What is “USP 800”? I’ve only recently heard about it.

It’s about hazardous drugs, and the compliance deadline for USP General Chapter <800> arrived Dec. 1, 2019. According to Logistics, more than 8 million U.S. Healthcare workers are exposed to hazardous drugs (HDs), which can lead to serious health issues. The purpose is to define standards for handling HDs.

It covers areas such as deactivating, decontaminating and cleaning; facility and engineering controls; spill control; medical surveillance; and all personnel coming in contact with HDs.

While you may think this might not affect long-term care, warfarin, for example, is on the hazardous list issued by the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health. Plus, there are all the drugs that are cut or crushed. In addition to drugs that are hazardous if altered by crushing, breaking, splitting or other manipulation from their intended dosage form, you need to consider potential exposure, surface contamination and medication errors. In fact, it is estimated that 10% of all medication is not suitable for splitting or crushing.

Appoint a compliance leader — an on-site pharmacist, nurse or administrative staff member. The compliance leader should know all USP <800> guidelines so that they can serve as a single point of contact for accountability and dissemination of information. Perform an initial risk assessment. This should include a review of whether certain drugs can be split or crushed, as well as whether equipment and safeguards are in place or are needed. 

The level of competency across a long-term care facility should be assessed every 12 months, as well as at the time a new hazardous drug is introduced.