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Institutional pharmacy practice, pharm tech

QuestionAnswer
prescriptions in an outpatient pharmacy within hospital filled prescriptions may remain in the pharmacy for 3 days before they are returned to stock
US Department of Health and Human Services ensures that hospitals meet all standards of safe operation
each state's board of pharmacy may inspect pharmacies to guarantee that all personnel are working within legal guidelines; has the authority to fine, and close, noncompliant pharmacies
The Joint Commission (TJC) offers special certifications and accreditations to organizations willing to go through a process and pay a fee for certifications and accreditations to show quality and patient safety; make unannounced visits, called surveys, a minimum of once every 39 months
TJC inspects and accredits long-term pharmacies and hospital pharmacies *(not retail pharmacies)
label from medication order patient's name, medical record number, and room number along with the medication info (drug name, strength, dosage form, route of administration, dose, quantity, and dosing interval)
CADM computerized adverse drug event monitoring
BPOE barcode point-of-entry
ADE adverse drug events
PAR periodic automatic replenishment
parenteral medications bypass the digestive system and are intended for quick systemic action
parenteral medications route of adminstration by injection via the intramuscular or IV route; includes piggyback antibiotics, large-volume IV solutions (i.e. sodium chloride, dextrose, amino acid infusions), and other parenteral medication orders
IV preparation areas required to have a clean room outside the compounding area that meets federal standards
clean rooms buffer the IV admixture room and allow preparation of IV labels and stock to be maintained in a clean yet separate area; must meet USP standards
horizontal laminar airflow hoods are cabinets that direct filtered air horizontally toward the opening of the cabinet, which provides a sterile environment for preparing parenteral medications
BSC biological safety cabinet
LAFW horizontal flow hood; used for preparing nonhazardous IV medications
HEPA high-efficiency particulate air filter; located in back of LAFW
tech note LAFW orientation of the hands must not block the flow of first-air (meaning hands cannot be moved between the vial, needle, or IV bag and the first-air)
first-air the air issuing directly from the HEPA filter
blocking the flow of first-air can allow contamination of the preparation
aseptic technique set of guidelines and procedures used to prevent the contamination of an object by microorganisms
aseptic technique is important in the preparation of all IV medications, IV nutrition solutions, chemotherapy products, and compounded ophthalmic medications
chemotherapy compounds are prepared within a vertical flow hood BSC, glove box, or a compounding aseptic containment isolator (CACI)
ISO International Standards Organization; an international standard-setting body composed of representatives from various national standards organizations
USP regulations state that compounding should take place in a ISO class 8 or better clean room
ISO ranks clean rooms as ISO class 1 (the cleanest) through ISO class 9; the lower the ISO rating, the cleaner the environment
contamination is measured by particle count; HEPA filters capture the contaminated particles
ISO class 8 environment means that the HEPA filter captures 3,520,000 parts per cubic meter that measure greater than 0.5 mcg
anteroom for gowning and degowning, and movement of personnel into and out of the clean room
PEC hood known as the primary engineering control; must provide an ISO class 5 or better environment must be used to perform compounding activities
glove box isolators barrier isolators; can be added to comply with USP standards for smaller hospitals who can not afford a clean room
glove boxes have been found to reduce the possibility of contamination, which is a major concern in error prevention; there are different classes of glove boxes; can be used for higher risk IV admixtures per USP regulations
70% isopropyl alcohol must be used to clean the hood and after each use
air in glove boxes filtered through a HEPA filter and then through a final HEPA filter before it is exhausted to the outside of the facility (not into the work area)
glove boxes are a closed system unlike the partially shielded vertical flow hood or horizontal flow hood
air flow in a glove box is vertical, therefore hands must not move over the top of any vial, needle, or IV bag; if the hands do move over these areas, aseptic technique is broken
USP 800 guidelines for hazardous IV preparations
CYTOCARE robotic systems that prepare hazardous IV preparations
in a room with negative air pressure the BSC is the proper hood to use
BSC's are partially open front vertical airflow hoods used to prepare chemotherapeutic agents; air is pulled down toward the tabletop filter from the ceiling of the hood which contains the first HEPA filter
chemotherapy hood does not allow the air to leave the container compartment; instead, the air is recycled through a second HEPA filter that removes any particulate matter before the air is recirculated into the work environment
vertical air flow in the BSC helps protect the person preparing the chemo agents from unwanted exposure; hands should not move over or above the items in the vertical flow hood
double gloves used in hazardous IV preparations first pair is worn under the wrist cuff of the gown and the second pair is pulled over the wrist cuff of the gown
tech alert for gloves safe practices recommend that gloves used to prepare chemotherapeutic agents should not be worn longer than 30 minutes. Hands must always be washed before and after removal of gloves
Created by: DbaileyC
 

 



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