It has commonly been posited that because USP <800> requires CSTD use during drug administration, the adoption of CSTDs on the nursing units should serve as a prompt for pharmacy to also adopt these devices and then harmonize both nursing and pharmacy HD handling standard operating procedures. And yet, the data suggests just the opposite: CSTDs are currently in use in 91% of pharmacies compounding HDs, while just 75% of nursing staff in these facilities are using CSTDs for drug administration.
Consider the exposure risk that exists when nursing spikes an HD bag at the bedside without the use of a CSTD, or the risk incurred when nursing removes an “empty” HD bag after infusion without a CSTD. These are exactly the high-risk scenarios that necessitate the protection of a closed system.
Providing protection from HD exposure solely on the compounding end of the HD handling spectrum leaves significant safety gaps for those staff managing HDs beyond the pharmacy. We know that pharmacy drives these implementations; in fact, CSTD adoptions have been led by nursing alone—without any pharmacy involvement—in just 3% of facilities with CSTDs. As such, pharmacy must take the lead in CSTD implementation for the HD administration process. Furthermore, the argument could be made that protection from HD exposure during drug administration is no less crucial today than it will be on the day that USP <800> becomes officially enforceable.
Each and every health care worker throughout the institution relies on pharmacy’s expertise in drug handling to keep them safe. Pharmacy must embrace this responsibility beyond the walls of the pharmacy, and ensure that nursing, housekeeping, and receiving staff benefits from the same protections from HDs that pharmacy staff receives.
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