Documentation of contrast hypersensitivity reactions: a socio-ecological scoping review

To investigate the critical yet often overlooked challenge of documentation of hypersensitivity reactions to contrast media. Inaccurate documentation not only informs future imaging events but also impacts other areas in medicine. This study applies Bronfenbrenner's adapted socio-ecological model to examine the literature related to contrast hypersensitivity documentation, highlighting systemic issues that perpetuate suboptimal practice.

A scoping review was conducted following the Arksey and O'Malley framework with adaptations for a socio-ecological lens. A search was conducted across Ovid MEDLINE, SCOPUS, ProQuest and CINAHL Plus (2000-present), identifying 673 articles. Seven studies met the inclusion criteria and were analysed using NVIVO software to identify key themes across Bronfenbrenner's system levels of micro, meso, exo, macro and chrono.

Findings revealed inconsistencies in documentation practices across all levels of healthcare. At the micro level, patient-practitioner communication is often hindered by the patient's inability to provide an accurate history. At the meso and macro levels, fragmented systems, lack of interoperability and inconsistent terminology contribute to the problem. At the chrono level, the impact of the evolution of documentation practices, standards, and policies over time have influenced current practices. This includes perpetuating a cycle of inaccurate information being utilised in clinical decision making, compromising patient outcomes and increasing healthcare costs.

This review is the first to highlight the systemic nature of contrast hypersensitivity documentation challenges using the socio-ecological lens. All medical and allied professionals who document and communicate medical histories can break this self-perpetuating cycle with simple actions such as accurately recording of contrast agent name, details of the reaction, severity, treatment and timelines. Further research is required to develop strategies to drive systemic change, ultimately to benefit patient safety.