Transcript Sterile - Dr. Gerry Cronin

Sterile
Chapter Topics
• Sterile supplies for IV preparation and
administration
• IV solutions
• Specialized sterile compounding procedures
• Premade parenteral products
• Hospital pharmacy calculations
• Hazardous agents
• Quality assurance
Learning Objectives
• Identify the role and function of equipment used in
intravenous preparation and administration.
• Identify the components of an intravenous
administration set.
• Describe common characteristics of intravenous
solutions.
• Identify types of intravenous solutions.
• Summarize the steps necessary for aseptic technique in
a hospital pharmacy.
• Describe the correct procedure used in preparing
compounded sterile preparations.
Learning Objectives (continued)
• Discuss the preparation of total parenteral nutrition.
• Differentiate between expiration dating and beyonduse dating.
• Understand the types of premade parenteral products.
• Calculate intravenous flow rates.
• Discuss the importance of and techniques for
preparing, handling, and disposing of hazardous
agents.
• Define the purpose and list examples of quality
assurance programs in the hospital.
Sterile IV Supplies
• Syringes
Sterile compounding
personnel must not touch
the sterile parts of a syringe
or needle. Inadvertent
touching of these critical
sites results in
contamination and,
consequently, disposal of
the needle-and-syringe unit
into a sharps container.
– Parts of a syringe
– Syringe selection and
measurement
• Select a syringe that can be filled at
least ¾ full.
• Consider the measurement accurate
to half of the smallest calibration
mark.
• Read the measurement at the point
of contact between the rubbertipped piston plunger and the inside
of the barrel.
Sterile IV Supplies (continued)
• Needles
̶
̶
Gauge refers to the
diameter of the
opening or lumen of
the needle.
Needles are
individually wrapped
to maintain sterility.
Sterile IV Supplies (continued)
• Handling of the needle-andsyringe unit
– Remove the outer wrapper
without touching the syringe
tip.
– Open the sterile packaging of
the needle.
– Hold the needle by the cap.
– Twist the needle hub to the
syringe cap.
– Do not touch the sterile parts
or critical sites of the syringe
or needle.
Sterile IV Supplies (continued)
• IV administration sets
– Also called IV
tubing or an IV
set
– Commonly
attached to an IV
infusion pump
that adjusts the
volume and
administration
rate
Sterile IV Supplies (continued)
• IV administration sets
– Components of an IV set
• Universal spike adaptor
– A sharp, plastic spike is used to pierce the IV’s tubing port.
– An air vent (on some IV sets) just below the spike allows filtered
air to enter the bottle as fluid flows out of it.
• Drip chamber
– Air bubbles rise to the top of the IV fluid, preventing them from
entering the tubing and patient.
– Nurses set the infusion rate by counting the drops.
– The drop set is the number of drops of a given solution that it
takes to make 1 mL.
Sterile IV Supplies (continued)
• IV administration sets
– Components of an IV set
• Roll clamp
–
–
–
–
–
–
Hard plastic clip containing a small roller
Loosely attached to the tubing
Freely moving along the length of the tubing
Rolled down to constrict tubing
Rolled up to open tubing
Allows healthcare personnel to regulate the IV flow rate
• Flexible tubing (IV tubing)
– Molded from pliable PVC and other plasticizers
– Not for use with Nitroglycerin and amiodarone
Sterile IV Supplies (continued)
• IV administration sets
– Components of an IV set
• Needle adaptor
– Located close to the patient
– Tapered to fit all needles and protected by a sterile cover
• Y-site injection port
– Allows medications to be added to the IV solution
• In-line filter
– Protects the patient against bacteria and emboli
– Preparation of an IV set
• Priming
– Flushing the tubing’s interior lumen with solution
– Eliminiates small particles
– Happens prior to medication administration
Sterile IV Supplies (continued)
• IV administration sets
– Medication delivery with an IV set
• Responsibility of nurses
– Attaching IV tubing to fluid container
– Establishing and maintaining a flow rate
– Managing overall regulation during
administration of the solution
• Tubing changed every 24 to 96 hours to
minimize infection
– Pharmacy personnel and IV sets
• Increasing need for pharmacy personnel
to understand IV sets
Sterile IV Supplies (continued)
• Filters
– Built-in or in-line filters
– Provide final filtration of fluid
– Protect patients against particulate
matter, bacteria, air emboli, phlebitis
– Do not remove virus particles or
toxins
– Common filter sizes:
• 0.5 micron: for removing large particles
• 0.45 micron: for filtering IV suspensions
• 0.22 micron: for removing bacteria
IV Solutions
• Chemical properties of IV solutions
Property
Description
pH value
The degree of acidity or alkalinity of a solution; blood plasma
pH: 7.4; IV solution pH: 7.0 (neutral)
Osmolarity
A measure of the number of milliosmoles of solute per liter of
solution (mOsm/L)
Osmotic
pressure
The pressure required to maintain equilibrium, with no net
movement of solution across body membranes
Osmolality
A measure of the number of milliosmoles of solute per
kilogram of solvent
Compatibility
The ability to combine two or more additives in solution
without any changes in physical or chemical properties
Stability
Stability under various storage conditions
IV Solutions (continued)
• Chemical properties of IV solutions
Property Description
Tonicity
The manner in which cells or tissues respond to surrounding fluid
Hypotonic
solutions
Have fewer dissolved particles than blood (less than
280 mOsm/L). When cells are exposed to this, water is
drawn in, causing them to swell. An example is 0.45%
sodium chloride (½ NS).
