Current CSTD Practices

January 2018 - Vol.15 No. 1 - Page #2
Category: Closed System Drug-Transfer Devices (CSTDs)

While the extension of the USP <800> implementation deadline until December 1, 2019 eases some pressure, pharmacy nonetheless has under 2 years to ensure that hazardous drug (HD) handling practices throughout the facility are compliant and that staff members handling HDs are protected. With few hospital pharmacies confident that they are currently in full compliance with USP <800>, focused activity around HD handling is currently the norm in most facilities. Typically, it takes a minimum of 18 months to conduct a gap analysis, review the findings, implement facility and workflow changes, train staff, and test for competency. Therefore, those facilities that have yet to undertake a comprehensive review of their current practices should be motivated by the December 2019 deadline to commence such an effort.

Much attention has been focused to date on creating facility-wide HD lists and adopting CSTDs, and most organizations have done a good job of establishing an HD list and accompanying policies for those drugs on Table 1 of the NIOSH list. Likewise, CSTD usage is expanding rapidly, for both medication preparation and administration. Pharmacy continues to drive CSTD adoptions with both pharmacy and nursing staff realizing the benefits of containment.

Notably, the expansion of CSTD usage is not motivated by the need to achieve USP <800> compliance, but rather, by a desire to ensure staff safety. The risk of repeated exposure to HDs is widely understood in pharmacy, and should be leveraged to increase administration support for HD containment efforts and the necessary infrastructure and technology investments.

CSTD use will continue to grow, as more than 9 out of 10 of those facilities currently without CSTDs plan to adopt this technology shortly. Similarly, most facilities (61%) are looking to expand the number of drugs for which they utilize CSTDs. As hospital pharmacies establish their handling processes for those drugs on Tables 2 and 3 in the NIOSH list, more products will be added to the organization’s HD list, requiring an increase in CSTD purchasing, which should be addressed in the pharmacy budget.

Expanding CSTD usage will require a similar expansion of staff training. It is important to determine which staff members will be trained on proper CSTD usage. As these devices become more commonplace in the hospital, an argument can be made for training all pharmacy and nursing staff on their proper use.


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