Online education module helps staff deal with adverse contrast reactions

An online education module could help improve patient care in the event of an adverse reaction to contrast media, as this type of didactic instruction has been shown to increase knowledge and comfort level among medical staff in managing contrast reactions.

“The inability to successfully treat a patient during at least the initial stages of an adverse reaction to contrast media may result in poor patient outcomes and is considered below the standard of care, exposing radiologists to potential medicolegal liability,” wrote Bethany L. Niell, MD, PhD, Massachusetts General Hospital, Boston, and colleagues. Their work was published in the February issue of the Journal of the American College of Radiology.

Adverse events from contrast media are rare; the overall incidence of adverse events related to low-osmolality ionic and nonionic contrast media are between 0.2-0.7 percent, with gadolinium-based contrast resulting in adverse events in 0.02-2.4 percent of cases, according to the authors. Because of the rarity of such events, the majority of personnel in radiology departments would not have had to be involved in the treatment of an adverse contrast reaction.

Niell and colleagues sought to evaluate nurses, technologists and physicians at their organization to determine their level of knowledge and comfort with dealing with contrast reactions. After this baseline assessment, personnel completed an online educational module regarding contrast administration. Knowledge and comfort levels with treating contrast reactions were then reassessed following completion of the module.

The initial evaluation revealed knowledge gaps related to the rarely-encountered event. Prior to accessing the educational module, 58 percent of physicians knew the medication of choice for contrast reactions was epinephrine, and less than half knew the correct dose of 0.3 mg.  At baseline, 40 percent of residents, 37 percent of fellow physicians, 44 percent of attending physicians, 46 percent of technologists and 27 percent of nurses reported feeling uncomfortable with treating a patient for an adverse contrast reaction.

After completing the educational exercise, physicians demonstrated growing knowledge of contrast reactions, with 95 percent able to identify the medication of choice and 84 percent able to select the correct dosage. The overall comfort level with dealing with contrast reactions also rose significantly among personnel.

Despite the gains, Niell and colleagues noted that 19 percent of personnel, including 14 percent of physicians, reported feeling uncomfortable treating patients experiencing an adverse contrast reaction, indicating that didactic instruction alone may not be enough to improve knowledge and comfort levels. The authors suggested that additional education in the form of high-fidelity simulation cases could be a way to better prepare personnel for contrast emergency management.