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OPERATIONS & MGMT
The case for mobile cleanrooms ........................
4
Retired pharmacists could expand COVID-19 vaccinator pool ................ 6 CLINICAL
Vancomycin and the move to AUC-based dosing ................................
14
Affordable alternatives to pricey ethanol locks ..................
18
A plan for predicting CAR T-Cell toxicity ..............................
20
POLICY
The cost equation for CSTDs: debating the data .............................
30
REVIEW ARTICLES
Parenteral Nutrition Therapy Assessment Tools and Guidelines See insert after page 18
Lean Thinking For CSTDs See page 32
Coalition Slams White Bagging Push by Payors
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Volume 48 • Number 5 • May 2021
Testing, vaccinations part of services offered
Pharmacy Colleges Pitch In on COVID-19
ayor-mandated “white bagging” is jeopardizing patient safety and exacerbating supply chain problems for hospitals and health systems, the ASHP and 61 health systems and group purchasing organizations recently told FDA Commissioner Janet Woodcock, MD, in a letter requesting a meeting to discuss the practice. White bagging typically involves clinician-administered drugs given to nonhospitalized patients—often infusion-based drugs that patients cannot take safely on their own. Historically, hospitals have purchased these drugs in advance and held them in stock, and when a patient needs the drug, the hospital compounds and administers the medication and is reimbursed by the medical plan. Under white bagging, payors move these drugs from
rom coast to coast, colleges of pharmacy have been spearheading COVID-19 testing and vaccination initiatives, both on and off campus. Pharmacy faculty at the University of South Carolina , in Columbia, were among the first in the country to develop saliva-based polymerase chain reaction (PCR) COVID-19 testing. Stephen Cutler, PhD, the dean and a professor at USC College of Pharmacy, said that innovation began in January 2020, when two of the college’s faculty were watching the as yet unnamed coronavirus
Continued on page 34
Continued on page 12
Pharmacists at the Medical College of Wisconsin Pharmacy School, in Milwaukee, help with COVID-19 testing and vaccinations.
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At Seattle Children’s:
Patients and covered entities feeling the pinch
Algorithm Drives More Appropriate PN Use in Children
Manufacturers’ 340B Restrictions On Contract Pharmacies Draw Ire
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ocusing on patient safety and engaging front-line dietitians in the development of an algorithm for appropriate use of pediatric parenteral nutrition allowed Seattle Children’s Hospital to achieve a significant, sustained reduction in PN usage and reduced the likelihood that PN contributed to central line–associated bloodstream infections (CLABSIs). After implementing a four-step quality improvement project on Continued on page 19
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eginning last summer, several drug manufacturers announced they would no longer extend 340B drug pricing to contract pharmacies. The manufacturers said the restrictions are part of a much-needed adjustment to a program that has seen “egregious markups” and other abuses. But the pharmacies caught up in the crossfire say the policy is having unintended consequences, including compromised patient care. Many individuals with diabetes, for example, are having to pay steep price increases for their insulin or switch to less expensive— and potentially less effective—products.
Cleanrooms and Sterile Compounding See pages 4, 5, 30
Affected 340B facilities say they also are worried about the financial fallout if the restrictions continue. “This is a very problematic time to cut these [contract pharmacy discounts],” said Jessica Galens, PharmD, the assistant chief pharmacy officer, business services, at UCSF Medical Center. “Hospitals are all suffering financially and because these savings are no longer available to us, it means that we can’t even think about expanding services to people in need when we’re just trying to keep our doors open.” Continued on page 28
