Selecting an Automated Parenteral Nutrition Compounder Device at a Tertiary Care Institute in Saudi Arabia.

Background: With advances in hospital automation, selecting an automated compounding device (ACD) for compounding parenteral nutrition (PN) may be challenging. A well-designed comparative review that considers safety and technical standards could assist in the selection process. United States Pharmacopeia chapter <797> and The American Society of Hospital Pharmacists (ASHP) has provided guidance on the safety and accuracy of ACDs. Objective: Utilizing a checklist of technical and performance specifications investigators sought to assess the adequacy of compounders available in the Kingdom of Saudi Arabia. Method: Investigators compared the NutriMiX KS-240 and the Exactamix EM 2400. A literature review of practice standards, safety, technical, and performance specifications was conducted. These were developed into a checklist of 46 technical and performance specifications. Investigators evaluated each ACD using the checklist. Results: It was found that 43 (93.48%) of the technical and performance specifications, required by the hospital, were met by the NutriMix KS-240, while 39 (84.78%) were met by Exactamix EM 2400. Conclusion: This review found that although ACDs comply with the majority of standards and specifications, software integration with the hospital information system may be a limiting factor in selecting an ACD. The investigators concluded that the NutriMiX KS- 240 matches the technical and performance specifications for automated compounders required by our institution.

Improving policies and practices for the extemporaneous compounding of oral liquid dosage forms in Saudi Arabian hospitals.

BACKGROUND: Pharmacists rely heavily on available reference material to guide the extemporaneous compounding of medicines. Extemporaneous compounding for individual patients has traditionally not been closely regulated, but is necessary in every setting. OBJECTIVE: To assess the adequacy of the evidence and recommend changes for the master formulae (MFs) used in the extemporaneous compounding manual at five Ministry of National Guard Health Affairs (MNGHA) tertiary care institutions in Saudi Arabia. METHOD: A descriptive cross-sectional study of all extemporaneous oral liquid dosage forms (n=75) was conducted. Investigators sought to establish if the current list of compounded oral liquid dosage forms were registered commercially, backed by a stability study or followed the Saudi Arabia Food and Drug Administration guidance on assigning beyond-use dates. A literature review of stability studies, tertiary references and package inserts was used to verify the MFs. Findings of each MF were tabulated and compared with available stability studies. RESULTS: It was found that 28 (37.3%) oral liquid dosage forms were registered by a regulatory authority, 8 (10.7%) MFs could not be traced to a stability study, while 3 (4%) MFs used beyond-use dates. The taskforce approved 15 (20%) MFs without changes, while 42 (56%) MFs had to be revised. CONCLUSION: This review found that, although resources on the compounding of oral liquid dosage forms exist, pharmacies need to carefully assess their quality and relevance and update local policies and practices. The majority (80%) of the current MFs used in MNGHA institutions were rejected due to inappropriate compounding practices and inaccuracies.