An assessment of exposed syringe inner walls as a route of exposure from hazardous drugs.

INTRODUCTION: Maintaining safe working environments for health care personnel, especially for those who regularly handle hazardous drugs (HDs), is of utmost importance. Studies have shown that when closed system transfer devices (CSTDs) are used with standard open barrel syringes, cyclophosphamide (CP), a commonly used HD, is transferred to the syringe plunger during compounding or administration processes. This contamination can then be transferred to the work environment, endangering workers. PURPOSE: The purpose of this study was to quantify HD contamination of the inner surface of standard open barrel syringes and to compare contamination levels between three commonly used HDs: 5-fluorouracil (5-FU), CP, and ifosfamide (IF). METHODS: Each HD was transferred from a vial to an intravenous (IV) bag using a standard open barrel syringe and Becton, Dickinson and Company (BD) PhaSealTM CSTD connectors. Samples were taken from the inner surface of each of the syringe barrels to measure the amount of HD contamination. Each drug was tested 15 times and compared to a positive control. RESULTS: Significant amounts of each drug were transferred to the inner surfaces of the syringes. The average amounts of each drug measured were: 5-FU, 1327.7 ng (standard deviation [SD] = 873.6 ng); CP, 1074.8 ng (SD = 481.6 ng); and IF, 1700.0 ng (SD = 1098.1 ng). There was no statistically significant difference between the three drugs (p = 0.14). CONCLUSION: This study underscores the presence of HD contamination on standard open barrel syringe inner surfaces after transfer of drug from vial to syringe to IV bag. Such contamination could be spread in the working environment and expose health care workers to harm.

Accessibility of Low-cost Insulin From Illegitimate Internet Pharmacies: Cross-sectional Study.

BACKGROUND: There is much public debate regarding the high cost of insulin. With 1-in-4 patients in the United States with type 1 diabetes reporting difficulties affording insulin, there is concern that some of these patients might look for cost savings on the internet, unaware that 96% of internet pharmacies are illegitimate. Patients who purchase insulin from illegitimate internet pharmacies remove themselves from traditional health care systems that ensure safe, quality-assured, and effective medication use. OBJECTIVE: This study aims to determine the accessibility of Humalog and NovoLog insulin from internet pharmacies and characterize how these sites approached patient safety, and priced as well as marketed their products. METHODS: From September to December 2019, we queried the phrases buy insulin online, buy Humalog online, and buy NovoLog online in common search engines. The first 100 search results from Google and Bing, and the first 50 search results from Yahoo! and DuckDuckGo were screened. Websites were included if they claimed to sell Humalog or NovoLog insulin, were active, free access, in the English language, and had a unique URL. The legitimacy of websites was classified using LegitScript. Safety and marketing characteristics were compared across the legitimacy of internet pharmacies. Internet pharmacy prices were compared with the prices offered through brick-and-mortar pharmacies using GoodRx. RESULTS: We found that 59% (n=29) of the 49 internet pharmacies in our analysis were illegitimate, whereas only 14% (n=7) were legitimate and 27% (n=13) were unclassified. Across illegitimate internet pharmacies, Humalog and NovoLog insulin were 2 to 5 times cheaper as compared with both legitimate internet pharmacies and brick-and-mortar stores. Risks associated with the use of illegitimate internet pharmacies by American consumers were evident: 57% (8/14) did not require a prescription, 43% (6/14) did not display medication information or warnings, and only 21% (3/14) offered access to purported pharmacists. This included 9 rogue internet pharmacies that sold Humalog and NovoLog insulin within the United States, where 11% (1/9) required a prescription, 11% (1/9) placed quantity limits per purchase, and none offered pharmacist services. Rogue internet pharmacies often offered bulk discounts (11/18, 61%), assured privacy (14/18, 78%), and promoted other products alongside insulin (13/18, 72%). The marketing language of illegitimate internet pharmacies appealed more to quality, safety, and customer service as compared with legitimate sites. CONCLUSIONS: The ease of access to low-cost insulin through illegitimate internet pharmacies calls for urgent attention. Illegitimate internet pharmacies place patients at risk of poor-quality medications and subpar pharmacy services, resulting in adverse events and poor diabetes control. A multifaceted approach is needed to close illegitimate internet pharmacies through legal and regulatory measures, develop better search engine filters, raise public awareness of the dangers of illegitimate internet pharmacies, and address the high costs of insulin.

