Questions and Answers on USP Chapter 797 with Clyde Buchanan:

• Answer B17: Clean Rooms - Since building a cleanroom is so expensive, why not return the responsibility for admixture preparation to nurses?
   
• Answer B17: In admixtures prepared just prior to administration, accidentally introduced microbes have less time to grow to pathological levels. But one study showed that 21% of nurse-prepared admixtures were made incorrectly (as to ingredients, dosage, unordered admixture, or incompatibility).⁵ Another study showed that 10.9% of the nurse-prepared admixtures in plastic bags were contaminated versus 5.6% for pharmacy prepared admixtures in plastic bags.³ Moreover, nurses are less well trained to make admixtures today than when these studies were published. Furthermore, since many sterile preparations are used for 24 hr or more (e.g., TPNs and patient-controlled analgesia syringes), microbes can easily grow to pathologic levels at room or body temperatures. There are too many complicated sterile preparations as well as situations in which nurses are not involved (e.g., patients' homes) to remove sterile compounding from pharmacy responsibility.

Answer provided by E. Clyde Buchanan, MS, FASHP,  Senior Director of Pharmaceutical Services for Emory Healthcare. He is also Adjunct Professor at the Mercer University, Southern School of Pharmacy. He received his B.S. Pharmacy degree from the University of North Carolina and MS/Residency from The Ohio State University. For six years he was Assistant Director of Pharmacy at Duke University Medical Center, then served as Director of Pharmacy at St. John's Hospital in Springfield, Illinois for 11 years before going to Emory.

He has served the American Society of Health-System Pharmacists as Chair, Special Interest Group on Administrative Practice; Vice Chair, Council on Legal and Public Affairs; and member of the House of Delegates, as wel as on several committees and task forces and invited writer for several ASHP publications, including Compounding Sterile Preparations, 2nd edition.

Mr. Buchanan has authored many papers, book chapters, and two books, and he has spoken on a national and international level on a variety of clinical and administrative pharmacy topics.

All opinions expressed in the following interview are those of Mr. Buchanan. When evaluating specific recommendations regarding compounding practices, practitioners are strongly encouraged to rely on a wide array of sources, including state and local authorities, accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations, and organizations such as the United States Pharmacopeia, as well as experts such as Mr. Buchanan.