UMass Memorial Medical Center Department of Radiology Policies/Procedures and or Clinical Guidelines

Transcription

1 UMass Memorial Medical Center Department of Radiology Policies/Procedures and or Clinical Guidelines Policy # Rad2055 IV Contrast in Patients Taking Metformin Developed By: Marcia Amaral, Director Radiology Operations Effective Date: _October 4, 2011 Approved by: Joseph Ferrucci, MD Radiology Chair Applicability: Intravenous administration of iodinated contrast agents in patients taking Metformin Keywords: IV contrast; Metformin Approved by: Kathryn Green, Sr. Director Radiology Rescission: Supersedes policy dated: April 8,2008 I. Policy: The management of patients taking medication containing Metformin who require the administration of iodinated contrast media includes the following components; 1. Review of the patients up to date medication lists for medications that contain metformin as part of the medication reconciliation process. 2. Provide information and instructions to the patient to discontinue the use of any medication that contains metformin until they speak with their physician. II. Definitions: Medication Reconciliation; A process of comparing new medications orders (to administer an IV contrast agent) to medications the patient is taking, following the guidelines of UMass Memorial Medical Center Policy# 2224 Medication Reconciliation. Metformin; a drug used for management of diabetics which carries a risk of serious side effects i.e. lactic acidosis when iodinated contrast agents must be administered. This drug should be discontinued before intravenous iodinated contrast is given and resumed two days (48 hours) after the study. If renal function is abnormal, the time intervals should be 4 days. Metformin should be reinstated only after renal function is found to be normal. Iodinated Contrast: A universally used intravenous contrast material that is well known to cause allergic reactions and decline in renal function. III. General Procedure (if indicated): The technical staff review the medication list for each patient prior to the administration of an IV contrast. For patients that are found to be taking medication that contains metformin instructions to stop the medication for 48 hours after the exam are provided to the patient at the end of the exam.

2 IV. Clinical/Departmental Procedure (if indicated): CT and Diagnostic Radiology ; 1. Out patients who are scheduled to undergo an exam or procedure whereby an IV contrast agent is administered are asked to bring a list of current medications with them. A Custom Medication Worksheet that includes the patients medication list will be printed from Allscripts and available for the patients to review. On arrival patients are asked to review and edit the medication list with up to date changes. For patients whose PCP does not have Allscripts access a worksheet will be provided to the patient to enter their home list of medications. In the event of an Allscripts downtime, patients are asked to fill in the name and dose of their medications onto the hospital Ambulatory Home Medication form (Appendix A, form # ) on arrival. 2. The patient s name and medical record number must be clearly written, printed or stamped on Custom Medication Worksheet from Allscripts or the Ambulatory Home Medication form. 3. Radiologic Technologist are responsible for the review of the medication list and reconciled against the list of medications containing Metformin. Names of patented medications containing Metformin, provided by the pharmacy at UMMHC, are noted on the IV Contrast Questionnaire. The Radiology Technologist must sign the bottom of the Cat Scan Questionnaire in the area dedicated to Technologist and check off that the home medication list has been reviewed. 4. Patients on Metformin who receive IV contrast are instructed to hold the Metformin for two days (48 hours) after IV contrast administration. Patients will be given written instructions upon completion of the exam (Patients Taking Metformin Instructions following Administration of Contrast Media) (Appendix C), and will be advised to contact their primary care or referring physician before resuming. Patients with impaired renal function should have their creatinine level checked by their primary or referring physician prior to resuming Metformin. 5. The Radiology Technologist documents on the IV contrast Questionnaire that the patient has been provided with the instructions to hold the medication until they speak with their physician. If using the Ambulatory Home Medication form the technologists circle the medication(s) to be held. They also must document on the bottom of Ambulatory Home Medication form SEE ATTACHED D/C INSTRUCTIONS sign, print name and date. The staff will then attach D/C Instructions (Patients Taking Metformin Instructions following Administration of Contrast Media) to the patients Custom Medication Worksheet or the patient s copy (yellow) of the Ambulatory Home Medication form. The pink copy of the Ambulatory Home Medication form sent to Medical Records.

3 V. Supplemental Materials: UMass Memorial Medical Center Policy #2224 Medication Reconciliation Policy # Rad2064 Radiology Medication Reconciliation Ambulatory Home Medication form # All scripts Custom Medication Worksheet Metformin instructional discharge form IV Contrast Information Sheet (patient questionnaire) for # NS Rad 0104 VI. References:

4 (APPENDIX A) Ambulatory Home Medication List Page 2 (yellow copy) of Hospital approved Medication Reconciliation Order Form (MROF form # rev 1/08)

5 (APPENDIX B) Radiology Department Inpatients / Emergency Room Instructions for patients taking Metformin following administration of contrast media. RE: MR# Date of Exam: Time of Exam: The combination of contrast and metformin (or a drug containing metformin) could possibly impair kidney function. This means that the patient must stop taking the Metformin medication for 48 hours after receiving intravenous contrast. Your patient should be advised to discontinue medications containing Metformin for the next 48 hours. Depending on your patient s medical history, a follow up BUN and Creatinine prior to resuming Metformin may be required. For emergency consultation, a Radiologist can be reached at: Memorial Campus: Monday Friday 8am 5 pm After Hours Call University at CT Technologist will direct the call to a Radiologist University Campus: Monday Friday 8 am 5 pm After Hours

6 Radiology Department Outpatients Instructions for patients Taking Metformin following Administration of Contrast Media Dear MR# Today you have just completed your examination with intravenous contrast. The combination of contrast and Metformin (or a drug containing Metformin) could possibly impair your kidney function. This means that you must stop taking the Metformin medication for 48 hours after receiving intravenous contrast. Please call your primary care physician (PCP) for instructions on restarting the Metformin, or to determine if a substitute medication is necessary in the interim. Your doctor may also require that you have a blood test to check kidney function before restarting the Metformin medication. For emergency consultation, a Radiologist can be reached at: Memorial Campus: Monday Friday 8am 5 pm After Hours Call University at CT Technologist will direct the call to a Radiologist University Campus: Monday Friday 8 am 5 pm After Hours