Characteristics of online pharmacies selling Adderall.

OBJECTIVES: Adderall (amphetamine-dextroamphetamine) is a controlled substance with harmful adverse effects if abused or misused. We assessed the availability of Adderall from common search engines, and evaluated the safety and marketing characteristics of online pharmacies selling Adderall. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: From December 2019 to February 2020, the phrase "buy Adderall online" was queried in four search engines: Google (N = 100), Bing (N = 100), Yahoo (N = 50) and DuckDuckGo (N = 50). Online pharmacies that claimed to sell Adderall and had unique Uniform Resource Locators, were active, free-access, and in English language were included. OUTCOME MEASURES: Online pharmacies were categorized as rogue, unclassified, or legitimate on the basis of LegitScript classifications. Safety and marketing characteristics, and costs were collected. RESULTS: Of the 62 online pharmacies found to sell Adderall, 61 were rogue or unclassified. Across all rogue and unclassified online pharmacies, prescriptions were not required (100%), pharmacist services were not offered (100%), and quantity limits were not placed on the number of Adderall purchases (100%). Rogue and unclassified online pharmacies appealed to cost, offering price discounts (61%), bulk discounts (67%), and coupon codes (70%). Contrary to their claims, cheaper prices were available for all formulations and dosages of Adderall from GoodRx than from these online pharmacies. Rogue and unclassified online pharmacies promoted and enabled the illicit purchase of Adderall, appealing to privacy (74%), offering purchase through cryptocurrency (74%), and claiming registration or accreditation of their sites (33%). CONCLUSION: Rogue online pharmacies are pervasive in search engine results, enabling the illicit purchase of Adderall without a prescription. Consumers are at risk of purchasing Adderall, a medication with high abuse potential, from unsafe sources. Law enforcement, regulatory agencies, and search engines should work to further protect consumers from unregistered and illegitimate online pharmacies selling Adderall.

Hysteresis in a quantized superfluid 'atomtronic' circuit.

Atomtronics is an emerging interdisciplinary field that seeks to develop new functional methods by creating devices and circuits where ultracold atoms, often superfluids, have a role analogous to that of electrons in electronics. Hysteresis is widely used in electronic circuits-it is routinely observed in superconducting circuits and is essential in radio-frequency superconducting quantum interference devices. Furthermore, it is as fundamental to superfluidity (and superconductivity) as quantized persistent currents, critical velocity and Josephson effects. Nevertheless, despite multiple theoretical predictions, hysteresis has not been previously observed in any superfluid, atomic-gas Bose-Einstein condensate. Here we directly detect hysteresis between quantized circulation states in an atomtronic circuit formed from a ring of superfluid Bose-Einstein condensate obstructed by a rotating weak link (a region of low atomic density). This contrasts with previous experiments on superfluid liquid helium where hysteresis was observed directly in systems in which the quantization of flow could not be observed, and indirectly in systems that showed quantized flow. Our techniques allow us to tune the size of the hysteresis loop and to consider the fundamental excitations that accompany hysteresis. The results suggest that the relevant excitations involved in hysteresis are vortices, and indicate that dissipation has an important role in the dynamics. Controlled hysteresis in atomtronic circuits may prove to be a crucial feature for the development of practical devices, just as it has in electronic circuits such as memories, digital noise filters (for example Schmitt triggers) and magnetometers (for example superconducting quantum interference devices).

PyLCP: A Python package for computing laser cooling physics.

We present a Python object-oriented computer program for simulating various aspects of laser cooling physics. Our software is designed to be both easy to use and adaptable, allowing the user to specify the level structure, magnetic field profile, or the laser beams' geometry, detuning, and intensity. The program contains three levels of approximation for the motion of the atom, applicable in different regimes offering cross checks for calculations and computational efficiency depending on the physical situation. We test the software by reproducing well-known phenomena, such as damped Rabi flopping, electromagnetically induced transparency, stimulated Raman adiabatic passage, and optical molasses. We also use our software package to quantitatively simulate recoil-limited magneto-optical traps, like those formed on the narrow 1S0 → 3P1 transition in 88Sr and 87Sr.

