Physicochemical and microbiological stability study of two new preservative-free methylprednisolone eye drops.

OBJECTIVE: To study the physicochemical and microbiological stability over 90 days of two preservative-free methylprednisolone sodium succinate (MTPSS) 1 and 10 mg/mL eye drops for use in ocular pathologies such as Sjögren's syndrome and dry eye syndrome. METHOD: The two eye drops were prepared from injectable MTPSS (Solu-moderin® and Urbason®), water for injection and normal saline solution. In accordance with ICH (International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use) guidelines, they were then stored in triplicate under refrigerated conditions (5±3 °C), at room temperature (25±2 °C), and at 40 °C (±2 °C). In accordance with the USP (United States Pharmacopeia), physicochemical controls of the active ingredient content were carried out by HPLC-UV (High Performance Liquid Chromatography with Ultraviolet detection), together with controls of pH, osmolality, and visual examination. Microbiological sterility was also tested under refrigerated conditions up to 30 days in open containers and up to 90 days in closed ones. RESULTS: The eye drops stored at 5 °C were the most stable; in the 1 mg/mL eye drops, degradation of the drug fell below 90% from day 21, and in the 10 mg/mL eye drops, from day 42. pH change did not vary by ≥1 unit in formulations stored at 5 °C, unlike the other formulations. Changes in osmolality did not exceed 5% on day 90 in any storage conditions. Samples of non refrigerate eye drops at 10 mg/mL, presented a white precipitate from day 14 and 28, respectively. Non-refrigerated 1 mg/mL eye drops presented suspended particles on day 90. There were no color changes. Microbiological analysis showed that sterility was maintained for over 90 days in the closed containers, although microbial contamination was detected from day 21 in the open containers. CONCLUSIONS: 1 mg/mL MTPSS eye drops show physicochemical and microbiological stability for 21 days under refrigeration, compared to 42 days for 10 mg/mL eye drops stored under the same conditions. However, since they do not include preservatives in their composition, they should not be used for more than 7 days after opening.

Physicochemical and microbiological stability study of two new preservative-free methylprednisolone eye drops. / Estudio de estabilidad fisicoquímica y microbiológica de 2 nuevos colirios de metilprednisolona sin conservantes.

OBJECTIVE: To study the physicochemical and microbiological stability over 90 days of two preservative-free methylprednisolone sodium succinate (MTPSS) 1 mg/ml and 10 mg/ml eye drops for use in ocular pathologies such as Sjögren's syndrome and dry eye syndrome. METHOD: The two eye drops were prepared from injectable MTPSS (Solu-moderin® and Urbason®), water for injection and normal saline solution. In accordance with ICH (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use) guidelines, they were then stored in triplicate under refrigerated conditions (5 ±3 °C), at room temperature (25 ± 2 °C), and at 40 °C (±2 °C). In accordance with the USP (United States Pharmacopeia), physicochemical controls of the active ingredient content were carried out by HPLC-UV (High Performance Liquid Chromatography with Ultraviolet detection), together with controls of pH, osmolality, and visual examination. Microbiological sterility was also tested under refrigerated conditions up to 30 days in open containers and up to 90 days in closed ones. RESULTS: The eye drops stored at 5 °C were the most stable; in the 1 mg/ml eye drops, degradation of the drug fell below 90% from day 21, and in the 10 mg/ml eye drops, from day 42. pH change did not vary by ≥1 unit in formulations stored at 5 °C, unlike the other formulations. Changes in osmolality did not exceed 5% on day 90 in any storage conditions. Samples of non refrigerate eye drops at 10 mg/ml, presented a white precipitate from day 14 and 28 respectively. Non-refrigerated 1 mg/ml eye drops presented suspended particles on day 90. There were no color changes. Microbiological analysis showed that sterility was maintained for over 90 days in the closed containers, although microbial contamination was detected from day 21 in the open containers. CONCLUSIONS: 1 mg/ml MTPSS eye drops show physicochemical and microbiological stability for 21 days under refrigeration, compared to 42 days for 10 mg/ml eye drops stored under the same conditions. However, since they do not include preservatives in their composition, they should not be used for more than 7 days after opening.

[Translated article] Map of use of parenteral analgesic admixtures in Spain. MEDPAIN project.

