ASHP Midyear: Expert Highlights Standardization, Technology to Enhance Compounding Safety and Quality

Charnae Ross, PharmD, MSHA, BCSCP, enterprise pharmacy regulatory manager at New York Presbyterian (NYP) highlights 3 key pillars for improving safety and quality in a large health system's pharmacy operations: standardization, collaboration, and continuous quality improvement. A prime example is the standardization of observational competencies across the enterprise, which involved a collaborative effort between pharmacy operations managers at each site to create a consistent training template. The use of the health system's emergency health records and compounding technology, such as barcode scanning and photo documentation, has also been crucial in preventing medication errors and enhancing the overall compounding process.

Pharmacy Times: Can you describe your overall approach to improving safety and quality in compounding across a large health system?

Charnae Ross: My overall approach to improving safety and quality in a large health system focuses on 3 key pillars: standardization, collaboration, and continuous quality improvement. Standardization is important because we are a large health system with different sized hospitals. We have to make sure that everything is standardized when it comes to compounding across the enterprise. Secondly, collaboration: I collaborate with the designated persons, which are the pharmacy operations manager at each of the sites, and then continuous quality improvements, going onsite, doing audits, improving our workflow, improving our policies, to make sure that the standards that is set to excel, to be quality enterprise is ensured.

Pharmacy Times: Can you provide specific examples of how NYP has standardized processes while addressing the unique needs of various locations or facilities within the system?

Ross: A perfect example I have is standardizing our observational competencies across the enterprise. I joined the organization sometime late last year, and right when I joined this work was already being done by the designated persons and pharmacy operations managers at the sites. We had a work group that was separate from our USP <797>, enterprise wide committee, and these managers, they worked on looking at the template that's provided by sole source and creating a template that all sites can use. This is important because we want to make sure that training is consistent across the enterprise and that all staff understand what's expected of them. This is very important to improving the quality and ensuring that we have a standard process in place.

Pharmacy Times: How has NYP integrated technology into compounding practices to enhance safety and quality?

Ross: We have EPIC as our [electronic health records], and we utilize the sense press, and so that requires barcode scanning, taking pictures of the compounded product, as well as taking pictures as you're going throughout the compounding process. That's very, very, very important. Our pharmacists that are there that are viewing these pictures have caught a couple of medication errors, preventing medication errors from happening, usually utilizing this technology. It definitely improves the compounding process, the overall efficacy and quality of the compounding process.

Pharmacy Times: How does NYP train or retrain staff to stay current on best practices and regulatory requirements for compounding?

Ross: So we follow the requirements that are in the chapter, making sure that our staff that are participating in compounding are validated every 6 months. We also have a didactic training program as well. We're leveraging sole source; this didactic compounding suite. Our staff are able to get a CE credit for this as well, and our pharmacists go through a robust training as well. One thing that I'm personally considering is a training program specifically for the designated persons that are that should be competent on the requirements of the chapter. So that's something that is hopefully forthcoming at NYP, is a specific training for designated persons, as well as those individuals who validate and do the glove fingertip and media feel observational competencies for our staff.

Pharmacy Times: What innovations do you foresee in the field of compounding that could further improve safety and quality across health systems?

Ross: What I love about coming to conferences like [American Society of Health-System Pharamcists] Midyear is going to the exhibit hall. So I went to the exhibit hall. You get to see different vendors, and one vendor that I came across was Germfree. They have a compounding hood that incorporates a camera. There's a computer; the printer is all attached to the compounding hood. It minimizes the amount of time the compounder has to go in and out of the hood. So that would be something that would be innovative new technology to improve the quality of the compounding process.