GUIDELINES FOR
NUCLEAR PHARMACY TECHNICIAN
TRAINING PROGRAMS

 

Prepared by Ad Hoc Committee on Nuclear Pharmacy Technicians
Nuclear Pharmacy Section
Academy of Pharmacy Practice and Management
American Pharmaceutical Association
Approved November, 2000

 

NUCLEAR PHARMACY TECHNICIAN TRAINING OBJECTIVES

Objective I

The nuclear pharmacy technician should demonstrate appropriate knowledge and understanding of the specific nuclear pharmacy site with emphasis on the technician duties and responsibilities, including standards of ethics governing pharmacy practice.

Competencies. The nuclear pharmacy technician should be able to:

1. Interpret the pharmacy's organizational chart in terms of general responsibilities and job status of personnel with whom the technician will have contact in carrying out assigned duties;

2. State the general employee performance standards of the pharmacy including reasons for initiation of disciplinary actions;

3. State all of the nuclear pharmacy technician's primary job responsibilities, the duties falling under each, and how these differ from the primary responsibility of the nuclear pharmacist;

4. State the pharmacy policies applicable to each of the primary job responsibilities and describe the procedures for each;

5. Define what is meant by a "decision requiring a pharmacist's judgement" and cite at least 10 examples;

6. Demonstrate the use of correct telephone communication technique and protocol in both receiving and in initiating calls;

7. Demonstrate the use of correct written skills by drafting a memorandum to the supervisor requesting a change in work schedule;

8. State the general requirements of any local, state, or federal laws that specifically affect any of the nuclear pharmacy technician's responsibilities; and

9. Demonstrate appropriate working knowledge of any additional training or safety requirements mandated by the pharmacy or by any local, state, or federal agency by successful completion of any required program (e.g. Notice and Instruction to Workers Frequenting a Restricted Area, Blood Born Pathogens Instruction).

Training Guidelines. Suggested topics include:

1. Organization, functions, and responsibilities of the pharmacy;

2. Pharmacy policies and procedures, including employee handbook;

3. Orientation of nuclear pharmacy technician duties (job description);

4. Relationship of technicians to pharmacists and other staff;

5. Communication principles and techniques;

6. Legal aspects of technician functions, such as:

a. Accountability and liability

b. Pharmacy regulations

7. Other aspects of regulatory compliance, such as:

a. Radiation Health regulations

b. OSHA regulations

c. Hazardous Materials management regulations

Objective II

The nuclear pharmacy technician should have a working knowledge of the radiopharmaceutical terms, abbreviations, and symbols commonly used in prescribing, compounding and dispensing radiopharmaceuticals.

Competencies. The technician should be able to:

1. Transcribe and generate computer labels without error for any 25 radiopharmaceutical orders selected at random from at least four different institutions serviced by the radiopharmacy;

2. Demonstrate a working knowledge of the multiple "names" and abbreviations of 10 radiopharmaceuticals (e.g. Cardiolite®, sestamibi, MIBI, C'lite, RP-30); and

3. Define the terms Curie, millicurie, microcurie using both decimals and scientific notation.

Training Guidelines. Suggested topics include:

1. Radiopharmaceutical-medical terminology; and

2. Radiopharmaceutical abbreviations and symbols, radioisotope abbreviations.

Objective III

The nuclear pharmacy technician should demonstrate an ability to perform the mathematical calculations required for the usual dosage determinations and solution preparations in the compounding and dispensing of radiopharmaceuticals.

Competencies. The technician should be able to:

1. Convert without error any given activity to pre and post calibration activity;

2. Perform the calculations necessary to prepare a standard cold kit from a generator elution;

3. Perform the calculations necessary to prepare a time-specific unit dose from a pre or post calibrated prepared radiopharmaceutical; and

4. Perform the calculations necessary to prepare weight-in-volume and volume-in-volume solutions.

Training Guidelines. Suggested topics include:

1. Review of fractions, decimals, scientific notation, ratios, and percentages;

2. Review of the Decay Equation;

3. Dosage calculations; and

4. Preparation of compounded solutions.

Objective IV

The nuclear pharmacy technician should demonstrate the ability to perform the essential functions relating to drug purchasing and inventory control.

