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

Partner with health care managers and health care providers to assess, coordinate, and improve health care


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Partner with health care managers and health care providers to assess, coordinate, and improve health care.

    1. Structure department staffing for quality care delivery and employee satisfaction.

      1. Recruitment and staffing programs

      2. Effective interviewing techniques and procedures

      3. Staffing ratios

      4. Retention programs

    1. Conduct process for departmental strategic planning per institutional mission.

      1. Demand forecasting through market research

      2. Implementation of measurable goals and objectives

      3. Outcomes measurements

      4. Market position

      5. Alliance development

    1. Advocate for quality patient care and assist patients in dealing with system complexities.

      1. Customer satisfaction methodologies

      2. Implementation of continuous quality improvement methods to enhance customer satisfaction

      3. Development and implementation of medical protocols to adhere to accepted standards of care

      4. Patient management coordination

        1. Appointment times

        2. Resource availability

        3. Transportation

  1. Understand the reciprocal impact of personal professional practice, health care teams, and the health care organization on the community and society.

    1. Identify ways in which an NMAA may interact with health-care professionals, health administrators, and community groups to positively impact the health and well being of one’s community.

    1. Gather information (e.g. demographics and socio-cultural beliefs) about the community in which one works and practices that affect health and disease.

    1. Participate in interdisciplinary team discussions, demonstrating the ability to accept, consider and respect the opinions of the other team members, while contributing an appropriate level of expertise to patient care.

      1. Grand rounds

      2. Committees internal to the institution

      3. Interdepartmental projects or reports’

      4. Interdisciplinary team discussions

      5. Interdisciplinary quality improvement projects

      6. Accreditation processes

      7. Community service

  1. Describe the major legal mechanisms for oversight and regulation of medical practice, including those related to licensure and discipline, negligence, malpractice, risk management, doctor-patient relationships, confidentiality, and patient’s rights.

    1. Compare civil and criminal law.

      1. Legal issues

      2. Civil liability

      3. Intentional torts

        1. Elements

        2. Assault

        3. Battery

        4. False imprisonment

        5. Emotional distress

        6. Fraud

        7. Invasion of privacy

        8. Defamation

          • Slander

          • Libel

        1. Vicarious liability

      1. Unintentional torts/negligence

        1. Elements

        2. Contributory
        3. Comparative

      1. Criminal law

        1. Criminal negligence

        2. Falsification of records

        3. Drugs

        4. Fraud

        5. Patient abuse

        6. Theft

    1. Explain civil procedures.

      1. Civil procedures

        1. Pleadings

        2. Summons and complaint

        3. Discovery

        4. Motions

        5. Trial procedure

        6. Evidence

        7. Verdict

        8. Appeals

    1. Follow the prescribed standard of care for the NMAA.

      1. Definitions

      2. Burden of proof

      3. Res Ipsa Loquitur

      4. Respondeat Superior

    1. Distinguish between the different types of consent.

      1. Informed

      2. Uninformed

      3. Implied

    1. Understand and comply with the patient’s directives in regard to medical care.

      1. Living wills

      2. Do-not-resuscitate orders (DNR)

      3. Power of attorney

    1. Comply with employer and employee legal obligations.

      1. Labor laws

      2. Unions

      3. Discrimination laws

      4. Harassment in the workplace

        1. Quid pro quo

        2. Hostile work environment

        3. Protected persons

        4. Unwelcome conduct

        5. Employer’s liability

        6. Sexual harassment

        7. Harassment
        8. Assault and battery

        9. Infliction of emotional distress

        10. Invasion of privacy

        11. Wrongful discharge

      5. Conditions of employment

        1. Position descriptions

        2. Drug screening

        3. Background checks

        4. Misrepresentation

      6. Liability coverage

        1. Employer

        2. Personal

      7. Equipment safety regulations

      8. Safety

        1. Hazard identification and control

        2. Policies and procedures

          • Occupational Safety and Health Administration

          • Centers for Disease Control and Prevention

          • Facility

          • State

        3. Employee training

        4. Fire, electrical and chemical safety

        5. Magnetic fields and radio frequency safety

        6. Injury prevention

        7. Safety/quality improvement committees

        8. Risk management

      9. Whistleblower protection

Pharmacology and Clinical Decision-Making for the Nuclear Medicine Advanced Associate


This content is designed to enhance the nuclear medicine advanced associate’s (NMAA) knowledge of pharmaceuticals commonly used by and given to nuclear medicine patients. The content addresses the intent of the drug and its effect on diseases, conditions and physiology. After learning this content and possessing the appropriate clinical skills, the NMAA will analyze the patient’s current condition with regards to medications and other therapies and determine the significance to the nuclear medicine procedure. He or she will suggest the appropriate action plan for the procedure for the specific patient. The NMAA will be responsible for the delivery and documentation of procedure-related pharmaceuticals and for patient assessment and monitoring before, during and after the procedure and drug administration. It is essential the NMAA have a clear understanding of the laws and policies related to pharmaceuticals in his or her practice setting.

