A colonoscopy is a medical procedure used to screen for colon cancer. It’s recommended for people with a personal history of colon polyps (benign growths that can turn into cancer), a family history of colon cancer, or a positive Fecal Immunochemical Test (FIT). Colonoscopies are considered to be relatively safe, but there are some risks associated with the procedure.

Although rare, perforation of the bowel is one of the most serious complications of colonoscopy. People with a pre-existing medical condition such as Crohn’s disease or ulcerative colitis are more susceptible to perforation, but it can happen to anyone. And while patients are well-educated prior to the procedure and informed of possible complications, Cathy Clackson, Director, Endoscopy Program, Island Health, believes we need to learn everything we can about the circumstances surrounding bowel perforations, and how to prevent them from happening, to keep patients safe.

“People often choose to have a colonoscopy because their doctor advised them to, or they’re worried about getting colon cancer because someone in their family had it. It’s usually a voluntary decision to go have a colonoscopy. It must be done well and with the highest attention paid to the patient’s comfort and safety, regardless of any medical condition they might have.”

According to Cathy, approximately 31,000 colonoscopies are performed each year at hospitals and clinics across Island Health. Bowel perforations occur infrequently, approximately 5 out of every 1,000 tests, but Cathy says BC PSLS offered her and her team a way to dig deeper into these events to learn more about them.

Island Health Endoscopy Program

(left to right) Dr. Zandieh, Gastroenterologist; Daniel Asfaw, LPN; Corrie Osborne, CNL

“I worked with our Quality and Safety team last fall to make changes to BC PSLS. Now, all patient safety events at Island Health that involve a bowel perforation (iatrogenic injury) are assigned a degree of harm of 3 (moderate harm) and forwarded immediately to me for review through the automatic notification feature in BC PSLS. There are eight of us looking at these events now, including a physician partner I reach out to when I see something concerning. We discuss these cases at our quarterly Quality Council meetings.”

Since implementing these small changes, Cathy says there’s a heightened level of awareness about the seriousness of bowel perforations among frontline staff.

“There’s a higher comfort level out there now with reporting these events in BC PSLS. We all want Island Health to have a high-functioning Endoscopy Program – what we’re trying to do is all very positive and staff understand that. They know we’re reviewing these cases so we can improve safety for our patients.”

Cathy says physicians are also engaged and actively participating in a new educational program called the Direct Operation Procedure (DOPS), which gives physicians the opportunity to be assessed on their colonoscopy technique by their peers.

New partnerships with Emergency Departments across Vancouver Island are helping to raise awareness among staff of the signs and symptoms of bowel perforation. “If a patient arrives in an Emergency Department with severe abdominal pain one or two days after a colonoscopy, there’s a possibility it’s related to the procedure.”

Cathy is encouraged by the work they’re doing at Island Health and is hopeful that provincial standards will one day be established.

“I think what we really need is consistent language and processes for colonoscopies across the province. We’ve done really well at educating the public around the importance of getting screened for colon cancer, so I’d like to see us go further as a healthcare system. It’s really about getting information back to the frontline and we’re making every effort to do that at Island Health.”

Special thanks to Cathy Clackson and the Island Health Endoscopy Program for sharing their story with us.

Congratulations on your achievements! 

Cathy would like to acknowledge frontline staff across Island Health for their ongoing support and dedication to safe patient care through the Endoscopy Program.

Cathy Clackson has been with Island Health for 33 years and has held several leadership positions throughout her career. She was appointed Director of the Endoscopy Program in 2015. Prior to her current role she was Director of Island Health’s Surgery Program.

To learn more about this project and the Endoscopy Program, you can reach Cathy by email at

To learn more about colon cancer screening and colonoscopies, please visit:


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