Hypertonic
solutions
Have more dissolved particles than blood (greater
than 310 mOsm/L). When cells are exposed to this,
water is drawn out, causing them to shrivel. An
example is 3% normal saline (NS).
Isotonic
solutions
Have a similar number of dissolved particles as blood
(280-310 mOsm/L). An example is 0.9% sodium
chloride (normal saline).
IV Solutions (continued)
• Types of IV solutions
Largevolume
parenterals
(LVPs)
• Used to replenish fluids; provide
drugs, electrolytes, and nutrients
• Available in 250, 500, 1000 mL
• Administered over 1 to 24 hours
Smallvolume
parenterals
• Used to deliver medications
• Available from 25 to 250 mL
• Administered over 10 minutes to
an hour
• Majority are IV piggybacks (IVPBs)
(SVPs)
IV Solutions (continued)
• Preparation of labels for LVPs and SVPs
– Required information
•
•
•
•
•
•
•
•
•
Patient’s name and identification number
Room number
Medication name and dose
Base solution and amount
Infusion period
Flow rate
Beyond-use date and time
Signature or initials of technician and pharmacist
Any additional information required by the institution or state
or federal guidelines
IV Solutions (continued)
• Aseptic preparation of IV products
Remove outer garments and jewelry.
Put on shoe covers, a hair cover, and a face mask.
Perform aseptic hand washing for 2 to 4 minutes.
Put on a sterile gown.
Apply sterile, foamed alcohol to hands and allow them to dry.
Put on sterile gloves.
IV Solutions (continued)
• Aseptic preparation of IV products (continued)
Clean the hood with sterile water and then 70% IPA.
Remove syringe from packaging, attach a needle, and discard the waste.
Swab needle-penetration closure on vials and injection ports with 70% IPA.
Withdraw medication from vial or ampule and inject it into IV base solution.
Check the solution for cloudiness, particulates, and appropriate color.
Present the product, containers, devices, and label to the pharmacist for verification.
In the Know: True or False
• The critical areas of a needle and syringe include the tip of
the syringe and needle hub.
true
• A 0.45 micron filter is capable of removing bacteria from an
IV solution.
false
• A solution with an osmolarity of 300 mOsm/L is considered
isotonic.
true
• Large volume parenterals (LVPs) are typically used to
deliver antibiotics.
false
Special Sterile Compounding
Procedures
• Vials
– Types of vials
• Single-dose vials (SDVs)
– Do not contain a
preservative
– Must be used within an
hour, per USP Chapter
<797>
• Multiple-dose vials
(MDVs)
– Contain a preservative
– Stable for 28 days
unless otherwise
specified by the
manufacturer
Special Sterile Compounding
Procedures (continued)
Withdrawing fluid from a vial
1. Choose the smallest-gauge sterile needle size appropriate.
2. Attach the needle to the syringe.
3. Draw air into the syringe equal to the amount of drug to be
withdrawn.
4. Swab the vial, puncture the rubber top with the bevel up, bring the
syringe and needle straight up and penetrate the rubber top.
5. Invert the vial and depress the plunger, emptying air into the vial.
6. Withdraw the necessary volume of liquid.
7. Remove the needle-and-syringe unit from the vial.
8. Inject the liquid medication into an IV base solution.
Special Sterile Compounding
Procedures (continued)
• Vials
– Reconstituting powdered
medication in a vial
Check the medication
package insert to verify
which diluent and what
volume should be added
to the medication vial to
make a correct
concentration of sterile
solution.
