Today I spent another day at UPMC Beacon Hospital. I came in at 8am (before the pharmacy actually opens) to observe a technician prepare chemo drugs. We had to dress in proper aseptic technique so I had to change into scrubs and remove all jewelry/makeup. Then we went into the clean room where the technician disinfected everything. There are 3 kinds of sprays they can use...1 for general cleaning, 1 for weekly cleaning that kills more bacteria, and 1 for monthly cleaning that also kills fungus. I've never inhaled so much cleaning product particles in my life... It took >1 hour for her to clean everything. Then she was finally ready to prepare 2 IV chemo bags. They use isolated chambers with negative pressure for the chemo, but they also have positive pressure chambers for other preparations. They do a lot of monoclonal antibody preparations but have also recently started to make some chemo drugs to keep costs down.

I spent a lot of the day with a pharmacist that deals with all the chemo and RA drugs. She spends a lot of time ordering medications for the patients. She also looks at patients' medication regimens and makes any comments/recommendations. She talked a lot about working in England--which she says was a lot more advanced in technology than in Ireland. And she said pharmacists had more of a proactive role in the hospitals there. The only real think the pharmacists can do clinically is switch PPIs (ie switching from pantoprazole to omeprazole to cut costs). One thing that struck me is that because the prescriptions aren't entered in electronically, the pharmacists often times do not check the prescriptions before the patient gets it...they just check it when they see it in the medication list and then can question it.

Ireland is definitely behind in innovating the hospital practice...Beacon is considered advanced so I'd be kind of interested to see things at one of the public hospitals