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RMH Pharmacy Expansion RMH-08-110 RFP Project Manual September, 2009 1.0 Background Ridge Meadows Hospital (RMH) Pharmacy department provides pharmacy services for residential care and acute care including both inpatient and outpatient populations. The department has been developed in various phases dating back to 1956. Minor renovations have been completed over the past 10 years but no major capital construction has occurred since the early 1990's. The department was last renovated during the introduction of the Unit Dose System in 1996. Since then, the consolidation of the satellite pharmacy into one pharmacy occurred with a net loss of 9.29 m2 in space. The current area on the second floor of the acute tower is 123.3 m2 and it is below the standard of 0.46 m2 per bed for a 285 bed hospital. Apart from being undersized, the pharmacy is located in a clinical zone and the space would be better utilized for patient or acute programs. It is proposed that the pharmacy relocate to the basement of the acute tower at RMH to a 246m2 area and renovate the space to suit their needs. This space is in the central core of the hospital and it will be a beneficial location for serving residential, acute care and also for receiving deliveries. The space is intended to be as ‘flexible’ as possible, with minimal solid walls. Utilization of wall systems and casework systems are seen as essential to the design. Managing Consultants are expected to work with Herman Miller or approved equivalent systems in the design process and coordinate their design with the furniture or wall system. 2.0 Space Moves As part of the expansion to the basement of the acute tower at RMH, there are a number of departments that need to be relocated by March or April of 2010. These space moves are being handled internally by FHA staff, and are not to be a part of the Managing Consultants scope of services. 3.0 Pharmacy Functional Programming The functional program and high level fit test have been completed for this project, indicating the operational and space needs for the pharmacy. In conjunction with the functional program, a high-level block form fit test was completed for the space that would allow the volunteer lounge to remain in its current location, but 2 offices external to the main core are identified for pharmacy use as a result. Refer to the appendices for the fit test example. A ventilation specialist was brought in to determine some of the limitations or opportunities for the BSC and fume hood in the new pharmacy space. Preliminary options for the relocation of the BSC and fume hood are identified. The final location of these components will be determined on the cost and functionality after the architect and mechanical consultants are chosen and have completed further review. The functional program, space list, ventilation letter and the fit test plan are attached as appendices to this report. 4.0 Project Timeline The key milestones for the pharmacy project include: • • • • • September 24, 2009 – Receive RFP for Managing Consultant Services. October 2009 – Start Preliminary Design March 2010 – Complete construction drawings/ project tender. April 2010 – Begin construction. February 2010 – Construction completion. Appendices to Project Manual i. ii. iii. iv. Pharmacy functional brief Pharmacy space list Pharmacy fit test Ventilation specialist letter Agency Name: Ridge Meadows Hospital Functional Program Brief, Pharmacy Services Prepared by: Department of Facility Planning & Real Estate Valerie Spurrell , Executive Director, RMH Jason Gore, Pharmacy Manager, RMH Mits Miyata, Director Pharmacy Date: June , 2009 Project Name Project Number Pharmacy Expansion RMH 08-110 Final Draft Name Date returned Final Draft FUNCTIONAL PROGRAM Functional Description Overview Ridge Meadows Hospital (RMH) Pharmacy department provides pharmacy services for residential care and acute care including both inpatient and outpatient populations. The department has been developed in various phases dating back to 1956. Minor renovations have been completed over the past 10 years but no major capital construction has occurred since the early 1990's. The department was last renovated during the introduction of the Unit Dose System in 1996. Since then, the consolidation of the satellite pharmacy into one pharmacy occurred with a net loss of 9.29 m2 in space. The current area is 123.3 m2 and is below the standard of 0.46 m2 per bed for a 285 bed hospital. Context and Assumptions Ridge Meadows Hospital has undergone an expansion of the Emergency Department and Ambulatory Care department (2008). The additional programs and