OBJECTIVE: This study is the first part of the MEDPAIN project "Update of analgesic parenteral admixtures: studies of use, compatibility and stability", and its goal is to develop a national map about the use of analgesic parenteral admixtures in healthcare settings. METHODS: Observational study, based on a survey aimed at Spanish hospital pharmacists, during the period December 2020 - April 2021. The questionnaire was designed in the RedCap® platform and disseminated through the Spanish Society of Hospital Pharmacy distribution list. An analgesic parenteral admixture (AM) was defined as the combination of two or more drugs, with at least one of them being an analgesic. The same combination of active ingredients, at different concentration and/or administered by different routes, was considered as a unique AM in this study. Some registered endpoints were related to the characteristics of the healthcare settings participating in the study, and others were related to the AM, such as drugs, doses and concentration range, route of administration, frequency of use, indication and type of patient (adult/pediatric) and where they are prepared. RESULTS: A total of 67 valid surveys from healthcare settings of 13 Spanish Autonomous Communities were received. They reported 462 AM. Every healthcare center informed an average of 6 AM (ICR p25-p75 = 4.0-9.0). Most of the reported mixtures were used in adults (93.9%) at hospital settings (91.8%), and they were mostly protocolized and frequently used. The 21.4% of them were compounded at the Pharmacy service. The AM included 26 different drugs, with opioid analgesics being present at the 87.4% of them. Midazolam was the most usual adjuvant drug. According to the definition of AM in this study, there were finally 137 different combinations mainly with two drugs (40.6%), but also with three (37.7%), four (15.2%) and five ingredients (6.5%). CONCLUSION: In conclusion, this study reveals the wide variability in current clinical practice and shows which are the most used analgesic parenteral admixtures in our country.

Map of use of parenteral analgesic admixtures in Spain. MEDPAIN project. / Mapa de utilización de mezclas analgésicas por vía parenteral en España. Proyecto MEDPAIN.

OBJETIVE: This study is the first part of the MEDPAIN project "Update of analgesic parenteral admixtures: studies of use, compatibility and stability", and its goal is to develop a national map about the use of analgesic parenteral admixtures in healthcare settings. METHODS: Observational study, based on a survey aimed at Spanish hospital pharmacists, during the period December 2020-April 2021. The questionnaire was designed in the RedCap® platform and disseminated through the Spanish Society of Hospital Pharmacy distribution list. An analgesic parenteral admixture (AM) was defined as the combination of two or more drugs, with at least one of them being an analgesic. The same combination of active ingredients, at different concentration and/or administered by different routes, was considered as a unique AM in this study. Some registered endpoints were related to the characteristics of the healthcare settings participating in the study, and others were related to the AM, such as drugs, doses and concentration range, route of administration, frequency of use, indication and type of patient (adult/pediatric) and where they are prepared. RESULTS: A total of 67 valid surveys from healthcare settings of 13 Spanish Autonomous Communities were received. They reported 462 AM. Every healthcare center informed an average of 6 AM (ICR p25-p75 =4.0-9.0). Most of the reported mixtures were used in adults (93.9%) at hospital settings (91.8%), and they were mostly protocolized and frequently used. The 21.4% of them were compounded at the Pharmacy service. The AM included 26 different drugs, with opioid analgesics being present at the 87.4% of them. Midazolam was the most usual adjuvant drug. According to the definition of AM in this study, there were finally 137 different combinations mainly with two drugs (40.6%), but also with three (37.7%), four (15.2%) and five ingredients (6.5%). CONCLUSION: This study reveals the wide variability in current clinical practice and shows which are the most used analgesic parenteral admixtures in our country.

Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments. A consensus Statement. Practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH).

OBJECTIVE: To establish a series of recommendations based on available evidence for monitoring surface contamination in the areas devoted to compounding hazardous drugs in pharmacy departments. METHOD: Based on a literature search in the Medline and Embase databases (search period: January 2009 to July 2019), as well as on a review of standards and recommendations issued by different healthcare organizations, a committee of experts from the Spanish Society of Hospital Pharmacists defined a series of safe practices for handling hazardous drugs and monitoring compounding work surfaces. Recommendation decisions were adopted by consensus among the members of the expert group, considering the recommendations reviewed, the monitoring situation in Spanish hospital departments, and the associated costs. RESULTS: Ten recommendations were formulated, structured into eight sections. They include aspects related to the drugs to be monitored; the  areas to be monitored; when samples should be taken; risk determination and preparation of a sampling protocol; analytical techniques; contamination thresholds; and design of an action plan based on the sampling and decontamination results obtained. CONCLUSIONS: Surface monitoring allows hazardous drugs detection and evaluation of the effectiveness of current protocols for the safe handling of such drugs in hospital pharmacy departments. The evaluation should include an analysis of the efficacy of engineering controls, work practices and cleaning and decontamination processes.

