A compounding compliance team at an academic medical center

Safety in parenteral nutrition compounding

Parenteral nutrition (PN) compounding is a complex process that requires knowledge and training to ensure the safety and efficacy of this form of nutrition support therapy. Unfortunately, errors and lack of adherence to safe PN compounding recommendations and sterile compounding requirements have resulted in patient injury and death. These lapses in the safe provision of PN have been the result of various factors, including a lack of understanding of PN compatibility, stability, and sterility requirements, as well as drug product shortages and order entry errors. This review will describe the current challenges with the education and training regarding PN compounding, compatibility and stability of PN admixtures, simultaneous administration of nonnutrient medications with PN admixtures, and specific challenges with special populations such as neonates, pediatrics, and those receiving home care.

Designing a microbiological monitoring program for compounding facilities

PURPOSE

We describe the evolution of a large multicenter health system's microbiological monitoring program to improve standardization of viable sample collection practices; results review, interpretation, and response; and record keeping. We also describe lessons learned and considerations for other organizations considering microbiological monitoring program enhancements.

SUMMARY

Developing a robust microbiological monitoring program requires policy and procedure development; training and education of staff involved in viable sample collection, results interpretation, and investigations; establishing a robust sampling plan; reviewing trend data; reviewing systems data; and conducting investigations. Well-defined policies and procedures ensure consistent response to "out of level" (ie, violative) sampling results. Staff education ensures staff involved in microbiological monitoring are educated on adequate sampling techniques and microbial contamination sources and mitigation strategies. Thorough record keeping is essential for microbiological monitoring sampling activities and ongoing systems monitoring. The records should include results, investigations, assessments, recommendations, and records of completed follow-up actions.

CONCLUSION

Facilities management requires a comprehensive microbiological monitoring and systems monitoring plan. In health systems with multiple sites, a centralized oversight and management program may be beneficial to standardize records, response planning, and overall control of controlled compounding environments.

Development of a sterile compounding training and competency program at a large academic medical center

PURPOSE

This article is one of the 5 articles describing steps taken to enhance sterile compounding compliance at a large, multisite academic medical center. This article focuses on the development of a comprehensive personnel training and assessment program for sterile compounding.

SUMMARY

Increased regulatory oversight and the release of new United States Pharmacopeia chapters motivated the reenvisioning of the medical center's sterile compounding personnel training and assessment program. The main challenges facing any entity undertaking sterile compounding include identification of compounding staff, development of policies and procedures, and baseline and ongoing training including observational competency assessments and record keeping. These challenges are exacerbated by high work volumes and variation in compounding practices encountered within a large multisite institution. Our organization developed a team of specialized pharmacists and pharmacy technicians to implement and enforce changes promoting the safe production and use of compounded sterile products and meet rising regulatory requirements. This team worked within various operational areas to customize purchased policies and procedures and group compounding staff based on training needs. The team performs ongoing personnel monitoring and training of new compounders in a shared training space. Challenges encountered and future considerations for program enhancement are described.

CONCLUSION

Implementation of standards and enforcement of staff behaviors in a large academic medical center is perhaps best completed by a team of highly trained experts working in collaboration with supervisors and using a dedicated training and testing space, as evidenced by the success of the described program in overecoming past challenges.