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Island Health Pharmacy Practice Residency
Central Intravenous Admixture (CIVA) Rotation
Preceptor(s)
Annemarie Rongve, BScPharm, ACPR
CIVA Pharmacist
Royal Jubilee Hospital
Office/Mobile: 250-370-8111 Ext:12306
Email: [email protected]
ROTATION DESCRIPTION
The Central IV Admixtures (CIVA) rotation provides the pharmacy resident with an introduction to the sterile
preparation of medications given via a number of different routes. Various examples include medications for
injection, topical or injectable ophthalmic preparations, bladder instillations, medications for intrapleural
administration and medications intended for epidural or intrathecal administration. The CIVA centre is based
at the Royal Jubilee Hospital, but the skills taught in this rotation will apply to any VIHA sight where a sterile
product is compounded.
During the CIVA rotation, the resident will be introduced to adult parenteral nutrition, BCCA oncology protocol
orders, the use of aseptic technique for the preparation of IV admixtures (including hazardous medications),
and the processing of other patient specific medication orders that require sterile preparation. In addition, key
resources and guidelines explicit to sterile product compounding will be explored. During the rotation the
resident will be expected to work and communicate with CIVA technicians/assistants, dieticians, physicians
and other pharmacists to process CIVA orders and resolve drug related issues as they arise.
Upon completion of the CIVA rotation, the resident will be able to assess adult parenteral nutrition orders for
solution stability and be able to resolve instability issues with the dietician or physician. The resident will also
be able to assess and resolve drug related problems on physician orders for CIVA prepared products and be
able to verify and complete CIVA orders using the Cerner computer system. The resident will be proficient at
locating sterile product information resources including IV monographs, procedure cards (ACP’s), stability data
websites (i.e. Trissel’s, King’s Guide) and documentation tools, as well as locating pertinent oncology related
information on the BCCA website in order to review, process and resolve drug related problems for BCCA
oncology protocol orders. Finally, the resident will be able to communicate and resolve CIVA related issues as
they arise with other health care professionals, describe key sterile product fundamentals and be able to
demonstrate basic sterile product preparation skills.
The resident is provided with informal feedback by the preceptor throughout the rotation, and is formally
evaluated at the end of the rotation in a one-to-one meeting with the preceptor where the resident is
expected to discuss key concepts of a sterile products admixture program.
Last revised August 12, 2015
ROTATION GOALS AND OBJECTIVES
Goal 1:
Develop and integrate the knowledge related to central intravenous admixture (CIVA) preparation
and dispensing, to manage, improve, and ensure safety of medication use for individual patients
and groups of patients.
Objectives:
1. The resident will relate the advantages and/or limitations of key components of the medication use system
in the area of sterile products with respect to the patient, the department and the organization through
both informal and formal resident-led one-to-one discussions with the preceptor. (CPRB 3.2.1)
Key components include:
 Organization and “work-flow” of the CIVA center
 Pharmacy Technician Regulation and its impact on the evolution of changing roles in sterile products
 Aseptic Compounding
 Description of transportation systems in sterile products
 Description of drug receiving and inventory maintenance in the CIVA department
2. The resident will document all collaborative interactions with other health care professionals during the
CIVA rotation time-frame. Interactions may occur with any of the following medical personnel:
Pharmacists, pharmacy assistants or technicians, nurses, dieticians and physicians. (CPRB 3.2.2)
3. The resident will demonstrate an ability to prepare and dispense sterile preparations according to
organizational policies and procedures by working in conjunction with the pharmacist and/or technician to
complete the daily CIVA work-load throughout the rotation. (CPRB 3.2.3)
4. The resident will demonstrate an ability to assess orders for appropriateness prior to verification by using
suitable resources throughout the rotation. Resources will include the medication profile, allergy history,
information obtained in power-chart, the abacus program, BCCA oncology protocols, aseptic compounding
procedures, IV monographs and other available information resources. (CPRB 3.2.4a & CPRB 3.2.4b)
5. The resident will demonstrate an ability to identify, analyze, and resolve medication drug problems with a
physician by transcribing and/or clarifying medication orders onto the patient medication profile or health
record as problems present themselves throughout the CIVA rotation.(CPRB 3.2.4b & CPRB 3.2.4c)
6. The resident will demonstrate a working knowledge of safe medication practices in sterile products
through both informal and formal resident-led one-to-one discussions with the preceptor regarding the
following CIVA topics: (CPRB 3.2.5)
 Island Health Hazardous medication Policies and Procedures
 Chapter USP 797 vs New CSHP Compounding Guidelines
 Description of quality control, validation and environmental monitoring with respect to sterile
compounding.