Application of the 2015 proposed NIOSH vapor containment performance protocol for closed system transfer devices used during pharmacy compounding and administration of hazardous drugs.

PURPOSE: The National Institute for Occupational Safety and Health (NIOSH) released a proposed protocol in 2015 to evaluate the vapor containment abilities of closed system transfer device technologies in order to provide meaningful comparisons between products. This study assessed the vapor containment ability of closed system transfer devices when following the methodology as outlined by the 2015 NIOSH proposed protocol. METHODS: This study evaluated six closed system transfer device brands following the draft NIOSH vapor containment protocol. The testing evaluated each closed system transfer device brand during both compounding (Task 1) and administration (Task 2). Five pre-specified steps for each task were repeated for a total of four manipulations per device. The Thermo Scientific™ MIRAN SapphIRe XL Infrared Analyzer was used to detect isopropyl alcohol vapor levels after each step. RESULTS: For Task 1, two closed system transfer device products (PhaSeal™ and Equashield®) adequately contained the isopropyl alcohol vapor and passed the predefined testing criteria. The same two products, plus one additional product (ChemoLock™), contained the vapor for Task 2 manipulations. Based on the results of this study, only two out of the six closed system transfer device brands passed testing criteria for both tasks, functioning as truly closed systems. CONCLUSION: To improve employee safety in chemotherapy preparation, closed system transfer devices that demonstrate no leakage should be the preferred choices of healthcare systems. In this study, PhaSeal™ and Equashield® proved to be adequately closed in both Task 1 and Task 2, while ChemoLock™ proved to be closed in Task 2 but not in Task 1. All other products failed both tasks when measuring for isopropyl alcohol vapor release.

Continuous Care Provided Through Comprehensive Medication Management in an Acute Care Practice Model.

BACKGROUND: Pharmacy practice models that foster pharmacists' accountability for medication-related outcomes are imperative for the profession. Comprehensive medication management (CMM) is an opportunity to advance patient care. OBJECTIVE: The objective of this study was to evaluate the impact of a CMM practice model in the acute care setting on organizational, patient, and financial outcomes. METHODS: Three adult service lines focused on at-risk patients identified using internal risk stratification methodology were implemented. Core CMM elements included medication reconciliation, differentiated clinical pharmacy services, inpatient MTM consultations, discharge services, and documentation. Mixed methods compared the effect of the CMM model before and after implementation. Historical patients served as comparative controls in an observational design. Pharmacists completed a 60-minute interview regarding their experiences. Qualitative data were analyzed using thematic coding to characterize perception of the model. RESULTS: Three pharmacists implemented the model on cardiology, hematology/oncology, and surgery transplant services and provided services to 75 patients during the study. A total of 145 medication-related problems were identified and resolved. CMM was associated with a nonsignificant reduction of 8.8% in 30-day hospital readmission rates ( P = 0.64) and a 24.9% reduction in 30-day hospital utilization ( P = 0.41) as well as a significant reduction of 86.5% in emergency department visits ( P = 0.02). Patients receiving discharge prescriptions from our outpatient pharmacies increased by 21.4%, resulting in an 11.3% increase in discharge prescription capture and additional revenue of $5780. Themes identified from qualitative interviews included CMM structure, challenges, value, and resources. CONCLUSION: This study demonstrated successful implementation of a CMM model that positively affected organizational, patient, and financial outcomes.

Challenges to miniaturizing cold atom technology for deployable vacuum metrology.