Competencies. The technician should be able to :

1. Prepare a written report of a physical inventory of pharmacy drugs and supplies using prepared forms and records;

2. Determine from existing reorder levels which inventoried items should be ordered and in what quantity;

3. Demonstrate an ability to check in a drug shipment by using the packing list or invoice and purchase order, completing the receiving report, and adding the items to the inventory;

4. Demonstrate the ability to appropriately store and retrieve from storage at least ten randomly designated items; and

5. Describe the procedure for lost shipments and for shipments received short or over quantity ordered.

Training Guidelines. Suggested topics include:

1. Inventory and purchasing procedures and records;

2. Maintaining radioactive materials records; and

3. Use of computer terminals.

Objective V

The nuclear pharmacy technician should demonstrate a working knowledge of drug dosages by imaging procedure, routes of administration, dosage forms, and be able to distinguish therapeutic from diagnostic radiopharmaceutical utilization.

Competencies. The technician should be able to :

1. Distinguish unit-dose and multi-dose prescription amounts;

2. List the three most common routes of administration of radiopharmaceuticals;

3. Identify an appropriate radiopharmaceutical dosage for a specified imaging procedure for ten radiopharmaceuticals (e.g. Tc-99m dosage for thyroid scan, Meckel's diverticulum, red blood cell labeling, or testicular scan); and

4. Distinguish the dosage appropriate for diagnostic or therapeutic use of a given radiopharmaceutical (e.g. I-131 for uptake and scan, whole body imaging, hyperthyroidism, or thyroid ablation).

Training Guidelines. Suggested topics include:

1. Sources of radioisotopes, radiopharmaceuticals and supplies;

2. Review of diagnostic procedures using radiopharmaceuticals;

3. Review of therapeutic procedures using radiopharmaceuticals;

4. Dosage forms (capsules, solutions, injectables, gases); and

5. Review of radiopharmaceutical dosages for specific procedures.

Objective VI

The nuclear pharmacy technician should have working knowledge of the procedures and operations relating to the reconstitution, packaging and labeling of radiopharmaceuticals.

Competencies. The technician should be able to:

1. Repackage and label 25 unit doses from bulk prepared radiopharmaceuticals and correctly complete all necessary records;

2. Demonstrate for each of five technetium labeled radiopharmaceuticals the reconstitution and unit or multi dose packaging of specified radiopharmaceuticals

a. Proper selection of each ingredient;

b. Correct selection of necessary equipment;

c. Proper assembly and use of the equipment;

d. Accurate calculation and measurement of each ingredient;

e. Proper completion of worksheet records and other required information;

f. Correct procedure for mixing and preparing radiopharmaceutical;

g. Correct procedure for quality control testing of the radiopharmaceutical;

h. Proper selection and preparation of dosage containers and closures;

i. Proper packaging technique for both unit and multi dose prescriptions; and

j. Correct selection and preparation of labels.

3. Identify from the pharmacy reconstitution procedure those functions that must be performed by a pharmacist only; and

4. Demonstrate proper completion of all record-keeping requirements for each formulation.

Training Guidelines. Suggested topics include:

1. Measurements of quantity (volume, weight, activity, and numbers);

2. Use, assembly, and maintenance of equipment and apparatus;

3. Control and recordkeeping procedures;

4.    Packaging considerations;

5.    Storage and inventory control;

6. Lot numbers and expiration dates and times;

7. Types of drug containers and packages; and

8. Labeling of drug containers and packages.

 

Objective VII

The nuclear pharmacy technician should have a working knowledge of the procedures and techniques relating to aseptic compounding and parenteral admixture operations.

Competencies. The technician should be able to:

1. List five different possibilities for contamination of an injectable solution during its preparation and for each possibility a precaution that would prevent the contamination;

2. Demonstrate the proper technique for using a syringe and needle for aseptic withdrawal of the contents of:

a. A rubber-capped vial, and

b. A glass ampul;

3. Demonstrate the proper technique for aseptic reconstitution of a cold kit;

4. Describe the occasions when hand washing is required and demonstrate the proper technique'

5. Demonstrate the correct technique and procedure for preparing at least three technetium radiopharmaceuticals, including the proper preparation of the label and completion of appropriate records;

