Expanded competencies for the nuclear medicine advanced associate (nmaa) introduction

Obtain patient informed consent as required for nuclear cardiology procedures according to state law and hospital policy


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Obtain patient informed consent as required for nuclear cardiology procedures according to state law and hospital policy.

    1. Understand the ethical and legal underpinnings of informed consent.

      1. Autonomy, veracity and confidentiality

      2. Who may give consent

        1. Competency issues

        2. Minors and mentally impaired adults

      1. Types of consent

        1. Express

        2. Implied by law

        3. Informed consent

      2. Components of valid informed consent

        1. Procedure that will be done

          1. Diagnosis

          2. Nature or purpose of the treatment or procedure.

        2. The name and qualifications of the person doing the procedure.

        3. The consequences or expected outcome.

        4. The risks involved, except for the very remote.

          1. Exceptions: risk of death or sterility, if applicable

        5. The alternatives to this procedure must be discussed

          1. Includes alternative of doing nothing

          2. Must then disclose the patient's prognosis

      3. Responsibilities of physician and health care providers

      4. When consent becomes invalid

        1. The procedure exceeds the consent given

        2. Inadequate information is given to the patient.

        3. The nurse or technologist answers medically related questions.

        4. The patient is given the consent form and told that it is just “routine papers”

        5. There is a force of circumstances
        6. There is a change of circumstances.

    1. Determine capability of patient to give informed consent.

    1. Explain procedure to the patient, including all components of a valid informed consent.

      1. List precautions used to reduce risks

      2. Review the confidentiality policy

      3. Answer any questions or direct questions to the appropriate health care professional

    1. Obtain the patient’s or guardian’s signature.

  1. Conduct treadmill testing per all protocol options under the direction of the supervising physician.

    1. Prepare patient for exercise protocol.

      1. ECG preparation

        1. Skin preparation

        2. Electrode placement

      2. IV establishment

      1. Baseline readings

        1. Blood pressure

          1. Normal

          2. Abnormal

        2. ECG tracings

          1. Normal

          2. Abnormal

    1. Determine type of exercise stress test.

      1. Exercise equipment options

        1. Treadmills and monitors

        2. Bicycle ergometer

      2. Protocol options

        1. Bruce

        2. Modified Bruce

        3. Naughton

        4. Patterson

        5. Ramp

        6. Isometric

        7. Pharmacologic

    1. Monitor EKG tracings and blood pressure for specific pathology and cardiac events during stress testing.

      1. Normal responses to exercise

        1. ST-Segment changes

        2. T-wave changes

      2. Arrhythmias

      3. Hypotensive/hypertensive response

      4. Nondiagnostic EKG

    1. Use the appropriate termination protocols.

      1. Absolute indication for termination

      2. Relative indication for termination

    1. Calculate the Duke Treadmill Score.

      1. Methodology

      2. Risk stratification

        1. Low

        2. Moderate

        3. High

  1. Prescribe and administer interventional drugs for pharmacological stress under the direction of the supervising physician.

    1. Explain the indications and contraindications for each pharmacologic stress agent.

      1. Adenosine

      2. Dipyridamole

      3. Dobutamine

    1. Identify the physiological action of each pharmacologic agent as it relates to stress-testing.

      1. Expected or normal responses

      2. Abnormal responses

    1. Calculate total dose, volume, and dose rate for each of the most common pharmacological stress agents.

    1. Set up drug administration pump.

    1. Prepare pharmacologic agents for administration utilizing sterile technique.

    1. Administer pharmacologic agents.

    1. Monitor the patient’s response to pharmacologic agents and treat patients appropriately in the event of an adverse effect.

      1. Possible side effects

      2. Treatment of side effects

  1. Analyze results of the stress test and imaging portion of the examination and prepare a comprehensive report for the supervising physician.

