Education event

Meeting New Requirements for Sterile Compounding Webinar
Learn about new and upcoming state regulations and federal standards, and how to comply

Register now
June 28, 2016
10:00 a.m. – 12:00 p.m., Pacific Time


The California State Board of Pharmacy (BoP) and United States Pharmacopeia (USP) Convention are planning changes that will significantly impact hospital pharmacy compounding of hazardous and non-hazardous medications and facility structures.

The BoP regulations are being finalized now and will become effective Jan. 1, 2017. In addition to cleaning, testing and personnel training, a significant anticipated change is the requirement that hospital pharmacies have a physically separate room for hazardous sterile compounding that meets specific ventilation requirements.

USP standards serve as a professional guide for compounding practices and medication administration. USP standard 797 will be finalized in February 2018 and will be used for survey purposes. USP standard 800, which was finalized in February 2016, is focused entirely on employee safety when handling hazardous medications.

Hear from California State Board of Pharmacy Executive Officer Virginia Herold and Supervising Inspector Michael Ignacio, and hospital pharmacists from CHA’s Medication Safety Committee, who will explain the new regulations and standards, and the impact on hospital procedures and operations.

Make plans now to attend and learn what the changes will mean for your hospital. Take home helpful tools and resources to ready your facility for compliance.

Recommended for:

Pharmacists in charge, chief operating officers, chief compliance officers, facilities managers and building engineers, CNOs, quality and infection control managers.


Where it all started, and why regulations and standards have been revised

  • High-profile lapses in process, increased industry scrutiny

Federal changes

  • USP Convention changes to 797 and 800 — what this means for operations
  • CMS Conditions of Participation

California State Board of Pharmacy updates

  • Upcoming sterile compounding regulations
  • Extension options for hospitals — the waiver process

Vital tools and resources

  • Sterile compounding matrix tools for lab testing, temperature monitoring, documentation, plant requirements
  • Regulation confusion? Check the new federal and state regulation crosswalk
  • And more resources


Virginia Herold, Executive Officer, California State Board of Pharmacy

Michael Ignacio, PharmD, Supervising Inspector, California State Board of Pharmacy

Jeannette Hanni, RPh, MPA, FCSHP, Bay Area Executive Director of Pharmacy Services, Sutter Health

Doug O’Brien, PharmD, Regional Director for Inpatient Pharmacy Services, Kaiser Permanente

Lynn Paulsen, PharmD, Director, Pharmacy Practice Standards, University of California, San Francisco

BJ Bartleson, RN, NEA-BC, Vice President, Nursing and Clinical Services, California Hospital Association (moderator)


Full participation in the webinar is required to receive professional continuing education (CE) credit. The registrant must complete an online evaluation, attest to participation and, when required, provide a professional license number.

Health Care Executives — CHA is authorized to award 2.0 hours of pre-approved ACHE Qualified Education  credit (non—ACHE) for this program toward the advancement, or recertification in the American College of Healthcare Executives. Participants in this program wishing to have the continuing education hours applied toward ACHE qualified education credit should indicate their attendance when submitting application to the American College of Healthcare Executives for advancement or recertification.

Compliance  This program has been approved for 2.4 Compliance Certification Board (CCB) Continuing Education Units. Granting of prior approval in no way constitutes endorsement by CCB of the program content or the program sponsor. (Note: CE recipients are solely responsible for retaining a copy for their records and for reporting credits to CCB)

Legal — CHA is a State Bar of California-approved MCLE provider. Provider number 1980. This participatory activity has been approved for 2 hours of MCLE credit.

Nursing — Provider approved by the California Board of Registered Nursing, CEP #11924, for 2.4 Contact Hours.


Members $185
Nonmembers $250
Multiple staff can participate from one location for one tuition fee.

Members are CHA member hospitals, CHA associate members and government agencies. Nonmembers are limited to non-hospital health care providers, clinics, post-acute facilities, and consultants, insurance companies, law firms and other entities that serve hospitals. Education programs and publications are a membership benefit and are not available to eligible nonmember California hospitals.

Cancellation Policy/Late Payment: A $50 non-refundable processing fee will be retained for each cancellation. Cancellations must be made in writing seven or more business days prior to the scheduled session and emailed to No refunds will be made after these dates. Substitutions are encouraged. Please note that payment is due on or before the program. Payments not received by the program date may be subject to a 10% late fee. In the unlikely event the program is cancelled, CHA will fully refund paid participants within 30 days.

Special Accommodations or Questions: If you require special accommodations pursuant to the Americans with Disabilities Act, or have other questions, please call (916) 552-7637.