6. Demonstrate the proper technique for cleaning a laminar air flow hood, including appropriate record keeping;

7. Identify the major components of a laminar air flow hood and state their functions;

8. Define or describe:

a. Microbial growth and transmission;

b. Origin, pharmacologic effect and prevention of pyrogens;

c. Sterility;

d. Heat sterilization; and

e. "Cold" sterilization;

9. Demonstrate the proper technique for visual inspection of parenteral solutions.

Training Guidelines. Suggested topics include:

1. Parenteral routes of administration common to nuclear pharmacy (rationale, precautions and problems);

2. Equipment and systems used in parenteral administration (needles and syringes, administration sets, containers, filters, and pumps);

3. Aseptic compounding techniques (specific to the system in use and including the prefilling of syringes);

4. Labeling and recordkeeping; and

5. Quality control (particulate matter inspections and monitoring of contamination).

Objective VIII

The nuclear pharmacy technician should demonstrate the ability to perform the usual technician functions associated with a specific radiopharmacy.

Competencies. The technician should be able to:

1. Demonstrate the proper technique for technetium generator elution, including appropriate record keeping;

2. Describe the specific dispensing and record keeping procedures that apply to the dispensing of :

a. Compounded radiopharmaceuticals;

b. Adaptive compounded radiopharmaceuticals;

c. Therapeutic radiopharmaceuticals;

d. Non radioactive drugs;

e. Investigational radiopharmaceuticals; and

3. List for each of 30 common radiopharmaceuticals;

a. The various tradenames;

b. The generic name;

c. The usual dose associated with a given procedure; and

d. The manufacturers and their calibration date/time, and expiration time;

4. Describe for at least ten technetium radiopharmaceuticals, as appropriate:

a. Quality control testing for radiochemical purity;

b. Quality control testing for radionuclidic purity;

c. Quality control testing for chemical purity; and

d. Procedural errors that result in substandard radiopharmaceuticals

Training Guidelines. Suggested topics include:

1. Setting up doses for patients;

2. Checking doses;

3. Equipment used to perform quality control testing;

4. Quality control techniques;

5. Review of prescription orders; and

6. Manufacturer package inserts

Objective IX

The nuclear pharmacy technician should demonstrate the ability to perform the manipulative and record keeping functions associated with the compounding and dispensing of radiopharmaceuticals.

Competencies. The technician should be able to:

1. Carry out the following functions for any 10 randomly selected radiopharmaceuticlas:

a. Correctly type the label;

b. Select the proper drug and lot from dispensing stock;

c. Compound the proper drug if not in dispensing stock;

d. Accurately measure the product and place in the proper container;

e. Properly label the dose container and exterior shielding; and

f. Complete the necessary records and documents.

2. Correctly determine the availability of radiopharmaceuticals not in dispensing stock, including:

a. Manufacturer;

b. Calibration and expiration time;

c. Soonest availability; and

d. Appropriate order quantity.

3. Designate from of a list of 10 steps involved in radiopharmaceutical dispensing those functions that only a pharmacist may carry out.

Training Guidelines. Suggested topics include:

1. Preparing prescription labels;

2. Manufacturer package inserts and information sheets; and

3. Measuring and assaying drugs.

Objective X

The nuclear pharmacy technician should demonstrate the manipulative and record keeping functions associated with quality control testing of radiopharmaceuticals.

Competencies. The technician should be able to:

1. Carry out the following functions for any ten randomly selected radiopharmaceuticals:

a. Select the appropriate solvents and media for the radiopharmaceutical chromatographic analysis;

b. Accurately perform the appropriate physical test;

c. Describe the species identified with the appropriate procedure; and

d. Complete the necessary records and documents.

2. Correctly carry out the following functions for any generator elution:

a. Select the equipment necessary to perform radionuclidic purity;

b. Accurately perform the purity test according to the equipment manufacturer's specification;

c. Determine the expiration time of the generator elution; and

d. Complete the necessary records and documentation; and

3. Correctly perform sterility testing of both radioactive and non radioactive products according to pharmacy protocols.

Training Guidelines. Suggested topics include:

1. Performing quality control testing;

2. Review of radiochemical and radionuclidic purity testing;

3. Review of sterility testing of radiopharmaceuticals; and

4. Review of USP and pharmacy standards of quality.