Q: As a director of pharmacy, what is your responsibility to your employees and/or patients in ensuring their safety?
I am charged with ensuring the safe utilization of hazardous drugs throughout the organization. So the use of a CSTD at Cambell County Health was initiated in response to regulatory requirements and an increased need for safety for the staff, increase in use for different treatment modalities, and a desire for a safe and quality product. The CSTD system we choose addressed some deficiencies we were noticing while optimizing our ability to provide excellent care with very challenging agents. This system has literal design features built in to ensure compliance and safety for staff and our patients.
Q: What were some challenges the pharmacy faced with your pre-existing CSTD system?
The most prevalent deficiency noticed was the lack of ensured compliance with the appropriate utilization of the product. It did not meet many of our patient care needs and often less safe workarounds were required to accomplish the treatment modality needed. Our new system has a unique foley administration device we needed to utilize that helps provide the therapy while still providing for as much of a closed system as possible with that type of higher-risk treatment modality.
Q: What was the reasoning to look at a different closed system transfer device system for hazardous drug compounding?
We were needing a more expansive system that provided uses in more applications and was easier to use than the system we were utilizing. We were looking for a system that could give us the following advantages: ease of use, a truly closed system, and flexibility for use in certain treatment modalities that we did not have with our previous system.
Q: What role does nursing play in the selection of a CSTD?
Our oncology/infusion center nurses played a huge role in helping select a CSTD. It was essential to get their perspective and buy-in as they are the ones at the end administering the product prepared by the pharmacy. We brought in the systems we thought were better options for a review and input from the nursing side. We coupled the nursing feedback with that of pharmacy’s research of the clinical studies, outcomes, costs, and hands-on evaluation of the systems to make our decision.
Q: Was the infamous cost issue a consideration for your review?
Absolutely! Any CTSD system utilized is an additional cost to the institution and it is necessary
to evaluate costs. Fortunately, with the utilization of our GPO contracts, the transition was fairly cost neutral from one system to another.
Q: Once the decision was made to switch CTSD systems, how was the transition?
We received incredible support including on-site training and assistance for both the pharmacy and the nursing staff. A pharmacy technician was brought in to work and train the pharmacy staff, as well as a nurse to work with and train the nursing staff. Our account representative worked extensively with us to ensure that we ordered and had the correct amount of inventory to make us successful without overstocking. The implementation side of our CTSD process was fairly straight forward and easy.
Q: What was your approach to implementing and standardizing a CSTD within your institution?
Due to incorporating our highest users of these systems into the decision process, it made the implementation process much smoother to incorporate into our practices. We only use one CSTD to ensure standardization and we made it a hard cutoff. Meaning, that once we had the product and new system, we did not use the older system. It was a balance of managing the old inventory, purchasing the new inventory, and deciding a go-live. Although it could not be a perfect, zero loss process, the staff did an excellent job to minimize losses.
Q: What do you feel are the advantages of your new CTSD system?
Definitely the flexibility of the system to be utilized in various treatment modalities and the safety it provides the pharmacy compounding staff. The CSTD system is very intuitive and is engineered to reduce or eliminate incorrect usage. The individual products are engineered to protect compounding and administering staff. It is a simple system to use and is not overly cumbersome while ensuring safety for the staff involved in providing treatment.
Q: Are there any other considerations you have about your decision with the CTSD system you chose?
The transition was positive for our institution, staff, and overall success. Our account representative still reaches out on a regular basis to offer both on-site (when possible) and virtual training for staff as transitions occur. We also are provided analytics to help maintain costs with utilization, which is helpful in the current environment.
Robert Quintana, RPh, Director of Pharmacy at Campbell County Health
Robert Quintana, RPh is the Director of Pharmacy at Campbell County Health in Gillette, Wyoming. He has an extensive 25-year pharmacy background in institutional, critical care, clinical, and infusion/oncology center practices.