Advice published in alternative bowel preparation regimes has been shared by the SoR in the wake of the global shortage of Gastrografin.
Gastrografin is a contrast agent commonly used during CT colonography procedures, and its shortage puts the provision of the service at risk.
Joint guidance has been published by the British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and the National CT Colonography Academy (NCTCA) on alternative bowel preparation regimes to ensure hospitals can maintain these procedures.
Safe, lawful practice
Radiographers are often involved in the supply and administration of bowel preparation agents, and will be keen to minimise disruption to patient services.
Alternatives to Gastrografin suggested by the BSGAR and NCTCS include Omnipaque-based tagging regimens, iodine-free options for patients with a history of anaphylaxis, and enhanced regimens for individuals with constipation or prior inadequate bowel preparation. These measures are intended as temporary solutions and will be reviewed as supply stabilises.
The SoR has recommended that radiology departments review the BSGAR guidance in full, including sample patient information leaflets from sites recognised as NCTCA Centres of Excellence.
Sue Johnson, professional officer and medicines lead at the SoR, said: “The guidance below is intended to support safe, lawful practice during a period of supply disruption. If you’re unsure whether you’re covered to supply or administer an alternative bowel preparation — pause, check, and escalate. It’s about protecting patients, services, and you.
“I would encourage all radiographers to take note of the expert guidance that has been shared and adopt it to keep services running. Equally as important is ensuring that medicines are being supplied legally and appropriately, and that radiographers don't inadvertently compromise their professional standards due to the shortage.”
Guidance and resources
Key points for radiographers include:
1. Check legal frameworks:Any Patient Group Direction (PGD) used must be current, signed, and formally authorised at organisational level. Individual radiographers must be appropriately trained and both named and authorised to work under the PGD. If a PGD has been updated or replaced to reflect alternative bowel prep agents, radiographers cannot use it until these conditions are fully met.
2. New or updated PGDs take time: Developing or revising PGDs can be a lengthy governance process. If a valid PGD is not yet in place, radiographers must not supply or administer under an inaccurate or draft document.
3. Use a Patient Specific Direction (PSD) where required:In the absence of a valid PGD, a Patient Specific Direction (PSD) must be in place. PSDs must be issued by an appropriately authorised prescriber and clearly specify the medicine, dose, route, and individual patient. This applies to both supply and administration.
4. Supply and Administration Process:The process of supplying and administering replacement procedures includes the prescriber (doctor or non-medical prescriber) conducting an individual, one-to-one assessment, and documenting the instruction in the patient’s record, explicitly stating the medicine to be supplied or administered.
A suitably trained and competent professional (i.e. radiographer) reviews the signed instruction to ensure it is valid and safe before supplying or administering the prescribed medicine. The person administering the medication must record the administration in the appropriate legal record. The prescriber remains legally responsible for the decision, while the clinician supplying or administering is responsible for their own actions.
5. Don’t assume ‘business as usual’: The gastrografin shortage has resulted in changes to bowel prep pathways in many services. Radiographers must familiarise themselves with local alternative regimens, check which medicines are covered by PGDs and which require PSDs, and escalate concerns early if governance is unclear.
Radiographers are strongly encouraged to use national professional resources when reviewing or developing local arrangements.
Access the BSGAR guidance on the Gastrografin shortage online here.
Information and resources on PGDs and PSDs, and the legal responsibilities of radiographers in relation to them, can be found online here.
National best practice on PGD development, authorisation, and governance can be found online here.
(Image: Photo by Hispanolistic via Getty Images)