services are placing increased demands on pharmacy services which are already undersized by 50% based on current standards. In addition, Fraser North planning has identified the long term need for additional beds and services in the north, including Ridge Meadows Hospital into the future. The actual number is not known at this time. Both internal and external factors contribute to the space issues. Internal factors include the addition of staff, to expanded programs, from 4 FTE in the 1980s to the current 12 FTE within the same allotted workspace. Changes in practice, including use of the unit dose system and the Central Intravenous Admixture Programs, are placing additional demands on space to house the equipment ,supplies and personnel, necessary for this distribution system. External factors include changes in clinical practice models and the involvement of pharmacists in therapeutic medication monitoring, patient care rounds, and provision of drug information to patients and care providers, Changes in the patient populations, such as an increase in severity of illness , increases the demands upon the drug delivery system and an increasing number of medications are ordered for immediate administration. Hospitals with outpatient programs require an area for confidential counseling and monitoring in close adjacency to the pharmacy. Because of ongoing expansion of the clinical programs involving pharmacy mandates (DVT outpatient program, oncology patient care, Home IV, patient counseling) a solution to the space deficiency is needed in order to meet the service demands for patient care at Ridge Meadows Hospital 1 Program Goals To improve pharmacy services workspace by relocating to a larger footprint and redesigning the internal processes to efficiently increase the ability to safely store, prepare and dispense medications, improve workflow processes and to support the area to move toward a different clinical service model. (Point of Use). Objectives: • To enlarge the footprint of the current department by relocating it to the lower level • Improve the generic space allocation for the functions within the pharmacy service • Improve workflow processes through redesign of the discreet functions within the pharmacy including o Inventory storage both non refrigerated and refrigerated o Narcotics management o IV Formation o Manufacturing and prepackaging area o Inpatient dispensing o Drug information and patient teaching services o Preparation of space to provide a change to point of use dispensing (ADC) Operating Description Organization and Management: Pharmacy services will operate under the leadership of the Site Manager. Pharmacy Services reports to the Director of Pharmacy Services, Acute Care. Hours of Operation: Pharmacy will operate from 0730 hours to 2000 hours Monday to Friday. Clinical services are available 7.5 hours Monday to Friday. Weekend hours are Saturday and Sunday 08:30 until 16:30. (Includes Stats) Implementation of the ADCs will result in the Night cupboard becoming redundant in the future during afterhours. Workflow Purchasing & Inventory Control Purchasing of pharmaceuticals will be coordinated by the PDDC in Langley. RMH staff will establish minimum and maximum par levels for inventory replenishment. All inventory orders will be recorded in the computer system and communicated electronically to the PDDC. A 2 hand held bar coding system will be implemented to scan and download stock levels at a future date. Eventually, a bar code system will be implemented Inventory shipments will be received in the Pharmacy by the technician staff, verified, and stocked in the appropriate storage area. Inventory shipments from PDDC will be received in pharmacy by the technician staff, verified and stocked in the appropriate storage area. Manufacturing & Packaging Current State: Unit dose system is the current method utilized and will transition easily to the ADC/POU methodology. Future State: Most items will be purchased in a manufactured form. Manufacturing of ointments, creams and other topical applications will be prepared in the Pharmacy (if not available commercially) on an as-needed basis. All oral doses will be prepackaged off-site at the PDDC and stored in the RMH Pharmacy. A two-week inventory of pre-packaged items will be held on-site. Medication Order Processing & Administration Current state is paper based and includes the following flow MD writes order -> order faxed to pharmacy-> order inputted by technician-> order checked by pharmacy against patient profile-> medication packaged for patient with label -> transported to unit. Future state The new point-of-use (POU) medication management system combines