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DEVELOPMENT OF A NURSE ASSESSED PATIENT COMFORT SCORE (NAPCOMS) FOR COLONOSCOPY
A Rostom, C Dube, M Rutter, R Hilsden, R Bridges
University of Calgary, Calgary, Alberta
Aims: Patient safety and comfort are important measures of colonoscopy quality that interact closely with other auditable outcomes. Patient comfort and expectations during the colonoscopy experience directly impact their acceptability of the test, a factor which is particularly relevant to adherence to colorectal cancer screening strategies. There is a balance between quality indicators such as cecal intubation rates and patient comfort and safety. It is possible that an endoscopist or service value high cecal intubation rates as their primary measure of quality, while sacrificing patient comfort or safety, or vice versa. To date, there are no validated instruments or scales to measure patient comfort during colonoscopy. The purpose of this study is to develop and validate a Nurses Reported Patient Comfort Scale to provide an objective assessment of patient comfort and level of sedation during the endoscopic procedures.
Methods: An expert panel of 7 endoscopists and 4 nurses from Canada and the UK, selected a series of candidate parameters for inclusion in the scale derived from the modified Gloucester Discomfort Score. Using an iterative modified Delphi approach, each parameter was voted on for inclusion, then voting was carried out on the wording and anchors for each item. The process was stopped after no further changes were suggested.
Results: The final scale includes domains for pain; sedation level; and global tolerability. The pain component is subdivided by intensity; frequency and duration, each with a score of 0 to 3 along with anchor descriptors. The total pain component varies from 0 to 9 with 0 being a pain free procedure and 9 being a procedure with frequent, intense, long duration pain episodes. Sedation level is rated from 0 (alert) to 3 (unresponsive). Global tolerability is rated from very well to poorly tolerated.
Conclusions: A nurse administered colonoscopy comfort score has been developed with content and face validity. Further prospective validation and reliability assessment are currently underway in the UK and Canada.