National Patient Safety Goals Kathleen M. Haig, R.N. Staci Sutton, R.N. A Shared Mental Model for John Whittington, M.D. Improving Communication Department Editors: Marcia M. Piotrowski, R.N., M.S., Peter Angood, M.D., Paula Griswold, M.S., Gina Pugliese, R.N., M.S., Sanjay Saint, M.D., M.P.H., Susan E. Between Clinicians
Colonoscopy brochure 3-13.inddInstructions for Colonoscopy Preparation
FOLLOW THESE INSTRUCTIONS FOR YOUR PREPARATION (Ignore
Directions to the Middlesex Endoscopy Center
instructions with the box.) Failure to take the prep as indicated below will From Points North or South result in a poorly cleansed colon and • Take Route 9 to exit 11, the Randolph Road Exit cancellation of the procedure. This
• At the end of the ramp, turn right onto Randolph Road. Proceed to the light at safety and to eliminate the possibility of having to repeat this
the top of the hill.
• Turn left onto Saybrook Road. Proceed down Saybrook Road for about seven tenths of a mile. Pass Middlesex Hospital Outpatient complex.
What You Will Need to Successfully Complete this Prep:
• There will be a sign on your right, HERITAGE MEDICAL CENTER, 400, 410, • Prior to your procedure have your prescription for MoviPrep® fi lled at and 420 Saybrook Road; turn right into the driveway.
• Follow the driveway and bear right to the second level. At the stop sign, turn left.
• Purchase any clear liquids listed below.
• The Endoscopy Center is in the second building. It has a green roof and the letter "D" over the main entrance.
Important information about your procedure DAY BEFORE YOUR PROCEDURE:
• Drink only clear liquids: Clear liquids consist of JELL-O®, apple juice,
From Points East of the Portland Bridge tea, black coffee, clear broth, soda, water, lemonade, Gatorade® • Take Route 66W over the Portland Bridge • Remain straight on Main Street and Popsicles® or any liquid you can see through; AVOID RED AND Your Procedure is scheduled for:
• Main Street turns into Main Street Extension PURPLE LIQUIDS. Solid foods, milk, or milk products are NOT
• Main Street Extension turns into Saybrook Road • Immediately after you go over the overpass there will be a sign on your left, HERITAGE MEDICAL CENTER, 400, 410, and 420 Saybrook Road; turn left THE EVENING BEFORE YOUR PROCEDURE:
into the driveway Beginning at 4:00pm: • Follow the driveway and bear right to the second level. At the stop sign, turn left.
1. Empty one (1) pouch A and (1) pouch B into the disposable container. • The Endoscopy Center is in the second building. It has a green roof and the Add lukewarm drinking water to the top line of the container. Mix to letter "D" over the main entrance.
dissolve. If preferred, mix the solution ahead of time and refrigerate prior to drinking. The solution should be used within 24 hours.
q Directions to Middlesex Hospital
2. The MoviPrep® container is divided by four (4) marks. Every 15 From Points North minutes, drink the solution down to the next mark (approximately eight • Take Route 9 South to Exit 13 (Route 17) (8) oz.), until the full container is complete. (Drinking a glassful as • At the light turn right onto Route 17 quickly as tolerated is better than sipping an ounce or two at a time).
• Turn right onto Crescent Street (this is now a one-way street) 3. After the above steps are complete, drink at least 16 oz. of the clear From Points South liquid of your choice.
Physician Ofﬁ ces
• Take Route 9 North to Exit 12 (Bow Lane) 410 Saybrook Road, Suite 201 • Middletown, CT 06457 • Turn left onto Bow Lane DAY OF YOUR PROCEDURE:
• At the stop sign, turn right onto Saybrook Road 12 Bokum Road • Essex, CT 06426 • Continue a clear liquid diet.
• At the fourth left, turn onto the Route 9 off ramp for Route 17 1291 Boston Post Road • Madison, CT 06443 • Drink the second part of your prep six (6) hours before your arrival • At the light turn right onto Route 17 1353 Boston Post Road • Madison, CT 06443 time following steps 1, 2, 3.
• Turn right onto Crescent Street (this is now a one-way street) 14 Jones Hollow Road • Marlborough, CT 06447 • Do not drink anything four (4) hours before your arrival time!!!
From Points East of the Portland Bridge 825 Meriden-Waterbury Road • Southington, CT 06489 • Take Route 66W over the Portland Bridge • At the light turn left and follow onto Route 9 South Phone (860) 347-4620 • Fax (860) 347-0521 • Take Route 9 South to Exit 13 (Route 17) • At the light turn right onto Route 17 • Turn right onto Crescent Street (this is now a one-way street) If you have any questions please call our ofﬁ ce 860-347-4620. What Occurs During a Colonoscopy?
Colonoscopy Preparation Instructions
Colonoscopy Preparation Instructions (cont.)
During the procedure, your doctor will examine the lining of your colon for Clear Liquid Suggestions You can have any of the following clear,
The Day Before Your Procedure
any abnormalities. If an abnormality, such as a polyp, is discovered, it may • Popsicles® (no red or purple) q For patients having the procedure at the Middlesex
be removed and biopsied, with no discomfort to you.