bar-coding and wireless technologies to link physicians, nurses and the pharmacy at the point of care (i.e., at the bedside). Through the use of hand-held mini-computers, computer networks and computerized medication dispensing units, patients will be administered medication including narcotics through the POU system. Once the new POU system is introduced, the workflow for the order processing and administration functions are anticipated as listed below. Ordering: Patients will receive a bar-coded identification bracelet, which stores information such as their condition, diagnosis, attending physician, client's weight, and height and body surface area. At the bedside or through secure log-in, patient care staff enters the medication order into the POU system, which monitors for drug interactions, allergies, duplicate therapy and dosage. The information system alerts the patient care staff member if the selected drug is not a formulary drug and offers formulary suggestions. Verification: The order is instantly transmitted to the pharmacy terminals (centralized and decentralized) for verification. STAT orders are queued to the top of the list of drugs ready for verification. It is anticipated that a significant percentage of orders will be immediately verified. Once verified the POU system will advise the pharmacist if the items is available in the ADC. Items not stored in the 3 ADC will be dispensed in the pharmacy and delivered to the patient care unit by the pharmacy porter, pneumatic tube, or by other means. The POU system will instantly update the patient's record and the nurse's hand-held unit. Administration: Using the hand-held unit and scanning the bar code on the client's ID bracelet, the nurse confirms the client, medication, dosage and time of drug administration. Once receiving a request from the nurse, the ADC opens the correct drawer and directs the nurse to the bin containing the correct medication. The nurse then scans the bar-coded medication to confirm the information. The nurse scans the client's bracelet and his/her tag for added security, ensuring once again that the right client is receiving the proper medication. The medication is administered and documented on the on-line Medication Administration Record (MAR). Intravenous (IV) medication Orders will also be entered into the POU system. Labels will be generated in the anteroom outside the sterile admixture room in the Pharmacy. Intravenous medications (first dose) will be prepared by Pharmacy in the IV room. Prepared product will be delivered by the Pharmacy staff on a scheduled basis. Prepared product will be stored in the medication room on each Patient Care Unit in refrigerated and non-refrigerated storage areas. ADC Replenishment All of the medications, stocked on the Units, will be stored in cassettes in the ADCs. Medications will be filled with fill lists generated through the POU Information System and distributed to the Units using totes and a master replenishment cart. The technicians will fill all medications, placing them into the totes with a record of dispensing, using bar coding technology. These are then brought to the floors and replenished on a scheduled basis by Pharmacy technician staff. In the longer term replenishment of ADCs may be done directly by the PDDC which will eliminate the requirement for inventory in the Pharmacy. However, as the timing is unknown, for planning purposes, inventory stock will be housed in the RMH Pharmacy. Supplies Office and other supplies will be requisitioned from Materiel Management and distributed by Materiel Management staff to the user area daily or as required, Monday through Friday Cleaning & Waste Removal Housekeeping staff will continue to provide general cleaning services on a regular basis. Housekeeping will also collect waste material from the user area and deliver it to the point of removal from the Hospital for either land fill or for recycling. Soiled linen and waste will be bagged and coded as necessary for removal, treatment, storage, and disposal. Enabling Technologies Information Systems The pharmacy information system will be connected to the hospital-wide information network for order entry, review and record keeping. Applications available will include: MAR, order entry, 4 ADT/CPI, formulary management, purchasing and administrative/managerial applications, and other clinical applications The Information System needs to be ubiquitously available throughout all patient care areas, potentially through handheld devices. It is anticipated that the system will accommodate order entry and order review to occur in all patient care areas. Eventually, the system will be integrated