Accuracy of pharmacy student self-assessment of a single sterile compounding technique following didactic training.

INTRODUCTION: The primary objective was to determine pharmacy students' ability to self-assess sterile compounding technique in a single evaluation three semesters after training in the curriculum. METHODS: School of pharmacy (SOP) students were trained and assessed on sterile compounding technique during their second year of school, with no additional formal assessments provided later in the curriculum. From 2016 to 2018, 262 students were asked to compound a simulated sterile product in their third year of pharmacy school and self-evaluate their technique, which was compared to an instructor evaluation with both people using the same rubric. RESULTS: Two thresholds were used to define successful assessment: strict (ability to detect ideal technique) and lenient (ability to detect harmful technique). The average match rate was 70.2% and 87.6% in the strict and lenient analyses, respectively, with outcomes varying between categories. In the product preparation and inspecting product categories, students who disagreed with assessors tended to misidentify their incorrect technique as correct. CONCLUSIONS: Pharmacy students who assessed themselves on sterile compounding technique three semesters after formal sterile compounding training were able to accurately self-assess in most cases, but when disagreeing with an assessor, commonly identified their incorrect technique as correct. Most students demonstrated the ability to self-assess sterile compounding technique and are prepared to assess their own sterile compounding in practice. SOPs could consider whether sterile compounding training coupled with self-assessment throughout the curriculum would be beneficial to further improve students' sterile compounding ability and accuracy of self-assessment.

Evaluation of the Efficacy and Superiority of Different Vial Rubber Closure Disinfection Techniques.

Contamination of sterile products has caused significant adverse outcomes in patients, including death. Limited research has been conducted on the efficacy and/or superiority of sterile isopropyl alcohol disinfection techniques of rubber stopper surfaces in sterile compounding. The objective of this evaluation was to investigate the efficacy and/or superiority between the following three disinfecting techniques of vial rubber tops when utilizing sterile isopropyl alcohol wipes: Intervention 1) three swipes back and forth using the same surface; Intervention 2) three swipes in a unidirectional manner using the same surface; Intervention 3) three swipes in a unidirectional manner using a different side of wipe with each swipe. The rubber stopper surfaces of 90 vials were contaminated with bacteria. Thirty vials were disinfected with each assigned technique, swabbed after drying, and plated. After plates were incubated for 48 hours, colonies were quantified, and the different techniques compared. When comparing the varying disinfection techniques to the positive control, Intervention 1 and Intervention 3 techniques showed statistical significance (P=0.00). The Intervention 2 technique showed no difference in colony counts from the positive control (P=0.259). Comparing the different techniques side by side, both Intervention 1 and Intervention 3 techniques were statistically different from the Intervention 2 technique (P=0.027, P=0.00). There was no statistical significance noted between the Intervention 1 and Intervention 3 disinfecting techniques (P=0.141). Disinfecting vials with three swipes in one direction with a different surface of the sterile alcohol wipe or disinfecting vials with a back and forth motion three times is superior to either not disinfecting the vial or disinfecting the vial with three swipes in one direction using the same surface of the sterile alcohol wipe during sterile compounding.

Development and Implementation of a Standardized Sterile Compounding Training Program.

Purpose: The purpose of the study is to develop and implement a standardized sterile compounding training program in a multihospital system that incorporates sterile compounding best practice recommendations and ensures compliance with United States Pharmacopeia (USP) Chapters 797 and 800 standards. Methods: Baseline sterile compounding training data were collected and reviewed for sterile compounding facilities across a multihospital health system, which included 37 distinct sterile compounding operations. Current sterile compounding personnel across the system completed preintervention assessments consisting of a written, knowledge-based exam; media-fill challenge test; and an observed assessment of aseptic technique. The personnel then completed refresher training of sterile compounding concepts by completing online and in-person courses. A postintervention assessment was then conducted to evaluate training methods and topics. Based on the intervention data, a training program for new sterile compounding personnel was developed and implemented. A program to provide annual, ongoing training to existing sterile compounding personnel was also developed and implemented. Results: There was a statistically significant improvement in sterile compounding written exam scores (P < .0001) and aseptic technique observation scores (P < .0001) after implementation of refresher training. The validated training program was then included in the development and implementation of standardized training for all new and existing sterile compounding personnel across a multihospital health system. Conclusion: A standardized and consistent, sterile compounding training program was developed for all new and existing sterile compounding personnel incorporating a live, in-person training course, as well as online and hands-on training.

Sterile Basics of Compounding: Relationship Between Syringe Size and Dosing Accuracy.

The purpose of this study was to investigate the accuracy and reproducibility of a 2-mL volume injection using a 3-mL and 10-mL syringe with pharmacy student compounders. An exercise was designed to assess each student's accuracy in compounding a sterile preparation with the correct 4-mg strength using a 3-mL and 10-mL syringe. The average ondansetron dose when compounded with the 3-mL syringe was 4.03 mg (standard deviation ± 0.45 mg), which was not statistically significantly different than the intended 4-mg desired dose (P=0.497). The average ondansetron dose when compounded with the 10-mL syringe was 4.18 mg (standard deviation + 0.68 mg), which was statistically significantly different than the intended 4-mg desired dose (P=0.002). Additionally, there also was a statistically significant difference in the average ondansetron dose compounded using a 3-mL syringe (4.03 mg) and a 10-mL syringe (4.18 mg) (P=0.027). The accuracy and reproducibility of the 2-mL desired dose volume decreased as the compounding syringe size increased from 3 mL to 10 mL.

Acquisition and Retention of Sterile Compounding Accuracy Skills.

Objective. To determine the accuracy of dose of pharmacy students' parenteral sterile preparation skills and to measure pharmacy students' skill retention 1.5 years later. Methods. An exercise was designed to assess each student's accuracy in compounding a sterile preparation with the correct potency during a second and then third year course. Results. Initially, the mean (standard deviation) of 141 students' compounded preparation dose was not significantly different than the desired dose. Additionally, 91.5% of products were within 10% of the desired dose. In the follow-up activity the next academic year, the mean dose was not significantly different than the original compounded dose. Similarly 92.9% were within 10% of the desired dose. Conclusion. Students' overall accuracy of sterile compounding was good initially and well-retained more than a year later, with more than 90% of students being within 10% of the desired dose in both courses.