Cold atoms are excellent metrological tools; they currently realize SI time and, soon, SI pressure in the ultra-high (UHV) and extreme high vacuum (XHV) regimes. The development of primary, vacuum metrology based on cold atoms currently falls under the purview of national metrology institutes. Under the emerging paradigm of the "quantum-SI", these technologies become deployable (relatively easy-to-use sensors that integrate with other vacuum chambers), providing a primary realization of the pascal in the UHV and XHV for the end-user. Here, we discuss the challenges that this goal presents. We investigate, for two different modes of operation, the expected corrections to the ideal cold-atom vacuum gauge and estimate the associated uncertainties. Finally, we discuss the appropriate choice of sensor atom, the light Li atom rather than the heavier Rb.

Vacuum Furnace for Degassing Stainless-Steel Vacuum Components.

Ultra-high vacuum systems must often be constructed of materials with ultra-low outgassing rates to achieve pressure of 10-6 Pa and below. Any component placed into the ultra-high vacuum system must also be constructed of materials with ultra-low outgassing rates. Baking stainless steel vacuum components to a temperature range of 400 °C to 450 °C while under vacuum is an effective method to reduce the outgassing rate of vacuum components for use in ultra-high vacuum systems. The design, construction, and operation of a vacuum furnace capable of baking vacuum components to a temperature of 450° C while maintaining a pressure of 10-3 Pa or lower is described. The furnace has been used for extended bakes at 450 °C while maintaining pressures below 10-5 Pa. As an example, we obtained an outgassing rate of 1.2 × 10-9 Pa L s-1 for a gate valve baked for 20 days at a temperature of 420 °C.

Quantum-based vacuum metrology at NIST.

The measurement science in realizing and disseminating the unit for pressure in the International System of Units (SI), the pascal (Pa), has been the subject of much interest at NIST. Modern optical-based techniques for pascal metrology have been investigated, including multi-photon ionization and cavity ringdown spectroscopy. Work is ongoing to recast the pascal in terms of quantum properties and fundamental constants and in so doing, make vacuum metrology consistent with the global trend toward quantum-based metrology. NIST has ongoing projects that interrogate the index of refraction of a gas using an optical cavity for low vacuum, and count background particles in high vacuum to extreme high vacuum using trapped laser-cooled atoms.

Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital.

Purpose: The purpose of this article is to share experiences after the development of a health-system pharmacy administration residency with a MS degree and express the need for additional programs in nonacademic medical center health-system settings. Summary: Experiences with the development and implementation of a health-system pharmacy administration residency at a large community teaching hospital are described. Resident candidates benefit from collaborations with other health-systems through master's degree programs and visibility to leaders at your health-system. Programs benefit from building a pipeline of future pharmacy administrators and by leveraging the skills of residents to contribute to projects and department-wide initiatives. Tools to assist in the implementation of a new pharmacy administration program are also described and include rotation and preceptor development, marketing and recruiting, financial evaluation, and steps to prepare for accreditation. Conclusion: Health-system pharmacy administration residents provide the opportunity to build a pipeline of high-quality leaders, provide high-level project involvement, and produce a positive return on investment (ROI) for health-systems. These programs should be explored in academic and nonacademic-based health-systems.

Development and evaluation of a novel product to remove surface contamination of hazardous drugs.

Background Even while following best practices, surface exposures of hazardous drugs (HDs) are high and numerous. Thus, it is important to develop new products to reduce the surface contamination of HDs. Hazardous Drug Clean (HDClean™) was developed to decontaminate and remove HDs from various types of surfaces and overcome the problems associated with other cleaning products. Methods HDClean was evaluated to remove mock surface exposures of HDs (docetaxel, paclitaxel, ifosfamide, cyclophosphamide, 5-FU, and cisplatin) from various types of surfaces. In two separate cancer centers, studies were performed to evaluate HDClean in reducing surface contamination of HDs in the pharmacy departments where no closed system transfer device (CSTD) was used. In a third cancer center, studies were performed comparing the effectiveness of a CSTD + Surface Safe compared with CSTD + HDClean to remove HDs. Results HDClean was able to completely remove mock exposures of a wide range of HDs from various surfaces (4 and 8 sq ft areas). Daily use of HDClean was equal to or more effective in reducing surface contamination of HDs in two pharmacies compared with a CSTD. HDClean was significantly more effective in removing HDs, especially cisplatin, compared with Surface Safe and does not have the problems associated with decontamination solutions that contain sodium hypochlorite. Conclusion These studies support HDClean as an effective decontaminating product, that HDClean is more effective than Surface Safe in removing HDs and is equal to or more effective than CSTD in controlling HD surface exposures.

