Abstract
Introduction Patient comfort is an important part of endoscopy and reflects procedure quality and
endoscopist technique. Using the validated, Nurse Assisted Patient Comfort Score (NAPCOMS),
this study aimed to determine whether the introduction of NAPCOMS would affect sedation
use by endoscopists.
Patients and methods The study was conducted over 3 phases. Phase One and Two consisted of 8 weeks of endoscopist
blinded and aware data collection, respectively. Data in Phase Three was collected
over a 5-month period and scores fed back to individual endoscopists on a monthly
basis.
Results NAPCOMS consists of 3 domains – pain, sedation, and global tolerability. Comparison
of Phase One and Two, showed no significant differences in sedative use or NAPCOMS.
Phase Three data showed a decline in fentanyl use between individual months (P = 0.035), but no change in overall NAPCOMS. Procedures involving trainees were found
to use more midazolam (P = 0.01) and fentanyl (P = 0.01), have worse NAPCOMS scores, and resulted in longer procedure duration (P < 0.001). Data comparing gastroenterologists and general surgeons showed increased
fentanyl use (P = 0.037), decreased midazolam use (P = 0.001), and more position changes (P = 0.002) among gastroenterologists.
Conclusions The introduction of a patient comfort scoring system resulted in a decrease in fentanyl
use, although with minimal clinical significance. Additional studies are required
to determine the role of patient comfort scores in quality control in endoscopy. Procedures
completed with trainees used more sedation, were longer, and had worse NAPCOMS scores,
the implications of which, for teaching hospitals and training programs, will need
to be further considered.
