Smarter, Not Harder

How CSTDs Can Infuse Flexibility and Efficiency

ICU Medical Blog
May 1, 2024

Compliance without complexity

Requirements for USP <800> compliance have made closed-system transfer devices (CSTDs) required for nursing while recommending that other departments, such as pharmacy, utilize the technology to keep staff safe from hazardous drug exposure. 

But what if this requirement protected your staff while also improving process efficiency? And what if that efficiency saved money?

Depending on your situation, that kind of inherent efficiency is completely possible, but isn’t always built into CSTDs. To ensure that you get these benefits while meeting the CSTD requirement, you should select technology that helps you comply with USP <800> and support sound workflows and safety, while soothing the concerns of technology acceptance by staff.

Overall, the benefits are well worth the extra consideration. From improving performance to decreasing lag time, there are a few ways that CSTDs can support safety, efficiency, and cost savings throughout your facility. Let’s get into them.

Choose CSTDs with fluid path ergonomics to help reduce repetitive stress 

Opening bottles and preparing syringes can be relentless and physically painful for pharmacy technicians. Repetitive stress injury (RSI) risk among hospital pharmacy technicians is high.1 The large volumes of fluid transferred add to the preparation pressure, with repetitive motions used especially in compounding hazardous drugs being strenuous on hands and wrists.2

These risk factors can lead to decreased productivity, medical treatment, time off, or disability.3 A CSTD that promotes an ergonomic fluid transfer force can help minimize discomfort and pain and limit repetitive strain injury risk, making it worthwhile to seriously consider fluid path ergonomics and RSIs when comparing CSTD options.

Look for a needlefree design, as CSTDs that incorporate needles typically have smaller fluid paths, and smaller fluid paths can require significantly higher amounts of push-pull forces to transfer fluids. Strenuous forces like these can increase the likelihood of repetitive strain during the compounding process.

Improve flow from pharmacy to floor

In the quest to streamline pharmacy operations and enhance efficiency, paying attention to the intricacies of CSTD infusion setups can yield significant benefits. For example, opting for vendors who offer sets that can be primed on the nursing floor (rather than solely in the pharmacy) presents a “win-win” opportunity. 

By shifting priming responsibilities away from pharmacy techs, this approach not only lightens their workload but also accelerates drug delivery to nursing units. Consequently, this proactive measure contributes to mitigating pharmacy backlog and reducing patient chair time. 

CSTDs can create opportunities to not only work safer, but reduce the time it takes to deliver care.

In addition, you can optimize efficiency by integrating low-volume sets that prime faster – ultimately shortening the time required to initiate and manage infusions by expediting the priming and flushing process for nursing staff.

This approach underscores the importance of collaborating with CSTD vendors that prioritize offering versatile solutions tailored to fit unique and diverse workflows, empowering healthcare facilities to operate more seamlessly and effectively.

Get more efficiency from CSTDs when pharmacy and nursing work together

As the providers that administer hazardous drugs to patients more than any other, nurses are at increased risk for exposure and are required by USP <800> to use CSTDs. However, most hospital decisions regarding CSTDs are made by the pharmacy.5

So, it would stand to reason that a CSTD implementation strategy is best administered with pharmacy and nursing involved in the device selection process. Doing so helps ensure that everyone's needs are met regarding functionality, ease of use, and comfort. 

Ensuring the early involvement of nursing in a multidisciplinary hazardous drug collaboration can help prevent isolated decision-making regarding CSTDs. 4 It can also encourage the adoption of the technology, especially by those who are unsure of how it will affect their job. 

For example, your nursing staff may have experience with CSTDs that require two pieces to create a closed system6 which adds an extra step in the already busy process. By reviewing CSTDs that provide options with luer-based connections more familiar to nursing staff, your colleagues may more quickly embrace the technology and become more efficient—another “win-win.”

The right CSTDs, at scale, can increase efficiency (and cost savings) throughout your facility.

Since some CSTDs can help improve pharmacy workflow and support safety, a strong case can be made for using the technology beyond nursing, and for whose collaboration in the selection of a CSTD device further bolsters the acceptance of this technology in your facility.

In short, the more the technology and process is accepted, the more it will be adopted and you’ll see the difference in efficiency and your bottom line. 

