Zen and the Art of Clinical Transformation- Contrast(ing) Opinions, Part 1

One area of clinical practice that has been scrutinized over the last decade is the treatment and administration of IV and oral Computed Tomography (CT) contrast media.  For years most hospitals considered them, and other contrast media, as non-medications that were harmless and required very little attention or tracking.  In fact, many hospitals continue to consider contrast media as non-medications or treat them as non-medications.  Here we will briefly examine the modern treatment of contrast agents and the challenges that they pose with the electronic medical record.

Coming from a hospital system that began treating contrast agents as a “medication” in 2002, the year I first began practicing as a Physician Assistant, I was surprised to learn of such controversy surrounding contrast as I began doing consulting work 10 years later.  When I recently polled other consultants to learn of their experience with contrast it was clear there is significant variation across the nation on how contrast is treated, ordered, and administered.  In fact, most of the consultant’s facilities I polled currently do not treat contrast as a medication.  This brings us to the first, and perhaps most important, question regarding contrast:  Is it a medication?

One reason that confusion may exist regarding contrast being a medication, apart from the longstanding norm was that it is not a medication, may be that it is often administered by a radiologist or even more commonly a radiology technologist (RT) and not by a nurse.  Luckily, both the American Society of Radiologic Technologist (ASRT) and the American College of Radiologist (ACR) have a similar opinion on the matter.  The ASRT manual has this to say: “[A medication is] any chemical substance intended for use in the medial diagnosis, cure, treatment, or prevention of disease.  Contrast media and radiopharmaceuticals are mediations.”  The ACR takes a similar stand and clearly states that both IV and oral contrast are “medications.”

If these two authorities still aren’t convincing that contrast should be classified as medication then try leaving contrast unsecured during a JHACO audit.  You will quickly learn that they also consider it to be a medication and will site you as non-compliant with the handling of medication, which all must be properly secured.  Of course, when you consider the host of problems that can be caused from the administration of these agents it certainly makes sense for this classification.  From life threatening allergic reactions to renal failure, inappropriate administration of contrast can have devastating affects on a patient’s outcome.

Final Thoughts

Contrast is a medication! I hope that at this point we are all in agreement that contrast must be treated as a medication by today’s standards.  But to truly treat it as a medication in today’s hospital environment it needs to be ordered electronically and populate on the eMAR so that we can take full advantage of interaction checking at the time of it being ordered, as well as interaction checking post-contrast administration when drugs are ordered or attempted to be given post-contrast where harm can occur when given close to contrast (i.e. Metformin).  But determining who should be ordering and documenting the contrast, both oral and IV, brings up a significant process challenge and will be the topic of the second part of this blog.

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