We thank Fallis et al for their observations on our pathway and paper. To answer their specific points, this study was carried out before the National Patient Safety Agency (NPSA) alert was issued. However, our patients collect their bowel preparation from a nurse at the endoscopy unit prior to the procedure. Patients are asked by the nurse whether they have any potential contraindications to bowel preparation as discussed in the NPSA guidance.1 After the NPSA alert was issued we also changed the referral form so that general practitioners are prompted to answer questions about co-morbidities and to request a blood test that will be available on the computer system when the patient attends the nurse appointment to collect the bowel preparation. If there is any potential problem, the case is discussed with an endoscopist present within the endoscopy unit and the preparation is given only if it is safe to proceed.
With regards to Fallis et al's second point pertaining to consent, patients are sent a booklet describing the risks and benefits of colonoscopy at the time the appointment is booked. Patients are also specifically informed that they can discuss the procedure or raise any concerns either when collecting the bowel preparation or immediately before the procedure. We feel that this ensures valid consent as recommended in the General Medical Council and Department of Health guidelines.2,3
In summary, we feel our pathway allows rapid access to the gold standard diagnostic investigations in an appropriate, safe and timely fashion.
References
- 1.National Patient Safety Agency. Reducing Risk of Harm from Oral Bowel Cleansing Solutions. NPSA/2009/RRR012. London: NPSA; 2009. [Google Scholar]
- 2.General Medical Council. Consent: Patients and Doctors Making Decisions Together. London: GMC; 2008. [Google Scholar]
- 3.Department of Health. Reference Guide to Consent for Examination or Treatment. 2nd edn. London: DH; 2009. [Google Scholar]