Add automation to the mix

Beyond CSTDs and other processes, you can further reduce RSI risk by adding an automated compounding system (ACS) to your pharmacy. These systems act as added muscle in the pharmacy, guided by technicians to handle the pulling and pushing of fluids to reduce the burden of repetitive physical work while providing better accuracy and precision.7

The ACS can also perform mix verification and documentation, helping to keep track of USP <797> required compounding records while speeding the delivery of sequential medications.8

Besides reducing RSIs, automated compounding systems also help minimize your technicians’ direct contact with hazardous drugs, helping to further enhance the safety of pharmacy staff.9

Fewer medication errors mean lower associated remediation costs.

Because precise measuring and mixing are programmed into the automated system, it can help reduce the risk of human error in medication dosage calculations, along with their associated costs.10 Expensive drug wastage due to overfilling or spills associated with manual compounding is also addressed with more accurate measurements and precise dispensing of medications.  

Now, if you have concerns about how much space an automation system may require, understand that some can fit in as small as a 6’ hood and may be implemented without a major overhaul to your pharmacy footprint.

So, even if you don’t have a large facility, you can still access the enhanced safety, efficiency, and cost-saving benefits of an automated system.

Leverage diverse product options to support flexible workflows

As facilities and clinicians have varying needs, the availability of diverse product options beyond CSTDs can allow for flexibility in workflow without compromising safety. 

Working with a vendor that offers customized solutions enables you to pick the components that work best for your challenging preparations.

For example, consider whether a vendor can accommodate specialty preparations like ambulatory delivery of Fluorouracil (5-FU) or the intravesical delivery of Bacillus Calmette-Guerin (BCG).

Is there an ability to provide niche products for challenging hazardous deliveries such as bladder administration? Is the vendor willing to help you find the safest way to prepare and administer your hazardous drug deliveries? Does a vendor recommendation include features that help remove priming from pharmacy to help reduce pharmacy backlog and provide the ability to safely and efficiently prime on the unit?

Hazardous drug delivery is complex, and it is important to find a vendor that can not only address niche needs but also collaborate on ways to help support safety initiatives specific to your facility.

Make sense of it all with a third-party assessment

On the road to compliance, there are many factors to consider in choosing a CSTD. Closing the gap between USP <800> and USP <797> compliance, CSTD implementation and use, and bringing pharmacy and nursing staff on board can be a monumental (and time-consuming) task.

Bringing in a third party to thoroughly assess your hazardous drug delivery process can help your facility identify what is currently working, pinpoint areas of concern, and choose an implementation path. 

A complimentary hazardous drug delivery assessment from ICU Medical can help support your next steps toward achieving compliance and adopting CSTD technology, as well as explore other technologies to further help you reduce exposure risk and enhance efficient workflows. Talk to one of our compliance experts today to start moving in the right direction. 

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  1. Reisz F, Gairard-Dory AC, Fonmartin K, Bourbon J, Gouriex B. Hospital pharmacy technicians and nurses are at high risk of developing repetitive strain injury. Prevention of work-related musculoskeletal disorders in pharmaceutical technology. GERPAC. 2016, quoted in Repetitive strain injury fact sheet. https://www. pharmaceutical-technology. Accessed December 18, 2023.
  2.  Belisle C. The repetitive motions used by pharmacy technicians when compounding cytotoxic drugs can be strenuous on hands and wrists. Tips for CSTD Use. Oncology Safety. 2017;14:S8. =1#page/10, quoted in Repetitive strain injury fact sheet. https://www. pharmaceutical-technology. Accessed December 18, 2023.
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  4. Wild D. The ins and outs of connecting CSTDs, Vials. Pharmacy Practice News. 2017. Accessed December 17, 2023.
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  6. Eisenberg S. Closed safety system for administration (CSSA): proposal for a new cytotoxic chemotherapy acronym. Br J Nurs. 2022 May 26;31(10):S26-S32. doi: 10.12968/bjon.2022.31.10.S2
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  8. Revisions to medication compounding requirements. June 20, 2023. The Joint Commission. Prepublication Requirements. Accessed December 20, 2023.
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  10. Kolobova I. Pharmacy automation: streamlining processes for improved efficiency. J Clin Res Pharm. 2023; 6(4):158.