 Safe medication checking practices
 WHIMIS and Material Safety Data Sheets
 Order entry and verification processes
 Latex Allergies and Sterile Product Preparation
Last revised August 12, 2015
Goal 2: Demonstrate the attitudes and behaviours that are hallmarks of a practice leader and mature
professional.
Objectives:
1. The resident will demonstrate responsibility for own learning, through the refinement and advancement of
critical thinking, scientific reasoning, problem-solving, decision-making, time management,
communication, self-directed learning, and team/inter-professional skills. (CPRB 3.4.1)
2. The resident will demonstrate commitment to the profession, collaboration and cooperation with other
healthcare workers, and an understanding of the role of the pharmacist and technician in the interprofessional team in the improvement of medication use for patients. (CPRB 3.1.1 3.2.2, 3.3.3)
Goal 3: Effectively respond to medication and practice related questions, while using the knowledge gained to
educate others.
Objective:
1. The resident will effectively respond to medication- and practice-related questions and educate others in a
timely manner, utilizing systematic literature search, critical appraisal skills and appropriate means of
communication (verbal or written, as appropriate). (CPRB 3.5.1.a.b.c.d.e)
REQUIRED ACTIVITIES
1.
2.
3.
4.
Complete the supplied reading materials in preparation for the CIVA rotation.
Complete the learning questions supplied with the reading package as a group.
Complete the self-assessment case scenarios on the BCCA website.
Demonstrate knowledge of the advantages and/or limitations of the medication use system in sterile
products by discussing select topics (as outlined in objective one) with the preceptor.
5. Demonstrate knowledge of safe medication practices in sterile products by discussing select topics (as
outlined in objective six) with the preceptor.
6. Maintain a tracking document on a daily basis that records all required learning activities throughout
the rotation. Examples of activities that must be tracked include the following:
a. Sterile preparations compounded in the IV room with the CIVA technician.
b. All final checks on completed sterile preparations sent into the pass-through (including neonatal
parenteral nutrition, specialty infusion bags, hazardous drug preparations, patient specific
medications and medications prepared as batches)
c. All patient orders that are assessed and processed, including the drug information resources used
to verify the order.
d. All collaborative interactions with other health care professionals during the CIVA rotation.
e. Physician order clarifications or order changes that are written and recorded in the patient chart.
f. All adult parenteral nutrition orders assessed for stability and final checks.
Last revised August 12, 2015
7. Demonstrate correct gowning and scrub-in procedures to the satisfaction of the CIVA technician team
leader.
8. Prepare at least three sterile compounds using aseptic technique with the CIVA technician team leader.
Describe the preparation process used for each in detail to the CIVA pharmacist.
9. Complete THREE mock-up parenteral nutrition orders, resolving the problems associated with each
test patient.
10. Assess a minimum of THREE adult parenteral nutrition orders for stability and be able to resolve
instability issues with the dietician or physician if required.
11. Apply a Beyond Use Date to TWO medication products assigned by the preceptor using the concepts
learned in the USP <797> guidelines document.
12. Locate an MSDS sheet for a chemical compound or a hazardous medication prepared in CIVA.
13. Respond to and answer all stability and drug information questions that arise in CIVA throughout the
rotation.
14. Contribute to the completion of day to day work in CIVA, specifically processing medication orders, and
preparing and dispensing sterile medications.
15. Work collaboratively with the other residents and with other CIVA personnel during the CIVA rotation.
PRECEPTOR CONTACT TIME
The preceptor will initially spend 3 -4 hours/day of detailed instruction on CIVA processes and CIVA learning
objectives. As the rotation proceeds the resident will be expected to undertake CIVA tasks utilizing the
preceptor to help when required. By the end of the rotation the resident will be expected to work
independently to contribute to completion of the overall daily CIVA workload.
EVALUATIONS
This rotation includes a formal final evaluation where the resident is expected to review their activity tracking
document with the preceptor, and explain how each completed activity relates to the key concepts of a sterile
products admixture program.
Final evaluations:
 Resident’s self-evaluation
 Resident’s evaluation of the preceptor
 Resident’s evaluation of the rotation
 Preceptor’s evaluation of the resident
 Preceptor’s self-evaluation
Last revised August 12, 2015