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Discussion

Compounding Medications

For the last few months we have had pre-compounded medications on back order and are now being asked to compound the medications ourselves with high risk meds, like Epi. According to the board of registered nursing in CA, nurses are not allowed to do this, but management is saying it is okay. Pharmacy is refusing to mix these meds for us. Has anyone experienced this, and what is your advice?

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    • Admin

    Our pharmacy is responsible for any compounding beyond certain things that the OR staff has always mixed (we have some surgeons that like a mix of 2 different locals, vein solution, heparinized saline). For irrigation with epi, pharmacy has always had the responsibility of compounding.

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    • Author
    8 minutes ago, Rose_Queen said:

    Our pharmacy is responsible for any compounding beyond certain things that the OR staff has always mixed (we have some surgeons that like a mix of 2 different locals, vein solution, heparinized saline). For irrigation with epi, pharmacy has always had the responsibility of compounding.

    Your pharmacy sounds amazing! Haha It's like pulling teeth to have them compound any medications for us. Thank you for your advice. I believe pharmacy is also responsible for this especially given the BRN states we are not allowed to do this under our scope of practice.

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    • Experts

    From CA Board of Nursing

    Quote

    Section 2725. 1 Legislative intent: Practice of Nursing Defined

    No registered nurse shall dispense drugs in a pharmacy, keep a pharmacy, open shop, or drugstore for the retailing of drugs or poisons. No registered nurse shall compound drugs.

    https://www.RN.ca.gov/pdfs/regulations/npr-I-15.pdf

    California State Board of Pharmacy Rules and Regulations

    Quote

    4051. (a) Except as otherwise provided in this chapter, it is unlawful for any person to manufacture, compound, furnish, sell, or dispense any dangerous drug or dangerous device, or to dispense or compound any prescription pursuant to Section 4040 of a prescriber unless he or she is a pharmacist under this chapter.

    https://www.RN.ca.gov/pdfs/regulations/bp4018.pdf

    Since you are aware that compounding meds in California against both nursing and pharmacy acts, by performing you are acting outside your scope of practice therefore jeopardizing your license if/when something goes wrong.

    If you are in a union, notify union management pronto. Has anything been put into writing regarding this issue by management or has it been verbal discussion? How far are you willing to go to protect your license? Have you discussed with your colleagues, are they willing to take a stand on the issue? Do you have a compliance hotline that you can report issue anonymously?

    Time to start a paper trail regarding problem. Print out these regulations and have a copy at work.

    Next time compounding being requested, contact pharmacist on duty regarding compounding need. If they refuse, tell them you are aware compounding restricted to pharmacist in CA per pharmacy and nursing laws, and filing incident report --might make them change their mind. If they still refuse, contact your supervisor. If supervisor insists, tell them you decline to protect your license and ask that they compound the drug.

    Write up incident report including names who you contacted in non-judgemental manor. Notify manager, send copy to your compliance department regarding with copy of regulations.

    Expect lots of flack--be prepared with exit plan if needed. Better to leave rather than jeopardizing license.

    Keep us updated on issue.

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    • Author

    Thank you for your reply. As this is an ongoing issue, I will keep you all updated as things progress. I am absolutely not willing to risk patient safety or my license.

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    What exactly are you being asked/expected to do?

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    • Author

    Since this is a sensitive topic, I'd rather not share the exact specifics at this time.

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    I would not do that. Pharmacy should do that. Nurses are not pharmacists. That's awful that management is not backing you up.

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    Rose_Queen said:

    Our pharmacy is responsible for any compounding beyond certain things that the OR staff has always mixed (we have some surgeons that like a mix of 2 different locals, vein solution, heparinized saline). For irrigation with epi, pharmacy has always had the responsibility of compounding.

    This is an old post but would like some clarification. 

    If RNs are not allowed to compound meds why would it be OK for OR RNs to still mixing "certain things things that the OR staff has always mixed"? 

    I work in the OR and was "trained" to mix local medications, add abx to irrigation, epi to BSS and just am now realizing that is NOT allowed.  

    Had a recent conversation w/DA who was unaware... I plan to refuse to compound any meds from now on.

     

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    • Admin

    Sterile compounding of 4 or more components is required to be done in a pharmacy clean room. Anything up to 3 components may still be mixed outside of the pharmacy. 

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    Rose_Queen said:

    Sterile compounding of 4 or more components is required to be done in a pharmacy clean room. Anything up to 3 components may still be mixed outside of the pharmacy. 

    Thank you, this is basically what my manager said re immediate use compounding- adding epi to BSS or 3L saline bags.  About clear as mud when the BRN says no RN shall compound drugs but the updated 797 implies we can (???) and of course all the managers and surgeons want us to compound for them.

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