with the electronic health record. Handheld devices will also be used for processing orders, accessing the electronic medical record and reviewing drug information literature from downloaded or external sources. Handheld devices will also be used for processing orders, accessing the electronic medical record and reviewing drug information literature from downloaded or external sources. A wireless infrastructure will be available to support bedside charting and the use of handheld devices. Workload Table 1.0 Workload volumes by year and category 2007/08 2008/09 % growth from 06/07 Proj 2020 % growth to 2020 New RX Inpatient 57422 66350 15.5% 89280 34.5 Outpatient 573 499 -12.9% 650 23% Chemo compound N/A N/A N/A N/A N/A Chemo intravenous 1547 1551 -.02% 1700 10% Chemo oral 641 629 0.2% 700 1% Iv compounded 244 307 20.5% 630 51% Iv large volume 165 162 0 7374 7940 7.1% 13600 71% 6 8 33% 250 389 35.7% 1390 72% 45390 51876 12.5% 64860 20.% N/A N/A NC 331060 (-9%) Iv Sm vol Other IV TPN Ward stock LOA 1 Refills 291424 327804 11% Total units 1 457151 39% 405036 Data source: Pharmacy Services at Ridge Meadows 5 Staffing & General Support Table: 2.0 Calculation of FTE’s per Bed /Service Service Bed numbers 09/10 Pharmacist Technicians Total Rx/Tech Mental Health/Psych 20 0.05 0.06 1.0/1.2 Critical Care 7 0.13 0.09 0.91/0.63 ER 11 0.08 0.09 0.88/0.99 General Medicine 51 0.04 0.08 2.04/4.08 General Surgery 22 0.04 0.08 0.88/1.76 Residential Care 148 0.01 0.02 1.48/2.96 Sub-acute Care 25 0.06 0.08 1.5/2.0 Hospice 10 0.03 0.06 0.3/0.6 total 8.99/14.22 2.1 Department personnel by FTE and category Position Typical daily staffing DAYS EVES Nights Manager 1.0 N/A N/A Admin support N/A N/A N/A Position DAYS EVES NIGHTS Pharmacists 3.0 1.0 N/A Technicians 7.0 1.0 N/A Dispensary 2.0 1.0 N/A Unit based clinical 2.0 N/A N/A Total count 15 3 0 6 Design Criteria External relationships: Pharmacy should be housed in a secure area with reasonable access to the vertical circulation of the building for transportation of medications, as well as staff access to the patient care units. Internal Relationships Concepts: Pharmacy should be subdivided into the following zones: o Receiving and breakout inventory storage this area should be separated and secured from the production zone. o Sterile IV formations, o Manufacturing and prepackaging area and unit of use dispensing replenishment, which includes order entry, verification and product checking. The planning and design of these areas is contingent on the equipment selected for storage and production. Areas allocated in the space table included in this document reflect general areas included in the production pharmacy. Specific planning will be required to address integration of information systems, modular storage and inventory units, narcotic storage and security, distribution carts with the flow of staff and production with in the pharmacy. Space and Equipment Requirements In support of the Region’s role and service goals, the RMH Pharmacy will introduce changes to its methods of operation. These initiatives which are the basis of the Region’s automation plan for Pharmacy Services will include: • Implementation of a new point-of-use (POU) drug distribution system. This will include automated drug dispensing cabinets (ADC) on patient care units for the majority of doses including first doses in addition to ward stock and narcotic inventories. Of note, some bulk and refrigerated items will not be stored in the ADC unit • Packaging of all adult oral doses with few exceptions (e.g., special access medications) at the Central Production Centre in Langley (referred to as PDDC). • Preparation of patient specific IV admixture refill doses and batch doses at the PDDC with the exception of TPN, chemotherapy and narcotic infusions requiring mixing, which will all be done on-site. All first doses up to 36 hours will be prepared on-site. • Centralized purchasing will be done at PDDC. Inventory control will be done by the RMH Pharmacy on-site. Incoming supplies will be inspected scanned and reconciled with orders in receiving. 