A Nursing Scheme For Bowel Cleansing Before Colonoscopy In The Elderly Based On FMEA

Objective:1.To investigate the effect and influencing factors of bowel preparation before colonoscopy in the elderly.2.To construct a optimal nursing scheme of bowel preparation before colonoscopy for the elderly based on the FMEA model.3.To evaluate the effect of nursing scheme on the bowel preparation for elderly patients,and the compliance and satisfaction,incidence of adverse reactions of the nursing scheme.Methods:1.Using Convenience sampling method to select 240 elderly patients(age ≥ 60years)who underwent colonoscopy in a tertiary hospital in Qingdao from January 2021 to June 2021.Bowel preparation quality was evaluated,and the affecting factors of bowel preparation were analyzed by multivariate Logistic regression.2.A FMEA research team was formed to analyze the bowel cleansing practices before colonoscopy in the elderly,to explore the failure modes and find potential failure causes and failure results in the process,and finally to calculate the risk priority number(Risk Priorty Number,RPN),put forward improvement measures in order,and finally determined the nursing scheme of bowel cleansing for the elderly based on the FMEA model.3.Based on FMEA model 240 elderly patients who were investigated in the previous status were chosen in the control group,and 240 patients who were admitted to the hospital for bowel cleansing preparation after July 2021 were in the observation group.The observation group used FMEA-based bowel cleansing practice.The intervention was carried out according to the plan,and the outcome indicators such as the quality of bowel cleansing,the compliance and satisfaction of patients,and the incidence of adverse reactions between the two groups were evaluated.All data were analyzed by SPSS23.0for statistical analysis.Results:1.In this study the incomplete intestinal cleansing rate was 27.08% in the elderly patients(BBPS score<6 points).By analyzing the data of patients with unqualified intestinal preparation and univariate analysis of possible factors,we found that high-fiber diet within 24 hours,previous constipation history(OR=8.142,95%CI:2.750～24.109,P<0.001),last stool trait(OR=0.335,95%CI:0.122～0.921,P=0.034),activity time(OR=0.013,95% CI :0.001～0.111,P<0.01),social support(OR=0.026,95%CI:0.004～0.162,P<0.01)were highly related to poor intestinal quality in elderly patients.2.Under the guidance of the FMEA,4 priority failure modes were found by calculating the risk priority number:(1)Inadequate evaluation of the patients,(2)insufficient activity,(3)unqualified diet,and(4)irregular PEG configuration.Find the root cause,formulate improvement measures,build an FMEA model for the elderly pre-colonoscopy bowel cleaning care plan,and optimize the elderly bowel cleaning process.3.FMEA model-based bowel cleansing nursing scheme for the elderly before colonoscopy was implemented.The results showed that the quality of bowel cleansing in the observation group was better than that in the control group,with statistical significance(P<0.01).The medication compliance and dietary compliance in the process were higher than those in the control group(P<0.05).At the same time,the satisfaction of patients in the observation group and the acceptance of repeat bowel cleansing were significantly higher than those in the control group(P<0.05).The incidence of abdominal distension in the observation group was significantly lower than that in the control group(3.33% VS 10%,P<0.05),and the difference was statistically significant.There was no significant difference in the incidence of other adverse reactions,such as nausea,vomiting,abdominal pain,dizziness and headache,P> 0.05.Conclusions:1.High-fiber diets within 24 hours,histories of constipation,the last stool,activity time and social support are the influencing factors of intestinal cleansing in elderly patients.2.FMEA model can identify potential risk factors in the process of bowel cleansing in the elderly,analyze the root causes and formulate improvement measures,which can continuously optimize the nursing program of bowel cleansing before colonoscopy in the elderly,and continuously improve the quality.3.The use of the FMEA-based pre-colonoscopy bowel cleansing nursing program for the elderly for bowel preparation can significantly improve the quality of bowel cleansing in the elderly,and at the same time improve the compliance and satisfaction of the elderly patients with the bowel cleansing process.The patient’s acceptance of repeat bowel cleansing improved.