Ensuring Quality: A Guide to Choosing Your Compounding Pharmacy

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Not all pharmacies are created equal. The choice of a compounding pharmacy can profoundly impact patient health and practice liability. This was starkly illustrated by the NECC pharmacy meningitis outbreak. Physicians must conduct due diligence when selecting a compounding pharmacy, particularly for complex medications like sterile injectables.

Understanding Quality Assurance

Physicians should familiarize themselves with the day-to-day operations of their chosen compounding pharmacy, paying particular attention to its quality assurance program. Key areas to inquire about include facility design, air filtration, temperature control, humidity levels, and overall air quality. Competent and well-trained compounding staff are essential for ensuring the highest quality medications, especially for intricate treatments like intrathecal infusions.

Environmental Monitoring

A reputable compounding pharmacy will have robust environmental monitoring practices in place, particularly in their clean rooms. This involves regular assessment for microbial and nonviable particulate contamination to maintain optimal compounding conditions. Physicians should inquire about the pharmacy's environmental monitoring program to ensure adherence to stringent quality standards.

Equipment and Procedures

Ensure that the compounding pharmacy possesses the necessary equipment and follows comprehensive policies and procedures for safely and accurately preparing intrathecal medications. Specialized equipment is required for compounding sterile injectables, and meticulous attention to detail is essential to maintain sterility and accuracy in preparation.

Key Questions to Ask

While on-site inspections are ideal, they may not always be feasible. Physicians should ask open-ended questions during the vetting process to gain a deeper understanding of the compounding pharmacy's operations. Questions should cover topics such as quality control measures, staff training, and frequency of quality checks. It's essential to ascertain not just if the pharmacy is taking necessary steps but how often they are implemented.


The tragic NECC pharmacy meningitis outbreak served as a sobering reminder of the critical importance of selecting a reputable compounding pharmacy. Physicians must go beyond industry minimum standards and perform thorough due diligence to safeguard patient health and practice integrity. By understanding quality assurance protocols, environmental monitoring practices, and asking the right questions, physicians can confidently partner with compounding pharmacies to provide safe and effective treatments for their patients.