7 Items will be removed from shipping containers and the corrugated cardboard containers removed for recycling. This area should be separated and secured from the production zone. Inventory storage is a secured room containing two weeks of inventory on-hand, replenished daily. Requirements for storage of narcotics and controlled drugs should meet the provincial/federal requirements. IV formation Areas IV formation will be conducted in a biological safety and laminar flow cabinets. Cabinet dimensions should determine room sizes. The operation of these units is influenced by internal air circulation into and within the room. This sterile room will be contiguous to a changing area and an ante room. The ante room will be connected with the IV formation room via a pass through window. A pass through refrigerator will connect the inventory storage area and the ante room. Entry Two entrances will be required, depending on layout and footprint. The main entrance will serve as public reception to the Department; this area should also contain a small area with 2 cubicles for patient information and dispensing of outpatient medications. A second entrance will serve as a receiving entrance from outside vendors and PDDC and serve as the exit for medication delivery to the ADC units. The administrative /clinical space which includes the drug information area should be accessible from the entrance w/o penetrating the dispensing and manufacturing room. Special Considerations An open floor design is best suited for most areas of the Department. In general most fixtures should be of modular design thus enabling easy movement and reconfiguration as the pharmacy design changes. The physical configuration and planning of the Pharmacy will support efficient production, and meet industry requirements for quality control in all drug production areas. All production areas are subject to protocols for asepsis and sterile production. The IV formation area should be walled off from the rest of the Pharmacy and its storage areas with an anteroom located at the entry. The chemotherapy hood must be vented to the outside. The IV formation area including the IV admixture room, anteroom and change room shall comply with USP<797> standards for design, including specific HEPA filter and HVAC requirements. Pharmacy design shall conform to the regulations of the professional and government authorities having jurisdiction. Confer with Canadian Society of Hospital Pharmacists, Health Canada guidelines and the BC Pharmaceutical Association. Security Access to all pharmacy areas will be subject to strict security control. 8 Codes & Standards In addition to the above criteria, the facility must conform to recognized national, provincial, and local building codes and standards as they may relate to safety and accessibility for patients, staff, and visitors. Production/Storage Area Storage shelving and refrigerated storage will be provided for bulk inventory and PDDC pre-packaged medications. Approximately 10 days of inventory (600 linear feet) will be maintained on six 9’ double-sided mobile shelving units, 6’ in height. Space for 2 hematology refrigerators will be provided to store inventory. A workstation to assemble ward stock medications will also be provided. Manufacturing/Compounding An area having a counter of no less than 6' plus a sink, will be provided for compounding and limited manufacturing. Equipment will include a packaging & product labeling machine. Above and below the counter will be a system of flexible shelving for storage of supplies. Drug Dispensing and Order-Entry Area There will be 4 (four) workstations, each equipped with computer terminals provided for order-entry and verification functions. The workstations will be utilized by Pharmacists and Technicians. Space will also be provided for 2 printers/scanners. An area for future installation of a pneumatic tube station will be required. This Order entry area should be acoustically protected as a quiet area were staff can maintain concentration on order processing. One large picking station will be required for assembly and replenishment of ADC medications. The station is best designed as a “horse-shoe”, using gravity flow shelving, which minimizes walking and enables quick retrieval. The medications will be stored in alphabetical sequence. Space will be provided nearby for storing totes and distribution carts. Controlled Substance Storage Conveniently placed within the footprint will be a narcotics vault with a work counter for assembling and preparing narcotic medications. IV Formation Based on current USP<797> guidelines, the IV formation area will consist of two separate spaces; an anteroom and IV admixture room. The anteroom will accommodate two order assembly stations equipped with a computer terminal, storage shelving units on casters, a hand wash sink, a double-door pass-thru refrigerator and 2 (two) IV carts. The IV admixture room will be a sterile room that will accommodate one - 6’ clean filed cabinets (laminar flow hoods), a work counter and holding space for a daily supply storage cart. All admixture jobs will be setup outside in the anteroom and transferred through an airlock/pass-thru. This room will be positive pressure 9 Chemotherapy preparations A