sent the front line of defense for their patients. Surgery centers must make sure everything they do is as fail-proof as possible.” While

ASCs should carefully

research any organization they are considering working with, it becomes paramount when the service provided by the organization could affect safety, Johnson says. “That is our main con- cern when performing any procedure that uses a drug, whether it is manu- factured by a compounding pharmacy or drug company. You should proceed with caution, do your research and know who you are dealing with before moving ahead with providing care.”

Working with Compounding Pharmacies

Check accreditation, state registration and licensure, and FDA track record BY ROBERT KURTZ


ompounding pharmacies can play an important role in supplying ASCs with medications they need to provide patient care, says Sharon John- son, RN, CASC, senior vice president of operations for ASC management and development company Ambulato- ry Surgical Centers of America, based in Hanover, Massachusetts. “There

are some patients who

need a specific drug manufactured by a drug company but cannot take the drug because of allergies to its pre- servatives,” she says. “In that case, we may consider purchasing a drug from a compounding pharmacy. Another time would be if the tablet/capsule form of a drug was not conducive for our pedi- atric patient population; we may want a compounding pharmacy to create a liquid form.”

Compounding pharmacies also can

develop their own drugs, which some- times catch the attention of surgeons. This was the case with a number of ophthalmologists who worked at some of Johnson’s ASCs and learned about an intravitreal injection designed for cataract surgery. “I had several sur- geons essentially demanding the solu- tion,” she says.

Before purchasing drugs from a compounding pharmacy for any rea- son, due diligence is required, says Michael O’Neal, a pharmacist consul- tant based out of Nashville, Tennes- see. “ASCs have the responsibility to provide safe, quality care, which now includes proper vetting of compound- ing pharmacies through state boards of pharmacy and the US Food and Drug Administration (FDA). ASCs repre-


Qualities to Look For When one of her ASCs asks if it can use a certain compounding pharmacy, Johnson first checks to see whether the pharmacy is accredited by the Phar- macy Compounding Accreditation Board (PCAB). “To achieve and maintain PCAB accreditation, compounding phar- macies need to meet strict guidelines about how their drugs are constructed and then quarantined to ensure prob- lems do not develop before the drug is sent out,” she says. “That is what the accreditation is intended to guarantee.” Confirm the pharmacy is registered with its state board of pharmacy, O’Neal advises. “For example, in Tennessee, there is public record of compounding pharmacies that have been validated by the Tennessee State Board of Pharmacy as sterile products producers.” Make sure the compounding

pharmacy is licensed in your state, regardless of whether the pharmacy is based in or out of your state, advises Carole Faucette, RN, clinical director of Cool Springs Surgery Center in Franklin, Tennessee. “Any time we consider using a compounding pharmacy, we take our time and do what is necessary to help us make an educated decision before

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