The research cycle: assessing the effectiveness of an intervention on the bowel preparation dispensing process

Shannon L. Edwards

BPharm | Acting Dispensary Manager, Cairns and Hinterland Hospital and Health Service | shannon.edwards2@health.qld.gov.au

[Pharmacy GRIT article no: 20241397]

Cairns Hospital Pharmacy Department dispenses 50–60 bowel preparation kits each week to patients undergoing a colonoscopy. A successful colonoscopy relies on effective bowel preparation to clear the colon of faeces.1 Poor bowel preparation may result in failure to detect abnormalities in the bowel including but not limited to adenomas and colorectal carcinoma,1 highlighting the importance of effective patient education. Inadequate bowel preparation occurs in 10–25% of colonoscopies; pharmacists play an important role in encouraging adherence and have the expertise to explain the process in a way that is easily understood by patients.2 Despite the importance of pharmacist involvement in the bowel preparation process pharmacists at Cairns Hospital found the process to be time consuming and a disruption to daily workflow. This research aimed to implement and evaluate a new and improved bowel preparation dispensing process. The intervention was successfully implemented in January 2023 and was assessed for a difference in pharmacy staff time, pharmacist interruptions, and patient waiting time. 

As a AdPha resident pharmacist, I wanted to conduct a project that was going to promote change within my department and benefit patients. When first deciding on my project, while I was tempted to choose a seemingly easy project such as a data collecting audit that does not attempt to implement change, I ended up selecting a project would make a difference to a pharmacist’s day-to-day practice and improve patient safety. I am proud to reflect that nearly 12 months post intervention, the new process for bowel preparation supply and dispensing has remained in place and patient wait times have been reduced.

There were many strengths of this study that will pave the way for future quality improvement projects I am a part of. One strength was that it was completed with minimal interruption to pharmacist and pharmacy assistant workloads. The data collection tool was simple; participating pharmacists, pharmacy assistants, and administration staff found it was easy to use and had minimal impact on their day-to-day tasks.

The main challenge I encountered whilst preparing and planning for this research project was a lack of relevant published literature. I found that there were few similar quality improvement projects published and can only assume that Australian pharmacy departments are implementing great quality improvement projects every year but submitting for publication may be seen as unnecessary or time-consuming. I understand that small scale quality improvement projects can be difficult to publish and the lack of similar published projects made the literature search process difficult. Potentially, local ethics requirements may contribute to this absence of relevant literature. Generally, quality improvement projects do not require local ethics approval or exemption (which is required for publication) and this can be a barrier for later academic publication. It would be good to have a forum for sharing quality improvement projects and our learnings between departments. I hope sharing my results, successes, and challenges may inspire other early career researchers to conduct a small quality improvement project which will implement change within their department.

Throughout this research project I learnt that the process is dynamic, the project did encounter some obstacles which required review and additional processes to be added. Initially, I thought research was linear with a clear beginning, middle, and end, yet what I encountered was a cycle. Although thorough planning occurred, upon assessment it was deemed necessary to slightly reformulate and adjust the planned methods. Although challenging, this process has been rewarding. I feel motivated to be involved in future research and look forward to opportunities that may arise.  

References

  1. Therapeutic Guidelines. Preparation for gastrointestinal procedures in adults [published Aug 2022; amended March 2023]. In: Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited; 2022.
  2. Millien VO, Mansour NM. Bowel preparation for colonoscopy in 2020: a look at the past, present, and future. Curr Gastroenterol Rep 2020; 22: 28.