Development of a new UHV/XHV pressure standard (Cold Atom Vacuum Standard).

The National Institute of Standards and Technology has recently begun a program to develop a primary pressure standard that is based on ultra-cold atoms, covering a pressure range of 1 × 10-6 Pa to 1 × 10-10 Pa and possibly lower. These pressures correspond to the entire ultra-high vacuum (UHV) range and extend into the extreme-high vacuum (XHV). This cold-atom vacuum standard (CAVS) is both a primary standard and absolute sensor of vacuum. The CAVS is based on the loss of cold, sensor atoms (such as the alkali-metal lithium) from a magnetic trap due to collisions with the background gas (primarily H2) in the vacuum. The pressure is determined from a thermally-averaged collision cross section, which is a fundamental atomic property, and the measured loss rate. The CAVS is primary because it will use collision cross sections determined from ab initio calculations for the Li + H2 system. Primary traceability is transferred to other systems of interest using sensitivity coefficients.

Assessment of final product dosing accuracy when using volumetric technique in the preparation of chemotherapy.

BACKGROUND: Studies have compared gravimetric and volumetric dosing accuracies in chemotherapy agents, finding high accuracy in gravimetric measurements with a mean deviation of ± 0.06%, while volumetric measurements had a mean deviation of ± 3.02%. METHODS: Chemotherapy doses prepared under a biological safety cabinet containing two weights from the precision scale between 15 December 2010 and 30 March 2011 were eligible for inclusion. Empty syringes attached to a closed-system transfer device were weighed prior to product manipulation. The product was then prepared using the syringe pull-back method (volumetric technique) and the same syringe containing drug was weighed (gravimetric method). RESULTS: A total of 1156 compounded sterile products were eligible for the study. The mean percent volume difference of preparations included was -0.53% with a range of -64.9% to 94.22% for individual doses. Of the prepared doses, 71.7% were within ± 5% and 87.4% were within ± 10% of the ordered dose. Secondary outcomes found to be associated with an increased percent volume difference were the pediatric population, smaller volumes prepared, drugs requiring reconstitution compared to already in solution, and final product dispensed to the patient in syringes. CONCLUSION: While the mean value of volumetric measurements is within the generally understood acceptable range for dispensing chemotherapy, the range of measurements is highly variable. Future studies are warranted to better understand the reasons behind the variation and to evaluate the impact of workflow changes on improving final product accuracy.

Determining the Need for Standardized Infusions and Concentrations at Hospitals within North Carolina.

Background: In 2013, the American Society of Health-System Pharmacists (ASHP) endorsed a policy recommending the development of nationally standardized drug concentrations and dosing units. Although many hospitals have started standardizing their intravenous (IV) solutions, few have taken the practice beyond their institutions or local geographical areas. Objective: This project evaluates the current IV standardization practices for adult patients across hospitals in North Carolina and compares them with each other. In addition, this project proposed standards and evaluated them for their impact on reducing observed variability. Methods: In the fall of 2013, an e-mail request was sent to select hospital pharmacy leaders in North Carolina asking them to voluntarily submit a copy of their adult IV standard concentrations and dosing guidelines. From these lists, the data were summarized and compiled to evaluate trends and compare the various policies. Results: A total of 18 different hospitals and health systems responded. Survey results showed more than 255 concentrations for 84 unique drugs. Of these, 37 were high-risk medications, with 135 unique drug concentrations. From this list, a single proposed concentration was developed for each medication. If utilized, this standardization would result in a greater than 65% reduction in potential drug concentrations in use. A single dosing unit was also proposed for all medications reviewed, resulting in a greater than 21% reduction in variation. Conclusions: Standardization of IV drug concentrations and dosing units statewide could reduce the variability in IV therapies and promote safer and more consistent practices in medication administration.

