Week 14

Noa’ia, greetings. Last week, we rang in to focus on using the telephone as a verbal tool for communicating with other healthcare professionals and customers. We’re hanging up on that now and shifting to a written channel of communication and (post mail’s modern counterpart) the humble email.

Email

Email is a common communication tool that pharmacy technicians use to interact and collaborate with other healthcare professionals.

Take a few minutes now to create a list outlining how, when and why pharmacy technicians might use email when collaborating with other healthcare professionals in their daily work. If you get stuck, reflect on how you observe your colleagues using email at your work placement.

When you’re ready, select the (+) symbol to compare your answers.

Writing effective emails

Have you had to write emails in a workplace or professional setting? Apart from dialling down the slang and emoji use, there are a few guidelines to remember when writing effective emails in the workplace. For general guidance, read this article from Mind Tools and watch the video (that looks like the image below) that is embedded in the article: Writing Effective Emails. 

Emails in the pharmacy

Let’s emphasise this point from the MindTools article:

Imagine how catastrophic misunderstood emails could be in a pharmacy setting! Using your knowledge of the content of communications for a pharmacy, consider at least two consequences that could happen from miscommunicating an email message. When you're ready, select the (+) symbol below.

As you can see, workplace emails in a pharmacy setting differ in some respects from emails in other workplaces, as they are centred on patient health, safety and privacy. This means that there are some extra considerations to make before hitting ‘Send’ on an email. Specifically, you must consider the following:

• Patient confidentiality: Ensure patient information shared via email is handled securely and complies with privacy regulations.
• Secure communication platforms: Use secure email platforms to transmit sensitive information securely and protect patient confidentiality.
• Accuracy of information: Double-check all medication-related information, dosage instructions, and patient details before sending the email to prevent errors that could compromise patient safety.
• Urgency: Due to the critical nature of medication-related information, pharmacy emails may require a higher degree of urgency than emails in other workplaces to ensure patient safety and well-being.

Key points

In summary, the following are important key points for communicating and collaborating with healthcare professionals using email.

• Include a descriptive subject line when sending an email.
• Use an appropriate and professional greeting.  
• Address the recipient appropriately.
• Use a polite and professional tone. 
• Use clear, concise, and professional language.
• Provide relevant information and answers to all the questions asked by the sender. 
• Ensure a logical flow and format. 
• Include an appropriate, courteous sign-off that identifies who you are and what your role is.
• Ensure correct spelling and punctuation - proofread before sending.
  • If this isn’t your strong suit, ask a colleague to review the email for you or use a spelling and grammar check like Grammarly or Hemmingway Editor.
• Check that you have correctly selected the intended recipient.
• Check that you have not selected ‘Reply all’ unintentionally.

Communication wrap-up

Over the last few weeks, we have covered why effective communication is essential when working with other healthcare professionals and how to use it. Bring your learning to the front of your mind with this end-of-topic pātaitai (quiz). Answer the seven following multi-choice questions.

If you don’t hit 100%, don’t be discouraged. The old adage ‘learn from your mistakes’ is true, as making mistakes allows you to analyse what went wrong and why, leading to a deeper understanding and retention of knowledge. You’ll also see how these mistakes can happen in the real world.

That wraps up our discussion on communication with other healthcare professionals for this week. Ka pai temahi, good work!

Introduction

Welcome back to Dispensing 2. This week, we will start our initial exploration of aseptic compounding, which will continue for three weeks. Over that time, we will discuss:

1. Contamination control
2. Clean rooms 
3. Quality control.

Me ruku ki te kaupapa, let’s dive into the topic.

Aseptic compounding

Aseptic compounding refers to the process of preparing sterile medications in a controlled environment to prevent contamination. It can be carried out in various settings, including hospitals, compounding pharmacies, and other healthcare facilities. These environments are equipped with sterile compounding areas where pharmacists and pharmacy technicians prepare sterile medications to meet specific patient needs.

Contamination control

Contamination is the presence of an unwanted constituent, contaminant or impurity in a material, such as microbes. It is important to remember that microbes exist everywhere – this includes people, objects, and surfaces. Microbes have the ability to survive for days or even weeks on surfaces, leading to a persistent source of contamination.

