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Discussion
The majority of existing sterile compounding training typically focuses more on skill rather than knowledge.3 The
development of this training program focused on both skill
and knowledge because sterile compounding practices
require highly skilled and knowledgeable compounders; failure of compounding personnel to follow quality standards
and best practice recommendations introduces the greatest
risk of contamination.1-4 Inconsistencies in training are seen
across sterile compounding facilities, and this was evident
within a large, integrated health system. The development of
a standardized training program helped to streamline training, as well as provide guidance, tools, and continued focus
on advancing sterile compounding safety.
Training programs must ensure consistent, initial, and
ongoing instruction of sterile compounding personnel. There
is currently a lack of sufficient literature on the development
of sterile compounding training programs; therefore, further
guidance, support, and innovation are necessary to ensure
safe sterile compounding practices. Previous studies demonstrated that repeated testing improves retention and skills,29,30
which may help aid in aseptic technique training and retention. Begley and colleagues studied repeated testing of skillbased activities essential to professional practice in pharmacy
students. Student scores on sterile product verification
improved significantly over 3 assessments but then plateaued,
demonstrating the students' mastery of the skill.29 Larsen and
colleagues demonstrated that repeated testing with feedback
resulted in significantly greater long-term retention of medical education compared with repeated, spaced study.30
With increased scrutiny and focus on sterile compounding
training with the anticipated release of revised USP Chapter 797
and USP Chapter 800,1,5 this newly developed training program
meets all necessary and required components to properly train
and assess sterile compounding personnel. This training, most
importantly, places a renewed focus on patient safety. In addition, the emphasis on training was to assess knowledge and skill
repetitively with movement to the next training level dependent
on these assessments, rather than on time spent in training.
The preintervention and postintervention phases assess 3
key elements USP Chapter 797 requires for sterile compounding training programs: (1) didactic review with written examination, (2) media-fill assessment, and (3) competency-based
skill assessments (ie, aseptic technique).1 The 5 main topics of
the written exam were all reviewed in the didactic portion of
refresher training and are in line with topics within USP Chapter
797 and sterile compounding texts.1,26-28 The media-fill challenge test and aseptic technique observation were evaluated to
determine whether the hands-on training was valuable to sterile
compounding personnel. Because scores overall were low in
the preintervention phase and significantly improved during
the postintervention phase, topics and techniques covered in
refresher training were considered beneficial and, therefore,
incorporated into the new training program.

Hospital Pharmacy 54(4)
There are limitations to discuss in relation to this study. It
was challenging to monitor and track the status of each compounder throughout the training process due to the size of
AHC and the large volume of sterile compounding personnel across the system. This was further complicated by the
short completion time frame window for each step and
assessment to be accomplished. All site directors were consistently made aware of each phase of the intervention and
were given approximately 3 months to complete each (preintervention, refresher training, and postintervention).
Depending on priorities within each site, this may have
affected the total completion rate, which was noticeable during the postintervention time window.
Ideally, each media-fill challenge test would have had an
aseptic technique rubric completed in conjunction with it
and those results should have been submitted together for
each individual. There may have been a misunderstanding
across sites as to what exactly was required to be completed
and submitted for data collection. Looking at the overall
results of media-fill challenge tests, it was evident that
there were more failed media-fill challenge tests in the postintervention phase compared with the preintervention
phase. A few of the failed tests did not have observation
rubrics submitted with them to determine whether a breach
in aseptic technique or other factors contributed to the
failed result. Also, 2 of the media-fill test failures in the
postintervention phase did not have a matched pair in the
preintervention phase to compare.
Observation of aseptic technique with the validation
rubric was completed by various personnel across the system and within each site, although it was set up to done by
the site super-user previously trained. As this assessment
was evaluated by multiple users, this may have led to inconsistencies in how each individual was evaluated. However,
as the pre-aseptic and post-aseptic technique observation
results were so dramatically different, it is unlikely this
affected the validity of the results.

Conclusion
A standardized and consistent, system-wide sterile compounding training program was developed for all new and
existing AHC personnel incorporating a live, in-person training course; online; and hands-on training. This training program has demonstrated improvement in sterile compounding
knowledge and skills across the system.
Acknowledgments
The authors would like to acknowledge statisticians Stephanie
Bo-Subait and Sandra Korman for their contribution to this study.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
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