Sterile Compounding Knowledge, Skills, and Confidence Among Graduating Doctor of Pharmacy Students

Accuracy of pharmacy student self-assessment of a single sterile compounding technique following didactic training

INTRODUCTION

The primary objective was to determine pharmacy students' ability to self-assess sterile compounding technique in a single evaluation three semesters after training in the curriculum.

METHODS

School of pharmacy (SOP) students were trained and assessed on sterile compounding technique during their second year of school, with no additional formal assessments provided later in the curriculum. From 2016 to 2018, 262 students were asked to compound a simulated sterile product in their third year of pharmacy school and self-evaluate their technique, which was compared to an instructor evaluation with both people using the same rubric.

RESULTS

Two thresholds were used to define successful assessment: strict (ability to detect ideal technique) and lenient (ability to detect harmful technique). The average match rate was 70.2% and 87.6% in the strict and lenient analyses, respectively, with outcomes varying between categories. In the product preparation and inspecting product categories, students who disagreed with assessors tended to misidentify their incorrect technique as correct.

CONCLUSIONS

Pharmacy students who assessed themselves on sterile compounding technique three semesters after formal sterile compounding training were able to accurately self-assess in most cases, but when disagreeing with an assessor, commonly identified their incorrect technique as correct. Most students demonstrated the ability to self-assess sterile compounding technique and are prepared to assess their own sterile compounding in practice. SOPs could consider whether sterile compounding training coupled with self-assessment throughout the curriculum would be beneficial to further improve students' sterile compounding ability and accuracy of self-assessment.

Economic Considerations and Cost-Saving Strategies for Sterile Compounding Education

OBJECTIVE

To determine economic considerations associated with the facilitation of sterile compounding education for students in schools and colleges of pharmacy across the United States.

METHODS

An online survey was sent to members of the American Association of Colleges of Pharmacy Pharmaceutics Section and Laboratory Instructor's Special Interest Group. Quantitative and qualitative data were collected on general information about the institution, student cohorts, compounding courses, types of compounds prepared, equipment, budgets, personnel, and cost-saving measures. Descriptive statistics were calculated using SPSS. Open-ended responses were used by respondents if the primary question could not adequately capture their institution-specific information. These answers were added to the study findings.

RESULTS

Of 555 surveys sent, 40 were completed. Reported annual sterile compounding budgets ranged from $500 to $95,500. Twenty-two percent of respondents reported collecting a lab fee from students to offset associated costs. Seventy percent of respondents specified cost-saving measures, including the use of expired drugs, reusing supplies or personal protective equipment, price comparisons, simulated drugs, and donations.

CONCLUSION

Findings from this study may assist pharmacy administrators and faculty in evaluating the costs associated with sterile compounding education and determining ways to reduce costs while maintaining the intent and quality of these courses.

Content Analysis of US FDA Warning Letters Issued to Compounding Pharmacies Regarding Violations of Current Good Manufacturing Practices Between 2017 and 2022

Purpose

Assessment of the US FDA-issued WLs content is an educational tool that can be used in the continuous training program of community pharmacists in compounding pharmacies. The study was designed to critically assess FDA warning letters (WLs) issued to compounding pharmacies in 2017-2022 for violations of Current Good Manufacturing Practices (cGMP).

Methods

Content analysis was used to evaluate WLs issued concerning (1) type of violations; (2) frequency of violations mentioned in the WLs; (3) specific evaluations of the deviations related to compounded sterile products, and (4) evaluation of corrective measures requested by the US FDA.

Results

A total of 141 WLs were evaluated. The main observed violations in the analyzed WLs were adulterated drug products (130), misbranded drugs (103), unapproved new drug products (42), failure to report adverse events (22), and failure to report drugs (11). Other violations were evaluated related to sterile product compounding with emphasis on personnel qualifications, quality control procedures, equipment, etc.

Conclusion

The continuous issuance of WLs by the FDA indicates the need for compounding pharmacies become more vigilant to reduce the recurrence of the addressed violations through establishing adequate training/retraining programs. The analysis of issued WLs can serve as a learning tool to help improve compounding procedures, reduce the recurrence of these violations, and enhance patient safeguards.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12247-022-09692-4.

"Practice makes perfect" strategy for teaching aseptic techniques improved observational scores but not preparation potency

INTRODUCTION

Student-compounded sterile preparations have been evaluated using observational scores, sterility testing, and potency determinations. Observational scores and potency determinations can be evaluated simultaneously, and three studies have been published using these assessment tools. One study found a significant number of students could not compound an acceptably potent preparation despite receiving very good observational scores. The previous study was judged to have an inferior instructional flaw, so a new teaching design, a "practice makes perfect" model, was utilized and was expected to increase the number of students compounding acceptably potent preparations.

METHODS

The "practice makes perfect" method provided students with more practice and one-on-one instruction time in aseptic techniques. First-year pharmacy students received both group practice sessions and individualized instruction on six occasions interspersed between three compounding assessments. Observational scores and potency results were compared between this study and the previously published study.

RESULTS

The "practice makes perfect" strategy improved students' observational scores but showed inconsistent results in the percentage of students who compounded an acceptably potent preparation and in the potency of preparations compounded by all students. There was no correlation between observational scores and potency values or between observational scores and the percentage of students compounding acceptably potent preparations at each individual observational score.

CONCLUSIONS

The study demonstrated that there was either a systematic error in the analytical potency protocol or that the observations made during student compounding were not adequate to identify problems that led to poor potency.