Types of contaminants

There are a few different types of contaminants that can put compounded products at risk of contamination. Have a guess at how each contaminant risks contamination before selecting the (+) symbol to see the answer.

Cleaning, sanitising, and disinfecting

The aseptic technique aims to protect the patient from infection and prevent the spread of pathogens. Often, practices that clean, sanitise or disinfect are insufficient to prevent infection.

Do you remember the meaning and differences between these practices? Test your knowledge before you turn each card to reveal the answer.

Asepsis

The ultimate goal of aseptic compounding is to reach asepsis - the state of being free from all contaminants. When a pharmaceutical product is compounded aseptically, it must be sterile, meaning it is free of all biological contaminants, not just those that can cause disease.

Sterility

In aseptic compounding of medicines, sterility refers to the complete absence of viable microorganisms, including bacteria, viruses, fungi, and spores, in the compounded product or in the environment where the compounding process takes place. Anything that is not sterile is considered contaminated.

Sterility is crucial in aseptic compounding because it ensures that the final compounded medication is free from contaminants that could potentially cause harm to patients, particularly those with compromised immune systems.

Compounding a sterile pharmaceutical compound requires the following:

1. The pharmacist or pharmacy technician to use the aseptic technique.
2. The attentive use of sterile equipment and supplies. 
3. Preparation of the compound in a controlled sterile environment.
4. Maintaining sterility of the final prepared product.

Sterilisation

Sterilisation is the process of making an object or environment sterile, ensuring that it is free from all forms of viable microorganisms. There are different types of sterilisation techniques, which use one or more of the following:

1. Physical sterilisation: Involves using physical agents such as heat, radiation, or filtration to destroy or remove microorganisms. 
   • Examples include:
     • Autoclaving (steam sterilisation — you can see autoclaving in action in the image above.)
     • Dry heat sterilisation
     • Ultraviolet (UV) radiation
     • Filtration through membrane filters.
2. Chemical sterilisation: Involves the use of chemical agents to disinfect or sterilise surfaces or equipment. This may include using liquid chemical sterilants or high-level disinfectants such as hydrogen peroxide, ethylene oxide gas, or glutaraldehyde. These chemicals disrupt the structure and function of microorganisms, ultimately rendering them inactive or unable to reproduce.

Supplies and equipment

The supplies and equipment for compounding and administering sterile preparations include:

1. Needles and syringes: Used for drawing up and administering sterile medications.
2. Ampules and vials: Containers for storing and dispensing sterile medications
3. Personal Protective Equipment (PPE): Worn to maintain sterility during compounding and administration.

Let’s take a closer look at each of these.

Needles and syringes

Needles and syringes are used during the preparation process of compounding to facilitate manipulations (withdrawing precise amounts of liquid from vials, mixing different medications, or transferring substances between containers). Both needles and syringes are manufactured in many different sizes and types, depending on the type of manipulation necessary.

Needles

Needles are made of either aluminium or stainless steel and used to transfer solutions during compounding. They are packaged individually by the manufacturer to guarantee sterility.

The main parts of the needle are the bevel, bevel tip, hub, shaft and lumen.

Use this matching activity to learn about these parts. Drag and drop the name of the part next to the correct description. As this is an introduction to the concept, mistakes are expected and are a good way to learn. So, if you get an answer wrong, don't worry! Instead, make sure to add the correct answer to your glossary or notes.

Needles vary in their lumen diameter and length, and both characteristics should be selected based on their intent of use. 

Lumen diameter and gauge size

• The diameter of the lumen (the internal space within the needle) is represented by gauge size. The higher the gauge, the smaller the lumen diameter and the sharper the needle. This is because gauge size is inversely related to needle diameter. So, a 20-gauge needle will have a larger lumen diameter than a 26-gauge needle.
• The selection of the proper gauge depends on the type of solution being transferred. Thicker fluids require needles with larger gauge sizes to accommodate their viscosity (thickness) and ensure smooth flow during transfer.
  • For example, thick solutions should be transferred using small gauge needles, such as 20 gauge rather than 25 gauge. This is because the 20 gauge needle will have a larger diameter than the 25 gauge to allow easier flow of the solution through the needle.

