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The next ARNA annual convention is March 2007 in Seattle, WA. ARNA has updated not only their website to include some new member forums, but also has revised the core curriculum (still costs $75). The American College of Radiology is an excellent resource for standards on Contrast Media Administration. Now that JCAHO considers contrast a medication, there are many standards and patient safety goals that need to be incorporated into the radiology RN's practice: medication reconcilliation; pharmacy review of orders, etc... Taking care of your patients of course is priority; but you will soon wonder how the department ever ran without a nurse! Your role will constantly grow and expand to include policy and procedure creation/revision as well as being an all around resource person! Good luck!

Evidence supports the use of vitamin K as referenced above. Rather than holding coumadin 3-5 days or starting Lovenox. We have patients hold coumadin the night before and then take a 5 or 10 mg po vit k, depending on their most recent PT/INR. Very effective. Plavix has caused us some grief. When doing lung or liver biopsies, the Radiologists want the patients off of plavix for at least a week. However, if the patient has a known drug-eluding coronary stent in place- the cardiologists say Do Not take my patient off plavix and find a radiologist who will do it despite the plavix...

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.

We also created pre-printed scripts that can be called into a pharmacy or handed out at the front desk- (prednisone and benadryl). Another option is a quick prep (set of pre-printed orders) we do for add-on cases etc. with IV methyl-prednisone, benadryl, and pepcid. Our radiologists have been great about signing orders/scripts.

RN's provide all of the Moderate Sedation in our Radiology Department with the exception of pediatric MRI Scans. All pedi MRI exams are done under general anesthesia. We follow a housewide policy outlining the procedure. All physicians involved in Moderate Sedation do have to be "credentialled" however ACLS is not required provided they have completed some other sort of airway management or inservicing... Our anesthesia docs were directly involved in the creation of the policy and provide the oversight for credentialling. It is good for 2 years.Our Rads must complete a sedation plan of care indicating their intent for sedation (be it for anxiolysis or truly moderate sedation) and document an ASA status. An H&P is required also. Our radiologist are not compliant with this so we try to provide an H&P from the referring Doc. It has to be less than 30 days old- or the Rad's have to update the H&P. In an effort to help the docs, we do provide a short form H&P that is basically fill in the blank. Regarding scales: We use Aldrete for discharge criteria and the Ramsey for sedation scale.

A situation arouse recently that resulted in the question "What is your standard of care for groin site preps?" Realizing everyone in our department does it a bit differently, I had to admit that we do not have "Standards of Care" that direct all staff through the same process for procedural care in the angio suites. At least it is not documented. Naturally, we have department wide P&P- but nothing that is so specific for this particular modality. ARNA has left me wanting for SOC also- so many are based on OR standards that are not applicable in the Interventional Radiology suites- and they are old. What is the recommendation out there so I don't have to re-create the wheel?