The Implementation of Visual Instructional Cards Improve Patient Compliance on Bowel Preparation for a Colonoscopy

By YU Oi Yi, Janet, MSc, BSN, RN, Digestive Medicine Centre (DMC)


Digestive medicine centre has diverse patient population: English speaking, Cantonese speaking or some patients do not know both English and Chinese. Patients are asking for colonoscopy as it is important for screening colorectal cancer. Colorectal cancer is second leading cause of death in Hong Kong and third leading cause of death in the world. In order to have successful colonoscopy procedure, it is dependent on bowel preparation of patient and strict diet restriction.

According to the literature, many patients reported experiencing unpleasant, difficult and disruptive care during the bowel preparation process for a colonoscopy. Up to 25% of patients are not given adequate bowel preparation instructions. A visual educational leaflet may increase patient understanding of the procedure and improve bowel preparation.

Purpose and Problem Statement

Currently, we provide written instructions for patients for patients who are undergoing colonoscopy procedures. The PICO question is: Does the implementation of visual instructional cards improve patient compliance on bowel preparation for a colonoscopy?

Implementation Plan

Four visual instructional cards were implemented with simple Chinese and English wordings. The four visual instructional cards are: how to take pico-prep, how to take klean-prep, the ready of the stool color for colonoscopy and the importance of a clean colon.

These instructioal cards were used in three centres: digestive medicine centre, gastroenterology and hepatology centre and endoscopy centre with focusing on two physicians’ cases: Dr. On On CHAN and Dr. Shing Jih HSU.


The results were gathered in September 2018. Total 91 cases were reviewed and surprisingly found that 86% cases have good bowel preparation while there is no report without mention how the bowel preparation is. To compare with the same period with 127 cases reviewed by not using the visual instructional cards for bowel preparation education, there are only 37% cases have good bowel preparation and 27% cases did not mention the bowel preparation status.

A questionnaire is distributed to both patients and nursing staff by asking how useful they found the visual instructional cards with 5 Likert-scale rating from 1 (not useful) to 5 (very useful). 54 patients replied with all the four images mean score over 4.5 and 14 nursing staff in three different centres replied with all the four images mean score over 4.3. It shows that the four visual instructional cards are really useful for bowel preparation for colonoscopy to both patients with better understanding and staff for easy interpret.

Recommendations and Next Steps

In the future, the visual instructional cards can be used for both inpatient cases and outpatient cases. The cards can be used in other centres including OPD or the surgery centre where colonoscopies are frequently scheduled.

To create visual instructional cards specific to post-operative care for better understanding and improve nursing education to patients.