Second, the only products that are made in the pharmacy are high risk medications, namely, antibiotics, monoclonal antibodies, and chemo. They can only make batches of an IV product with licensed drugs. If a product does not have a label on it (like not an individual patient order) then they can keep it on the floor as stock but if it's for an individual patient then they are not supposed to give it to anyone else if that patient does not end up needing it. It can be in the hospitals best interest to make these batch orders because then the ward already has stock of the drug and typically the expiration is longer (e.g. when they make clarithromycin as a batch the expiration is 49 days but if they make it for an individual patient and label it as such then the expiration is 7 days) Similar to USP 797, they use Quality Control NW to provide guidance on expiration or BUD for products.
Third, the aseptic unit in the pharmacy is not open 24 hours (8-5pm only!) There are three sessions that the technicians work in: 8-10am, 11-1pm, and 1-5pm.
Fourth, there is much more strict adherence to sterility. There are three separate rooms that are used for aseptic preparation with little chamber compartments (hatches) that allow the various supplies (needles, vials, bags, etc) and final product to be transported. They spray all the supplies (even the needles that are wrapped in paper) with isopropyl alcohol and then follow that up by wiping it down with an alcohol wipe which then sits in the hatch on a two minute timer to dry. Also, once a month they do a double settle plating where they test for contamination. Once a week they do 42 settle plates and contact plates plus broth fills; and during each aseptic session they do finger and settle plates. WOW. I think Elise and I's jaws were on the floor when we heard this!
While chemo spikes are used occasionally here, they only have one size spike so they are limited as to what products they can use it with and they still use a needle to draw the product up to put into the bag. They do put chemo in a specialized bag that is bright yellow to identify it as chemo which is something that is similar to what is done in most hospitals in the US.
Almost all IV products at Wythenshawe are made my technicians. There are different levels for the technicians. It starts at Ban 2 and goes all the way up to Ban 8. The level depends on the amount of training and experience you have had.
The MHRA or the Medicines and Healthcare products Regulatory Agency is the government agency which is responsible for ensuring that medicines and medical devices work and are acceptably safe. They typically audit every 8-10 years. This agency is probably the equivalent of the Joint Commission and FDA mixed into one.
Elise and I had a brief meeting in the afternoon with one of the clinical pharmacists we have been working with on the prescribing errors project. We showed him the data that we had compiled and hopefully Elise and I will be putting together a paper on the pilot study that will get turned into a poster. Only have to make it through the IRB exemption forms....all 7 sections.
The last part of our day was spent in the outpatient CF (cystic fibrosis) satellite clinic. They also have an entire inpatient CF ward that is on the floor below the outpatient clinic. The satellite clinic is relatively new and Elise and I got to meet the woman who developed the business plan for it's creation, Jan. Jan was a huge proponent for pharmacist involvement in a CF's patient outpatient clinic stay. The prescriptions are brought to the pharmacy and the pharmacist fills the meds and brings the prescription directly to the patient's room so they minimize any potentially infection introduction. There are designated clinic days for the patients (e.g. Pseudomonas group 2 meets Thursdays; this is the group that is transmissible - they caught pseudomonas from another person in contrast to group 1 which are patients that are self pseudomonas colonizers) We learned a lot about the treatment options available for the typical infections seen in CF as well as the routine medications used in the UK for adult CF patients. The majority of the medications are similar - one big difference was that they use a lot of theophylline. They also don't use a lot of mucomyst and megace has somewhat fallen out of favor.
Speaking with Jan was really great because she has been working in CF for about 25 years- so she had an incredible amount of expertise in the area! She also has been a huge advocate in the hospital for the CF patients and created an additional role for pharmacists to make a difference!
Elise and I really enjoyed our time at Wythenshawe! We were always doing/seeing something new and with the additional prescribing errors project, the time flew by! The pharmacists we met were awesome and we could not have asked for a more welcoming group of people!
Outside the inpatient pharmacy
Working hard in the hot desk room at Wythenshawe
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