Automated dispensing of parenteral nutrition formulations
Parenteral nutrition solutions are designed to provide patients with their nutritional requirements, and are composed of amino acids, glucose, lipid, electrolytes (eg, calcium, sodium, potassium, phosphate, magnesium), trace elements and vitamins. Paediatric licensed formulations are only available for children aged one year or above and they frequently provide an insufficient calorie content. As a consequence of this, the majority of paediatric hospitals within the United Kingdom now provide tailor-made parenteral nutrition for their patients.
The manufacture of formulations for parenteral nutrition has improved and changed vastly over the past 20 years, moving from a “burette and syringe” system to automation and use of computer software. Nevertheless, the use of new technologies is coupled with risks, such as system failure, and sufficient validation1 and personnel training are imperative to reduce these risks.
The Medicines Act 1968 states that aseptic dispensing is exempt from licensing requirements provided it is performed under the supervision of a pharmacist and carried out in a closed and controlled environment. Products manufactured must also have an expiry date of less than a week.
At Great Ormond Street Hospital, a multidisciplinary team advises clinicians in prescribing parenteral nutrition. Validated AsCribe computer software is used to formulate regimens by amending the appropriate standard trust regimen. There is a product database at Great Ormond Street Hospital that contains a list of all the ingredients required to manufacture parenteral nutrition. Worksheets, labels and details of a regimen are printed by an authorised pharmacy technician and are checked by a pharmacist. The regimen provides information on the administration process for nurses. The computer system’s inherent safety checking program is used to minimise the risk of errors occurring; for example, it can check that the glucose concentration of a parenteral nutrition regimen is satisfactory.
At Great Ormond Street Hospital, we use the Baxa Micro/Macro MM23 compounder to manufacture parenteral nutrition bags that do not contain lipids (see later). An automix (a machine that uses specific gravity to mix the large volumes of ingredients for parenteral nutrition formulations) is used to manufacture bags containing lipids, and vitamins are added manually to these bags. A giving set connects the lipid and non-lipid bags together, and a filter is incorporated into the giving set on the non-lipid side.
The British Parenteral Nutrition Group Filter Working Party2 recommends filtering parenteral nutrition during both administration and aseptic dispensing.
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Citation: Hospital Pharmacist URI: 10976659
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