 95% confidence interval of 10% around the point estimate for the intraclass correlation coefficient (ICC). Patients with significant psychiatric or cognitive disorders were excluded from the study. Two nurses were asked to observe each colonoscopy and then complete the comfort scale. Both patients and physicians completed a four-point Likert scale which rated overall comfort during the procedure. The reliability of the new comfort scale was measured by calculating the ICC between the two nurse observers, and the validity of the scale was assessed by calculating the correlation and agreement between the nurse reported scale and patient reported comfort. Results: Total enrollment in this study was 300 patients, with 150 patients from Calgary, Canada, and 75 patients from both South Tyneside and the University Hospital of North Tees in the United Kingdom. The average age of the study group was 56.8 years of age, and 51% of the patients were male. The vast majority of the included patients underwent colonoscopy for colorectal cancer screening or surveillance. The ICC between the two nurses was 0.84 (95% CI: 0.80 to 0.87). The ICC between the nurses and patients was 0.61 (95% CI: 0.53 to 0.67). The ICC between physicians and patients was 0.52 (95% CI: 0.43 to 0.60). A NAPCOMS score of >5 correlated with a patient rating of moderate to severe discomfort. There was high agreement between patient post-procedure ratings (pre-discharge) and the one week post-procedure rating with an ICC of 0.73 (95% CI: 0.67-0.78). Conclusions: NAPCOMS is a reliable and valid instrument for measuring patient comfort during outpatient colonoscopy in the setting of moderate sedation use. When a NAPCOMS score reaches six the team should reflect on whether to continue the procedure with moderate sedation or to consider alternate procedures or sedating agents to allow for a more comfortable experience for the patient.
Figure 1: Colon cleanliness as visualized on colonoscopy
Sa1152 The Value of the Trendelenburg Position During Routine Colonoscopy: A Pilot Study Abdo M. Saad, Jessica Winn, Venu Chennamaneni, Hazem T. Hammad, Murtaza Arif, Abhishek Choudhary, Manish Thapar, Nicholas Szary, Matthew L. Bechtold, Jack Bragg, Jamal A. Ibdah, John B. Marshall Background: Colonoscopy is the most accepted and commonly performed procedure for colorectal cancer screening. The procedure is sometimes difficult. The causes of difficult colonoscopy can be categorized into either a fixed angulated sigmoid colon or a redundant colon. The use of a Trendelenberg position is postulated to help in advancing the colonoscope by straightening the sigmoid colon, reducing the redundancy. Gynecologic surgery frequently utilizes the Trendelenberg position to allow easier access to the pelvic organs. The purpose of this pilot study was to gain experience in performing colonoscopy in the Trendelenburg position and to assess the safety of placing the patient in this position while performing a colonoscopy. In addition, this study would help us to more accurately estimate the number of patients needed to perform a randomized controlled trial. Methods: Patients presenting to our ambulatory endoscopy center to undergo routine screening or surveillance colonoscopy were eligible for the study. After obtaining informed consent, patients were randomly assigned to the standard left lateral horizontal position or to the 15° Trendelenburg position during insertion. Separate data sheets were completed at the end of each procedure by the endoscopist, nurse, and patient. Results: Twenty patients were assigned to the 15° Trendelenberg position and 20 patients were assigned to the standard left lateral position. The time to reach the cecum was 5.67 ± 3.95 minutes in the Trendelenberg group and 6.55 ± 4.50 minutes in the standard group. One patient desaturated to 81% in the Trendelenburg group while two patients desaturated to 88-89% in the standard group. Desaturation resolved with an increase in supplemental oxygen. The mean highest intra-procedure blood pressure was 133.10 ± 15.55/83.25 ± 11.74 mmHg in the Trendelenburg group and 130.60 ± 24.41/ 81.70 ± 13.78 mmHg in the standard group. A power analysis revealed the need of 100 patients in each group to detect a two minute difference in the cecal intubation time between the Trendelenberg and the standard position. Conclusions: This pilot study shows that performing routine colonoscopy in the Trendelenberg position is a safe intervention that could shorten the duration of the procedure. A randomized controlled trial is warranted.
Figure 2: Rates of cecal visualization and need for repeat colonoscopies in methadone and control patients Sa1150 What Do Young People and Parents Want From an Inflammatory Bowel Disease (IBD) Service? Rebecca Little, Cameron Imrie, Audrey Derby, Peri Gillespie, Grant R. Caddy, Tony C. Tham Introduction: At present, there are guidelines from the US and Europe regarding the formation of transition clinics for adolescents with IBD. This includes a UK Inflammatory Bowel Disease (IBD) Standards guidance on optimal service provision for pediatric and adolescent care. However most of these guidelines come from intuitive reasoning and opinion, as there is a lack of data on what constitutes an ideal service for young patients with IBD. Aim: To develop a comprehensive knowledge and understanding of the key service requirements of young people with IBD as well as their parents. Methods: Pediatric and adolescent patients age 6 - 18 years, were identified from databases in two teaching hospitals and from the membership of the N Ireland branch of Crohn's and Colitis UK, which is a patient support group. Anonymous questionnaires were sent to these patients and their parents separately. The questionnaires asked about their perceived quality of care, clinic care, general comments, input from specialists, support and information, plus any suggestions. Results: 105 questionnaires were sent and 51 responded (49%); of these 21 were from patients and 30 from their parents. Over 84% were happy with the quality of care they are receiving. Reasons patients and parents were reluctant to attend clinics included: blood tests, nurse specialist or doctor not available, lack of car parking. 90% preferred to see the attending (Consultant) rather than a fellow. Nurse specialist, dietetics, specialist IBD surgeon, psychologist, skin / eye specialist input was thought to be beneficial by 95%, 81%, 71%, 59%, and 45% respectively. The following support service and information were considered important: immediate contact with healthcare personnel for disease flare, support groups for young adults, insurance and financial advice, knowledge about IBD developments and research, email service, surgical input regarding stomas. Conclusions: The majority of young patients with IBD and their
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AGA Abstracts
AGA Abstracts
parents are satisfied with the care they are receiving. Support from specialist services such as nurse specialist, dietitians, specialist IBD surgeons, psychologist, plus rapid access to services when the disease flares were thought to be important by the patients and their parents. Knowledge of what these patients and their parents want will help to design an optimal IBD service.
Figure 1: Colon cleanliness as visualized on colonoscopy
Sa1152 The Value of the Trendelenburg Position During Routine Colonoscopy: A Pilot Study Abdo M. Saad, Jessica Winn, Venu Chennamaneni, Hazem T. Hammad, Murtaza Arif, Abhishek Choudhary, Manish Thapar, Nicholas Szary, Matthew L. Bechtold, Jack Bragg, Jamal A. Ibdah, John B. Marshall Background: Colonoscopy is the most accepted and commonly performed procedure for colorectal cancer screening. The procedure is sometimes difficult. The causes of difficult colonoscopy can be categorized into either a fixed angulated sigmoid colon or a redundant colon. The use of a Trendelenberg position is postulated to help in advancing the colonoscope by straightening the sigmoid colon, reducing the redundancy. Gynecologic surgery frequently utilizes the Trendelenberg position to allow easier access to the pelvic organs. The purpose of this pilot study was to gain experience in performing colonoscopy in the Trendelenburg position and to assess the safety of placing the patient in this position while performing a colonoscopy. In addition, this study would help us to more accurately estimate the number of patients needed to perform a randomized controlled trial. Methods: Patients presenting to our ambulatory endoscopy center to undergo routine screening or surveillance colonoscopy were eligible for the study. After obtaining informed consent, patients were randomly assigned to the standard left lateral horizontal position or to the 15° Trendelenburg position during insertion. Separate data sheets were completed at the end of each procedure by the endoscopist, nurse, and patient. Results: Twenty patients were assigned to the 15° Trendelenberg position and 20 patients were assigned to the standard left lateral position. The time to reach the cecum was 5.67 ± 3.95 minutes in the Trendelenberg group and 6.55 ± 4.50 minutes in the standard group. One patient desaturated to 81% in the Trendelenburg group while two patients desaturated to 88-89% in the standard group. Desaturation resolved with an increase in supplemental oxygen. The mean highest intra-procedure blood pressure was 133.10 ± 15.55/83.25 ± 11.74 mmHg in the Trendelenburg group and 130.60 ± 24.41/ 81.70 ± 13.78 mmHg in the standard group. A power analysis revealed the need of 100 patients in each group to detect a two minute difference in the cecal intubation time between the Trendelenberg and the standard position. Conclusions: This pilot study shows that performing routine colonoscopy in the Trendelenberg position is a safe intervention that could shorten the duration of the procedure. A randomized controlled trial is warranted.
Figure 2: Rates of cecal visualization and need for repeat colonoscopies in methadone and control patients Sa1150 What Do Young People and Parents Want From an Inflammatory Bowel Disease (IBD) Service? Rebecca Little, Cameron Imrie, Audrey Derby, Peri Gillespie, Grant R. Caddy, Tony C. Tham Introduction: At present, there are guidelines from the US and Europe regarding the formation of transition clinics for adolescents with IBD. This includes a UK Inflammatory Bowel Disease (IBD) Standards guidance on optimal service provision for pediatric and adolescent care. However most of these guidelines come from intuitive reasoning and opinion, as there is a lack of data on what constitutes an ideal service for young patients with IBD. Aim: To develop a comprehensive knowledge and understanding of the key service requirements of young people with IBD as well as their parents. Methods: Pediatric and adolescent patients age 6 - 18 years, were identified from databases in two teaching hospitals and from the membership of the N Ireland branch of Crohn's and Colitis UK, which is a patient support group. Anonymous questionnaires were sent to these patients and their parents separately. The questionnaires asked about their perceived quality of care, clinic care, general comments, input from specialists, support and information, plus any suggestions. Results: 105 questionnaires were sent and 51 responded (49%); of these 21 were from patients and 30 from their parents. Over 84% were happy with the quality of care they are receiving. Reasons patients and parents were reluctant to attend clinics included: blood tests, nurse specialist or doctor not available, lack of car parking. 90% preferred to see the attending (Consultant) rather than a fellow. Nurse specialist, dietetics, specialist IBD surgeon, psychologist, skin / eye specialist input was thought to be beneficial by 95%, 81%, 71%, 59%, and 45% respectively. The following support service and information were considered important: immediate contact with healthcare personnel for disease flare, support groups for young adults, insurance and financial advice, knowledge about IBD developments and research, email service, surgical input regarding stomas. Conclusions: The majority of young patients with IBD and their
S-229
AGA Abstracts
AGA Abstracts
parents are satisfied with the care they are receiving. Support from specialist services such as nurse specialist, dietitians, specialist IBD surgeons, psychologist, plus rapid access to services when the disease flares were thought to be important by the patients and their parents. Knowledge of what these patients and their parents want will help to design an optimal IBD service.