1. ASK THE EXPERT By Joseph W. Coyne, RPh
Q:
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PHARMACY
&Purchasing Products24 ■ October 2014 ■ www.pppmag.com
A:
How CanYou Accommodate Pregnant
Employees in an HD Environment?
Accommodating pregnant or breastfeeding
employees, or employees attempting to conceive,
can be a daunting task for a pharmacy that performs
a high volume of hazardous drug (HD) compound-
ing. The key to handling these staffing challenges
is establishing clear policies and procedures with a
proper focus on safety and ensuring that employees
are cross-trained, competent, and educated in all
pharmacy duties.
At Cancer Treatment Centers of America
(CTCA)—a cancer center comprising five acute care
facilities with a central medication distribution model
and just over 100 beds—we compound approximately
1500 doses per day. This high volume of compound-
ing mandates that long- and short-term staffing issues
be anticipated and addressed as early as the initial
hiring process. It is important to be candid with po-
tential employees during the interview process so that
they understand the technician job entails handling
HDs and will include training on identifying hazard-
ous agents, safe handling practices, and spill manage-
ment, in addition to other duties.
Thorough staff training and education is es-
sential to ensuring that pharmacy personnel are
prepared for any situation. At CTCA, all new hires
participate in an orientation and onboarding pro-
cess. New technicians do not begin compound-
ing until they finish their training, complete their
competencies, and demonstrate comfort with the
compounding process; the goal is to avoid on-the-
job training. The onboarding process begins with
an examination of compounding volumes, peak
days, trends, and infusion schedules to determine
the best days for training so proper time and at-
tention can be given to the employee. Once train-
ing is complete and competencies are established,
new employees generally begin compounding non-
hazardous medications on low-volume days so they
can ease into their compounding responsibilities
and become familiar with policies and procedures
before moving on to HD compounding. New em-
ployees also receive thorough training in the usage
of closed system drug-transfer devices (CSTDs).
Technicians should be cross-trained as a mat-
ter of good practice; we believe this is necessary
regardless of the reason for employee absences or
job restrictions. The key to effective cross training
is maintaining competencies. Thus, a strong annual
competency-testing program is essential. It is also
important to shift staff duties whenever possible to
ensure all technicians are familiar with the various re-
sponsibilities within the pharmacy. Implementing a
rotating schedule of duties can achieve this and also
help eliminate staff burnout. A secondary option is
to rotate vacation or leave coverage to avoid having
the same employee cover shift gaps. Although all
employees need not be as proficient as those who
perform certain tasks as part of their daily responsi-
bilities, every staff member should be competent to
execute each pharmacy duty safely and effectively.
It is our policy to remove pregnant or breastfeed-
ing employees or those attempting to conceive from
any situation that risks exposure to HDs. As such,
these staff members are precluded from hazard-
ous compounding, as well as any handling of HDs,
including receiving or delivering HDs to the floor.
Instead, these employees are reassigned to other
general pharmacy functions, such as non-hazardous
compounding (eg, antibiotics and TPNs when not
prohibited by drug allergies or other restrictions),
order entry, unit-dose repackaging, cart fills, and au-
tomated dispensing cabinet management. They may
also assist in the training of new employees or be as-
signed a special project.
When an employee is unable to compound, staff
scheduling can be a major concern, as productivity
must be sustained. Mandating overtime, outsourc-
ing, or utilizing temp agencies are possible solutions;
however, given the expense of these approaches,
they may be best reserved for long-term absences.
Oftentimes, creative scheduling is the best solution.
For short-term absences and vacations, look to ad-
just the schedules of per diem or part-time employ-
ees. With intermittent absences, shift changes (eg,
moving to four 10-hour days or altering shift start
and end times), providing guaranteed overtime, or
offering flex time may be the best solution. Whether
it is a simple one-for-one employee schedule switch,
switching job functions for a period of time, moving
non-scheduled functions to off-hours, or extending
hours and providing overtime, we make sure that all
employee roles in the pharmacy are filled so patient
care is never compromised.
To properly accommodate employees with re-
strictions, pharmacies must be diligent about cross-
training staff and be prepared to rearrange schedules
as necessary to ensure all pharmacy duties are cov-
ered. Technicians must be provided with the train-
ing and tools necessary to be successful at managing
any task within the pharmacy. Pharmacists, as well
as other support staff, must be prepared to step in
and support the operation whenever necessary. The
staffing challenges this situation presents in no way
should have an impact on the quality of patient care
delivered and, therefore, may require a combination
of all the solutions addressed herein. ■
Joseph W. Coyne, RPh, has served as the vice
president of pharmacy services at Cancer Treat-
ment Centers of America since 2009. Joe obtained
his BS in pharmacy from the Philadelphia College
of Pharmacy and Science, where he is currently
an adjunct senior clinical professor with the depart-
ment of pharmacy practice.
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