04-14-2016 05:24 PM
How to stay in the guidelines of immediate use CSP for our rural hospitals with only a drug room. Example compounding a vancomycin 1250 mg piggyback. The question
to me was reconstituting a vial of vancomycin 500 mg and withdrawing 250 mg and injecting into the IV bag and then use vial-mate (vial to bag) to connect a 1 gram vial of
vancomycin to the bag to get the 1250 mg dose. Would this method be acceptable for immediate use guidelines. Any suggestions for the rural hospitals and compounding
doses that require more than one vial of drug.
10-18-2017 04:06 PM
I also have this Question for my rural hospital that doesnt have an iv room for mixing. All admixing is done on a counter at a nurses station (only by nursing since our pharmacy is only open for 30 min a day) and is being classified as immediate use mixing on a daily baisis. Is this acceptable?
What would the proper Garbing or PPE be in the situation when its being mixed on a counter daily?
What should the counter/area cleaning process be?
Does the Counter need to be made of a certain material?
Per- chapter 797, testing needs to be done for contamination of the mixing surface and of compounders hands after hand washing and gloving. Does this also apply to the iv mixing area for immediate use? And the hand testing even though gloves may not be required?
Are gloves required to mix immediate use meds daily on the counter?
What are all the required Aseptic technique requirements in the immediate use mixing situation?
Can Nurses mix meds and administer them with out a second check if this is a daily way of mixing patient medication for our patients?
Any advice is appreciated! I am not familiar with this process since ive never worked in a critical access Hospital before!
10-18-2017 04:13 PM
The immediate use provision in the current USP <797> is not intended to be a "replacement" for not having a PEC. This provision is inteneded for emergency situations such as a code only. Here is the exact language:
The immediate-use provision is intended only for those situations where there is a need for emergency or immediate patient
administration of a CSP. Such situations may include cardiopulmonary resuscitation, emergency room treatment, preparation
of diagnostic agents, or critical therapy where the preparation of the CSP under conditions described for Low-Risk Level CSPs
subjects the patient to additional risk due to delays in therapy. Immediate-use CSPs are not intended for storage for anticipated
needs or batch compounding. Preparations that are medium-risk level and high-risk level CSPs shall not be prepared as
10-18-2017 04:54 PM
10-19-2017 09:55 AM
Compounding sterile preparations must be done in a primary engineering control (hood). It is not acceptable or safe to routinely mix CSPs on the counter. The only time this is acceptable is if you are meeting the immediate use provision in USP <797> for emergent situations. Daily infusions do not meet this requirement.