• Reconstitute with a diluent
such as sterile water or normal
saline.
• Use a vented needle that allows
the diluent to be injected while
venting the positive pressure
within the vial.
Special Sterile Compounding
Procedures (continued)
• Vials
– Preparing a CSP with a vial’s contents
• The vial, filled syringe, and base solution are arranged on
the hood for the pharmacist to check.
• The pharmacist completes the verification check.
• The technician repositions items so that critical
components receive uninterrupted airflow from the HEPA
filter.
• The technician swabs the injection port, removes the
needle cap, and inserts needle into port.
• The technician depresses the flat knob of the plunger
until all medication is injected into base solution.
• The technician removes the needle-and-syringe unit and
disposes of it in a sharps container.
• The CSP is visually checked and labeled.
In the Know: True or False
• Multi-dose vials are given a BUD of 60 days.
false
• When withdrawing fluid from a vial, a volume of
air is drawn into the syringe equal to the amount
of drug to be withdrawn.
true
• When reconstituting powdered medication in the
vial, consult the package insert to find out what
diluent and volume to add.
true
Special Sterile Compounding
Procedures (continued)
• Ampules
– Parts of an ampule
Part
Description
Neck
Critical site, must be swabbed
with 70% IPA before opening
ampule.
Break
ring
Scored area on the neck that
marks the site where the ampule
should be broken
Special Sterile Compounding
Procedures (continued)
• Ampules
– Opening an ampule
1. Tap the head of the ampule to clear
medication from the head and neck.
2. Wrap a 70% IPA swab around the neck of
the ampule.
3. Using gentle but firm pressure, snap the
neck of the ampule away from you.
Special Sterile Compounding
Procedures (continued)
• Ampules
– Withdrawing medication from an ampule
• Hold the ampule upright.
• Place the needle (bevel pointing down) of a filter needle or
the tip of a filter straw in the corner near the opening.
– Tiny glass particles are screened out by the filter needle.
– Filter needles are unidirectional.
– Can either be used to withdraw fluid from an ampule or inject
fluid into an IV or IVPB, not both.
• Withdraw the medication.
• Change the filter needle to a regular needle to inject contents
into an IV or IVPB.
Special Sterile Compounding
Procedures (continued)
• Ampules
– Preparing a CSP with an ampule’s contents
• The ampule, filled syringe, used filter needle, and base solution are
arranged on the hood for the pharmacist to check.
• The pharmacist completes the verification check.
• The technician repositions items so that critical components
receive uninterrupted airflow from the HEPA filter.
• The technician swabs the injection port, removes the needle cap,
and inserts the needle into the port.
• The technician depresses the flat knob of the plunger until all
medication is injected into the base solution.
• The needle-and-syringe unit are removed and disposed of in a
sharps container.
• The technician visually checks the CSP and then labels it.
Special Sterile Compounding
Procedures (continued)
• Total parenteral nutrition (TPN) solution
– TPN components
•
•
•
•
•
•
Sterile water for hydration
Dextrose for calories and energy
Amino acids for protein synthesis
Fatty acids for chemical processes and energy
Electrolytes, vitamins, and minerals for energy processes
Medication (such as insulin) for treatment of a disease
Special Sterile Compounding
Procedures (continued)
• Total parenteral nutrition (TPN) solution
– Preparing TPN
• TPN is always prepared in volumes of at least 1,000 mL.
• In small hospitals, a technician prepares the base solution,
draws up the additives, then injects them into the base.
• In larger hospitals, an automated compounding device (ACD)
is used.
• If a fat emulsion is ordered as part of the TPN solution, this is
called a 3-in-1 TPN solution.
Special Sterile Compounding
Procedures (continued)
• Total parenteral nutrition (TPN)
solution
– Administering TPN
• Requires insertion of a central venous
catheter (CVC) or central line because
TPN is hyperosmolar or hypertonic.
• Administered via an infusion pump
• IV tubing includes a 0.22 micron inline filter.
• Aseptic technique in preparation and
catheter care are critical to avoid
bacterial contamination.
• Tubing is replaced with each new bag.
Premade Parenteral Products
• Vial-and-bag systems
– Types of vial-and-bag systems
• ADD-Vantage (Hospira) and MINI-BAG
Plus (Baxter) are two examples.