Conventional Medication Competencies

1. Identify key drug laws impacting consumer safety.

2. Identify the five schedules of controlled substances and cite a drug example of each.

3. Identify the role of the Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) in the regulation and control of consumer drugs.

4. Explain strategies for health care workers involved in dispensing medications to comply with the restrictions of drug laws.

5. Identify common abbreviations and symbols used for medication orders.

6. Differentiate among drug names (generic, chemical, trade, official).

7. Explain the restrictions of drug sales implied by the designation of: over the counter, legend drug and controlled substance.

8. Research drug reference information from standard pharmacological resources.

9. Describe the biological processing of drugs in the body.

10. List common variables affecting drug action within the body.

11. Describe common unexpected responses to drugs.

12. Describe the purposes for and principles of clinical drug trials.

13. Accurately perform calculations for drug dose delivery.

14. Describe various forms of drug preparations and supplies.

15. Incorporate the principles of responsible drug administration in the patient care setting to prevent medication error.

16. Use proper medical techniques of drug administration for common routes of delivery.

17. Describe dose modifiers for pediatric and geriatric patients.

18. Identify factors that may lead to cumulative effects in the elderly.

19. List the categories of drugs that frequently cause adverse side effects in older adults.

20. Identify guidelines and competencies for sedation and analgesia according to Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements.

21. Describe the side effects and cautions with preoperative medications.

22. Describe the methods for administering local anesthetics.

23. Describe the goals and desired effects of conscious sedation.

24. Describe the undesirable effects of conscious sedation.

25. Perform assessments of the patient and patient’s records prior to and during examinations requiring the use of conscious sedation.

26. Participate in patient management during examinations that require the use of conscious sedation.

27. Identify drugs for sedation and analgesia.

28. Recognize the side effects, contraindications and interactions common to each category of anti-infectives.

29. List the side effects common to antineoplastic agents.

30. Explain precautions in caring for patients receiving radioactive isotopes.

31. Demonstrate an awareness of the clinical side effects of major analgesics, sedatives and hypnotics.

32. Recognize common seizure disorder medications.

33. Recognize the side effects, contraindications and interactions for psychotropic medications in common use.

34. Identify the uses, side effects, cautions and interactions associated with the use of diuretics.

35. Describe the side effects, contraindications and interactions of antacids, antiulcer agents, antidiarrheal, antiflatulents, cathartics and laxatives and antiemetics.

36. Describe conditions that may be treated with corticosteroids.

37. List potential side effects of long-term steroid therapy.

38. Identify diabetes medications.

39. Identify the symptoms of hyperglycemia and hypoglycemia, and appropriate interventions.

40. Identify the use, side effects and precautions associated with estrogens and progestins.

41. Identify types of antiarrhythmics and the side effects.

42. Identify types of antihypertensives and the side effects.

43. Identify types of coronary vasodilators and the side effects.

44. Compare and contrast heparin and coumarin derivatives in terms of administration, action and antidotes.

45. Describe the uses of and precautions necessary with oxygen therapy.

46. Identify the uses, side effects and contraindications for bronchodilators and antitussives.

47. Describe the action and uses of antihistamines and decongestants.

48. Identify commonly used skeletal muscle relaxants and the side effects.

49. Describe medications used for osteoporosis therapy.

Conventional Medication Curriculum Content
I. Consumer Safety and Drug Regulations

