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Contributor
Posts: 21
Registered: ‎01-18-2016
0

Immediate-Use CSPs in rural hospitals

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.

 

Thank you

 

llonsbury

Member
Posts: 3
Registered: ‎10-18-2017
0

Re: Immediate-Use CSPs in rural hospitals

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! 

 

Thank you

 

 

 

 

 

Advisor
Posts: 41
Registered: ‎05-17-2016
0

Re: Immediate-Use CSPs in rural hospitals

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

immediate-use CSPs.

 

 

Member
Posts: 3
Registered: ‎10-18-2017
0

Re: Immediate-Use CSPs in rural hospitals

So since we do not use a hood to mix IVs... Can we mix on a counter daily like this? What requirements do we have to meet to be able to do so?? We have a few patients that come in daily for infusions and they are all mixed on a counter outside of the pharmacy. Is this acceptable? I personally didn't think so, but the nurses here say that how they have always done it. I just started working at this facility.
Advisor
Posts: 41
Registered: ‎05-17-2016
0

Re: Immediate-Use CSPs in rural hospitals

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.

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Member
Posts: 3
Registered: ‎10-18-2017
0

Re: Immediate-Use CSPs in rural hospitals

Thank you for your input! I will be informing them and taking action here. I definitely agree that this should not be routine.