USP General Chapter <800> requires closed system drug-transfer devices (CSTDs) for hazardous drug (HD) administration where the dosage form allows, but only recommends CSTD use for compounding. Yet, recent PP&P data shows a higher percentage of usage for pharmacy than for nursing: While 91% of hospital pharmacies utilize CSTDs for HD preparation, only 75% of nursing units use CSTDs for HD administration.1 This begs the question: Are nurses not using the device, or does nursing not have a device at all?
Typically, CSTDs are selected by the pharmacy department to protect personnel during HD compounding. But now pharmacy must endeavor to support nursing’s use of CSTDs during HD administration.
Include Nursing in Device Selection
Depending on the organization, nursing may be at the table during CSTD deliberations, or they may be left out of the discussion. In a best-case scenario, representatives from pharmacy and nursing can debate the merits of different devices and arrive at a mutually agreeable decision.2 Oftentimes these discussions will result in choosing a device that meets the needs of pharmacists while also being able to successfully integrate with existing pumps and IV tubing for administration. Sometimes, a hybrid approach is taken in which pharmacy will use a different device (from the same or a different manufacturer) than nursing. Either way, both departments will have the necessary CSTD protection.
Unfortunately, decisions are occasionally made unilaterally by pharmacy and nurses are excluded. Nursing may be required to use the device chosen by pharmacy, or left with no device at all. The CSTD may not meet the needs of bedside/chairside administration, resulting in staff frustration and at worst, discarding the device entirely. Including nursing in the decision-making process helps ensure the chosen CSTD will be used as intended.
Designate an HD Person
Section 4 of USP <800> requires that a designated HD person be assigned to manage the facility’s HD program. USP does not dictate who this person should be or which department they should represent, but the individual must be able to network collaboratively between pharmacy and nursing. If nurses are not using the CSTD provided by pharmacy, a nursing-based task force could examine the issues by soliciting feedback to determine the problem. Retraining may be required so that nursing staff understands the correct way to use the device. If nurses do not understand the importance of using the device, this can be corrected with further education.
After ensuring all nursing staff understands the rationale for using a CSTD and its correct use, an audit must be put in place to ensure compliance. The audit should occur after education and be repeated at regular intervals to assess for practice drift.
Ensure Proper Integration
If a device does not integrate well with existing equipment, working with the manufacturer is the first step, as they may have additional components available that can remedy the problem(s). If a device that works well for pharmacy does not work well with the equipment nurses use for administration, evaluating alternative CSTDs may be necessary. The designated HD individual should work with nursing representatives to facilitate product assessments and trials.
Seth Eisenberg, RN, OCN, BMTCN, is a professional practice coordinator for infusion services at the Seattle Cancer Care Alliance Ambulatory Clinic.
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