A. Drug laws

1. 1906 Pure Food and Drug Act

a. Drug standards

2. 1938 Federal Food, Drug, and Cosmetic Act

B. 1970 Controlled Substances Act

1. Five schedules of controlled substances

C. Role of the FDA

D. Role of the DEA

E. Health care workers and the law

F. Implication of USP Chapter <797> Pharmaceutical Compounding
II. Abbreviations and Systems of Measurement

A. Common abbreviations for medication orders

B. Medication order components

1. Date

2. Patient’s name

3. Medication name

4. Dosage or amount of medication

5. Route/manner of delivery

6. Time to be administered or frequency
III. Pharmaceutical Terminology References

A. Classifications

B. Identifying names

1. Generic name

2. Chemical name

3. Trade name

4. Official name (as it appears in the United States Pharmacopoeia - USP/ National Formulary - NF)

C. Legal terms referring to drugs

1. Over-the-counter

2. Legend (or prescription) drug

3. Controlled substance

D. Terms indicating drug actions

1. Indications

2. Actions

3. Contraindications

4. Cautions

5. Side effects and adverse reactions

6. Interactions

IV. Sources of Drug Information

A. Drug references

1. Physicians’ Desk Reference Companion Guide

2. United States Pharmacopoeia/dispensing information

3. American Hospital Formulary Service

4. Compendium of Drug Therapy (Physician’s ed.)

5. Electronic drug databases and analysis

V. Pharmacotherapeutic Decision-Making

A. Effects of drugs

1. Systemic effects

2. Local effects

B. Pharmacokinetics

1. Absorption

2. Distribution

3. Metabolism

4. Excretion

5. Other variables

a. Age

b. Weight

c. Sex

d. Psychological state

e. Drug interactions

1) Synergism

2) Potentiation

3) Antagonism

f. Dosage

1) Minimum and maximum dose

2) Loading dose

3) Maintenance dose

4) Toxic dose

5) Lethal dose

6) Therapeutic dose

g. Route

1) GI tract/enteral

2) Parenteral

3) Inhalation respiratory

C. Undesirable responses to drugs

1. Teratogenic effect

2. Tolerance

3. Dependence

4. Hypersensitivity

5. Anaphylactic reaction
VI. Clinical Drug Trials

A. Principles of the controlled trial

B. Pragmatic and explanatory trials

C. Protection of subjects

D. Efficacy assessment

E. Randomization

F. Single-blind and double-blind trials

G. Sample size

H. Choice of comparator

I. Preparing a protocol

J. Auditing the clinical trial
VII. Safe Dosage Preparation

A. Calculation guidelines

B. Basic calculation

C. Ratio and proportion

D. Pediatric dosage

E. Geriatric dosage

VIII. Responsibilities and Principles of Drug Administration

A. Responsible drug administration

B. Medication error avoidance

IX. Administration Routes, Techniques and Preparations

A. Gastrointestinal

1. Oral

2. Nasogastric tube

3. Gastric tube

4. Rectal

B. Parenteral

1. Buccal

2. Transcutaneous

3. Inhalation therapy

4. Injections

5. Topical

6. Application to mucous membranes

C. Appropriate documentation of administration and patient outcomes

1. Dose

2. Time

3. Route

4. Location of injections

5. Sign or initial record

6. Documentation involving narcotics and any medications

X. Pediatric Considerations

A. Anatomic and physiologic variables

B. Pharmacokinetic and pharmacodynamic considerations

C. Concerns with neonates

1. Blood-brain barrier permeability

2. Renal function

D. Factors affecting dose

1. Body surface area

2. Weight

3. Age
XI. Geriatric Considerations

A. Anatomic and physiologic variables

B. Pharmacokinetic and pharmacodynamic considerations

C. Drugs and geriatrics

1. Cumulative effect of drugs

2. Gray list drugs (inappropriate for use in nursing homes)

3. Drugs that may cause mental impairment

4. Nonsteroidal anti-inflammatory drugs

5. Polypharmacy

XII. Preoperative Medication and Local Anesthetics

A. Sedation and analgesia

1. Policies and procedures

2. Guidelines

3. Competencies

B. Typical exams requiring conscious sedation

1. Endoscopic exams

2. Vascular and cardiac catheterizations

3. Bronchoscopy

4. Bone marrow aspiration

5. Computed tomography

6. Magnetic resonance imaging

C. Applied definitions

1. Conscious sedation and analgesia

2. Premedication

3. General anesthesia

4. Local anesthesia

5. Postprocedural and postoperative pain management

D. Conscious sedation goals

1. Altered level of consciousness and mood

2. Maintenance of consciousness

3. Cooperation

4. Elevation of pain threshold

5. Minimal variation of vital signs

6. Rapid degree of amnesia

7. Safe, prompt recovery and ambulation

E. Desired effects of conscious sedation

1. Relaxation

2. Cooperation

3. Purposeful responses to verbal communication and instruction

4. Purposeful responses to tactile stimulation

5. Easy and prompt arousal from sleep

F. Undesirable effects of conscious sedation

1. Deep unarousable sleep

2. Hypotension

3. Bradycardia

4. Agitation and combativeness

5. Hypoventilation

6. Respiratory depression