    1. Create a comprehensive report detailing the results of the stress portion of the test.

      1. Indications and patient demographics

      2. Methodology

        1. Exercise time

        2. Maximum heart rate

        3. Blood pressure

        4. Symptoms

        5. Tolerance (exercise reserve)

      3. Findings

        1. PQRST Changes

        2. Ectopy

        3. T-Wave abnormalities

        4. Affected leads

        5. Dysrhythmia

          1. Tachycardia

          2. Bradycardia

          3. Blocks

        6. Physiologic responses

      4. Risk Assessment: Duke Treadmill Score

      5. Validity of examination

      6. Conclusion with clinically relevant comments.

    1. Examine rotating raw data from both stress and resting image acquisitions and evaluate image quality.

      1. Upward creep

      2. Contamination

      3. Body habitus

      4. Motion

      5. Patient exceeds field of view

    1. Review data for incidental finding outside of the heart.

      1. Tumor uptake

      2. Enlarged viscera

      3. Halo patterns around heart

      4. Breast uptake

      5. Liver uptake

    1. Compare and contrast stress vs. resting processed images for perfusion defects.

      1. Enlarged right ventricle

      2. Enlarged left ventricle

      3. Evaluate chamber volume data

    1. Determine if the heart-to-lung ratio and TID are abnormal.

      1. Normal values

      2. Abnormal values

    1. Evaluate the wall motion of stress and resting images for ejection fraction and kinetic abnormalities.

      1. Dykinesis

      2. Akinesis

      3. Hypokinesis

    1. Review and evaluate bull’s eye polar maps and summed stress scores.

      1. Normal values

      2. Abnormal values

    1. Create a comprehensive report detailing the results of the imaging portion of the test.

      1. Indications

      2. Patient demographics

      3. Dosing information

      4. Imaging parameters

      5. Findings

      6. Conclusion.

        1. Normal

        2. Abnormal
        3. Ejection fraction

        4. Summed stress score

  1. Facilitate or recommend patient-specific cardiac related procedures based on nuclear cardiology examination results (outcomes management) according to the supervising physician.

    1. Order or facilitate scheduling of complimentary diagnostic procedures as indicated.

      1. MUGA

      2. Viability

      3. Blood Test

      4. CTA/ Calcium Scoring

      5. PET

      6. Heart CATH

      7. ERNA

      8. MRI

    1. Identify the clinical pathways as outlined by the AMA/ACC for cardiac disease.

      1. Cardiac intervention

        1. Stents

        2. By-pass

        3. Angioplasty

          1. Drug eluting

          2. Non-drug eluting.

      2. Medication adjustments

      3. Risk factor modification and life style changes

      4. Surgical intervention

Overview for the Interpersonal and

Communication Skills Curriculum

Interpersonal and communication skills go beyond medical interviewing and history taking; they are at the heart of quality patient care. These skills overlap considerably with those in the professionalism competency domain and permeate the entire fabric of the educational program. In looking at the key components of interpersonal and communication skills, three broad areas of interest emerge:

  1. 1. communication with patients and families

  2. 2. communication with colleagues

  3. 3. scholarly communication

In practical terms, it is often difficult to separate interpersonal and communication skills because both are interrelated. Interpersonal skills are those skills that relate to the impact that one’s communication has on another. Communication skills can be thought of as a concrete skill set (e.g., the ability to deliver bad news, encourage patients to change behavior, present a lecture). In practical terms, it is often difficult to separate interpersonal and communication skills because both are interrelated.

Learning effective interpersonal and communication skills with patients and families, with colleagues, and in the scholarly setting is a life-long process. It is anticipated that the competencies in this section will be demonstrated in the clinical setting as well as the traditional classroom setting. NMAA educators will most likely provide instruction through modeling behavior, role playing, observation and mentoring through intervention.

Interpersonal and Communication Skills

Curriculum Content

  1. Demonstrate team communication and leadership skills to work effectively with others as a member or leader of a health care team or other professional group.

    1. Demonstrate leadership skills by leading a group project to successful completion.

    1. Communicate with referring physician to assure appropriate examination selection, including actions to be taken if the requested procedure appears to be inappropriate.
      1. Requisition Process

        1. Receipt of order

        2. Verification of order

        3. Appropriateness of indication

        4. Correlation with history

        5. Contraindications

      2. Verbal orders

    1. Collaborate with other health care team members to improve service delivery.

      1. Communications regarding

        1. Patient preparation

        2. Schedule necessary procedures prior to nuclear medicine procedure

        3. Secure results of necessary procedures prior to the nuclear medicine procedure

        4. Schedule or facilitate the scheduling of follow-up examinations upon completion of the nuclear medicine procedure

        5. Report nuclear medicine examination results under the direction of the supervising physician and as allowed by institutional policy

          • To the patient if indicated

          • To the referring physician

      2. Hand-off of patients in institution

        1. Standardized method to reduce reducing medical errors

        2. Aligns with Joint Commission initiatives

  1. Protect and preserve personal and confidential information of others to which access is provided.

    1. Adhere to privacy and regulatory standards and requirements regarding the accountability and protection of patient information.

