hospital pharmacy: lecture four
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Intravenous admixture drugs in hospital pharmacyTRANSCRIPT
Intravenous Admixture Drugs in Hospital Pharmacy Anas Bahnassi PhD RPh
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Lecture Objectives
• Define and describe the different types of admixture solutions
• Describe different routes/methods of parenteral drug administration
• define common terminology associated with parenteral drug administration
• describe the basic principles of aseptic technique
• demonstrate appropriate aseptic technique used in the preparation of IV admixtures
• describe the advantages and limitations of a pharmacy-based IV admixture service
• describe the specialized equipment and supplies used in an IV admixture service, including TPN and chemotherapy
• describe the techniques and technology that may be used to increase efficiency and productivity of an IV admixture service
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Sterile IV solutions that are prepared by using one or more medications or electrolytes and will
be administered via the parenteral route
Admixture Preparations
Irrigation Solutions
Ophthalmic Solutions
Intrathecal Solutions
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Intravenous Admixture Preparations
• Compounding sterile admixture medication has originally started to prepare sterile intravenous, intrathecal, ophthalmic, and irrigating solutions that were not available commercially
• 40% of hospital inpatients receive IV preparations including replacing fluids and electrolytes, provide nutrition and administer medication.
• It can be administered in the hospital or to patients at home.
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Parenteral Drugs
Experts
Pharmacists
Administer Parenteral Solutions Compound
parenteral Solutions
Monitor Parenteral Solutions
Compatibility Stability
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The pharmacy must maintain a clean area out of the direct flow of traffic with a vertical or
horizontal laminar air flow hood to prepare IV admixtures
Pharmacist’s Responsibilities in Admixture Preparations
Contamination
Pharmacy education should prepare pharmacrists to deal with problems of physical,
chemical, and therapeutic incompatibilities and to design suitable alternatives Compatibility
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Drug stability information must be readily accessible to the pharmacist in order to determine optimum conditions for drug
storage prior and after preparation Keeping a drug at ideal storage conditions
will help to establish a reasonable expiration date for the product.
Inspection method to test product sterility and overall integrity must be instated
Pharmacist’s Responsibilities in Admixture Preparations
Stability
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Errors are reduced if a pharmacy based admixture program is instated
When pharmacists prepare admixture preparations errors become less frequent.
The use of standardized dosing charts, including precalculated drug doses and
dilutions contained in admixture area reduce the chance of error significalntly
Advantages of Admixture Prepared by Pharmacists
Errors
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Pharmacists should design and enforce admixture preparation system that ensures
quality of the prepared preparations This system should include policies and
procedures that can be applied in centralized and decentralized settings
This system will provide a mechanism to monitored quality to the prepared
preparations
Advantages of Admixture Prepared by Pharmacists
Quality
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Admixture preparations have the advantage of being prepared for each individual patient
and administered according to certain directions tailored for the individual patient.
Admixture preparations ensures the application of total pharmaceutical care as the pharmacist prepares, administers , and
monitor the patient therapy
Advantages of Admixture Prepared by Pharmacists
Individual-ization
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Admixture Pharmacy System Process
Determine • Dose
• Diluent
• Rate of Administration
Label against original prescription
Check the solution against original order
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Establishing an Admixture Pharmacy System
SYSTEM COMPONENT
Preparation Area
Storage Area
Personnel Policies and Procedures
Admixture Systems
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Preparation Area Description
Washable floor covered with vinyl
or epoxy
Laminar Flow Hoods Vertical
Horizontal
Refrigirator
Preparation Tools
Adequate Light
Adequate Counter Space
Restricted Area
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Policies and Procedures
Preparation should be according to a policies and procedures manual
Detailed information of preparation, labeling, storage, and expiring date determination should be accessible
Stability
Compat-ibility
Aseptic Techniques
IV Profiling
Labeling and
Checking
Quality Assurance
Auxiliary Labels
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Policies and Procedures
Stability is affected by
Stability and Sterility determine expiration date
Stability Place
Environmental Conditions
Diluents Used
Environmental Conditions
Other Drugs
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Increase the effect or show
toxic effects
Interaction that lead to
Inactivation
Deterioration
Precipitation
Policies and Procedures
Types of incompatibilities
Compat-ibility
Physical
Chemical
Therapeutic
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Policies and Procedures
A sterile parenteral dosage form is free from living microorganisms, particulate matter, and pyrogens.
Aseptic Techniques
IV Profiling
Review preparation against patient’s current profile
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Policies and Procedures
Labels should reflect the information provided in the prescription
Labeling and
Checking
Patient Name Bottle Sequence Number Name and
amount of each drug
Environmental Conditions
Name and volume of admixture
Flow Rate Date and times of
Administration Preparation and Expiration dates
Preparer initials
Auxiliary Labels
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Policies and Procedures
System to check aseptic environments and the pharmacist’s access to both patient’s profile and final product provide more stringent quality control over parenteral therapy
Admixtures of drugs not available commercially can be prepared using the powder form.
The resulting solution should be filtered before addition to IV bag
Quality Assurance
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Policies and Procedures
Required to avoid fatal errors
Auxiliary Labels
Note Strength Activate before use
Protect from light
Do Not Refrigirate For epidural use
only
Caution: Chemotherapy
Agent
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IV Room Equipment Laminar
Flow
Refrigerator
References
HEPA Filteration
Vertical or Horizontal
Check every 6 months
Slows microbial growth
Needle means contamination
Handbook of Injectable Drugs
Compatibility and compounding
charts
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IV Room Charts Examples
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IV Room Personnel
Training
Organized
Job Description
Regular
Intense
Module Based
Specialization
Distribution
Who will do what
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IV Room Storage Area The
prepared Mixture
Refrigirator
IV Room Admixture Systems
Systems require little involvement of actual compounding, it helps with general needs not
special orders
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Anas Bahnassi PhD RPh
Hospital Pharmacy
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