Department of Medicine

DEPARTMENT OF MEDICINE

GASTROENTEROLOGY LAB

STANDARD OPERATING PROCEDURE ENDCOSCOPY

Patient Preparation

1. Patients are advised to fast for 6 hours before gastroscopy

2. If undergoing colonoscopy, patients are advised to drink plenty of clear fluid after taking a prescribed bowel cleansing agent up to 2 hours before the procedure starts.

3. Pre-procedural investigations such as for HBsAg, Anti-HCV, HIV 1 & 2, RT PCR COVID 19are needed. Specialized investigations like ECG, PT-INR, APTT, RFT are advised when required.

4. Diabetic patients are placed first on the list to reduce their fasting times and patients with other special requirements are catered for accordingly.

5. Patients on anticoagulant therapy receive a bridging plan if required and Clopidogrel is stopped 7 days before the planned procedure. Cardiology opinion is sought if necessary.

6. Patients with implantable devices e.g., Pacemakers must be identified before admission and if necessary, cardiology opinion requested.

Consent

1. Steps of scheduled procedure are explained in the patient’s language along with possible adverse events.

2. Consent for the procedure is taken and documented in Hindi and English.

Infection Prevention

1. HIV Kits/PPE are worn when undertaking procedure.

2. Long hair must be tied back and off the shoulder and all staff are required to be bare below the elbow.

3. Gowns are provided to patients having lower GI procedures

4. Patients with known infection are scheduled for the end of the list minimising the risk of cross infection e.g., patients with MRSA infection.

5. Scopes are decontaminated using Glutaraldehyde solution

6. Standard precautions are taken

7. Endoscopy Suite and equipment are routinely cleaned pre and post use and the domestic department provides a daily schedule of additional work as agreed.

Work Force Requirements

1. Colonoscopy, Flexible Sigmoidoscopy and Gastroscopy = 2 Endosopy Technicians and the Endoscopist

Performing the Procedure

1. Procedure specific positioning is required for upper or lower GI endoscopy e.g., colonoscopy

2. Scope is checked – e.g., light, air, suction

3. Consumable therapeutic equipment checked before use e.g., polypectomy snare

4. Dentures removed for EGD and mouth guard inserted

5. Equipment checks performed before use e.g., lower setting of diathermy confirmed with Endoscopist for right colon

6. Patients with pacemakers are pre assessed and the Cardiology Pacemaker clinic is contacted for advice re management peri procedure if required.

7. Patients will be monitored throughout the procedure and the following observed: -

Prevention of Retained Foreign Objects

1. Sharps used are prepared away from the patient bedside and disposed of post-use as per Hospital Infection Control Policy.

Labelling of Specimens

1. Any specimens taken during procedure are labelled with patient’s details.

2. Specimens are sent along with fully filled investigation forms.

Bowel Preparation for Colonoscopy

1. Do not eat anything 2 hours before starting to take the PEG solution and then until after your test

2. Lunch 12.30 – 1p.m

3. 1p.m Stop Eating

4. 3p.m Begin drinking PEG solution

5. There are 4 Litres of PEG solution to drink which should be taken over 4-6 hours

6. No evening meal – clear fluids only(Water with or without squash, fizzy drinks, clear soups, tea, and coffee, but with no milk).

7. 9p.m. Complete the PEG solution

8. Drink Clear fluids up to 2 hours before your appointment time

PROCEDURE OF PREPARING PEG SOLUTION

1. Fill a jug with 1 Litre (1 ¾ pints) of water and add 1 sachet of PEG

2. Drink a glass every 15 minutes and aim to complete the jug in 1 – 1 ½ hours

3. You can chill the jug of water with PEG in the fridge and/or add squash such as orange, lime, lemon

4. You will start opening your bowels 1-2 hours after starting the PEG solution, so stay near a toilet.

5. You will produce watery bowel movements like diarrhoea

SOP of Teaching

Department of Medicine

1. Teaching of all courses is as per National Medical Council (NMC) Guidelines and under supervision Dean, Faculty of Medicine.

2. Curricula for all courses is duly revised and passed through Board of Studies, Department of Medicine every year.

3. MBBS curriculum is being revised as per Curriculum Based Medical Education (CBME) 2019 as per NMC Guidelines.

4. Courses Taught

5.     Number of Teachers = 15

Professors = 5

Associate Professor = 1

Assistant Professor = 9

Senior Resident = 5

SOP of Teaching

Department of Medicine

1. Teaching of all courses is as per National Medical Council (NMC) Guidelines and under supervision Dean, Faculty of Medicine.

2. Curricula for all courses is duly revised and passed through Board of Studies, Department of Medicine every year.

3. MBBS curriculum is being revised as per Curriculum Based Medical Education (CBME) 2019 as per NMC Guidelines.

4. Courses Taught

5.     Number of Teachers = 15

Professors = 5

Associate Professor = 1

Assistant Professor = 9

Senior Resident = 5

VISION

• To achieve regional and international excellence in the field of Internal Medicine through leadership in medical education, medical care and scientific research.

DEPARTMENT OF MEDICINE

MISSION

• To sensitize the medical students to develop an attitude for Continuous Medical Education and Clinical Research.

• To prepare highly competent Physicians capable of providing comprehensive health care to the community.

• To inculcate ethical values and behaviors that serve to maintain patient interest above physician self interest.