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Compounding Medications

Posted
by OR_RN OR_RN (New) New Nurse

Specializes in Operating Room. Has 5 years experience.

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?

Edited by OR_RN

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

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.

OR_RN

Specializes in Operating Room. Has 5 years experience.

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.

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

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.

OR_RN

Specializes in Operating Room. Has 5 years experience.

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.

What exactly are you being asked/expected to do?

OR_RN

Specializes in Operating Room. Has 5 years experience.

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

rockchickrn, ADN

Specializes in Psych. Has 26 years experience.

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