What are the necessary preparations and follow-up instructions for a patient undergoing a colonoscopy?

Colonoscopy Preparation and Follow-up Instructions

For optimal colonoscopy outcomes, patients should receive both verbal and written instructions for bowel preparation, with a split-dose regimen that includes the second portion taken 4-6 hours before the procedure and completed at least 2 hours before the start time. 1

Bowel Preparation Protocol

Pre-Procedure Diet

• 3-2 days before colonoscopy: For patients at high risk of inadequate preparation, restrict intake of vegetables and legumes 1
• Day before colonoscopy:
  • Low-residue and low-fiber foods or full liquids for early and midday meals 1
  • Clear liquids only after midday meal 1
  • Avoid red or purple liquids (can be confused with blood)

Bowel Preparation Medication

• Split-dose regimen (strongly recommended):

  • First half: Evening before procedure
  • Second half: Beginning 4-6 hours before procedure time, completed at least 2 hours before start 1
  • For afternoon procedures, same-day regimen is an acceptable alternative 1

• Recommended volume:

  • 2L preparation regimens are preferred over 4L regimens when possible 1
  • For patients with history of inadequate preparation, consider 4L polyethylene glycol-electrolyte solution plus 15mg bisacodyl 1

• Adjuncts:

  • Oral simethicone may be used to reduce bubbles 1
  • Avoid routine use of other adjuncts 1

Patient Support

• Provide patient navigation support via telephone or automated electronic messaging 1
• For patients reporting incomplete adherence to preparation instructions, consider proceeding with colonoscopy to at least the sigmoid colon before deciding to abort 1

Post-Procedure Follow-up

Follow-up Based on Preparation Quality

• Adequate preparation: Follow standard screening or surveillance intervals based on findings 1
• Inadequate preparation:
  • Repeat colonoscopy within 12 months for screening/surveillance procedures 1
  • For abnormal non-colonoscopic colorectal cancer screening tests, repeat as soon as possible (generally within 3 months) 1

For Patients with Previous Inadequate Preparation

Modify preparation instructions to include one or more of the following 1:

• Enhanced communication of preparation instructions
• Increased patient navigation
• Stricter dietary restrictions (clear liquids only day before)
• Addition of promotility agents
• Treatment of underlying constipation
• Temporary cessation of constipating medications (anticholinergics, opioids)
• High-volume preparation regimens

Quality Metrics

• Target bowel preparation adequacy rate: 90% at both individual endoscopist and endoscopy unit levels 1
• Inadequate preparation reduces adenoma detection rates by approximately 5% 1
• Adequate preparation is associated with shorter procedure and cecal intubation times 2

Common Pitfalls and Solutions

1. Poor patient adherence:

   • Provide clear written and verbal instructions 1
   • Adherence to dietary instructions significantly impacts preparation quality 2
   • Consider patient navigation support 1

2. Timing issues:

   • Same-day preparation provides better mucosal cleansing for afternoon procedures 1
   • Preparation on the day of colonoscopy has better cleansing quality and higher diagnostic yield 3

3. Patient discomfort:

   • Split-dose regimens are better tolerated than whole-dose regimens 4
   • Lower-volume preparations (2L vs 4L) improve patient compliance 1

4. Special populations:

   • Hospitalized patients have poorer preparation quality and may require specialized protocols 5
   • Patients with history of inadequate preparation require more aggressive regimens 1

Regarding the specific patient case with the request for wet wipes, these can be provided as requested for one month, but ensure the patient also receives comprehensive bowel preparation instructions as outlined above to optimize colonoscopy outcomes.