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Hospital Pharmacy: Lecture Four

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Intravenous admixture drugs in hospital pharmacy

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Hospital Pharmacy: Lecture Four

  1. 1. Intravenous Admixture Drugs in Hospital Pharmacy Anas Bahnassi PhD RPh 2012 Anas Bahnassi PhD RPh
  2. 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• Anas Bahnassi PhD RPh 2012 describe the techniques and technology that may be used to increase efficiency and productivity of an IV admixture service
  3. 3. Admixture Preparations Sterile IV solutions that are prepared by usingone or more medications or electrolytes and will be administered via the parenteral route Anas Bahnassi PhD RPh 2012 Irrigation Ophthalmic Intrathecal Solutions Solutions Solutions
  4. 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 Anas Bahnassi PhD RPh 2012 medication.• It can be administered in the hospital or to patients at home.
  5. 5. Pharmacist’s Roles in Admixture Pharmacists Monitor Parenteral Parenteral Drugs Solutions Experts Administer Parenteral Compound SolutionsPreparations parenteral Anas Bahnassi PhD RPh 2012 Solutions Stability Compatibility
  6. 6. Pharmacist’s Responsibilities in Admixture Preparations The pharmacy must maintain a clean area outContamination of the direct flow of traffic with a vertical or horizontal laminar air flow hood to prepare IV admixtures Pharmacy education should prepare pharmacrists to deal with problems of physical, Anas Bahnassi PhD RPh 2012 chemical, and therapeutic incompatibilities Compatibility and to design suitable alternatives
  7. 7. Pharmacist’s Responsibilities in Admixture PreparationsStability 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 Anas Bahnassi PhD RPh 2012 date for the product. Inspection method to test product sterility and overall integrity must be instated
  8. 8. Advantages of Admixture Prepared by PharmacistsErrors 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 Anas Bahnassi PhD RPh 2012 dilutions contained in admixture area reduce the chance of error significalntly
  9. 9. Advantages of Admixture Prepared by PharmacistsQuality 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 Anas Bahnassi PhD RPh 2012 This system will provide a mechanism to monitored quality to the prepared preparations
  10. 10. Advantages of Admixture Prepared by PharmacistsIndividual- ization 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 Anas Bahnassi PhD RPh 2012 the pharmacist prepares, administers , and monitor the patient therapy
  11. 11. Admixture Pharmacy System Process Check the solution against original order Anas Bahnassi PhD RPh 2012 Label against original prescription • DoseDetermine • Diluent • Rate of Administration
  12. 12. Establishing an Admixture Pharmacy System Preparation AreaAdmixture Storage Systems Area SYSTEM COMPONENT Anas Bahnassi PhD RPh 2012 Policies and Personnel Procedures
  13. 13. Preparation Area Description Washable floorcovered with vinyl Restricted Area or epoxy Refrigirator Laminar Flow Hoods Vertical Adequate Light Horizontal Preparation Tools Anas Bahnassi PhD RPh 2012 No Smoking Adequate Counter No Food Space No Drink
  14. 14. Policies and ProceduresStability Labeling Aseptic and Techniques Checking Compat- Quality IV ibility Assurance Profiling Auxiliary Preparation should be according to a policies Labels and procedures manual Anas Bahnassi PhD RPh 2012 Detailed information of preparation, labeling, storage, and expiring date determination should be accessible
  15. 15. Policies and ProceduresStability Place Environmental Conditions Environmental Conditions Diluents Used Stability is affected by Anas Bahnassi PhD RPh 2012 Other Drugs Stability and Sterility determine expiration date
  16. 16. Policies and Procedures Physical Precipitation InactivationCompat- ibility Chemical Deterioration Types of incompatibilities Anas Bahnassi PhD RPh 2012 Therapeutic Interaction that lead to Increase the effect or show toxic effects
  17. 17. Policies and Procedures Aseptic Techniques IV ProfilingA sterile parenteral dosage form is free fromliving microorganisms, particulate matter, and Anas Bahnassi PhD RPh 2012pyrogens. Review preparation against patient’s current profile
  18. 18. Policies and Procedures Labeling and Checking Patient Name Bottle Sequence Environmental Number Conditions Name and amount of each drug Name and volume of admixtureLabels should reflect the information provided in the prescription Anas Bahnassi PhD RPh 2012 Preparer initials Auxiliary Labels Preparation and Date and times of Flow Rate Expiration dates Administration
  19. 19. Policies and Procedures Quality AssuranceSystem to check aseptic environments and thepharmacist’s access to both patient’s profileand final product provide more stringent Anas Bahnassi PhD RPh 2012quality 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
  20. 20. Policies and ProceduresNote Strength Activate before Protect from light use Auxiliary Required to avoid fatal errors Labels Anas Bahnassi PhD RPh 2012 Caution: For epidural useChemotherapy Do Not Refrigirate only Agent
  21. 21. IV Room Equipment Laminar Flow Refrigerator HEPA Filteration References Slows microbial Vertical or growth Horizontal Handbook of Injectable Drugs Needle means Anas Bahnassi PhD RPh 2012Check every 6 contamination months Compatibility and compounding charts
  22. 22. IV Room Charts ExamplesAnas Bahnassi PhD RPh 2012
  23. 23. IV Room Personnel Training Organized Regular Job Description Specialization Intense Who will do what Distribution Anas Bahnassi PhD RPh 2012Module Based
  24. 24. IV Room Storage Area ThepreparedMixture Refrigirator IV Room Admixture Systems Anas Bahnassi PhD RPh 2012 Systems require little involvement of actual compounding, it helps with general needs not special orders
  25. 25. Hospital PharmacyAnas Bahnassi PhD RPh abahnassi@gmail.com http://www.linkedin.com/in/abahnassi http://www.slideshare.net/abahnassi Anas Bahnassi PhD RPh 2012 http://bahnassi.coursesites.com http://twitter.com/abahnassi http://www.udemy.com/hospital-pharmacy attribution – non-commercial – share alike

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