sigmoidoscopy+standardized+workflow

Standard workflow for scheduling a Sigmoidoscopy

(For simpler instructions for referring your patient for a flexible sigmoidoscopy, go to the Gastroenterology page) Approved by APC 12/17/09 At referring site: i. Documented iron deficiency anemia (absence of this condition does not need to be confirmed prior to sigmoidoscopy scheduling) ii. Positive fecal occult blood iii. Upper colonic bleeding (i.e. blood mixed with stool) iv. One 1st degree relative with colon cancer or advanced adenoma prior to age 60 v. Two or more 1st degree relatives with colon cancer or advanced adenoma at any age vi. Long-standing inflammatory bowel disease At sigmoidoscopy site:
 * 1) Provider orders sigmoidoscopy with MR-191 or MR-263 as indicated for colon cancer screening or diagnosis of lower colon symptoms:
 * 2) In general, colonoscopy rather than sigmoidoscopy is indicated if any of the following are present:
 * 1) Provider prescribes bowel prep medications
 * 2) Standard prep is two (2) bottles of Citrate of Magnesia (4 ounces each) and four (4) Bisacodyl tablets (5 mg each)
 * 3) For patients with significant renal impairment (i.e. Cr>2.5), consider avoiding Citrate of Magnesia (Magnesium is renally excreted) and instead prescribe one (1) gallon of polyethylene glycol (Golytely) and two (2) tablets of metoclopramide 10 mg.
 * 4) Nurse/MA schedules patient in Epic. If no appointments are available patient is placed on the FLEX SIG waiting list in Epic. Place patient only on the sub-list for the patient’s county region, Central, East or West (patients will be offered appointments in any available region regardless of the region the patient is listed on). Nurse MA enters to indications for the referral (from the MR-191 or MR-263) into Epic if patient is being scheduled at another site or placed on the waiting list. Do not schedule patients into the Gastro CONSULT ONLY waiting list.
 * 5) MA gives patient bowel prep instruction sheet, filling in the dates for each step of the bowel prep.
 * 1) One to two weeks before scheduled appointment, nurse/MA contacts patients to:
 * 2)  confirm they are able to keep their appointment
 * 3) confirm they have gotten their bowel prep instructions and medications
 * 4) answer any questions patients have about the procedure or bowel prep
 * 5) If the patient is not able to keep their appointment the appointment is cancelled and the patient is rescheduled if desired by the patient.
 * 6) If patient has not received the bowel prep instructions or prescriptions, the nurse/MA will mail the patient a new set of instructions and/or prescriptions.



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