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Advancing Safety in Compounding

For many people, obtaining prescription medication typically involves a trip to their local retail pharmacy and the medication is most often in the form of a tablet or a pill. For hospitalized patients, the administration of medication is more complex, as many medications are often administered directly into the blood stream.

Injectable drugs need to be sterile and the dose is typically more precise because of the direct route into the blood stream. Premixed drugs–those that are commercially manufactured–are a common way to provide injectable, sterile medications to hospitalized patients. When a premixed formulation of a drug cannot be made available because the drug is not stable and cannot be commercially produced, or is not available in the dose and formulation needed by the patient, injectable medications must be produced through a process called compounding.

Compounding, a pharmacist's preparation of customized dosage forms and/or prescription medications to meet an individual patient's or physician's needs, is an important part of individualized patient care.1 Typically prepared in the hospital pharmacy under sterile conditions, these medications can be customized for a patient's condition, size or need for a different route of administration. Certain medications also have shorter shelf lives and may need to be compounded or reconstituted within a certain timeframe of administration. Some patients require customized parenteral nutrition solutions based on disease and health status. It is important that compounding be performed safely and effectively to ensure that patients are getting sterile drugs in the proper formulation, concentration and dosage, at the right time and without contamination during the preparation.

Baxter provides pharmacy workflow systems for healthcare pharmacies to use during the compounding process. When it comes to compounding, the company's priority is focused on helping pharmacies become more efficient and advance safety.

Products with safety in mind

The right technology can make a significant difference in helping pharmacists compound medications safely, accurately and efficiently. Pharmacy informatics is developing rapidly as a specialty within the practice of integrated medication therapy that enhances hospital pharmacy operations by improving communication, documentation and efficiency. Baxter's portfolio of pharmacy workflow systems are designed to help promote these qualities.

For example, Baxter's ABACUS Calculation software helps simplify the ordering, calculation and labeling process for compounded and premix products. Its automated calculations help the clinician minimize the risk of errors during the formulation ordering process. In addition to ABACUS Calculation software, Baxter's EXACTAMIX Automated Compounding System is a device that automates multi-ingredient solution compounding such as total parenteral nutrition and other multi-ingredient solutions. To complement Baxter's compounding portfolio, the DoseEdge Pharmacy Workflow Manager is an integrated system that automates the process of routing, preparing, inspecting, tracking, and reporting on IV and oral liquid doses-providing transparency, visibility, and documentation for the dose preparation and dispensing process within healthcare pharmacy settings. DoseEdge's features include automatic calculations and barcode verification of ingredients, which help the clinician reduce preparation errors and facilitate uniform processes among users. Since March 2008, more than 2.3 million potential preparation errors have been identified using the DoseEdge System.2

Public-private partnerships that support excellence in compounding

In addition to having the right technology, sharing best practices within the pharmacy community is an important component of compounding safety. Baxter has embraced this approach by collaborating with local governments and public institutions, including with the award-winning public hospital, Changi General Hospital (CGH) in Singapore.

In late 2014, Baxter and CGH announced plans to establish a Centre of Excellence in Compounding, which will be located at CGH and be fully operational by 2017. The center will establish a new model of care delivery extending beyond the hospital and into the community and patients' homes, focusing on two main goals.

First, combined with the expertise of the Singapore University of Technology and Design (SUTD), the Centre of Excellence in Compounding Sciences will develop and deploy a fully-integrated system to track customized medications throughout the compounding process, from physician's prescription to administration to patients in the hospital or at home with nursing support. SUTD will then analyze the system by looking at results pre- and post- implementation.

The CGH center will also develop clinical protocols and care paths to enable the administration of compounded sterile solutions to patients at home. Patients suited to be outpatients but requiring specialty medications can often be admitted to a hospital to receive treatment for up to six weeks, or in some cases must make daily trips to the hospital to receive the medication. However, through CGH's development of these new protocols and care paths, patients suited for home administration of these medications will be able to be identified, trained and monitored by a nursing team in order to receive treatment and recover in the comfort of their homes. This has the potential to reduce the cost to patients as well as reduce the likelihood that patients will acquire infections in the hospital.

Building a foundation for a strong future

In addition to these efforts, Baxter plans to create an Academy of Compounding Sciences in the future to support education and research in compounding. This continued commitment to innovation and collaboration in promoting safety in compounding and healthcare delivery demonstrates Baxter's larger commitment to meeting the unique needs of patients and saving and sustaining lives.

1American Pharmacists Association. Accessed on May 6, 2015. Accessed on May 6, 2015. https://www.pharmacist.com/sites/default/files/ files/Profile_09_Compounding_SDS_FINAL_082907.pdf
2Data on file: Baxter Healthcare Corporation, March 1, 2008 to May 1, 2015