Hospital Pharmacy: Lecture Four

Intravenous admixture drugs in hospital pharmacy

1. Intravenous Admixture Drugs in
Hospital Pharmacy
Anas Bahnassi PhD RPh
Anas Bahnassi PhD RPh 2012

2. 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
Anas Bahnassi PhD RPh 2012

3. 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
Anas Bahnassi PhD RPh 2012

4. 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.
Anas Bahnassi PhD RPh 2012

5. Parenteral
Drugs
Experts
Pharmacists
Administer
Parenteral
Solutions Compound
parenteral
Solutions
Monitor
Parenteral
Solutions
Compatibility Stability
Pharmacist’s Roles in Admixture Preparations

Anas Bahnassi PhD RPh
2012

6. 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
Anas Bahnassi PhD RPh
2012

7. 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
Anas Bahnassi PhD RPh
2012

8. 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
Anas Bahnassi PhD RPh
2012

9. 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
Anas Bahnassi PhD RPh
2012

10. 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
Anas Bahnassi PhD RPh
2012

11. Admixture Pharmacy System
Process
Determine
•Dose
•Diluent
•Rate of Administration
Label against original
prescription
Check the solution
against original order
Anas Bahnassi PhD RPh
2012

12. Establishing an Admixture
Pharmacy System
SYSTEM
COMPONENT
Preparation
Area
Storage
Area
Personnel
Policies and
Procedures
Admixture
Systems
Anas Bahnassi PhD RPh
2012

13. 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
No Smoking
No Food
No Drink Anas Bahnassi PhD RPh
2012

14. 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
Anas Bahnassi PhD RPh
2012

15. Policies and Procedures
Stability is affected by
Stability and Sterility determine expiration date
Stability Place
Environmental
Conditions
Diluents
Used
Environmental
Conditions
Other Drugs
Anas Bahnassi PhD RPh
2012

16. 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
Anas Bahnassi PhD RPh
2012

17. 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
Anas Bahnassi PhD RPh
2012

18. 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
Anas Bahnassi PhD RPh
2012

19. 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
Anas Bahnassi PhD RPh
2012

20. 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
Anas Bahnassi PhD RPh
2012

21. 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
Anas Bahnassi PhD RPh
2012

22. IV Room Charts Examples
Anas Bahnassi PhD RPh
2012

23. IV Room Personnel
Training
Organized
Job
Description
Regular
Intense
Module Based
Specialization
Distribution
Who will do what
Anas Bahnassi PhD RPh
2012

24. 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
Anas Bahnassi PhD RPh
2012

25. [email protected]
http://www.linkedin.com/in/abahnassi
http://bahnassi.coursesites.com
attribution – non-commercial – share alike
Anas Bahnassi PhD RPh
Hospital Pharmacy
http://www.slideshare.net/abahnassi
http://twitter.com/abahnassi
http://www.udemy.com/hospital-pharmacy
Anas Bahnassi PhD RPh
2012