As hospital nuclear medicine departments were established in the 1960s and 1970s, each department developed detailed policies and procedures to meet the specialized and specific handling requirements of radiopharmaceuticals. In many health systems, radiopharmaceuticals are still unique as the only drugs not under the control of the health system pharmacy; however, the clear trend-and now an accreditation requirement-is to merge radiopharmaceutical management with the overall health system medication management system. Accomplishing this can be a challenge for both nuclear medicine and pharmacy because each lacks knowledge of the specifics and needs of the other field. In this paper we will first describe medication management standards, what they cover, and how they are enforced. We will describe how we created a nuclear medicine and pharmacy team to achieve compliance, and we will present the results of their work. We will examine several specific issues raised by incorporating radiopharmaceuticals in the medication management process and describe how our team addressed those issues. Finally, we will look at how the medication management process helps ensure ongoing quality and safety to patients through multiple periodic reviews. The reader will gain an understanding of medication management standards and how they apply to nuclear medicine, learn how a nuclear medicine and pharmacy team can effectively merge nuclear medicine and pharmacy processes, and gain the ability to achieve compliance at the reader's own institution. Modernnucl ear medicine was born about 50 y ago with patenting of the Anger scintillation camera (1961) and introduction of 99m Tc as an ideal medical tracer (1960) (1,2). Most of the growth in nuclear medicine over the last half century has been the direct result of the introduction of new radiopharmaceuticals. Many of these agents (hepatobiliary agents, bone tracers, sestamibi, macroaggregated albumin, 18 F-FDG, and others) were revolutionary advances in functional imaging, leading to clinical use of multiple radiopharmaceuticals in most nuclear medicine departments. Many nuclear medicine procedures also use a variety of nonradioactive drugs (pharmacologic stress agents, cholecystokinin analog, furosemide, and others). As a result, most health system nuclear medicine departments today routinely dispense dozens of different radiopharmaceuticals and other medications (Fig. 1).Historically, radiopharmaceuticals have been managed separately from other medications in many health systems. Because of their radioactivity, radiopharmaceuticals require special handling within the medication use process and their own special procedures and safeguards to ensure safe and effective use. As nuclear medicine departments were established and evolved, many developed their own radiopharmaceutical policies and procedures intended to avoid improper administration and ensure safe use. Concurrently, many health system pharmacy departments, working hard to meet increasingly rigorous and expanding standards, have ...
