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• IV Admixture Preparation Objectives


  • Drugs must be added to sterile intravenous fluids in an aseptic manner
  • No drugs combined with intravenous solutions should result to an incompatibility
• IV Admixture Preparation Objectives

  All prepared IV admixtures should have proper label on: contents - drugs, fluid vehicle, stability period
• Proper labelling


  Allows the nurses to spend their time in meeting patients' emotional and physical needs
• Hospital Pharmacist Duties in IV Admixture Preparation


  1. Interpret the physician's orders

  2. Consult with medical and nursing staff when necessary

  3. Monitor the proper storage and handling of drug products in the IV admixture area

  4. Follows proper labeling practices
• Hospital Pharmacist Duties in IV Admixture Preparation


  1. Checks and compares schedule cards, patient profile or computer entry with original prescription order for accuracy

  2. Double checks the completed IV admixture for clarity and accuracy

  3. Documentation must include accuracy signature
• Hospital Pharmacist Duties in IV Admixture Preparation


  Coordinate the overall requirements of the nursing and medical staff for essential pharmaceutical services
• General Procedures: IV Admixtures


  1. All IV orders are considered stat unless a specific time or a specific instruction is sent

  2. IV orders should be filled and sent to the ward or floor ASAP
• General Procedures: IV Admixtures


  1. All IV admixtures are double checked by a different pharmacist (NOT the pharmacist who prepared it) before delivery

  2. Labels should be already be prepared prior to IV admixture preparation
• General Procedures: IV Admixtures


  All IV admixtures delivered to the nursing units should be stored in the refrigerator unless the drug has a "do not freeze" auxiliary label
• General Procedures: IV Admixtures


  IV admixtures that require protection from light shall be stored and dispensed in photosensitive cover bags
• Large Volume Parenteral (LVP)


  • Used to provide electrolytes and nutrition
  • With or without additives
  • Administered by IV infusion
  • For single dose
  • Volume of: 100 mL - 1000 mL
• Small Volume Parenteral (SVP)


  • Used to provide therapeutic effect
  • For single and multiple dose
  • Volume of less than or equal to 100 mL
• IV Admixture: Facilities


  • Centralized admixture service could be located in a reasonably small area of the pharmacy
  • May be a laman lang laminar airflow room, but it must be adjacent to the dispensing area
  • Admixture preparation area should be located in a separate area within the pharmacy
• Laminar Air Flow Hood


  • Provides ultra-clean environment
  • Reduce the risk of airborne contamination during the preparation of IV admixtures
  • HEPA filter removes nearly all bacteria
• Laminar Air Flow Hood


  • Provides clean air in the working area
  • Prevents room air from entering the LFH
  • Suspends contaminants introduced in the work area by the material or personnel
• Application of LAFH in Hospital Pharmacy


  • Preparation of IV admixtures and sterile products
  • Filling unit dose syringes
  • Reconstitution of powdered drugs
• Personal Protective Equipment


  • Mandatory for all healthcare staff involved in the preparation of IV admixtures
  • Examples: Sterile gowns, Head caps, Sterile gloves, Surgical face mask
• Labeling Requirements


  • Name of the patient
  • Ward, room and bed number
  • Date and time of preparation
  • Name of drug and contents
  • Dose and frequency
  • List of additives and their quantities (for TPN and other preparations which contain more than on drug)
  • Rate of IV infusion
• Labeling Requirements


  • Expiration date (including the specific time)
  • Name and signature of Pharmacist who prepared the solution
  • Countersignature of the Pharmacist who check the solution
  • Special precaution, storage requirement and instruction
• Physical Incompatibility


  • Occur when two drugs combined in a solution produce a change in appearance of that solution
  • Visual change may be: Change in color, Evolution of gas, Development of haze/turbidity, Formation of precipitate
• Chemical Incompatibility


  • Occur when two drugs react to cause the chemical degradation of one or both drugs
  • May not be detected visually, but can be detected by analytical methods
• Therapeutic Incompatibility


  Occur when two drugs are administered together to produce a response that is different in nature or intensity from that intended