Evaluating the Sensitivity of a Media-Fill Challenge Test Under Various Situations as a Reliable Method for Recommended Aseptic Technique Competency Assessment.

Background: Microbial contamination of compounded medications is a serious concern within hospital pharmacies as it can lead to severe patient injury. The United States Pharmacopeia <797> mandates that pharmacy personnel responsible for preparing compounded sterile preparations must annually demonstrate competency in aseptic technique by performing a media-fill challenge test. Objective: The purpose of this study is to evaluate the sensitivity of a commonly used media-fill test through proper and improper compounding techniques. Methods: Two aseptically trained pharmacy technicians performed media-fill challenge testing by carrying out 5 separate manipulations 5 times each for a total of 25 trials. Sterile vials, syringes, and intravenous bags were prepared. The first manipulation followed best-practice aseptic technique and sterile compounding procedures. Each of the following 4 manipulations removed one aspect of best-practice aseptic technique. The prepared products were incubated at 20°C to 25°C. A positive result for microbial contamination is indicated by visible turbidity within the vials, syringes, and intravenous bags at the following check points: 24 hours, 72 hours, 7 days, 14 days, 21 days, and >30 days. Results: Twenty-five trials, each containing 10 distinct admixtures, resulted in a total of 250 compounded preparations. No single preparation showed signs of turbidity, sedimentation, or visible microbial growth at any of the 6 checkpoints yielding a 0% contamination rate. However, the positive controls inoculated with bacteria did have positive microbial growth results. Conclusion: A more sensitive test needs to be developed to provide assurances that all poor aseptic practices are detected in compounding personnel.

Pharmacy-Initiated Transitions of Care Services: An Opportunity to Impact Patient Satisfaction.

PURPOSE: A transitions of care program at an academic teaching hospital was designed to reengineer the fragmented discharge process. The team included a pharmacy technician, called a transition specialist, who coordinated the medication needs of discharging patients. This study intends to assess the impact of the transitions of care program on patient satisfaction scores. METHODS: Two datasets of Press Ganey and Hospital Consumer Assessment of Healthcare Providers (HCAHPS) were analyzed. Patients eligible for inclusion were age 18 years or older and successfully discharged from the study facility. All participants received usual care by a servicebased pharmacist, medication counseling by a nurse prior to discharge, and other standard of care services by the inpatient medical team. The intervention group received the previously stated usual care plus services by the transitions of care program. RESULTS: The results from HCAHPS scores proved inconclusive. The results from the Press Ganey dataset found that the surgery transplant service demonstrated statistically significant improvement for satisfaction scores, and they warrant further review. CONCLUSIONS: Results demonstrate that HCAHPS metrics do not correlate with the successes or lack thereof of the transitions of care program. Press Ganey might be a potential surrogate marker for assessing the impact of this program. This study is the first to qualitatively evaluate pharmacy transitions of care service using patient satisfaction scores.

Development of optimized adult epidural infusion preparations to reduce waste and improve operational efficiency.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Despite national recommendations to standardize infusion concentrations, there is minimal guidance on institution-specific strategies and outcomes related to epidural infusion concentration standardization and optimization. The purpose of this project is to identify the optimal compounded preparation for use in select adult epidural infusions and assess the impact on drug and fluid utilization and cost savings if the designated preparation is adopted. METHODS: A previously validated tool, the VERB (vial, exchange, rate, and bag) analysis, was applied to epidural infusion pump administration data to identify preparations optimized for efficient supply and resource utilization at a large academic medical center. RESULTS: Weighing all components of the VERB analysis, the preferred preparation of hydromorphone and bupivacaine for the hospital site was hydromorphone (10 µg/mL) and bupivacaine (0.125%) in 50 mL of 0.9% sodium chloride injection (2,500 µg of hydromorphone per epidural). The preferred preparation of fentanyl and bupivacaine was fentanyl (2 µg/mL) and bupivacaine (0.0625%) in 50 mL of 0.9% sodium chloride injection (100 µg of fentanyl per epidural). Both recommendations are different from the currently utilized preparations at the study site. CONCLUSION: Analyzing historic drug administration data using the novel 4-step VERB analysis identified optimized drug preparations and fluid bag sizes for the most-prescribed epidural drug combinations at the hospital study site.

