Date of Award

Spring 5-23-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Kevin Maxwell PhD, DNP, FNP-BC, RNend



Introduction: The purpose of this evidence-based practice (EBP) Doctor of Nursing Practice (DNP) project is to improve overall patient satisfaction scores, patient safety and education retention postoperatively. The aim is to provide patients with the opportunity to review their discharge instructions and seek clarification prior to their procedure.

Background: Roughly 75 million endoscopies are conducted annually in the United States. The majority, 68%, are gastrointestinal endoscopies. Routine endoscopy procedures such as a colonoscopy or esophagogastroduodenoscopy utilize moderate sedation which is often a combination of midazolam and fentanyl. This combination reduces anxiety and discomfort during the procedure. The amnesic effects of midazolam which may linger, pose challenges to patients and families. Current practice is to provide discharge instructions to patients after their procedure. Family members are restricted from the immediate post procedure area where the discharge instructions are given. The post-procedure recovery time is 30 minutes from the time the last sedation medication was administered. Patients have reported feeling overwhelmed waking from sedation, getting dressed and receiving discharge instructions all within less than 30 minutes. They report being unable to comprehend and retain post-procedure discharge instructions. This led to poor satisfaction scores which are tied to hospital reimbursements.

Methods: The 5As behavior change model was utilized for this EBP project. This model guides the process of counseling patients utilizing intervention strategies of Ask, Acquire, Appraise, Apply Assess which are utilized to address and increase patient motivation and behavioral change. A six question Likert survey was utilized as a data collection tool.

Results: There was a total of 35 participants. A paired t-test was used to determine if there is a significant difference between the means of the groups. All of the p-values were < 0.05. Patients have reported increased satisfaction in their care and outcomes postoperatively.

Evaluation: This EBP project can be replicated to other endoscopy outpatient clinics. The results of increased patient satisfaction scores reinforce the need for post-procedural discharge instructions in the pre-operative phase of care. Patients report improved retention of discharge instructions and improved patient satisfaction scores.

Keywords: endoscopy discharge, patient satisfaction, moderate sedation, patient safety, education

Available for download on Thursday, May 08, 2025

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