Over the past several months, a shortage of iodinated contrast media has been publicized, which may have an impact on the ordering of special imaging studies. Here are three sets of risk mitigation solutions for addressing this shortage:
Follow ACR Recommendations
The American College of Radiology (ACR) Committee on Drugs and Contrast Media has offered some recommendations to help imaging providers address this issue:
- Use alternative studies with or without contrast appropriate for patient diagnosis and/or treatment
- Use alternative versions of contrast media and/or sourcing from different vendors
- Discuss strategies that may be appropriate for repackaging of higher volume single-use vials (involve infection control and pharmacy)
- Minimize individual doses to reduce waste
- Identify studies for which higher concentration agents are needed for optimal visualization
- Use recognized and approved alternatives to nonionic contrast for oral, rectal and genitourinary administration
- Collaborate with other departments which use iodine-based agents to prioritize use
Consider a Contrast “Time-out”
If in short supply, action should be taken to develop mitigation, prioritization, and procurement strategies in addition to communications with ordering physicians. It is possible that the use of contrast media substitutions in drug, concentration and/or indications may lead to confusion with resulting administration errors. It is recommended that a ‘contrast time-out’ is added to any imaging procedure to assure that the correct agent, amount, and concentration is being used.
[H2] Document Clearly in Patient Medical Records
Physicians Insurance recognizes the concern that may arise for malpractice exposure if a study with contrast is indicated, and contrast media is not available, or substitution is utilized. In such circumstances, documentation can be a critical risk mitigation solution. We recommend that patient medical record documentation include:
- The healthcare crisis impacting patient care
- Alternative studies considered and utilized in accordance with any revised clinical guidelines
- Patient factors taken into consideration
- Shared decision-making with the patient
- Any contrast media deviations from normally used studies including the agent, dosage and concentration
- Confirmation of procedural “Time out” prior to administration of the contrast media
- Plans for future care
Please feel free to contact your risk management consultant for further assistance.
Resource: Journal of the American College of Radiology, Volume 19, Issue 7, July 2022, Pages 834-835. Statement from the ACR Committee on Drugs and Contrast Media on the Intravenous Iodinated Contrast Media Shortage - ScienceDirect