Q&A with Carlo Lupano,
RPh, MBA, CCP
Pharmacy Purchasing & Products: What are the most significant benefits of using frozen premixed antibiotics?
Carlo Lupano: These products are useful for a number of reasons. They are convenient, come ready to use, and therefore do not require mixing, which eliminates compounding time, the potential for medication errors, and the introduction of contamination during compounding. Any time fewer steps are required from preparation to administration, safety is enhanced. In addition, because these products are manufactured following FDA Good Manufacturing Practices, the possibility of errors and contamination is reduced. Ready-to-use products also decrease the lag between the time a physician orders a medication and the time it is dispensed to nursing for administration, because the technician simply takes the defrosted bag out of the refrigerator and labels it, and the pharmacist subsequently verifies it is correct. The patient does not have to wait while the drug is compounded in the cleanroom.
The extended expiration dates associated with frozen, premixed antibiotics translate into reduced waste and thus lower costs; even after they have been thawed, these products typically do not expire for another three to four weeks. Unlike most other medications that remain stable at room temperature, antibiotics must be refrigerated, and their expiration dates are shortened once they are prepared. Further cost savings are realized because no diluent, needles, syringes, or additional supplies need to be purchased in order to administer the medication. Finally, because frozen premixes are ready to use, nurses require little training in proper procedure; they simply receive the medication and administer it.
Purchasing frozen, premixed antibiotics is the best available solution to meet our facility’s needs. In addition, after accounting for all costs—including time to prepare and the additional equipment required for compounding purposes—purchasing frozen, premixed antibiotics was the least expensive option for our hospital.
PP&P: How was the decision made to add frozen, premixed antibiotics to the formulary?
Lupano: Pharmacy and nursing leadership convened to discuss which method of providing antibiotics would be the most beneficial at our hospital. We evaluated the available options, including IV drug admixture systems, which deliver the antibiotic and diluent in separate compartments that must be combined immediately before dosing, and syringe pump systems, which dispense antibiotics using large syringes. Neither of these options was ideal for our facility, as the IV drug admixture systems require mixing and numerous steps to prepare antibiotics, and using the syringe pump system would have required the facility to purchase new pumps to accommodate the large syringes. After carefully considering the pros and cons of each option, pharmacy and nursing agreed that purchasing frozen, premixed antibiotics was the simplest, least expensive, and most appropriate choice for our organization.
PP&P: What were the challenges of implementing frozen premixes?
Lupano: There were a few hurdles to implementing the use of frozen, premixed antibiotics. The central challenge pharmacy faced was space constraints—lack of space for the large freezer necessary to store the frozen products. However, a suitable location was determined after an evaluation of the space. Another challenge was logistical: pharmacy and nursing needed to proactively anticipate antibiotic volume usage and stock the refrigerator accordingly to ensure the premix had time to thaw before use. Although this step was initially challenging, adding in the products’ thaw time quickly became part of typical workflow. Next, because the thawed medications need to remain at refrigerated temperatures during transport to the nursing units, pharmacy purchased insulated cooler bags, which have worked well keeping antibiotics at the recommended temperature during transport. Finally, the defrosting bags can look messy in the refrigerator due to condensation. But the refrigerators’ dehumidifiers ensure that the medications have thawed completely and that they are dry when removed from the refrigerator to be dispensed.
PP&P: What effect did the use of frozen, premixed antibiotics have on workflow?
Lupano: Workflow in the pharmacy improved significantly as a result of using frozen premix. After the physician orders the drug, the pharmacy technician retrieves it from the refrigerator and labels it; it is then checked by the pharmacist. Because the products are ready to use, they do not require compounding in the cleanroom, where delays can occur. Other systems require processing in the cleanroom, mixing with a diluent, and labeling, which can affect when the patient receives their medication. Using premix ensures patients receive medications on time.
Carlo Lupano, RPh, MBA, CCP, is the pharmacy manager for ambulatory services at the Valley Hospital in Ridgewood, New Jersey, where he has worked since 2001. Carlo received his pharmacy degree from St. John’s University and his MBA in health care administration from Bernard Baruch College and the Mount Sinai School of Medicine.
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