separate room will be provided for preparation of antineoplastic medications prescribed for all oncology patients of the Hospital. The chemotherapy preparation room (clean room) and anteroom shall comply with USP <797> standards for design including specific HEPA and HVAC requirements. The chemotherapy preparation room will accommodate a biological safety cabinet and shall allow for 100% total exhaust of the safety cabinet, using separate ducting and fan returns for each cabinet. Low wall mounted returns are to be ducted to the outside wall. This room will be negative pressure. Access to the chemotherapy preparation room shall only be through the anteroom. Access from the anteroom into the chemotherapy preparation room shall be by a handsfree door made of glass and aluminum appropriate to clean room design. The change area will be shared between the IV admixture room and the chemotherapy preparation room. This area is used to gown and scrub prior to entering the prep areas. The change area will then have access to either of the ante rooms and then into the preparation areas. Administrative Office/Drug Information/ Wicket Offices/workstations will be provided for the following positions: o Site Manager All other work space will be as per Fraser Health Integrated workspaces for integrated workplaces. An area with 4 cubicles with computer stations with internet access to on-line drug information will reside in the pharmacist work area. An adjacent education space will be shared for staff meetings, conferencing etc for up to 8-10 people on a pre booking basis. Patient information area will have up to 3 cubicles to provide privacy during counseling.. This area should also be utilized as the internal storage for transport carts, until they can be taken into the main pharmacy area. A glass wicket is required in this area to allow for pass through of medication to staff and for outpatient pick up. Staff Area An n area will be provided for storing coats and belongings. Cube lockers, 20 in total will be provided for secured storage. 10 11 RMH Pharmacy Space list RMH Pharmacy Space Needs Production /Storage area Unit area units net area Notes decasing area standin ht island or counter and waste holder 1 Receiving breakdown area - decanting area -inventory control desk - waste holding 5.7 3.7 2 0 1 5.7 2 Bulk Storage -non refrigerate - refridg storage 0.71m3 -freezer storage 0.71m2 8.2 0 5.6 2.6 1 8.2 3 Active storage14days inventory - storage mobile shelves 2,3 -- mobile carts 11.9 11 0.9 1 11.9 4 Controlled Substance storage -narcotic vault 7.7 4 1 7.7 -workstation 3.7 5 Manufacturing and compounding -work counter -sink station -supplies storage - packaging/product labeling station -packaging cadette 11.6 4.6 1.9 4.6 2.8 1 11.6 work counter,sink,supplies storage,pkging labelling,station 6 Emergency eye station 1.4 1 1.4 wall mounted eye wash Unit area units 46.5 net area Notes lab pharmaceutical grade fridge lab pharmaceutical grade fridge 1 narcotic cart, 1 lab/pharm grade fridge wall mounted flat screen and key board with seat subtotal Dispensing/ADC Replenishment Area 3 shelving units /double sided, work station power/data 1 mobile cart 7 Order entry review stations -order processing workstations -printers 20.2 18.4 1.8 8 ADC Replenishment Picking stations 9.3 1 9.3 U shaped shelving with gravity flow standin ht counters label printer 9 Cart totes holding area 13.9 1 13.9 distribuion cart 10 housekeeping closet 0 1 0 delete and use existing 11 Pneumatic tube station 1.9 1 1.9 Unit area units net area Notes Ante-room (ISO 8) -order assembly and verification -sink station -pass through refrig 1.6m3 -supplies storage -transfer cart -clothes storage and gowning 19 3.7 1.9 2.8 4.6 1.4 4.6 1 19 eye wash sink station, power,data sink shelving IV admixture room(ISO 7) 14 1 IV FORMATION STATION 12 13 -clean field cabinet-large(ISO 5) -daily storage holding -work counter/supplies storage -pass through refrigerator 1.6m3 Fraser Health Authority Confidential 5.6 1.9 3.7 2.8 05/08/2009 1 20.2 power,data quiet area 4 stations 2 hi capacity printers and fax Shared space with the chemo area. 14 power 1 class IIA laminar flow hood, cart holding,workcounter/supplies storage label printer,positive pressure Page 1 RMH Pharmacy Space list Chemotherapy Formation Area Unit area units net area Notes order assembly eyewash sink,refrig, pass thru from bulk storage/iv cart holding 14 Ante room (ISO7) -order assembly and verification -medication storage -pass thru refrigerator 0.8m3 -eye wash station -scrub sink 10.8 10.8 3.7 1.9 1.9 1.4 1.9 1 10.8 15 Chemotherapy Sterile Room (ISO7) -class ii biosafety cabinet(ISO5) -pass thru refrig 0.8m3 -daily storage