Lumen length

• The length of the needle is the distance from the hub of the needle to the tip of the needle. Needle lengths vary from 3/8 inch to 2 inches.
• A longer needle should be chosen when working with thick closures or lengthy entry ports on containers.
• You can see different examples of needles on the webpage where we found the image above. Check it out yourself here (after confirming you are over 16 years old): New Zealand Needle Exchange Programme. 

There are also many different types of needles to use for different types of transfers and manipulations. Expand the labels below to explore three types.

Syringes

Syringes attach to a needle and hold solutions that are to be administered to a patient or that are about to be transferred from one container to another. Traditionally, glass syringes were used, but they have now been almost completely replaced with plastic syringes. Plastic syringes are packaged by the manufacturer in an individually sealed paper or plastic overwrap. This maintains sterility until the package has been opened. Plastic syringes are disposable and are intended for single use only.

The main parts of the syringe are the luer lock tip, barrel, calibrations, plunger flat end and plunger piston.

Use this matching activity to learn about these parts (and a few more!). Again, if you get any answers incorrect, use this as a learning opportunity and add the term to your glossary or notes.

Sizes

Syringe sizes vary from 0.5ml to 60ml, indicating the maximum volume that can be drawn up into the syringe. The larger the syringe is, the lower the accuracy of the measured volume.

It is important to consider the accuracy of measurement when selecting a proper syringe size. For example, a large syringe should not be selected to draw up a small volume. The smallest syringe size that can accommodate the desired volume should be used.

Anatomy of a needle and syringe

Here, you can see the anatomy of a needle and syringe and how they fit together.

Ampules and vials

Ampules and vials are types of containers used for storing pharmaceutical liquids. They are typically made of glass and have different designs to suit various applications in the medical and pharmaceutical fields.

Ampules are small, single-dose containers that are usually sealed by melting the glass to create a hermetic (airtight) seal.

Vials, on the other hand, are larger containers with a rubber stopper or aluminium cap to seal the contents. Both ampules and vials are used to store and transport liquids such as medications, vaccines, and other sterile solutions.

Ampules

Source: Pharma Lab Global

These are glass containers that hold sterile injectable solutions. They are broken at the neck prior to accessing the solution and have pressure points that mark the desired point to break them. You can be seen as the blue dot in the picture.

Due to the potential for glass to enter the solution being withdrawn, a filter needle must be used when withdrawing contents from an ampule.

Vials

These can be made up of plastic or, more commonly, glass. Glass vials have a rubber closure, also referred to as the rubber stopper, to prevent the passage of air or fluids inside and outside of the vial. A cap covers this rubber stopper and must be removed before the contents of the vial can be accessed.

While these covers protect the rubber closure, they do not guarantee its sterility. Therefore, it is necessary to disinfect the rubber closure prior to puncturing it.

Personal Protective Equipment (PPE)

In aseptic compounding, maintaining contamination control is vital, and one key aspect is the use of PPE. Throughout the compounding process, it's imperative for the aseptic operator to wear PPE consistently. This equipment serves as a barrier against shedding skin and hair cells, as well as the deposition of cough droplets or any other contaminants, thereby safeguarding the integrity of the compounding area.

Wearing PPE

Typical items of PPE include the following (which you can also see in the above image):

• Sterile gloves
• Surgical mask or respirator
• Hair cover or hood
• Gown or coverall
• Shoe covers or boots

The order in which the PPE goes on matters! This is because you don't want to inadvertently contaminate a piece of PPE by mistake (for example, if you put gloves on first and then touch your hair to put the hair cover on). Therefore, when preparing for aseptic compounding, the operator must follow these seven steps, in order:

1. Shoe covers 
2. Hair cover 
3. Beard cover (if applicable) and mask 
4. Face/eye protection 
5. Hand hygiene 
6. Gown 
7. Gloves. 

Watch: My job in a minute: [...] Sterile Compounding Technician (1:23 minutes)

Mātakitaki mai, watch here as a pharmacy technician in the United States, describes her responsibilities in aseptic compounding. Listen out for the factor that inspired her to pursue this role and what motivates her to remain in it.

Did you notice what items of PPE the operators were wearing?

We have now come to the end of this session. Ko koe a runga, you're awesome, as there was a lot of new learning to take in! In our next session we dive into personal hygiene, the steps for aseptic gowning, and clean room.