Implementation plan

Recommendation	Time frame for implementation: <1 year, 1 to 3years or >3 years	Expected effect on costs	Limitations for implementation	Barriers to implementation¹	Actions needed for implementation²	Parties responsible for actions³	Other remarks
Warn patients who have had a previous hypersensitivity reaction to contrast media, that a late hypersensitivity reaction may be possible, usually a skin reaction.	1 to 3 years	None	Lack of knowledge of guideline. Lack of experience for recognizing late hypersensitivity reactions after contrast administrations.	Lack of knowledge of guideline.	Disseminations of guideline	NVvR
Patients should contact their general practitioner if they have a late hypersensitivity reaction after CM administration. Consider informing the radiology department about the occurrence and symptoms of a late hypersensitivity reaction after CM administration.	1 to 3 years	None	Lack of knowledge of guideline. Lack of experience for recognizing late hypersensitivity reactions after contrast administrations.	Lack of knowledge of guideline.	Disseminations of guideline	NVvR
When the symptoms of a late hypersensitivity reaction are mild, a wait-and-see approach can be justified.	1 to 3 years	None	Lack of knowledge of guideline. Lack of experience for recognizing late hypersensitivity reactions after contrast administrations.	Lack of knowledge of guideline.	Disseminations of guideline	NVvR
Treat late hypersensitivity reactions symptomatically. Consider treatment of skin reactions with oral or topical corticosteroids.	1 to 3 years	None	Lack of knowledge of guideline. Lack of experience for recognizing late hypersensitivity reactions after contrast administrations.	Lack of knowledge of guideline.	Disseminations of guideline	NVvR
When severe symptoms develop, such as generalized pustulosis or painful cutaneous blisters, refer the patient to a dermatologist.	1 to 3 years	None	Lack of knowledge of guideline. Lack of experience for recognizing late hypersensitivity reactions after contrast administrations.	Lack of knowledge of guideline.	Disseminations of guideline	NVvR

¹ Barriers can be found at multiple levels. They can exist at the level of the consultant, the hospital organisation, and the health care system.

² Actions needed for implementation, but also actions to promote implementation. Think about checks during quality visits, guideline publication, information of hospital management, etcetera.

³ Who is responsible for implementation of recommendations will largely be determined by the level where the barriers are expected to be.