Draft Performance Requirements

MM1 (1 comments )
When an intravenous contrast agent is used in radiology and MRI services and when diagnostic radiopharmaceuticals are used in nuclear medicine services, the organization uses medication protocols in the absence of a pharmacist’s prospective and/or retrospective review of the medication order.

MM2 (0 comments )
Prior to administering Gadolinium based MR contrast agent (GBMRCA), a patient's estimated Glomerular Filtration Rate (eGFR) should be obtained (within 6 weeks prior to Gadolinium administrations) when the patient meets one or more of the following criteria:

History of renal disease. Age = or > 60 years. History of hypertension. History of diabetes. Administration of Gadolinium contrast agent in excess of FDA approved dosing. History of severe hepatic disease or pending/recent liver transplant.

For patients in this last category, the patient's GFR assessment should be nearly contemporaneous with the MR examination for which GBMRCA is to be administered.

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Comments

26 Mar 08 13:13 | LauraMarks said...:
Pharmacy and Radiology in teamwork
At my institution pharmacy and radiology have worked together to create protocols for medication history review, drug/disease interaction with contrast; metformin management; IV incompatability detection and management; contrast administration and ADR monitoring/treatment. My recent research indicates we need to go further into protocols for each type of contrast and move these protocols through the P&T committee. I would disagree with the concept that pharmacy should create these independent of radiology; but the concern that RX wouldn't be competent in the area of contrast is silly.

02 Nov 07 14:00 | NasimKarmali said...:
Does anyone have a protocol in place for the use of contrast in radiology that they would be willing to share? I am particularly interested in how others are tackling the issue of holding biguanides - what process is in place to ensure that the patient resumes their medications?

25 Oct 07 17:45 | LynnElder said...:
agree that if pharmacy is involved in the creation of the contrast protocols, then the radiologist running the procedure is on point to review allergies with the specific patient undergoing the procedure.

22 Oct 07 12:53 | RingerD said...:
I believe that it is critical that the pharmacist be involved in the creation of the protocol for use of the IV contrast. Our hospital has developed a questionaire that addresses the clinical issues that need to be addressed to identify risk factors. Our hospital's process is very similar to the one given by a previous responder, James Machin.

22 Oct 07 08:44 | SharonBradley said...:
While I appreciate the concern for patient flow through a busy imaging department/center, I don't feel we can sacrifice patient safety purely for the sake of expediency. The two concepts are not mutually exclusive.

For outpatient procedures, it may be difficult to obtain the required information prior to performance of the imaging study requiring contrast administration. Imaging departments/centers should work with referring medical staffs and radiologists to consider protocols requiring certain information to be obtained when a procedure is booked. If patients requiring imaging studies are allowed to "walk in" versus being scheduled, then referring medical staffs may need to be educated on the required elements of a prescription for a procedure such as the procedure to be done, the indication for the procedure, and renal function parameters.

Theoretically, inpatient studies should be less of an interruption in patient flow. Notification of the pharmacy when a study is ordered should trigger appropriate reviews.

19 Oct 07 15:17 | MargaretJones said...:
I believe that general Pharmacists are definitely knowledgeable enough and qualified to make decisions about contrast agents. I agree that if they are involved in the creation of protocols then constant overview should not be necessary. The hindrance it would put on patient flow would be tremendous!

09 Oct 07 17:39 | JamesMachin said...:
We use a questionaire derived with pharmacy input which is used to identify risk factors for possible contrast toxicity which is reviewed with the patient prior to contrast administration. If there is a positive answer to any of the questions, the radiologist is informed, and makes a decision on course of action. Creatinine clearance is estimated as well, and if abnormal, the radiologist is also contacted to determine if contrast should be given. The pharmacy is not involved on a per patient basis, and should not be, as this would seriously delay and disrupt patient care. In addition, radiologists, cardiologists and nephrologists are better versed to determine the risk/benefit of using contrast.

09 Oct 07 15:50 | RichardSheriff said...:
In the case of Nuclear Medicine, 80% of the radiopharmaceuticals used in patient imaging facilities are procured from a centralized nuclear pharmacy located outside the hospital. In some cases these pharmacies are up to 150 miles away. It is impractical for a qualified nuclear pharmacist to review the appropriateness of radiopharmaceutical administration without access to patient records. However, assistance can be rendered in policy an dprotocol establishment in reference to drug of choice selection to fit patient criteria.

08 Oct 07 16:01 | ConnieHogrefe said...:
There are many instances where the general Pharmacists are not as qualified/ knowledgeable as the Radiology staff to be adequately involved in the review process. If the Pharmacists, Radiologists, Radiology department work in conjunction to come up with viable protocols, then review by the Pharmacy should not be needed.

04 Oct 07 14:27 | RobO said...:
Pharmacy should not be involved. The physicians and staff in radiology departments should be much more qualified to administer contrast related standards/policies. Renal function should be measured in terms of estimated Creatinine Clearance rather than absolute serum creatinine level. This should apply both to CT and to MRI. There should be clear cut policies regarding temporary stoppage of metformin containing medications following intravascular contrast administration.

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