[SWAT_RN]

Has anyone found the solution to the "new" standard for contrast management?
We are having an awful time trying to be in complience.

[sunnymqt]

I don't know what standard your talking about??

[veegeern]

I'm not sure what you're referring to, but we just implemented at new policy so that contrast shows up as given in EMAR. Our radiology techs come to the floor and administer the contrast, and I think that they're the ones who document that it was given. Not sure...will have to read that email again. Anyway, it shows up in the EMAR as given, and the nurses aren't documenting it.

[radman]

Do you mean contast management or med reconcilation? I have been to several radiology conferences in the midwest pre-CRN test in Feb, and most areas were just thinking about it or never heard of it. Our rad dept is currently in the process of working on something similiar to OSU's. Risk management and pharm are currently reviewing it.

[aguthrn]

I believe that everyone is talking about the new JCAHO standard on Medication reconciliation. This standard is new for 2006 and includes all encounters in the hospital setting.

It is my understanding that this JCAHO standard indicates that all patients that enter the hospital, regardless of in-pt or out-pt status, must have a reconcilation of their medications upon arrival and again prior to discharge. The standard indicates that this is necessary in the out-patient setting as well if the patient has any medication administration during this visit (including, but not limited to contrast). So I think simple imaging studies not requiring contrast or other medication administration would be the only ones exempt from this process.

This new standard presents a major RN staffing issue within the Radiology Department. As we are all aware that in larger facilities with current staffing ratios, it would be impossible to meet this standard.

Another major concern with this that I have is that the standard reads that this reconcilation can be done by a Nurse, Physician or Pharmacist. It also states that the medications must be reconciled to include the following information: Medication, Dose, Frequence and Next dose due. The Radiologist, who does not have a general medical knowledge of these patients are not going to be willing to assume the responsibility of reconciling medications for all of these patients.

When I spoke with the Director of pharmacy, I was advised that it was not very practical to have the in-patient pharmacist do the reconcilation as it would be very timely and potentially delay the procedure for more than an hour.

As for the RN's, they can reconcile what the patient/family member states they are taking upon arrival, but then would need to advised them which of those medications to resume upon discharge. This would in effect be ordering medications which is outside our scope of practice.

If anyone has a head start, please let me know, as I would welcome any advise. I work at a hospital with a very busy Radiology Department and can not imagine the total impact that this is going to have.

[TNnursejane]

Are you talking about that the radiologist needs to be in the room when contrast is given??? That has been a rumor that we heard and I haven't heard any further. But it's always been as long as their is a radiologist is on the department then the techs push the contrast.

As far as the contrast being treated as a med, that's what i understand is the JCAHO standard now, that it is considered a med and has to be treated as such. I'm new in the department I'm working and I'm the lone rn. I'm working on documentation of the contrast dose, route ect...

[aguthrn]

What they are saying right now is that the radiologist who doesn't even lay eyes on the the patient for CT with contrast must review all medications taken by the patient and advise which ones are to be resumed post imaging. Patients are frequently gone prior the exam being looked at by the Radiologist (unless it is a protocol for stat read).

I have spoken with the Manager of our pre and post surgical unit and they are battling this as well, because physicians don't want to take responsibility for medication they are not prescribing, especially surgeons/radiologist that are not managing the daily care of these patients. They traditionally advise the nurses to contact the physician that ordered the medication. Since patients routinely are on multiple medications sometimes ordered by various different doctors, this is problematic and time consuming. For nurses who are already being pressed to get those out-patient's in and out, not only for patient satisfaction, but for optimal bed utililization this can and will be over whelming.

Very frustrating for us all.

[hawks5]

The first step is to identify why this standard would be important in an outpatient imaging setting: 1. Risk for renal impairment 2. Risk for invasive procedures with patients on anti-coagulation etc... Those are two reasons why I can understand the need for some sort of reconciliation in Radiology. How do we accomplish this is the problem. I agree with "aguthrn"- there are not enough nurses and time, and certainly not enough cooperation and understanding from the Rad's. I think there will have to been an expectation that all patient's scheduled for a contrast study, bring in a list of medications- or fill out a list on arrival. There will need to be an order set or pre-printed order that the Radiologist signs after review of the patient's meds and risk factors as well as an area on the medication list for the Radiologist to make a mark indicating: 1. Refer to primary physician. 2. Resume all medications. 3 Hold glucophage containing meds for 48 hrs or 3. Other:.... It's not an easy answer- I'm anxious to see what others are doing.

[DutchgirlRN]

Where would I find a copy of these guidelines? When I work at the hospital our computer prints out our admit and dc med reconciliation forms. When I work in the outpatient imaging center our history of meds only includes allergies and whether or not they are on Avandmet, Metformin, etc....

Patient do not bring med lists with them. I can't imagine what a pain this would be if we had to do med reconciliations in the center!

[NRSKarenRN]

Great powerpoint presentation:
2005 JCAHO National Patient Safety Goal Requirements


From JCAHO.org:

Goal 3 (Medication safety)

Goal 8 (Reconcile medications)

• The Medication Reconciliation Process Flow Chart

Is this just an inpatient requirement?

No, it is not just for inpatients. As the Goal states, it applies “across the continuum of care.” Any time a patient enters a health care organization—whether an emergency department, an

ambulatory clinic, a home care service, or other setting or service—if medications are to be used or the patient’s response to the treatment or service could be affected by medications that the
patient has been taking, then this Safety Goal applies. [New, 2/06]