Understanding individual experiences with stick-built and modular cleanrooms: Lessons learned and a call to action.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The purpose of this study was to assess the real-world experiences of cleanroom managers and specialists who have designed, installed, and maintained stick-built and/or modular cleanrooms, delineate the advantages and disadvantages of each type of cleanroom, and gather sterile compounding cleanroom design and installation advice and lessons learned. METHODS: This study was conducted via surveys and semistructured interviews of individuals with cleanroom experience in the previous 5 years. Qualitative analyses were conducted on participants' survey and interview responses to assess their satisfaction with each type of cleanroom and to determine what they perceive to be the pros and cons of each type based on their own experiences. Key lessons learned and advice from these individuals were also extracted from their survey and interview responses. RESULTS: Fourteen individuals from 13 US states completed the survey; twelve participated in follow-up interviews. Fifty percent of the participants (n = 7) had installed 5 or more cleanrooms in the previous five years and over half (n = 8; 57%) had 7 or more years of cleanroom experience. The average satisfaction scores for each type of cleanroom, on a 1 to 10 scale, was 5.3 for stick-built (n = 11) and 9.3 for modular (n = 4). The pros of stick-built cleanrooms included greater design and material flexibility and lower up-front costs. The pros of modular cleanrooms included the cleanroom experience and expertise of modular vendors, quick and easy installations, guaranteed certification, and high-quality and durable design features and materials. Additionally, modular cleanrooms had fewer long-term maintenance issues, greater long-term flexibility, and lower indirect and long-term costs than stick-built cleanrooms. Key pieces of advice from the participants included the following: do your homework before beginning a cleanroom project; make sure heating, ventilation, and air conditioning system(s) and air handlers are adequate for your needs; and remember that the ultimate purpose of a quality cleanroom is patient safety. Participants also advocated for industry-wide cleanroom standards that go beyond USP regulations. CONCLUSION: The findings of this study confirm many of the purported pros and cons of each type of cleanroom, with further insight gained into the relative quality and costs of each type. Modular cleanrooms were considered by most participants to be a better long-term option, based on quality and lifetime costs, if feasible to install. Study participants also emphasized that designing and installing pharmacy cleanrooms is a complex and time-intensive process that often comes with a steep learning curve. While there are federal and state cleanroom standards available and consultants for hire, a comprehensive resource or manual that could provide guidance, insight, and collective lessons learned on cleanroom design and installation is needed.

Understanding pathways to health-system pharmacy administration: A journey mapping study.

PURPOSE: Pharmacy administrators play a critical role in the success of health systems, yet pathways to pharmacy administration are incompletely understood. The purpose of this study was to explore and describe pathways to becoming a health-system pharmacy administrator, including challenges experienced and resources needed. METHODS: Participants (N = 21) individually completed one or more journey maps detailing the pathway(s) to pharmacy administration and then engaged in small group discussion to identify common themes. A large group debrief was used to share and identify findings across small groups. Thematic analysis was utilized to identify common ideas shared. RESULTS: There was variation across the maps, illustrating many steps one might follow to become a pharmacy administrator. In the 23 maps completed, pathways most frequently began with pharmacy school (n = 9, 39.1%), high school (n = 6, 26.1%), or undergraduate training (n = 4, 17.4%). Most included residency training or dual master's of science in health-system pharmacy administration/residency training (n = 16, 69.6%). Common challenges included distractions, time constraints, grades/performance, financial constraints, and stress. Common resources needed included exposure to diverse career paths, pipeline and outreach support, mentoring, and leadership. Themes included debate about the definition of a pharmacy administrator, questions regarding the core competencies of the pharmacy administrator, discussion regarding ways to enter pharmacy administration, and reflection on the role of serendipity and networking. CONCLUSION: Understanding the pathways to pharmacy administration is critical to fostering a sustainable and competent workforce. Work must be done to identify strategies and develop processes for identifying, equipping, and retaining talented health-system pharmacy administrators and leaders.