We had the opportunity to chat with one of the top industry experts in pharmacy compounding, Eric S. Kastango, and hear his recommendations to new pharmacists as well as his take on developments in the business of compounding pharmacy.
A practicing pharmacist since 1980, Eric received the National Association of Boards of Pharmacy (NABP) Henry Cade Memorial Award in 2014 in recognition of his assistance to the states and the NABP in addressing the meningitis compounding tragedy that occurred in 2012.
The following interview was edited for length and clarity.
After 35 years in the profession, what advice would you give someone just starting out in their pharmacy career?
ESK: Find your passion! Find what you love to do and what you’re good at; then try to be the best at it. And, always, always, do the right thing. That isn’t always easy. Pharmacists must have a moral compass and must recognize that they have a huge professional, ethical and moral responsibility to take care of patients and keep them safe. They must use their skills as pharmacists to the best of their ability to ensure that patients receive safe and effective therapies.
I’d also advise new pharmacists to seek out people who are much smarter than they are and try to hang out with them. They’ll learn through osmosis and opportunity. I’ve been very lucky to work with really smart people who were willing to mentor me and help me become a better pharmacist.
How did you become interested in compounding sterile products?
What are the biggest changes you’ve seen in the profession since graduating from pharmacy school?ESK: I had the wonderful opportunity while in pharmacy school to work run the IV room in the evenings at Brigham and Women’s Hospital, which was cutting edge at the time. I really got into it and realized I had a passion for compounding and operations. After graduation, I moved to New Jersey, which was about 20 years behind in the industry. After working at a hospital for a year, I got a job working for home infusion company that was doing high-risk compounding of parenteral nutrition solutions from non-sterile powders. We made thousands of liters of these solutions and I really loved what I was doing. Then, my goal as new graduate was to publish one article. Now, 85 articles later—I’ve realized that part of what I love is teaching: advocating a certain standard of practice and quality systems.
ESK: There’s been a huge push by the profession to encourage the clinical side of pharmacy. Pharmacists have a tremendous opportunity to contribute to clinical practice, prescribe drugs and provide care, particularly in rural areas. We need to remember, though, that the profession is truly defined by being able to compound, dispense and counsel patients, and if we give that up, we’ll cease to exist as a profession.
What are the major trends to watch in pharmacy today?
ESK: The catastrophic event that happened in Massachusetts in 2012 with New England Compounding has shaken things up. I think that state boards of pharmacy are smarter, better trained, and more skilled. They are now inspecting pharmacies for compliance. A manager told me early on that “people respect what others inspect.” We’re seeing that now as pharmacists realize that compliance is not optional; we have to do it and it’s a core element of the practice of pharmacy. Compliance and patient safety will continue to be under the microscope.
Do you have any general advice for other pharmacists?
ESK: My father used to say, “Sound it out. Look it up.” I worry that too few pharmacists want to understand the “why” behind the “what.” You have to take the initiative for your own learning. It goes beyond answering the question, to understand the basis of the question and the basis of the answer. Otherwise, you never learn or advance your knowledge. You become a one-trick pony. If you just “check the box,” you don’t really understand a lot of what we do on the operational and compounding side.
Eric S. Kastango, M.B.A., B.S.Pharm., FASHP, is president of Clinical IQ LLC, a health care consulting firm and CriticalPoint, LLC, a web-based education company.
Eric S. Kastango received his Bachelor of Science degree in pharmacy from the Massachusetts College of Pharmacy and Allied Health Sciences and his Master of Business Administration degree from the University of Phoenix.
He completed 65 hours of training in nuclear pharmacy at Purdue University and 80 hours of didactic training for the Six Sigma-Green Belt certification that he started with BD Medical Systems. He is one of four recipients of the 2013 Outstanding Service Award from the Massachusetts Society of Health-System Pharmacists and the 2014 recipient of the NABP Henry Cade Memorial Award that recognized his efforts and assistance to the states and NABP to address the compounding tragedy that occurred in 2012.
Since 1980, he has practiced pharmacy in a number of practice settings, including hospitals, community, and home care, in a number of different of roles, including the Corporate Vice President of Pharmacy Services for Coram Healthcare Corporation. He has also managed a FDA-registered cGMP manufacturing operation for Baxter Healthcare Corporation.
He is an active member and Fellow of the American Society of Healthcare Pharmacists and served on the USP Sterile Compounding Committee from 2005-2010 and 2010-2015 USP Council of Experts, Compounding Expert Committee until April 2013. He is actively working with NABP and state boards of pharmacy to provide training to their sterile compounding inspectors.
Eric is author of the 2004 ASHP Discussion Guide on Sterile Preparation: Summary and Implementation of USP Chapter 797, the ASHP Sterile Product Preparation CD-ROM: A Multimedia Learning Tool, the ASHP web-based 797 Compliance Advisor Gap Analysis Tool for USP Chapter 797, He assisted in the development of ASHP Outsourcing Vendor Assessment Tool and ASHP Insourcing program along with and the CriticalPoint web-based educational series on Sterile Compounding and the Annual National USP <797> Compliance Survey now in its fifth year. Eric has over 200 invited national and international professional presentations on various pharmacy practice topics such as pharmacy compounding and quality systems.