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Compounding Concerns

Cheryl Clark, for HealthLeaders Media, October 14, 2013
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This article appears in the October issue of HealthLeaders magazine.

It's a safe bet the fungal outbreak affecting patients who received contaminated steroid products prepared by the New England Compounding Center last fall has placed hospital leaders on a nervous edge, regardless of whether they were ever among that pharmacy's customers.

Though alarming for its size and scope—the outbreak led to the deaths of at least five dozen patients and sickened about 700 more in 20 states—it was not the first, or the last, such incident to cause harm on a large scale.

Some 20 serious errors involving preparation of products from compounding pharmacies since 2001 have resulted in 982 patients becoming ill, including at least 77 deaths in at least 32 states, according to a spring report from the Pharmacy Sterile Compounding Summit organized by the Pew Charitable Trusts and the American Hospital Association.

The harm caused blindness or vision loss, bloodstream infections, meningitis, and even strokes from drugs used for chemotherapy, parenteral nutrition, IV flushes, eye and spinal injections, and IV sedative solutions.

While state and federal legislators and regulators are looking at the issue and considering changes, leading healthcare providers are not waiting around.

"Until that time comes, we in hospital pharmacies have to do our own diligence to determine if the partners that we're using or want to use to provide outsourced products for our patients are going to meet our needs," says Bill Churchill, chief of pharmacy services at 747-bed Brigham & Women's Hospital in Boston.

"Every hospital that has the capability needs to drive its own bus on this. You need to take the bull by the horns."

Partly out of recognition that purchasing drugs from outside compounding pharmacies poses an avoidable risk, the 1,409-bed Scripps Health system in San Diego took steps two years ago to launch its own $3.5 million facility to serve as a centralized compounding pharmacy for its five hospitals, unifying smaller operations at each facility.

The move was facilitated by state legislation that set up a special pharmacy category under state licensing purview a year ago, and Scripps officials hoped to become one of the first health systems in the state to take advantage of the new law.

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