But if your facility has safety or cost concerns, or simply doesn't
have the time or resources to properly vet an outside compounder,
there's another option. You can start small by focusing on a specif-
ic medication or solution you want to stop mixing in the OR and
break down the process step by step until you find a better way.
That's what Sanford Medical Center Fargo (N.D.) did recently. The
facility used to rely on a variety of irrigation solutions, which were
often compounded or mixed by a circulator right in its ORs. When
the Joint Commission raised concerns about the safety of such an
approach, Sanford took the following steps to do away with its irri-
gation compounding practices, according to Laci R. Soper, BSN, RN,
the facility's operating room educator.
• Standardized the options. Sanford's first course of action was a
detailed analysis of 50 surgeon preference cards. Throughout the analy-
sis, certain solutions — such as a combination gentamicin-saline solu-
tion — were eliminated as Sanford attempted to standardize the solu-
tions surgeons used.
"You need to first find out what your surgeons are willing to part
with, and then go from there," says Ms. Soper.
With the help of the surgeons and clinical leaders, she gradually
began eliminating the irrigation solutions Sanford surgeons could do
without.
In the end, the facility reduced its broad list of irrigation solutions to
just three main options: A commercially available low-concentration
0.05% CHG jet lavage system, a saline solution and a pharmacy-pro-
duced antibiotic solution created in compliance with USP 797.
• Made education the priority. If you're planning on greatly reduc-
ing or eliminating a formerly compounding-heavy approach to med-
ication distribution, you can't afford to cut any corners with the staff
education component. When Sanford's standardized irrigation proto-
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