Pharmacists' opinions about and compliance with recommendations for intravenous admixture practices.

Hospital pharmacy departments nationwide were surveyed to determine compliance with and opinions on the importance of recommended practices for preparation of i.v. admixtures. Questionnaires that included 84 recommendations by the National Coordinating Committee on Large-Volume Parenterals, the American Society of Hospital Pharmacists, and the Joint Commission on Accreditation of Hospitals were mailed to 625 randomly selected acute-care hospitals. Questions covered the compounding area and recommended equipment; selection, education, and training of personnel; compounding procedures; quality assurance; labeling and record keeping; and reference materials and professional services. The response rate was 43% (198 usable replies). Responses indicated that 42 (50%) of the recommended practices were followed in fewer than 75% of the hospitals, 25 (30%) in fewer than 50% of the hospitals, and 17 (20%) in fewer than 25% of the hospitals. Twenty of the recommendations were considered marginal in importance. Adherence to published guidelines for i.v. admixture services varies among hospitals in the United States; compilation of a single set of guidelines should be considered.

Handling antineoplastic-drug admixtures at cancer centers: practices and pharmacist attitudes.

Results of a 1986 national survey of handling practices for antineoplastic drugs at cancer centers and pharmacists' attitudes toward the importance of recommended practices are reported. A sample of 323 hospitals representing the 27 comprehensive cancer centers (CCCs) and 296 member institutions of the Association of Community Cancer Centers (ACCC) was selected for participation in the survey. Respondents were asked to rate the importance of a recommendation using a five-point scale. Data were analyzed according to hospital bed capacity (small, medium, and large). A total of 175 usable questionnaires were returned, yielding a response rate of 54%. Overall, 99.6% and 94.7% of CCCs and ACCC member institutions, respectively, used vertical-laminar-airflow containment h oods. Personnel used in antineoplastic-drug preparation varied according to hospital size, with CCCs using technicians more frequently than ACCC members. Training methods for personnel were similar among hospitals, although CCCs reported using written testing during training more often than ACCC members. Concern about the safety of the pregnant or breast-feeding woman and of the fetus or infant has led to precautionary policies and procedures in many hospitals. Most hospitals handled antineoplastic waste separately from other waste and regarded this as extremely important. Incineration of antineoplastic waste was used by most hospitals. Antineoplastic-drug-handling precautions taken at CCCs and ACCC member institutions have improved during recent years; pharmacists' perceptions of the importance of various recommendations for handling antineoplastic agents may be helpful in analyzing and developing relevant guidelines.

Providing 24-hour nutrient infusions to critically ill patients.

The outcome of critically ill patients receiving total parenteral nutrient (TPN) therapy was evaluated, and the percentage of wasted TPN solutions administered as one-per-day (2- or 3-L) or multiple-per-day (750-mL or 1-L) infusions was determined. Between March 31 and June 1, 1984, all patients who were treated by the nutritional support service (NSS) and who met the study criteria were included in the study. The 24-hour nutrient content of each TPN solution was determined using a published method. Patient outcome was determined using TPN therapy data that were collected from the patients' medical charts and NSS records. To determine waste, all discarded TPN solutions were recorded. A total of 20 patients (10 men and 10 women) were included, representing 23.6% of the 76 patients who received TPN therapy during the study period. Study patients received 24-hour nutrient solutions for a mean of 16.4 +/- 12.9 days and required a mean of 3.9 +/- 4.6 days to reach sufficient metabolic stability to qualify for 24-hour infusions. During the study period, 56 (2.8 +/- 2.5 per patient) orders were changed. The percentage of wasted TPN solutions was low; 4.3% (17 of 1326) multiple-per-day and 1.7% (5 of 292) one-per-day solutions were wasted. Twenty-four-hour TPN solutions can be used successfully in critically ill patient populations.

Managing employee apprehension toward handling cytotoxic drugs.

A strategy for dealing with employee apprehension about handling cytotoxic agents without a biological safety cabinet is described. Available evidence in the literature concerning the health risks of handling cytotoxic drugs was reviewed with employees. A committee was appointed to evaluate the institution's needs and current practices for handling cytotoxic agents. Airflow studies were conducted in the pharmacy department's sterile preparation areas, and policies and procedures were developed for use until biological safety cabinets could be installed. Plans were developed for dealing with special situations, such as exemption of certain employees from preparation of cytotoxic drugs or refusal of an employee to prepare these drugs. Managers can substantially reduce employees' apprehension about handling cytotoxic drugs by keeping employees informed about departmental plans, listening to their concerns, and developing procedures for safe handling of these agents.

Comprehensive intravenous admixture services: logistics and quality assurance in a university affiliated teaching institution.

The role of supportive personnel, as well as the supervision of intravenous (IV) admixture compounding by staff pharmacists, should be clearly identified by the departmental manager. In doing so, the department should strive to achieve an optimal mix of professional and technical personnel with automated technology. Close attention must be paid to quality assurance in order to maintain the highest quality parenteral admixture. The logistics of comprehensive IV admixture services are described for a university affiliated teaching institution. Emphasis is made on a three-faceted approach to quality assurance, including technician training, end-product testing, and equipment maintenance.