Surgery Center Damage Control: Case Study on Compounding Pharmacies

At the 11th Annual Orthopedic, Spine & Pain Management-Driven ASC Conference in Chicago on June 15, CEO and President of APAC Partners Faisal Rahman, MD, gave a presentation titled "Handling the Crisis With Compounding Pharmacies."

In October 2012 the New England Compounding Company issued a recall of its products after contaminated products were distributed across the country. Many surgery centers and pain management facilities were impacted by these products. As of March 2013, there were 722 confirmed cases of contamination and 50 deaths nationwide.

"We received a call last year about the recall and immediately stopped using NECC products," said Dr. Rahman. "We removed all NECC products from our shelves and compiled a list of all epidural patients and then prepared a hotline for patients. We had to prepare our staff for patients who called into the hotline to figure out whether they may have been affected."

The contaminated product contained fungal meningitis, which sometimes shows up four to six weeks after exposure. APAC contacted everyone who possibly was contaminated at the practice by phone and followed up with them.

"The patient strategy was to identify the patients with exposure and then contact them with telephone calls or personal visits," said Dr. Rahman. "We told our staff members how to communicate with these patients so the message was common and consistent. It worked out very well."

The group also created a strategy for dealing with the media attention surrounding the outbreak. The media strategy was to approach journalists openly and be consistent with the message. Physicians were able to speak to the press with the overall message, but they were not scripted.

"We sat down with them and told them to tell the truth," said Dr. Rahman. "They informed the press and were open about what was going on. We also had to meet with referral sources and discuss the issue, since 95 percent of our patients are referred from other physicians. We got to the referring physicians before they contacted us, and that was a good thing."

In the middle of the controversy, APAC devised a new drug purchasing strategy that included demanding more detailed and exhaustive criteria before purcahisng from compounding pharmacies. The compounding pharmacy would have to be accredited and the group requests sterilization reports.

"We have to continuously educate our staff on handling safety and side-effects," said Dr. Rahman. "And we can't short cut documentation. There are very detailed documentations of everything we have done and internally developed clinical protocols. You can never over-communicate."


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