• Only selected products are available.
• Vial-and-bag systems are assembled in
an ISO Class 5 environment.
• Since vial-and-bag systems do not
require sterile compounding, they are
not considered CSPs.
• USP Chapter <797> beyond-use dating
guidelines do not apply.
• Follow manufacturer’s
recommendations for handling,
storage, and beyond-use dating.
Premade Parenteral Products
(continued)
• Vial-and-bag systems
Benefits of Vial-and-Bag Systems
Safety
Decreased risk of admixture errors, contamination, and
needle sticks
Efficiency
Doses premeasured for rapid reconstitution and assembly
Cost-effectiveness
No admixture or supply costs necessary
Assembly and Activation of Vial-and-Bag Systems
Activation
Technician attaches vial to IVPB; labels the product
Activation
Nurse breaks internal chamber at the connecting site;
drug mixes with fluid; Nurse administers solution
Premade Parenteral Products
• Frozen IV solutions
(continued)
– Benefits
•
•
•
•
Less wastage
Later expiration dates
Reduced risk of microbial contamination
Less labor-intensive preparation
– Handling of frozen IV solutions
•
•
•
•
•
Thaw at room temperature or in refrigerator
Warming bath or microwave not recommended for thawing
Label product once thawed
Expiration dates vary
Once thawed, cannot be refrozen
In the Know: True or False
• The critical site of an ampule is the neck.
true
• When breaking an ampule, snap the neck of the
ampule towards you.
false
• The purpose of dextrose in a TPN solution is to provide
calories and energy.
true
• Vial-and-bag systems are assembled on the nursing
unit.
false
Hospital Pharmacy Calculations
• Determining IV administration flow rates
What is the rate in mL/hr?
How long will this bag last?
x = TV/H
x = TV/IR
What time will the next bag be
needed?
How many bags will be needed for
the patient in a 24-hour period?
Step 1: x = TV/IR
Step 2: Add number of hrs (x) to
the current standard time
Step 1: x = TV/IR
Step 2: Divide 24 by the number of
hours calculated in Step 1
KEY:
TV=total volume
H=number of hours over which CSP will be administered (H)
IR= infusion rate
Hospital Pharmacy
Calculations (continued)
• Determining IV administration flow rates
Problem
A physician orders 4000 mL of D5NS to be administered over
24 hours. What is the infusion rate in milliliters per hour?
x = TV/H
TV = 4000 mL
H = 24 hours
4000/24 = 166.67 rounded to nearest whole number
x = 167 mL/hour
Hospital Pharmacy
Calculations (continued)
• Determining IV administration flow rates
Problem
The prescriber has ordered 500 mg of cefazolin in 50 mL of
D5W to be administered at 100 mL per hour. How long will it
take to administer this medication?
x = TV/IR
TV = 50 mL
IR = 100 mL/hr
50/100 = 0.5 (or ½ hour)
x = ½ hour or 30 minutes
Hospital Pharmacy
Calculations (continued)
• Adding electrolytes to base solution
– Electrolyte solutions contain dissolved mineral salts.
– Solutions are measured in milligrams (mg) and in
milliequivalents (mEq).
– Compounded LVP solutions typically require drawing
up as an additive and injecting into the base solution.
– The ratio-proportion method is used to determine the
volume of additive.
Hospital Pharmacy
Calculations (continued)
• Adding electrolytes to base solution
Problem
You are requested to add 44 mEq of sodium chloride (NaCl) to an IV
bag. Sodium chloride is available as a 4 mEq/mL solution. How many
milliliters should you add to the bag?
x mL = 1 mL
44 mEq
4 mEq
x mL = 44 mL
4
x = 11 mL
Hazardous Agents
• Risks of exposure to hazardous agents
Route of exposure
Example
Trauma or injury
Accidental needle stick or cut from broken
container
Inhalation
Fine mist from broken bottle or poor
manipulation technique
Ingestion
Ingesting powder particles when crushing an oral
tablet
Direct skin contact
Accidental spills
Hazardous Agents (continued)
• Risks of exposure to hazardous agents
– Acute health consequences
• Skin contact resulting in skin rash or allergic reaction
• Infertility, miscarriage, neonates with low birth weight or
congenital malformations
– Long-term health consequences
• Higher risk for skin and bladder cancers and leukemia
Hazardous Agents (continued)
• Protective clothing
– Disposable, lint-free, impervious, closed-front gown
with cuffed sleeves
– Hair and shoe covers
– Eye protection, face mask, gloves
(Remove and discard all protective garb before leaving
the hazardous drug preparation area.)
