The production of chemotherapy and total parental nutrition products in a hospital pharmacy

Having never worked in production before, it has been an interesting experience to see another side to hospital pharmacy. I can now check chemotherapy and also check total parental nutrition (TPN) products, something which, prior to this rotation, was completely alien to me. 

A day would typically start with bagging up any chemotherapy that has already made so they are ready for the nurses to collect for the patients that are due in that day. The process of creating chemotherapy goes through multiple checks by both the pharmacists and the technicians. Firstly, the chemotherapy is scheduled in to be made as soon as the prescription is received from the chemotherapy unit. A worksheet is then created to calculate the exact dose of the required chemo based on the concentration of the drug. Labels are created from the worksheet and both the label and the calculation are double checked. The worksheet then goes into the aseptic unit where the ingredients are assembled and also checked. Then the chemo is made by the specialist technicians. The role of the pharmacist is to do the final check of the chemotherapy, final check the calculation to ensure it has been made correctly and final check the label. A visual check is also performed to ensure that the chemo has no particles inside.

The TPN is made in the afternoon. As I work at a busy hospital, there are many patients who have TPN regularly, which means there is a possibility of staying at work later than usual to finish checking the bags. The checking process involves ensuring the labels are correct and that the computer-generated worksheet is correct. Then the ingredients, which consist of things like lipid, potassium and glucose, are checked to ensure that the correct ingredients and the correct amounts have gone into the bag. Finally, the TPN bags are checked for particles.

The recent incident which made the headlines of contaminated feeds for babies brings to light the importance of creating TPN in a sterile environment. It should always be ensured that the ingredients for the feeds are stored in the correct environment. The final checking pharmacist should therefore also check for any spillages, which would provide a source for contamination. 

Overall, I have learnt that checking chemotherapy and TPN is a case of risk versus benefits. In the case of production, it is a case of a higher risk and therefore the responsibility of the pharmacist is emphasised. There are many guidelines and policies which have to be strictly adhered to in order to reduce the risk of error, for example, avoiding contamination and ensuring the correct ingredients go into the end product. It is this difference that makes production a completely different sector of hospital pharmacy – checking the name, form, dose and strength of medicines in the dispensary is very different to checking TPN in the aseptic unit! I have learned a lot and am glad I can finally put a picture to another side of pharmacy. More than ever, I understand the importance of guidelines and policies as it is these policies that ensure chemotherapy and TPN is created in the correct way and in the required environment before being released.