For a cleaner clean room, try technology training
New CD-ROM provides policies, procedures
You sink a fortune into your pharmacy clean room, but it’s only meaningful if pharmacists and technicians consistently follow strict mixing guidelines. With a training program on CD-ROM called Good Compounding Practices from Cognitive Design Associates (CDA), an Upper Saddle River, NJ-based health care consulting firm, you can make sure your pharmacy is operating according to well-founded policies and procedures and ensure that pharmacists and technicians are on the same page.
Chances are that somewhere, somehow, you’re doing things that hinder the effectiveness of your clean room, no matter how hard you try, according to Kate Douglass, president of CDA. Douglass notes that it doesn’t take much to undermine the effectiveness of your investments.
"We have seen people storing product in the clean room," she says. "That increases particulate count, and it doesn’t matter that you just spent $120,000 on the clean room. People spend a lot of money on high-tech clean rooms, but all that is lost if they don’t know how to operate the facility and they’re not organizing their work flow properly."
Douglass says it’s not just oversights such as storing product that can undermine your best efforts to keep your clean room clean. Pharmacists who walk in and out of a clean room dozens of times a day, or keep on the scrubs that they just went out to lunch in, are making simple yet costly mistakes when it comes to keeping particulate matter at a minimum.
And then there’s professional discretion when mixing.
"There isn’t any room for professional discretion when it comes to aseptic compounding," says Douglass. "There’s certainly room for professional discretion when interacting with physicians and patients, but in aseptic compounding there just is not a lot of room for professional discretion."
The problem is that there is no single standard for pharmacists to follow. And that’s where CDA and its CD-ROM, Good Compounding Practices, come into play.
"There is no one standard that says this is the way you need to compound," says Douglass. "We took information from acknowledged sources such as ASHP [American Society of Health-System Pharmacists], NABP [National Association of the Boards of Pharmacy], USP [US Pharmacopoeia], and the FDA [Food and Drug Administration], identified commonalties, and applied them to what is reasonable in the business setting, resulting in Good Compounding Practices."
CDA’s Good Compounding Practices can give a home infusion pharmacy guidelines for a streamlined process and helps fill in the gaps for areas that may have been overlooked.
extenCare, an Elkridge, MD, pharmacy that provides mixing services for a number of clients ranging from hospitals to long-term care facilities, has been using the CD-ROM for about a month.
Stacy Reid, CRNI, OCN, clinical operations director for extenCare, says anyone who works in the clean room has to come through the program.
"All of our personnel have been trained in the process control procedures we use to control our final product, and this CD-ROM is adjunct to that," she says. "It’s a way to test employees and see if they have learned and retained the training."
Reid points out that there are several benefits of the CD-ROM:
1. It starts with basic principles and provides a solid foundation of knowledge in the review portion. Before tackling advanced issues, the review begins with fundamental principles such as why a clean room is used, how it operates, what contamination means, and the differences between various types of contamination.
Douglass notes that even though such information is basic, it’s still critical.
"We strongly urge people to go back to the basics," she says. "Go back to good gowning and gloving, go back to using masks, go back to what works. Look at your own processes and procedures internally, tighten them up, and make them consistent."
2. Good Compounding Practices allows staff to proceed at their own pace.
"The computer-assisted series allows a learner who is advanced to go through and complete the requirements quickly," says Douglass. "The software incorporates elements such as hypertext where an advanced-level word that a novice learner might not know is explained when the learner clicks on the word and the definition appears."
3. Because the policies and procedures are laid out in a specific manner, it’s easy for pharmacists and technicians to use the same exact policies and procedures, thereby removing the potential for confusion that arises from professional discretion.
"Professional discretion allows you to make TPN [total parenteral nutrition] a certain way and another pharmacist to make TPN another way," says Reid. "With Good Compounding Practices, everything is done the same way all the time."
As a result, when Reid looks in her clean room, she can see who is doing what by looking at where they are. The color of tub the pharmacist is using and the way the label is tilted on top of his or her hood tell Reid exactly where the pharmacist is in the mixing process because these elements are predetermined in the procedures. According to Reid, this allows staff to get into a very quick routine.
Using the CD-ROM as a study tool isn’t enough, though. Once the review is complete, staff must pass a test on the material. Reid says the testing module is beneficial because it provides her with an objective method of measuring progress.
"This has assisted me by providing a concrete tool to tell someone, You are not where you need to be at this point, and we need to extend your orientation,’" she says. "Instead of subjective things people often use, this is a black-and-white way to assess someone’s competency."
But Reid has access to more than just a final pass/fail grade. Because the test allows people to progress at their own pace, Reid can see what areas any particular staff person had difficulty with.
"The program tells you how many times they had to try to get the right answer, so you can tell when they are struggling with a concept or technique," she says. "We put that in a person’s file, and if they didn’t do well, they have to go back to the drawing board."
Douglass adds that the convenience of providing training on a CD-ROM is another benefit.
"It’s not only a way to document training, but staff can do training during downtime between job activities or take it home," she says. "They can do it on a PC anywhere."
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