Administration of contrast that has been supplied under a PGD

Questions have been asked as to whether or not it is acceptable for a registered or unregistered healthcare professional (HCP) to prepare and/or administer contrast to an individual that has been supplied by a Radiographer (or Speech and Language Therapist) under a Patient Group Direction (PGD).

The legality of preparation and/or administration of contrast supplied by another healthcare professional under a PGD will depend on the route of administration, the process being followed and the legal status of the contrast agent.

For general principles of PGD use for the administration of contrast media please refer to Use of Patient Group Directions for the administration of contrast agents in imaging services

Advice by preparation type

Parenteral contrast (e.g. IV)

All parenteral contrast agents are Prescription Only Medicines (POMs).

No delegation of administration of a parenteral medicines supplied under a PGD is permissible under the legislation.

Therefore IV contrast must be supplied and administered by the registered Radiographer approved to operate under the PGD; this includes all preparation and required manipulation of the contrast (e.g. dilution) and/or loading of pre-filled syringes into injectors. No part of the process can be delegated to another registered or unregistered HCP (e.g. health care assistant, radiographic assistant, nurse or another radiographer).

For further information refer to Delegation of supply or administration of medicines using a Patient Group Direction

Multi injector devices

Where multi injector devices are used to administer contrast under a PGD these must be set up by a radiographer who will be undertaking administration under the relevant contrast PGD.

At the time of set up, appropriate records (e.g. details of the contrast/sodium chloride loaded, date and time of loading, batch numbers and expiry, Infection Prevention and Control (IPC) procedures have been followed) must be completed in line with local guidance. No other person (e.g. a radiography assistant) can be involved in the setup of the multi injector device where a PGD is being used to administer the contrast.

If, during the imagining session, another radiographer,  also approved to work under the relevant PGD, takes over administration whilst the multi injector device is still loaded (i.e. they do not load the contrast/sodium chloride themselves) they must check all the appropriate records to ensure the appropriate contrast/sodium chloride has been loaded and is within the permitted timeframe for the contrast/sodium chloride to be used, IPC procedures have been followed and appropriate records completed. If they are appropriately assured that processes have been adhered to, they can then administer the contrast/sodium chloride to individuals under the relevant PGD.

Non-parenteral prescription only contrast (e.g. oral or rectal) requiring dilution before administration

The contrast must first be supplied to the patient by the registered Radiographer (or Speech and Language Therapist) approved to operate under the PGD.

Once it has been supplied the contrast agent can then be diluted and administered by another registered or unregistered HCP (e.g. health care assistant, radiographic assistant, nurse or another radiographer).

The process of dilution and/or administration should follow a locally approved protocol/SOP which includes the required training and competence of the HCP undertaking the dilution and/or administration.

The MHRA and CQC have confirmed that single dose medicines which are non-parenteral and which are supplied by a healthcare professional under a PGD and immediately administered by another person, such as a HCP, in the same examination room or clinic do not require labelling.

Non-parenteral prescription only contrast (e.g. oral or rectal) requiring thickening before administration

The contrast must first be supplied by the registered Radiographer (or Speech and Language Therapist) approved to operate under the PGD.

Once it has been supplied the contrast can then be thickened and administered by another registered or unregistered HCP (e.g. health care assistant, radiographic assistant, nurse or another radiographer). The process of thickening and/or administration should follow a locally approved protocol/ SOP. This should include the required training and competence of the HCP undertaking the thickening and/or administration.

The MHRA and CQC have confirmed that single dose medicines which are non-parenteral and which are supplied by a healthcare professional under PGD and then immediately administered by another person, such as a HCP, in the same examination room or clinic do not require labelling.

Supply and/or administration Pharmacy Only (P) and General Sales List (GSL) medications

Some contrast agents are P/GSL medicines, For advice on the supply and/or administration Pharmacy Only (P) and General Sales List (GSL) refer to When Patient Group Directions are not required

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