Reducing risk of harm from oral bowel cleansing solutions

This Rapid Response Report alerts healthcare organisations to risks of death and harm from electrolyte abnormalities, dehydration and serious gastro-intestinal problems following the inappropriate use of oral bowel cleansing solutions prior to surgery and/or investigative procedures.

Products include Picolax®, Citramag® , Fleet Phospho-Soda®, Klean Prep®, and Moviprep®. Harm from these medicines results from lack of clarity in relation to who is authorising the use of these medicines and who is authorised to supply them.

The National Reporting and Learning Service received one report of a death and 218 patient safety incidents involving the use of bowel cleansing solutions up to January 2009. The Medicines and Healthcare products Regulatory Agency received 11 fatal outcome reports and 44 reports up to 2005. These indicate electrolyte imbalance or dehydration due to inappropriate fluid intake or use of these products where there is a clinical contraindication.

All healthcare organisations using bowel cleansing solutions should ensure that:

• A clinical assessment is undertaken to ensure that there is no contraindication or risks from the use of a bowel cleansing solution.
• Use of a bowel cleansing solution is authorised at the same time as the surgery or investigative procedure.
• An explanation on the safe use of the product is provided to the patient or carer.
• A safe system exists that involves an authorised clinical professional in the supply of the medicine and written information for each patient.