Hazardous Agents (continued)
• Protective clothing
– Double gloving
• Tuck disposable gloves under
the sleeve cuff of the gown.
• Place chemotherapy gloves
over the top of the gown cuff.
• Turn gloves inside out when
removing and discard them in
a sharps container.
Hazardous Agents (continued)
• Receipt and storage of hazardous agents
Receipt of Hazardous Agents
Gloves must be worn.
Damaged packages should be inspected in
an insulated area such as a vertical hood.
Hazardous drugs should be delivered
directly to their storage area.
Receipt of broken vials should be treated
as a hazardous agent spill.
Hazardous agents should be stored
separately from other medications.
Storage of Hazardous Agents
Storage areas should carry warning labels.
Access to storage and work areas for
hazardous materials should be restricted.
The storage area should maximize product A list of hazardous agents should be
recognition and minimize any potential for compiled and posted throughout the
breakage.
workplace.
Hazardous Agents (continued)
• Equipment for preparing
hazardous agents
– Biological safety cabinet (BSC)
• This specialized hood is used to
prepare chemotherapy and other
hazardous materials.
• HEPA-filtered air flows downward
and outward through the back
and sides.
• Contaminated air is filtered either
to outside or back inside cabinet.
• A plexiglas shield at the front of
the cabinet stops about eight
inches from the work surface.
Hazardous Agents (continued)
• Equipment for preparing
hazardous agents
– Compounding aseptic
containment isolator (CACI)
• Vertical airflow hood used to
prepare hazardous materials
• Fully enclosed
• Hands placed into fixed gloves
located at front of cabinet
• Supplies brought into hood
through inner pass-through
window
Hazardous Agents (continued)
Supplies Used in Hazardous Drug Preparation
• Safely draws fluid
from a vial into a
syringe or injects it
from a syringe into an
IVPB or IV
Closed-System
Transfer Devices
• A thin mat used to
soak up potential fluid
spills and prevent
fluid from seeping
through to the
surface of the hood
Chemotherapy
Compounding
Mat
• A device used to
relieve the negative
pressure within a
medication vial
Chemotherapy
Dispensing Pin
Hazardous Agents (continued)
• Hazardous agents in vials
When working with
hazardous drugs, sterile
compounding personnel
should use negative
pressure techniques
whenever possible.
Under no circumstances
should a volume of air
greater than 75% of the
volume of the drug
withdrawn be injected
into the vial.
– Use a CSTD or chemotherapy
dispensing pin, if available.
– If above not available:
• Slowly inject diluent into the vial.
• Allow excess pressure from vial to
vent into the syringe.
• Withdraw the reconstituted drug
from vial using negative pressure
techniques so that no drug is
leaked or aspirated.
• Inject contents of syringe into an
IV or IVPB.
Hazardous Agents (continued)
• Hazardous agents in
ampules
– Tap the head of the
ampule to clear medication
from the head and neck.
– Wrap a 70% IPA swab
around the neck of the
ampule.
– Using gentle but firm
pressure, snap the neck of
the ampule away from you.
– Withdraw fluid using a
filter needle.
• Oral hazardous drugs
– Wear gloves, a gown, and a
respirator.
– Clean contaminated
equipment after use.
– When crushing a drug in a
unit-of-use package, place
in a small, sealable plastic
bag and crush with a spoon
or pestle.
– Compounding with these
drugs should be done in an
area free from drafts and
traffic.
Hazardous Agents (continued)
Priming, Labeling, and Administering Hazardous Agents
Priming an IV
administration set
Priming should be done in a BSC or CACI. Insert the
spike of the administration set into the CSP’s tubing
port. Fluid will run from the CSP through the tubing,
thus priming it.
Labeling hazardous
agents
The label must contain the patient’s name and room
number, solution name and volume, drug name,
dosage, CSP administration information, storage
requirements, and be clearly identifyed as a
hazardous agent.
Administering hazardous
agents
Nurse must wear a mask, gloves, and special gown.
Two nurses will check the dose and labeling before
administration.
Hazardous Agents (continued)
Hazardous Agent Spill
1. Post warning sign outside of or near location of the spill.
2. Wear a gown, durable gloves, goggles, and a mask or respirator.
3. Place broken glass into puncture-proof containers.
4. Start cleaning the spill from the edge and work inward.
5. Use absorbent sheets, spill pads, or pillows for the liquids and damp
cloths for the solids.