cart 8.9 8.9 5.6 1.9 1.4 1 8.9 Incl class IIB biosafety cabinets, room to be neg pressure work counter/supplies storage printer Unit area units net area Notes Administration Area 16 17 Admin support (recep) -workstation -file/record storage -wicket Area office equipment -copy/fax -work counter 18 office manager 19 Alcove pyxis controller 20 Resource area this area to be incorporated into #21 21 Pharmacists Work area( central staff) -cubicles storage Pateint counselleing cubilcles/delivery cart storage.2,3 counselling cubicles. Wicket for drug pick up staff and patients inside the admin pharmacy area/cart storage area combine with office equipment area 7 4.6 1.9 1.5 6.5 3.7 2.8 1 7 1 6.5 8 1 8 phone data 0.5 1 0.5 data drops,power 0 1 0 window with ledge power data phone Utilize education conf room adjac 22 1 22 5*3.3 4.6 dual screen pc, data power,phone STAFF AREA Unit area units net area Notes purse lockers 22 staff room -cube lockers -coat rack 11 4 7 1 11 23 Staff washroom 2.8 1 2.8 TOTAL NSM Gross factor 1.20 TOTAL GROSS 202.3 242.76 all spoace to be verified by the architect. Fraser Health Authority Confidential 05/08/2009 Page 2 .. .. .. .. . 4021 West 31 Avenue Vancouver, BC, V6S 1Y7 Phone 604- 822-9707 Fax: 822-9588 email: [email protected] Ed Chessor & Associates Angela Bennett (Toop) Capital Project Planner Fraser Health Facilities Planning & Real Estate #300, 10233 - 153rd St., Surrey, BC V3R 0Z7 Dear Angela, Subject: Ridge Meadows Hospital Pharmacy I enjoyed meeting you yesterday and our tour of the present pharmacy, the lab on the first floor and the basement area around the proposed new pharmacy. This will summarize my observations: The existing pharmacy seems crowded with equipment and materials, leaving minimal room to move. The room in which the IV bags are filled and antineoplastic drugs are prepared has a Class 2 Type B2 hood for the antineoplastics and a biological safety cabinet for the IV bags. These are side by side, and I will feel better about patient safety when they are relocated into separate rooms. Photo 1 – Antineoplastics hood on left, IV Preparation hood on right ............................ August 9, 2009 Page 2 of 2 Ridge Meadows Pharmacy Relocation The room also contains a refrigerator and several shelf units for drugs and related materials in it’s 200 square feet of floor space. Like the rest of the lab, it is crowded. The new facility should have the refrigerator for antineoplastics storage and storage for equipment that may be contaminated with antineoplastics in the same room as the hood used for preparing the antineoplastics. The room should be dedicated to antineoplastics and kept under a slight negative pressure relative to adjacent spaces. The existing hoods appear to be current technology and in good condition. They appear suitable for relocation. Hoods used for preparation of antineoplastic drugs require their own exhaust duct and stack. I am not aware of any alternative to this. We looked at the possibility of running a duct down the corridor from the new pharmacy and out the wall near the loading dock. Unfortunately there is a beam in the ceiling near the pharmacy that would need to be cored for this new duct. We discussed the possibility of taking a duct straight up through the first floor, through the roof, on up the wall to a new fan on the second floor roof. This would be a much better option than going through the beam and down the corridor, as the duct would be shorter by at least 80 feet and a few elbows might be eliminated. We looked at a fume hood in the lab to evaluate the possibility of connecting the antineoplastics hood to the duct that serves the lab hood. The hood in the lab is narrower, and we only saw one so it is likely that the exhaust duct is smaller than the one for the antineoplastics hood. Unless the duct is at least 16 inches in diameter it would not be practical to move enough air through this duct to operate both hoods at once. If it is smaller than the existing duct for the antineoplastics hood (12 or 14 inch diameter), it might not be adequate for that hood alone. The best location for a stack is near the middle of the highest part of a building roof. We looked at two portions of the storage room near the loading dock as potential locations for antineoplastics preparation. Both seemed too small to me, and although it would be easy to get ducts to the outside wall of the building from them, taking the duct from there to the fan on the roof would still be a challenge. Please call if you have questions about this letter. Ed Chessor, P.Eng., MBA, CIH Industrial Ventilation Engineer Phone 604 822-9707; Cell 604 813-9707 Ed Chessor, MBA, CIH, P.Eng.