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Adult patients undergoing cardiac surgery at Baystate Medical Center (BMC) are required to perform a mechanical bowel preparation prior to surgery, but this practice is not required at other major cardiac centers in the United States. The assumption is that a pre-operative mechanical bowel preparation will decrease the incidence of post-operative ileus. However, this practice is not without risk and unwelcomed sequelae. Mechanical bowel preparation may be a safety risk for a patient with an unsteady gait or those medically compromised. In addition, patients undergoing cardiac surgery have expressed dissatisfaction related to a pre-operative mechanical bowel preparation. This practice is also labor intensive as it requires nursing instruction and assistance with toileting. This project sought to determine if there was evidence to support the practice and theory that mechanical bowel preparation decreased the incidence of a post-

operative ileus in adult cardiac surgery patients. A systematic review of the literature was undertaken to evaluate evidence-based practice on the use of pre-operative mechanical bowel preparation at major cardiac centers. The review revealed that there is no research specifically related to patients undergoing cardiac surgery, however, the review revealed that other specialties, such as colorectal and GYN, do not support the practice of pre-operative mechanical bowel preparation. Results of this review will be shared with the Heart &Vascular leadership team and all stakeholders in order to make an evidence-based decision regarding this practice. By terminating this practice, it is hypothesized that patient safety and patient satisfaction would increase and that BMC would save money by (1) eliminating the need to purchase the product for mechanical bowel preparation, and by (2) eliminating the nursing time spent educating patients on how to use the product. If the process is terminated, a performance improvement study will be undertaken to quantify the hypothesized decreases in post-operative ileus and commensurate cost, and increases in patient and nursing satisfaction.