• Clear broth or bouillon Endoscopy Center
You will need to call the center the day before your procedure, between The procedure is accomplished by providing you with intravenous sedation, • Black coffee and tea (regular or decaffeinated), with no cream, milk, or non-dairy creamer 2:00 and 3:00pm, to obtain your arrival time. The center can be reached
and then slowly passing a flexible tube with a very small camera through at (860) 343-1240. In regard to your medical history, the center will call
the rectum into the colon, also called the large bowel. It is then slowly • Clear juice, with no pulp (apple, white grape, and lemonade) NO you ahead of time.
orange juice is permitted withdrawn, giving your doctor the opportunity to visualize the interior • JELL-O® (lemon, lime, or orange flavor) with no fruit or toppings surfaces. Your doctor will also have the ability to remove tissue. Any tissue For patients having the procedure at Middlesex Hospital
• Gatorade®, Powerade®, or Kool-Aid® (clear, green, or yellow) You will receive a call the day before your procedure, between 2:00 and samples obtained will be sent to a laboratory for analysis. The results of 5:00pm, to obtain your arrival time and to conduct a medical history.
your biopsy will be available to discuss with you in approximately 7 to
• Soft drinks (Sprite®, ginger ale, 7-Up®, cola) 10 business days after your procedure. Because the removal of tissue
The Day of Your Procedure
samples requires breaking the tissue surface, you may notice mild blood NOTE: None of these liquids should have red or purple dyes 1. Do not drink four (4) hours before your scheduled arrival time! smears after your procedure. This should resolve on its own. For this For Patients Taking Coumadin® or Blood Thinners: Please discuss
2. Do not put anything in your mouth four (4) hours before your arrival reason you are also being provided with written instructions that include these medications with your gastroenterologist. You will need to stop time. (i.e. gum, hard candy, mints, ice cubes, etc.) information on taking Coumadin®, Plavix®, and other blood thinners.
taking these medications days before your procedure. Please 3. Dress in loose, comfortable clothing, and do not bring any valuables also tell your cardiologist or primary care doctor prior to stopping your (including jewelry) with you. This procedure is relatively safe with minimal discomfort. Your doctor will Coumadin® or blood thinner.
4. Bring a valid picture ID and insurance card to your procedure.
go over any risks. As indicated above, you will receive sedation prior to Do not take any vitamins, herbal or diet medications prior to procedure.
5. Please note: You must have a responsible adult drive you to and from starting your procedure. The sedative will relax you, make you sleepy, It is recommended that you stop using these 1 week before your
your procedure, and stay with you overnight. Have your designated and decrease any discomfort you may feel. When the procedure is procedure. Please check with your physician regarding any prescription driver arrive to your procedure location two hours after your arrival time. finished you will be brought to the recovery room so that your vital signs and over-the-counter medications that you may take.
This is an estimated length of time. We appreciate your patience; some (blood pressure, pulse, temperature, and respirations) can be monitored. procedures take longer than others. You cannot drive. A taxi or a bus When you are stable, you will be given post-procedure instructions and For Patients Taking Insulin or Oral Hypoglycemics:
can be used after the procedure if an adult accompanies you. If this is not followed your procedure discharged. Please review these before leaving so that all your questions will be cancelled.
may be answered. Additionally, it is absolutely necessary you have someone else drive you to and from your procedure as you will be too At least 2 weeks before your procedure, you need to have the
1. Apply protective ointment to rectal area before starting prep and fatigued or sleepy to safely operate a motor vehicle.
following lab work, and/or an electrocardiogram (EKG) done.*
re-apply as needed (i.e. diaper rash ointment) q Blood Work
2. Use generic baby wipes to help reduce toilet paper irritation. In order for this procedure to be successful, your colon needs to be Take the form (lab slip) to one of the lab facilities listed on the form, cleaned of all waste matter. Therefore it is very important that you follow to have lab work done. Exception: PT/INR must be done in the early your bowel prep instructions carefully. You may contact our office with morning the day before your procedure. Please Note:
any questions. Remember, an incomplete cleaning may require you to 1. Please be aware of your copayments and deductibles. They are due at reschedule your procedure. Take the form (lab slip) to one of the lab facilities listed on the form, the time of service. Call your insurance company for more information.
2. All Non-Medicare patients should ask your insurance company if your coverage changes if polyps are found during your procedure.
q No blood work or EKG is required.
3. Whether your procedure is scheduled at the Middlesex Endoscopy * This testing is neccessary for anesthesia screening. Failure to submit all Center or Middlesex Hospital you will receive charges from the doctor, reports in a timely manner will result in cancellation of your procedure.
facility, pathologist, lab, and anesthesiologist.
Technical University of Crete Department of Electronic and Computer Engineering A thesis submitted in partial fulfillment of the requirements for the degree of Master of Computer Engineering Chania, October 2006 Abstract The availability of large volumes of digital content in modern applications (e.g., digital libraries and organization intranets) and the on internet has generated