7. Airway obstruction

8. Apnea

G. Assessment and documentation prior to starting a study

1. Informed consent

2. Preprocedural assessment

3. Laboratory evaluation

H. Assessments during a procedure

1. Vital signs

2. The dose, route, medication, time of administration and effects of conscious sedation agents and other medications

3. Oxygen therapy

4. Level of consciousness throughout the procedure

5. Any reactions and required interventions

6. Type and amount of IV fluids, blood and blood products used

I. Airway management

1. Positioning of the airway

2. Use of oropharyngeal and nasopharyngeal airways

3. Application of positive pressure ventilation

a. Ambu Bag use

J. The recovery period

1. Preprocedural/presedation state

a. Airway

b. Breathing

c. Level of consciousness

K. Drugs used for sedation and analgesia

XIII. Vitamins, Anti-infective and Antineoplastic Drugs

A. Vitamins, minerals and herbs and alternative medicines

1. Impact on procedures

2. Interactions

B. Anti-infective drugs

1. Impact on procedures

2. Interactions

C. Antineoplastic drugs

1. Impact on procedures

2. Interactions

XIV. Drugs by Body System

A. Autonomic nervous system drugs

1. Andrenergics (Sympathomimetics)

2. Adrenergic blockers (Alpha and beta blockers)

3. Cholinergics (Parasympathomimetics)

4. Cholinergic blockers (Anticholinergics)

B. Central nervous system drugs

1. Analgesics, sedatives, and hypnotics

a. Analgesics

b. Sedatives and hypnotics

2. Anticonvulsants, antiparkinsonian drugs, and agents for Alzheimer disease

a. Anticonvulsants

b. Drugs for absence epilepsy

c. Drugs for grand mal and psychomotor epilepsy

d. Antiparkinsonian drugs

e. Agents for Alzheimer disease

3. Psychotropic medications, alcohol and drug abuse

a. CNS stimulants

b. Antidepressants

c. Antimanic agents

d. Anxiolytics

e. Antipsychotic medications

f. Alcohol

g. Drug abuse

C. Urinary system drugs

1. Diuretics

2. Medications for gout

3. Antispasmodics

4. Cholinergics

5. Analgesics

6. Treatment of benign prostatic hypertrophy

7. Alpha blockers

D. Gastrointestinal drugs

1. Antacids

2. Agents for treatment of ulcers and gastroesophageal reflux disease

3. Antispasmodics/anticholinergics

4. Agents for treatment of inflammatory bowel disease

5. Antidiarrhea agents

6. Antiflatulents

7. Laxatives and cathartics

8. Antiemetics

E. Endocrine system drugs

1. Pituitary hormones

2. Adrenal corticosteroids

3. Thyroid agents

4. Diabetic agents

F. Reproductive system drugs

1. Androgens

2. Impotence agents

3. Estrogens

4. Progestins

G. Cardiovascular drugs

1. Cardiac glycosides

2. Antiarrhythmic agents

3. Antihypertensives

4. Coronary vasodilators

5. Antilipemic agents

6. Vasoconstrictors

7. Anticoagulants

8. Platelet inhibitor therapy

H. Respiratory system drugs and antihistamines

1. Oxygen

2. Respiratory stimulants

3. Bronchodilators

4. Corticosteroids

5. Asthma prophylaxis

6. Mucolytics and expectorants

7. Antihistamines

8. Decongestants

9. Smoking cessation aids

I. Musculoskeletal and anti-inflammatory drugs

1. Skeletal muscle relaxants

2. Anti-inflammatory drugs

3. Osteoporosis therapy

Contrast Media

Content imparts an understanding of contrast media used during common diagnostic procedures. Topics include an overview of the chemical makeup and physical properties of select contrast agents, selection of contrast agents for given exams, patient risk factors, premedication strategies, indicators/symptoms of a patient contrast media reaction and recommendations for care and treatment of patients experiencing an adverse reaction to a given contrast agent.

Contrast Media Competencies

1. Discuss the rationale for the use of contrast media.

2. Differentiate between negative and positive contrast agents.

3. Identify the physical properties of select contrast agents.

4. Describe the structural differences and characteristics of low and high osmolar injectable contrast media.

5. Identify the desired contrast agent employed for select exams.

6. Discuss the resources used to identify patients at risk of an adverse reaction to contrast media used to perform a given diagnostic procedure.

7. Identify patient indicators for altering the selection of contrast media used to perform a given procedure.

8. Recite the patient preparation necessary for various contrast and special studies.

9. Identify the strategies employed when faced with patients with a known history of a previous allergic reaction.

10. Recognize the indicators/symptoms associated with a patient experiencing a mild, moderate or severe reaction to contrast media.

11. Implement strategies for treating a patient experiencing an adverse reaction to contrast media.

12. Discuss patient counseling and recommended follow-up care for patients undergoing a procedure requiring the use of contrast media.

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