I can only tell you about our practice, so here it goes. We were an individual private practice up until about 2 1/2 years ago when we were purchased by the hospital chain across the street. I've been with them two years. From what I understand, before the hospital bought us, we had pharmacy techs who mixed chemo and we did have a hood. The clinic did not really fall under any regulatory agencies - no Joint Commission, nothing. After the hospital purchased us, we now are classified as an outpatient arm of the hospital and follow all the same regulations they do. We now have a pharmacist at our site, we have three hoods (two chemo, one non-chemo). About 2 months ago we started using a closed transfer system on the IV bags. We've had a total pharmacy remodel and now fall under the USP 797 codes, etc.
Our pharmacist has taken the lead on all this in cooperation with the hospital pharmacy director. We are still completely self sufficient. We have our main guy and a part-time person. There have been one or two pharmacists from the hospital who have trained at our place to fill in, but we've only needed them once or twice and that was in the late afternoon when most chemo mixing is finished. I think pharmacists from the hospital would be overwhelmed by the volume of chemo mixed at our place daily, compared to what the hospital does.
As far as supplies, the hospital tries to have us use the same vendors that they use for cost purposes. I think we do on a lot of things, but some things they've tried to get us to change we've put our foot down. They tried to make us switch angiocaths recently, but we won. They made us go to a safety huber needle (the ones we used before didn't have safeties on them, but for patients going home with their needles in, they laid very flat on their chests and were more comfortable.) They did let us trial several types and pick the ones we preferred instead of automatically using what the hospital uses.
Our practice has been around a long time and our nurses (the ones who have been with the practice for a long time) probably know more about chemo and cancer than most of the hospital staff. We are lucky in that they respect our opinions most of the time.
Does this answer your questions?