27 Chapter 27: Emergency Response for Compound Related Incidents

Pharmacies must have a clearly defined and practiced emergency response plan for incidents involving hazardous and non-hazardous compounding materials. These plans are essential for protecting staff, the public, and the environment, and they must be tailored to the risk level of the compounding activities performed.

1. Types of Incidents

Emergency response planning should address the following types of compounding-related incidents:

2. Emergency Preparedness

A per NAPRA section 11.1 and 11.2, pharmacies must:

• Maintain written emergency procedures and SOPs for compounding-related incidents.
• Ensure all staff are trained and regularly retrained in emergency procedures.
• Provide accessible emergency equipment, including:
  • Spill kits (hazardous and non-hazardous)
  • Eye wash stations
  • Safety showers
  • Fire extinguishers
  • First aid kits
  • Personal protective equipment (PPE)

Emergency procedures must be part of initial training and reviewed annually.

3. Spill Management Protocols

For Hazardous Spills (e.g., cytotoxic drugs):

1. Isolate the area to prevent further exposure.
2. Don appropriate PPE:
   • Double chemotherapy gloves
   • Disposable gown
   • Eye and respiratory protection
   • Sleeve and shoe covers
3. Contain and clean the spill using a hazardous drug spill kit.
4. Dispose of waste in accordance with hazardous waste regulations.
5. Decontaminate the area following the deactivation–decontamination–cleaning protocol.
6. Report and document the incident, including corrective actions taken.

NAPRA references ASTM D6978-compliant gloves and outlines specific PPE and procedures for spills in Section 9.2.3.

For Non-Hazardous Spills:

• Follow pharmacy SOPs for minor spills.
• Use gloves and gown.
• Clean with appropriate cleaning agents.
• Dispose of waste according to product and facility policy.

4. Exposure Response

• Skin or eye contact: Use eye wash or safety shower for at least 15 minutes.
• Inhalation: Remove person to fresh air and seek medical attention.
• Ingestion: Follow SDS instructions and seek medical advice immediately.

Document all exposures, regardless of severity, and report to occupational health services.

5. Fire and Flammable Chemical Response

• Ensure MSDS/SDS and WHMIS symbols are available for flammable ingredients.
• Use Class B fire extinguishers for solvent fires.
• Evacuate and alert emergency services if fire cannot be contained safely.
• Follow facility fire evacuation procedures.

6. Post-Incident Protocols

• Incident report forms must be completed immediately following an event.
• Conduct a root cause analysis (RCA) for significant or repeated incidents.
• Update SOPs and training based on incident outcomes.
• Evaluate employee health status and follow-up care where exposure occurred.

Here is an example of an Incident/ Accident Reporting Form used in Saskatchewan:

SCPP Incident/Accident Reporting Form

7. Alignment with Provincial Requirements

Each province may have additional regulations or workplace health and safety requirements (e.g., Ontario’s Occupational Health and Safety Act, Alberta’s OHS Code). Pharmacies must:

• Stay updated on local and provincial legislation.
• Integrate provincial emergency preparedness guidelines into SOPs.
• Collaborate with local waste disposal and emergency services.

Emergency Response Readiness Checklist: