Team Member Updates

Important Pharmacy Update: Contrast Shortage

Update – Friday, May 27:

Several ministries within FMOLHS have recently received limited quantities of contrast product. The shortage has not fully resolved. However, we do anticipate receiving more orders to be filled by our wholesalers over the upcoming weeks as GE manufacturers are increasing the supply available to the United States weekly. The system workgroup reviewed current inventory and utilization for each market; restrictions will be slightly modified to incorporate more outpatient orders for contrast while continuing to ask for judicious use across our ministries.

INPATIENT AND/OR ER USE - All Ordering Physicians and LPs Should:

1. Eliminate the use of oral contrast except for suspected post-surgical bowel leakage. Restrict the use of IV contrast to only CT angiograms, IR, Cardiovascular, and Activated Traumas.
2. Order alternative imaging exams if appropriate, such as non-contrasted CT, ultrasound or MRI. All ER CTs should be non-contrast except activated trauma and CTAs. Please review the ACR guidelines to evaluate suitable alternate options.
3. Tier 1 and 2 procedures can be ordered as needed. If there are questions about a need for iodinated contrast outside of these parameters, please consult with a radiologist.
4. Emergency Departments are required to utilize the Wells Clinical Prediction Rule prior to ordering CTA for evaluation of pulmonary embolus with documentation in the medical record and order to optimize clinical evaluation.
   
   

OUTPATIENT PROCEDURE 

Outpatient Imaging Departments will begin opening additional imaging slots for studies requiring contrast to include the following diagnosis – Cardiovascular and/or Cancer. Any patients that have been rescheduled due to the shortage should be prioritized accordingly.

Clinicians who previously placed an order for an outpatient contrasted CT that they believe now meets the criteria for Tier II, should contact the attending Radiologist or Administrator on-call to have the order reviewed with the new criteria.

All other imaging procedures requiring contrast should continue to be postponed (please review the UPDATED Tier 1 and 2 procedures for exceptions) or performed as a non-contrast scan. We will continue to monitor the situation on a weekly basis and communicate any changes.

For guidance on Outpatient orders reserved for Emergent and Urgent clinical indications, please reference the UPDATED Contrast Tiers List. If there is a potential need for iodinated contrast outside of these parameters, please reference Tiers III, IV & V in the Contrast Tiers List or contact the Radiologist or Administrator on-call.

To reach the Radiologist on call:

Baton Rouge:

• 6:30 a.m. – 8:00 p.m.: (225) 765-6361
• After 8:00 p.m.: (225) 765-8644
• For the Administrator on Call (AOC) please call the House Manager at (225) 765-8297

Northshore:

• To reach the direct line of the House Supervisor, please call (985) 750-0481.
  
  

Provider and Medical Staff Updates – Omnipaque Shortage

Update – Thursday, May 19:

At this time, all IV contrast products remain critical shortage across the ministry. We greatly appreciate your support and collaboration during this unprecedented challenge as we continue to conserve our supply as best as we can. 

GE announced yesterday factories are currently at 50% capacity and anticipate orders to ship to the US this week. The system team reviewed current inventory and utilization for each market and restrictions will not be lifted at this time. 

To continue to conserve our supply for the patients who most critically need contrast, we have made some slight updated system-wide effective immediately in the contrasted studies that we order. 

All Ordering Physicians and LPs Should Continue To:

1. Eliminate the use of oral contrast with the exception of suspected post-surgical bowel leakage (inpatients included). Restrict the use of IV contrast to only CT angiograms, IR, Cardiovascular, and Activated Traumas.
2. When able, order alternative imaging exams if appropriate, such as non-contrasted CT, ultrasound or MRI. All ER CTs should be non-contrast except activated trauma and CTAs. Please review the ACR guidelines to evaluate suitable alternate options.
3. Tier 1 and 2 procedures can be ordered as needed. If there are questions or a potential need for iodinated contrast outside of these parameters, please consult with a radiologist.
4. Emergency Departments will be required to utilize the Wells Clinical Prediction Rule prior to ordering CTA for evaluation of pulmonary embolus with documentation in the medical record and order to optimize clinical evaluation.
   
   

OUTPATIENT PROCEDURE EFFECTIVE IMMEDIATLEY

1. All outpatient contrasted procedures should continue to be postponed (please review the UPDATED Tier 1 and 2 procedures for exceptions). All existing and future scheduled examinations can be performed as a scan non-contrast. If contrast is needed, then the procedure should be delayed.  We will continue to monitor the situation on a weekly basis and communicate any changes.

For guidance on Outpatient orders reserved for Emergent and Urgent clinical indications, respectively, please reference the UPDATED Contrast Tiers List. If there is a potential need for iodinated contrast outside of these parameters, please reference Tiers III, IV & V in the Contrast Tiers List or contact Radiologist or Administrator on-call.

Clinicians who previously placed an order for an outpatient contrasted CT that they believe meets the criteria for Tier II, should contact the attending Radiologist or Administrator on-call (as outlined in step 4 above) to have the order reviewed with the new criteria.

As a reminder, if you have a question about whether contrast is needed for a study, please call Radiology or the Administrator on-call to discuss the study and determine the next best step.

A system-wide committee led by Dr. Steven Gremillion, FMOLHS Chief Medical Officer, will continue to meet weekly to discuss rationing and supply based on the needs of each market, and will monitor the situation on a weekly basis to communicate any changes.

Thank you for always being prepared to serve.