The Pulse | Friday, January 25, 2019

Facilitating the Detection of Adenomas and Preventing Colon Cancer

Wendi McDonough, MSN, RN, CPAN, CGRN

Gastrointestinal (GI) physicians are skilled in detecting adenomas and preventing colon cancer.  However, nurses, technicians and informatics staff contribute to and enhance the doctor’s ability to complete a thorough exam. Here are a few tips for endoscopy nurses and technicians to keep in mind.  

Team Communication and Focus During the Exam

Having all staff focused on the goal of the exam prevents missing important information. We often ask patients, “Why are we doing your procedure today? Are you having any problems or new symptoms you need me to tell the doctor, or is this a routine exam?” If a patient tells me they have been experiencing diarrhea, I will ask the physician at the start of the case, “Are you planning on taking biopsies?” In turn, the physician may tell us the exam is a screening, or if he has plans to look at an old polyp site. These communications ensure we are prepared and to refocus the team. 

Working Together to Increase Polyp Detection

Doctors and their team members are human, and may be distracted by day-to-day duties that can affect the quality of the exam. This includes: conversations during the exam; pages or calls from the hospital, office, or home; and exhaustion from lack of rest, after a difficult case, or a schedule with too many cases.

We have all been in cases where the polyp site is in a difficult location, the colon spasms or moves, or the patient’s condition changes. Quickly setting up for a biopsy increases the chances that the doctor can remove a polyp. I have seen my doctors pause when they see us setting up and ask, “What did you see?” Having all eyes watching the screen decreases the chances of missing a polyp. Staff engagement is essential in increasing quality and polyp detection while still being efficient. 

Utilizing Electronic Medical Records to Determine ADR and Prep Adequacy

After the procedure, the physician documents the indication for the exam (screening, surveillance, diagnostic). Analyzing this data was done by hand before we worked with our information technology team to add areas to the physician’s record where they could simply check the indication of the exam, withdrawal time, and quality of prep. 

One of my next tasks is to determine how often a prep is inadequate, and if this has an impact on our quality and efficiency. A poor prep can increase the complexity of the exam and risk to the patient, decrease the ability to visualize polyps, and increase healthcare spending due to repeating the exam.  Educating patients on the risks of having a poor prep, how to complete the prep, and who to call if they need help during the process is a way nurses can have an impact on prep adequacy and polyp detection.

Further Discussion

What does your team do to increase polyp detection? I encourage you to start a discussion on the SGNA Communities page.