6. Use spill pads and water to rinse the area.
7. Use detergent to remove residue.
8. Wipe down spill area with a detergent solution at least three times.
Hazardous Agents (continued)
• Procedures in case of exposure
– If skin exposed, flush affected area
immediately then cleanse with soap
and water.
– If eyes exposed, flush eyes with large
amounts of water or use eye-flush
kit.
– Remove and dispose of
contaminated garments and gloves.
– Wash hands thoroughly.
– Escort exposed worker to the
emergency room.
– Report exposure to the supervisor.
– Complete an incident report.
Hazardous Agents (continued)
• Final exposure and delivery to the patient care unit
– Inspection of CSP
• Check for accuracy in the identifications and quantities of
ingredients, technique for mixing, packaging, labeling, and
physical appearance.
– Delivery and administration of CSP
• Must prevent damage, leakage, contamination, or
degradation during delivery
• Nurse must document administration times on the MAR.
CSP and Manufactured Product
Returns
• Criteria for reuse
̶
A CSP can be redispensed only
when the pharmacist or
pharmacy technician is certain
that it remained sterile and
chemically stable during its
storage on the nursing unit.
̶
̶
Storage conditions must remain in
compliance with USP Chapter
<797>.
A new patient-specific label must
be generated.
In the case of a proprietary vialand-bag system that has not been
“activated,” the vial-and-bag
system may be returned to the
pharmacy for reuse and relabeling.
In the Know: True or False
• Two pairs of gloves must be worn when preparing
hazardous agents.
true
• Hazardous agents should be stored separately from
other medications.
true
• When preparing hazardous agents, a volume of air
equal to the volume of drug to be withdrawn should be
injected into the vial.
false
• If a hazardous agent spills, start cleaning the spill from
the center and work outward.
false
Quality Assurance
• Overview
– Purpose of a quality assurance (QA) program is to detect and
correct errors so as to prevent recurrence.
– Emphasis is to fix systems and not to affix blame.
• Quality assurance in handling hazardous agents
– Documentation of personnel training is required by USP Chapter
<797>.
– Follow written procedures for the handling and disposal of
hazardous agents.
– Follow directions for the treatment and documentation of any
exposure.
– Requirements for environmental and air sampling are required
per USP guidelines.
Chapter Summary
• IV infusions are used to deliver parenteral fluids, electrolytes,
medications, or nutrients such as lipids, amino acids, sugars, and
vitamins.
• Medications for parenteral administration must be prepared in a
horizontal or vertical laminar airflow hood using proper aseptic
technique and the under the supervision of a licensed pharmacist.
• A pharmacy technician must become familiar with various syringes
and needles as well as the components of each IV administration
set.
• Parenteral medications can be administered by bolus injection or by
infusion.
• A Y-site injection port allows nursing personnel to add medication
to an IV solution.
Chapter Summary (continued)
• An in-line filter in the IV administration set helps to protect the
patient against particulate matter, bacteria, air emboli, and
phlebitis.
• CSPs have many chemical properties that must be understood by
the pharmacy technician.
• Many types and volumes of IV solutions may be used as a means of
administering parenteral medications.
• Parenteral solutions with or without medications may be
administered via IV push, large-volume infusions, or small-volume
piggybacked infusions.
• Medications may need to be reconstituted from vials or withdrawn
from ampules before adding to the IV solution.
Chapter Summary (continued)
• Special IV solutions prepared or labeled in the pharmacy include
TPNs, proprietary vial-and-bag systems, and frozen IV solutions.
• A technician must be able to perform various types of calculations
when preparing CSPs.
• Hazardous drugs require special techniques, equipment, and
procedures to protect the health of the employee, especially
women who are pregnant, breast-feeding, or trying to conceive.
• Accidental spills or exposures require immediate treatment,
cleanup, reporting to the supervisor, and the completion of an
incident report.
• The pharmacy technician must undergo specific specialized training
before working in a sterile compounding environment.
Chapter Summary (continued)
• All parenteral medications must be properly labeled, checked, and
physically inspected by the pharmacist before being sent to the
nursing unit.
• Unused and returned manufactured parenteral products and CSPs
can be used if the beyond-use dating has not been exceeded and if
proper storage conditions on the nursing unit can be verified.
• A QA program to detect and correct errors is important to ensure
the quality of patient care and employee safety and is required for
accreditation.