FEATURE
most instances, if you are not follow- ing the standards and nationally rec- ognized guidelines for safe injection practices, cite you.”
surveyors
will definitely
Keep Up With the Rules The rules governing medication prepa- ration practices change constantly and could be challenging to keep up with, Patrick says, but ASCs must keep on top of them.
The Rules of Medication Preparation
Train, monitor and audit BY ROBERT KURTZ
R
ancho Bernardo Surgery Center makes medication preparation a constant area of focus, says Steph- anie McIntosh, RN, administrator for the San Diego, California-based ASC. “Keeping it
at the forefront
of everyone’s mind is what keeps us vigilant with following regulations and proper practices.”
That needs to be the mindset of
an ASC or mistakes are likely to occur, says Marcia Patrick, RN, a Tacoma, Washington-based infection prevention and control consultant and surveyor for the Accreditation Association for Ambulatory Health Care (AAAHC). “The Centers for Disease
Control and Prevention
(CDC) has a long list of outbreaks that can be attributed to unsafe medication preparation practices. This is an area ASCs must be concerned about because of the potential for direct
If it says single-dose or single-patient use on any label, it means single patient: one use, one patient, one time.”
— Marcia Patrick, RN Accreditation Association for Ambulatory Health Care
patient harm, such as transmission of infectious diseases.”
The Centers for Medicare & Med-
icaid Services (CMS) and accredita- tion surveyors also closely scrutinize the area of medication preparation, says Alyssa Whitmore, ASC account manager for Lake Forest, Illinois- based PharMEDium, a provider of pharmacy-outsourced, ready-to-use sterile compounded preparations. “In
16 ASC FOCUS NOVEMBER/DECEMBER 2016
One major area undergoing revi- sions and clarifications from CMS over the past several years concerns the use of single- and multi-dose vials. “For an old nurse, which I am, these were huge changes from what we did in the past,” Patrick says. “Those kinds of changes are often the hardest for people to embrace, understand and follow, so ASCs should pay very close attention to them.” For example, infectious diseases are transmitted when a single-dose vial is used for multiple patients, Patrick says. “If it says single-dose or single-patient use on any label, it means single patient: one use, one patient, one time.” Along with adhering to CDC infec- tion control guidelines, ASC staff who compound sterile preparations must follow state boards of pharmacy regula- tions and United States Pharmacopoeia (USP) 797 standards according to their state’s regulatory status level, Whitmore says. “These detailed requirements for compounding sterile preparations are changing and evolving.” McIntosh’s ASC diligently follows all medication preparation rules but pays closer attention to some practices because of their increased potential to cause harm in the event of a mistake. One such practice is labeling. “If you are not careful, one can eas-
ily mislabel a drug concentration or even misidentify a medication, partic- ularly when the medication is a ‘look- alike/sound-alike’ (LASA) drug,” she says. “The likelihood of making a mis- take can increase when you must pre- pare a medication quickly in response
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