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Enhancing the Quality of Colonoscopy Through Split-Dose Bowel Preparation

Riegert, Monica, DNP, CRNP; Nandwani, Monica, MSN, CRNP

doi: 10.1097/SGA.0000000000000036

Colonoscopy is a primary method for colorectal cancer screening, yet its efficacy as a screening tool is largely dependent on the quality of bowel preparation. An estimated 25% of patients undergoing colonoscopy have poor bowel preparations at the time of their procedure. There is empirical evidence to support that split-dose bowel preparations yield better bowel cleansing than day-prior bowel preparation regimens. The aim of this quality improvement project was to enhance the quality of colonoscopy at a large urban academic center through the use of split-dose bowel preparation. A total of 74 patients participated, with about half undergoing the current practice of day-prior bowel preparation and half undergoing the intervention of split-dose bowel preparation. Several procedural and patient outcome measures were collected and used for comparison to determine which bowel preparation was optimal for use in the practice setting. The findings revealed that split-dose bowel preparation resulted in better bowel cleansing, reduced recall intervals for the time to the next recommended colonoscopy, and improved patient tolerance, supporting its use in the practice setting to enhance the quality of colonoscopy.

Monica Riegert, DNP, CRNP, is with Johns Hopkins Medical Institutions, Baltimore, Maryland.

Monica Nandwani, MSN, CRNP, is with Johns Hopkins Medical Institutions, Baltimore, Maryland.

Correspondence to: Monica Riegert, DNP, CRNP, Johns Hopkins Medical Institutions, 600 North Wolfe St, Blalock Building 402, Baltimore, MD 21287 (e-mail:

The authors thank Dr. Haera Han, PhD, RN, and Dr. Anthony Kalloo, MD, for their valuable comments on this article and for their guidance and encouragement throughout this project.

The authors declare no conflict of interest.

Received June 12, 2012

Accepted December 11, 2012

© 2014 by the Society of Gastroenterology Nurses and Associates, Inc.