Implementation plan

Recommendation	Time frame for implementation: <1 year, 1-years or >3 years	Expected effect on costs	Limitations for implementation	Barriers to implementation¹	Actions needed for implementation²	Responsible for actions³	Other remarks
Make an individual risk-benefit analysis with the patient’s requesting physician and nephrologist to ensure a strict indication for gadolinium-enhanced MRI in patients with eGFR < 30 ml/min/1.73m².	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
For optimal prevention of NSF in patients with eGFR < 30 ml/min/1.73m² use low-risk (ionic and non-ionic) macrocyclic GBCAs for medical imaging.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
In patients on chronic haemodialysis, GBCA administration may electively be scheduled shortly before the next haemodialysis session to limit the amount of circulating GBCA.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
For prevention of NSF in patients who are already dependent on haemodialysis or peritoneal dialysis, the administration of GBCA does not have to be followed by an immediate haemodialysis session.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination 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 implementations. Think about checks during quality visits, guideline publication, information of hospital management, et cetera.

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