The pharmacy at Grande Ronde Hospital is located behind an unmarked door. The room is windowless, with only a computer giving a live feed of the world outside for staff to look at. Though medications are dispensed from this department, don’t think of it like your typical neighborhood pharmacy. Think of a commercial kitchen, instead.

”We have medications all over this hospital,” said Hope Murphy, GRH Pharmacy Manager. “We help every patient.”

Every floor, every department and every patient at the hospital will likely need medication. And the sheer amount of ailments and procedures that occur at the hospital at any given moment is vast. Some medication has a shelf life of a few weeks, while others can be just a few hours. Some are formulated on site.

”Some (medications) take a long while to dissolve,” Murphy said. The pharmacy staff will compound the medication knowing the patient has an appointment at a specific time. Life happens; weather can stop a patient, as well as many other issues that can arise. Much like a restaurant preparing a special dish, the medication is made to order for the patient.

”When you’re talking about a medication that costs thousands of dollars, we don’t mix them until the patient is here and has met the criteria for safe administration,” Murphy said.

Some medications, for example, require specific blood markers to be given safely, she further explained, which have to be measured before we can mix and administer.

Kyle Troutman, PharmD., Clinical Staff Pharmacist, said the pharmacy department has an anteroom and an International Standards Organization (ISO) 7 cleanroom where they mix the medication. The ISO number refers to the particle count in the room. He explained the smaller the ISO number, the cleaner the room. When working with medications for patients going through chemotherapy, cleanliness is imperative.

Troutman explained most medications are compounded inside the high tech “hood” to ensure minimal bacterial growth. This high tech “hood” is comparable to a kitchen range hood, but on steroids. With an ISO 5, it’s the cleanest space in the hospital and heavily regulated – as is the cleanroom.

“Even the temperature has to be a certain range,” Murphy said of the cleanroom. “It’s all very precise.”

For comparison, the pharmacy department, outside the cleanroom, has an ISO 9. That’s pretty typical of a regular room where people congregate.

Murphy, who completed her schooling in 2003, has seen the evolution of Personal Protective Equipment (PPE), and what’s required to administer medication to a patient at a hospital. Now, they’re required to have the anteroom, which is the buffer zone between the department’s room, and the cleanroom. You’re required to wear certain PPE. You’re required to have a sink only used for entering the cleanroom. The air pressure and the ISO are very precise and monitored regularly to ensure compliance and safety.

”Regulations have gotten so strict,” said Troutman.

And it’s all for the patients’ benefit.

With Troutman, he is required to know the medications and the side effects for people of all ages. 

“A child’s body is different than an elderly person,” Murphy said. It’s not a tongue-in-cheek jab either. GRH sees the full spectrum of patients and Troutman has to be on the top of his game when studying a patient, their medication and medical history and administering the life-saving drug.

Troutman gives some credit to the utilization of technology, though. Technology has continued to advance in his department with patient safety being at the forefront of its focus.

“Everything has to fit together seamlessly,” Murphy said. “We look at every drug that goes into every patient.”

The pharmacy department knows one wrong move can greatly impact a patient. They want to make sure the right medication is administered in a timely manner. Patient safety and care are the priorities.

“We (mix the medication) as quickly as we safely can,” Troutman said.

There are 11 people working in the department and Murphy makes sure they are all able to mix medication safely. But preparing the medication takes as long as it takes. They know every minute counts for the patient, as it does for the drugs, too.

The staff are always recorded when inside the cleanroom to show the specifics of what they’re mixing, and the amount, to the camera. This then is checked by a pharmacist who is monitoring them through the system.

”Our goal is to make the patient well,” Murphy said.

That goes for all GRH patients from the maternity ward to the oncology department.