28 Emergency Response for Compound Related Incidents

Unexpected incidents during compounding—such as spills, exposures, or equipment failures—pose serious risks to personnel, patients, and the environment. Pharmacies must have a well-defined, rehearsed emergency response plan that aligns with the type and level of risk involved in their compounding activities. These plans are not only regulatory requirements but essential safety practices that promote accountability, staff readiness, and public protection. A strong emergency response framework includes anticipating potential incidents, equipping staff with the right tools and knowledge, and embedding response procedures into the culture of the pharmacy.

1. Types of Incidents 

Understanding the types of emergencies that may arise during compounding activities is essential to developing a responsive and effective plan. Each incident type carries its own risks and requires targeted procedures to manage appropriately.

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

2. Emergency Preparedness

Effective preparedness begins with well-defined procedures, staff training, and the availability of emergency response equipment. Pharmacies must build a culture of safety by embedding these procedures into daily operations and routine training.

As per NAPRA regulations, pharmacies must:

• Maintain written emergency procedures and SOPs for compounding-related incidents.
• Ensure all staff are trained and regularly retrained in emergency procedures.
  • must include WHMIS training, especially for chemical hazard
• 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)
• Ensure safety data sheets are readily accessible in compounding areas or digitally for quick reference in an incident.
• Emergency procedures must be part of initial training and reviewed annually.

3. Spill Management Protocols

Spills can happen suddenly and unexpectedly, and a timely, well-executed response is critical to minimizing harm. The appropriate protocols vary depending on the nature of the spilled substance.

For Hazardous Spills (e.g., cytotoxic drugs): Hazardous material spills pose significant health risks and must be handled with extreme caution and specialized PPE.

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: Though less dangerous, non-hazardous spills still require careful management to avoid cross-contamination and environmental harm.

• 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

Accidental exposure to compounds can have immediate and long-term health consequences. Rapid, appropriate action minimizes harm and supports staff safetySkin 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

Compounding sometimes involves the use of flammable solvents, making fire safety planning essential. Personnel must be trained to respond quickly and safely.

• 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

A comprehensive post-incident response is key to preventing future occurrences. It also helps in identifying gaps in training, infrastructure, or procedure

• 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.  This template is found on the Saskatchewan College of Pharmacy Professionals website:

SCPP Incident/Accident Reporting Form

7. Alignment with Provincial Requirements

In addition to national standards, each province and territory may have unique health and safety regulations that must be integrated into the pharmacy’s emergency plans. 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:

Emergency preparedness is a very important aspect of safe and compliant compounding practice. Whether responding to a minor spill or a major hazardous exposure, staff must act quickly, knowledgeably, and in accordance with established protocols. Clear SOPs, proper equipment, and documented training ensure that the pharmacy can mitigate risks and protect all stakeholders. Post-incident evaluations and continual updates to procedures help build a resilient and responsive safety system. By aligning with NAPRA standards and provincial requirements, pharmacies reinforce their commitment to high-quality compounding and the safety of both their teams and the communities they serve.