What You Need to Know

​Colonoscopies are performed for screening, therapeutic, and diagnostic reasons, with over 15 million being performed every year in the United States.¹ Screening colonoscopies play an integral part in the diagnosis and treatment of colorectal cancer and are estimated to decrease the risk of death from colorectal cancer by 60%.¹ While providing essential healthcare services to patients, this routine procedure comes with risks such as post-procedure bleeding and perforations of the intestinal tract.² Post-procedure bleeding can occur when polyps are removed for testing during the procedure. Employing techniques to prevent complications and enhancing patient awareness of what to look for while recovering are essential to increase patient safety during and after these procedures.

Reports  recently  submitted  to  the  Pennsylvania  Patient  Safety Reporting System (PA-PSRS) describe patient safety events that involved patients experiencing bleeding and/or a perforated bowel following a colonoscopy. In some of these reports, patients required hospitalization to control post- procedure bleeding, while others described a return to the operating room and/or death due to a perforation.^1,3 Strategies to reduce the risk of bleeding include using evidence-based techniques when removing polyps based on their size and managing a patient’s use of anticoagulants or daily aspirin. Polyps less than one centimeter are recommended to be removed using a cold polypectomy technique (i.e., using a snare or forceps that do not require electrocautery). The risk of bleeding with removal of larger polyps can be decreased by using endoscopic clips, nylon loops, or injecting epinephrine. Generally, patients who chronically use anticoagulants will require cessation of these medications before their procedure or other management to decrease bleeding risks.⁴ Techniques to decrease the risk of perforation during a colonoscopy include injecting fluid under large or flat polyps before removal and avoiding dilation in areas with significant inflammation.³

Patient education plays a key role in managing post-procedure recovery. To prepare patients to manage possible post-procedure complications, patients should be educated on the signs and symptoms to look for during recovery. Patients should be informed that while a small amount of bleeding may occur with their first bowel movement after the procedure, persistent bleeding or passing of blood clots is a concern, and they should seek medical attention if it occurs. Patients should also look out for persistent abdominal pain and fevers in the days and up to two weeks after a colonoscopy. ⁵ To ensure effective communication, the timing of when this information is provided should be considered. Providers should avoid explaining these signs and symptoms during the immediate post- procedure time frame, as patients may still be feeling the effects of anesthesia. Instead, this conversation with the patient should occur during a preprocedure appointment or before anesthesia is administered preprocedure, and this information can also be communicated to a family member to ensure understanding.

Combining evidence-based techniques to minimize the risk of complications with clear patient education regarding signs and symptoms that require further medical attention can result in increased patient safety for routine colonoscopies.

References

Your Role to Ensure Correct-Site Surgery

Your Role to Ensure Correct-Site Surgery

Target audience:

Physicians, nurses, and other healthcare staff professionals involved with the surgical process

Approximate completion time

30 minutes

Education credits 

Pennsylvania nursing 0.5 hour

Course objectives

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Not Settling for Empty Promises From Gas Cylinder Vendors

In a gastroenterology procedural center, a cart is used to integrate equipment for endoscopies and colonoscopies, including large (size E) carbon dioxide cylinders used for insufflation to reduce pain and discomfort during colonoscopies. The tanks are switched out when empty and are often changed between cases, but sometimes they must be replaced during a case. Each CO2 tank is delivered in a plastic bag with a rubber band closure, a tag that reads “full,” and a seal over the valve.

In June 2022, a gastrointestinal (GI) tech grabbed a CO2 tank from the full rack that was both bagged and tagged, but when the tank was hooked up to the insufflator equipment, they discovered it was empty. Had this tank needed to be changed during a procedure, it would have put the patient at risk. The center reported the event to the vendor and returned the tank for investigation. One month later, the vendor reported they could not determine whether the tank was leaking but had replaced the valve.

On four more occasions over the next six months, a tank packaged as full was empty when brought into the procedure room. The vendor questioned whether the staff was comingling tanks and offered more signage.

In mid-September 2023, the nurse manager again reached out for vendor feedback and an improvement plan. The vendor reported a new companywide mandate where size E medical gas cylinders would no longer be shipped in bags, would be inspected after filling, and would be equipped with a built-in seal and washer to ensure proper connection. This new process was implemented to segregate full and empty cylinders on delivery.

The steadfast persistence of the nurse manager to hold the vendor accountable produced a safer process to fill, mark, and deliver CO2 tanks, and make it easy to discern with a glance whether a tank is full or used when it is brought into the procedure room.

Here's what's happening in patient safety in PA

Artificial Intelligence and Human Factors in Healthcare Quality and Safety

Hosted by Penn State College of Medicine

This conference will focus on the emerging need for optimization of the human-AI interaction in healthcare and the issues at the intersection of human factors engineering, patient safety, quality and value enhancement, and AI. Recognized academic, clinical, and industry experts will attempt to define future directions in this field and propose an agenda for research over the next five to seven years.

When: April 10–11, 2025

Who should attend: Healthcare professionals, administrators, and policymakers involved in healthcare quality and safety, and anyone who is interested in learning more about the future of healthcare quality and safety in the era of AI. The conference will highlight the approach of human factors in AI, with the goal of optimizing the “human-AI dyad” to enhance the quality, value, effectiveness, and safety of care. Attendees will learn from a diverse range of academic and industry leaders in the fields of human factors engineering, artificial intelligence, and healthcare quality and safety. Discussions will address critical topics such as error prevention, detection, recovery, health system resilience, and alleviating provider burnout—all of which are more pertinent than ever as AI tools continue to reshape the healthcare landscape.

Registration fee: In-person attendance is $150. Virtual attendance is $100. Students and trainees attendance is $50.

In January 2023, the nurse manager reported the empty tank issues to the center’s patient safety committee. The committee asked for investigative reports. In March 2023, the facility management company, a separate entity that orders and manages tanks at the center, found tanks in the full rack that had been delivered in open bags with no seal. When tested, the tanks were full, although the open bags and lack of a seal suggested they were empty.

The vendor created a new process in which tanks would be filled, sealed, and tagged as full in an obvious manner, and drivers were to ensure full tanks remained wrapped on delivery. Despite these efforts, in July 2023 a tank marked full was empty when hooked up in the procedure room. On two other occasions in August 2023, tanks that should have been full were empty when staff attempted to use them. These tanks were sent to the vendor for evaluation.​​​