Dogma: belief or set of beliefs that is accepted by the members of a group without being questioned or doubted (Merriam-Webster)
I have opinions, lots of opinions. And like most, I believe my opinions are valid; it’s human nature. It’s not uncommon for me to find people within a group that agree and disagree with my opinions. However, once in a while I come across an entire group of people that stand in disagreement with my thoughts. That’s not crazy to imagine, but when that happens I’m forced to re-evaluate. Let’s face it, if everyone thinks I’m wrong, it’s possible that I am.
Such is the case with my thoughts on the use of technology and personnel in the i.v. room, which are on record at this site and are quite transparent. In a nutshell I believe that:
- Technology can be used to improve both pharmacy operations and patient safety. Generally speaking people don’t disagree with this philosophy, but rather the details of type of technology and how best to use it. Tomayto, tomahto. There is good and bad pharmacy technology. With that said, some of the technology available for sterile compounding is quite good.
- Pharmacies shouldn’t skimp on the technology they use. What does “good enough” mean anyway? I’m specifically speaking about comments I made recently in this post: “You’re literally getting one half of the functionality necessary to ensure accurate compounding [when using only bar-code scanning for verification]”. I’m not backing down on that one. If you’re using bar-code scanning to verify that you have the correct drug, that’s great. But if you’re only method for verifying accurate volumes is to have a pharmacist look at it, you’re wrong. I can’t put it any more plainly than that. “Good enough” simply doesn’t cut it in my mind.
- Pharmacists are not the be-all end-all of the verification process. Many in my profession are stuck on the idea that a pharmacist must be the final check in any compounding process. Why? What makes pharmacists better at it then say, a technician? There’s data out there to suggest that technicians do a fine job in a verification role. In some instances as good, if not better than pharmacists. Here’s the thing, a pharmacist’s education includes many things, but checking isn’t one of them. I don’t recall a “verification” or “checking” class in pharmacy school.(1) I took a truckload of chemistry (organic, biocchem, PChem, etc), lots of anatomy (gross included – yes, I dissected a body), histology, enzyme kinetics, pharmacokinetics, more pharmacology than I can recall, etc. You know what I didn’t take? A class on how to verify that something was properly compounded or has the right label on it. All that came as on-the-job training when I went to work in a hospital. The first time I had to do a final check on a CSP I had no idea what I was doing. I put my initials on it because that’s what I was supposed to do. I had no idea if it was right or not. What makes the situation worse is that most pharmacists find checking to be a nuisance, and are often distracted by other “more important” things. No, pharmacists aren’t better at verification than a technician. The idea that a pharmacist must perform a final check on a CSP rather than a technician – or other qualified individual – is nothing more than ancient dogma.
In summary, after deep consideration, I’m not wrong. My opinions are valid: you should be using the most complete solution possible in the i.v. room, and you need to get over the idea that a PharmD is required for a “final check”.
- I attended UCSF School of Pharmacy. UCSF is arguably the best pharmacy school in the country. That’s not bragging, it’s simply putting context to what “the best” includes – or in this case doesn’t include – in their curriculum.