      1. Joint Commission
        1. Accountability for protecting patient information

          • Information collection

          • Information maintenance

          • Use of personally identifiable health information

          • Contractual agreements

            1. Confidentiality clause

          • Monitoring compliance

          • Demonstrating compliance

            1. Audits

            2. External reviews

        2. Consents

          • Informed

          • Specific

          • Voluntary

          • Release of information

            1. Purposes

            2. Types of information released

            3. Recipients of information

        3. Education regarding policies, rights and responsibilities

          • Patient education

          • Provider education

      1. Patient information standards

        1. Privacy issues

          • HIPAA goals

            1. Uniformity of electronic data interchange

            2. Confidentiality of electronic health data

          • Parties HIPAA regulations apply to

            1. Health care providers

            2. Health plans

            3. Health care clearinghouses

          • Parties not covered by HIPAA regulations

          • Electronic transactions and code sets

            1. Technical standards

              1. Formats

              2. Data content

            2. Electronic transactions

              1. Claims/referral inquiry and submission

              2. Eligibility inquiry

              3. Financial transactions

        2. Privacy standards

        3. Security standards

          • Physical and technical safeguards for the storage and transmission of protected health information

          • Unique identifiers

            1. Providers

            2. Employers

            3. Health plans

            4. Individuals

          • Electronic digital signature

        4. Enforcement

          • Centers for Medicaid and Medicare Services (CMS)

          • Electronic code sets

          • Office of Civil Rights (OCR)

          • Privacy standards

          • State laws and regulations affecting the use and disclosure of health information

        5. Medical informatics

          • Definition of informatics

          • Application in medicine

          • Telemedicine

          • Management

            1. Data

            2. Information

            3. Knowledge

          • Information systems and standards

            1. Hospital information system (HIS)

            2. Radiology information system (RIS)

            3. Picture archiving and communications system (PACS)

            4. Digital imaging and communications in medicine (DICOM)

    1. Identify potential abuses of confidential patient information.

      1. Information as a commodity

      2. Potential abuses

    1. Describe the challenges associated with maintaining the confidentiality of patient information stored in computer systems and transmitted via networks.

      1. Patient issues

        1. Trust in the physician
        2. Who gets what information

        3. Rights in the case of an error or unauthorized disclosure of information

      1. Provider issues

        1. Implementation of confidentiality procedures

        2. Patient education on confidentiality rights

      2. Managed care organizations

        1. Information shared with external parties

      3. Research

        1. Access to information without breaching patient rights

  1. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.

    1. Listen to the “patient’s story,” extract important details from the history taking, and provide information to their patients in an understandable way.

    1. Demonstrate effective interviewing skills for patient assessment.

      1. Skills of good interviewing

        1. Nonverbal communication

        2. Facilitation

        3. Reflection

        4. Clarification

        5. Summarization

        6. Validation

        7. Empathic responses

        8. Transitions

      1. Challenges to the practitioner

        1. Patient at different ages and comprehension abilities

        2. Situation that call for specific responses

    1. Demonstrate effective communication skills with and provide psychosocial support to specific groups of people such as the terminally ill, physically or emotionally impaired, culturally diverse patient, families, and colleagues.

      1. Cultural diversity

        1. Development of a personal value system

        2. Interrelationship between personal, community and societal values

        3. Influence of personal value system on behavior

        4. Development of professional values

        5. Influence of professional values on patient care

        6. Kohlberg’s theory on the influence of individual morality to behavior

        7. Differences between culture and ethnicity.

        8. Influence of cultural beliefs regarding illness and recovery

        9. Medical ethnocentrism

        10. Influence of societal factors on quality of health care

        11. Alternative/complementary medicine

        12. Culture of poverty and its effect on health care

        13. Family dynamics in a cultural, social, ethnic and lifestyle context

      1. Terminal illness

      2. Psychological impairment

      3. Physical impairment

    1. Demonstrate effective age-specific and gender-specific communications.

    1. Be receptive to the clinical significance of the patient’s personal beliefs and values for adaptation of an exam protocol or departmental policies.

      1. Religion

        1. Use of blood products in an exam
        2. Mandatory presence of family member during studies

      1. Life style (e.g., vegetarians and gastric emptying studies)

  1. Demonstrate emotional resilience and stability, adaptability, flexibility and tolerance of ambiguity and anxiety.

    1. Maintain composure in all situations.

    1. Refrain from negative conversations

    1. Demonstrate self-awareness of personality traits.

  1. Follow appropriate protocol in resolution of conflict, exhibiting proper restraint when presented with potentially volatile situations.

    1. Potential areas of conflict in the workplace

      1. Harassment in the workplace

      2. Quid pro quo

      3. Hostile work environment

      4. Protected persons

      5. Unwelcome conduct

      6. Employer’s liability

      7. Sexual harassment

      8. Harassment

      9. Assault and battery

      10. Infliction of emotional distress

      11. Invasion of privacy

      12. Wrongful discharge

      13. Unclear expectations

      14. Lack of clear jurisdiction

      15. Operational or staffing changes

    1. Conflict prevention

      1. Chain of command

      2. SOP

      3. Mediation

    1. Common resolution strategies

      1. Avoidance

      2. Fight

      3. Surrender

      4. Compromise

      5. Collaborate

  1. Maintain comprehensive, timely, and legible records for medical, legal, quality improvement and financial purposes.

    1. Medical records

    2. Legal record

    3. Health information systems; informatics;

    4. Quality improvement

    5. Regulatory

    6. Health law/legal

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