Objetivo: Establecer unas recomendaciones, en base a la evidencia disponible, para la monitorización de la contaminación de superficies en las áreas de elaboración de medicamentos peligrosos de los Servicios de Farmacia.Método:A partir de una revisión bibliográfica en las bases de datos Medline y Embase desde enero de 2009 a julio de 2019, así como de la consulta de documentos de estándares y recomendaciones de organizaciones sanitarias, un comité de expertos de la Sociedad Española de Farmacia Hospitalaria ha definido una serie de prácticas seguras sobre manipulación de medicamentos peligrosos y monitorización de superficies de trabajo. Las decisiones de recomendación se tomaron por consenso entre el grupo de expertos teniendo en cuenta las recomendaciones encontradas, la situación en nuestro entorno y los costes asociados a la monitorización.Resultados: Se han definido 10 recomendaciones estructuradas en ocho secciones. Se incluyen aspectos relacionados con los medicamentos a  monitorizar; localizaciones a monitorizar; momento de la toma de muestras; determinación del riesgo y plan de muestreo; técnicas analíticas; umbrales de contaminación; plan de acción según los resultados del muestreo y descontaminación.Conclusiones: La monitorización de superficies permite determinar la presencia de medicamentos peligrosos y evaluar la eficacia del programa de manejo seguro de los mismos en los Servicios de Farmacia. La  evaluación debería incluir un estudio de la eficacia de los controles de  ingeniería, de las prácticas laborales y de los procesos de limpieza y descontaminación.

Hospital Pharmacy Compounding against COVID-19 pandemic.

As in other areas of the health system, COVID-19 has had a dramatic impact on  hospital compounding. This area has faced numerous challenges, including the  shortage of frequent-use products (hydroalcoholic solutions, lopinavir/ritonavir  suspension), the use of new preparations for SARS-CoV-2 (tocilizumab,  remdesivir), or requests from overwhelmed wards unable to assume the safe  preparation of a high volume of medications (intravenous solutions). The  demand for all types of preparations (topic and oral medications, intravenous  solutions) has increased dramatically. This increase has highlighted the shortage of resources allocated to this area, which has made it difficult to meet the high  demand for preparations. In addition, the pandemic has revealed the scarcity of  research on such basic aspects as agent stability and drug compatibility. One of  the most relevant conclusions drawn from the COVID-19 pandemic is that the  basic areas of hospital pharmacy, along with other, must be maintained and  reinforced, as these are the areas that make us essential.

Como todo el sector sanitario, la farmacotecnia hospitalaria ha sufrido el impacto de la pandemia de la COVID-19, enfrentándose a la necesidad de cubrir el  desabastecimiento de productos de uso frecuente (soluciones hidroalcohólicas,  lopinavir/ritonavir suspensión), a nuevas preparaciones surgidas de las nuevas  necesidades provocadas por el SARS-CoV-2 (tocilizumab, remdesivir), o a  peticiones de plantas desbordadas por la carga asistencial, incapaces de asumir  con un mínimo de seguridad la preparación de numerosos medicamentos  (mezclas intravenosas). El incremento de actividad ha sido en todo tipo de  preparados (tópicos, orales y mezclas intravenosas) y ha puesto de manifiesto la escasez de recursos destinados a esta área, que se ha traducido en serios  problemas para afrontar todas las elaboraciones necesarias, así como la falta de  investigación en aspectos tan básicos como la estabilidad o la compatibilidad de  medicamentos. Probablemente, una de las conclusiones más importantes que  podemos extraer tras la COVID-19 es que ­sin menospreciar otras áreas de la  farmacia hospitalaria que también deben desarrollarse­ debemos mantener y  potenciar las áreas básicas de nuestra profesión. Aquellas que nos hacen imprescindibles.

The importance of quality control in raw materials used in pharmaceutical formulations.

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Review of evidence on handling hazardous drugs and Products in Urology Services; consensus document between the Spanish Urology Association and the Spanish Society of Health-System Pharmacists.

OBJECTIVE: The intravesical administration of hazardous drug products is a  standard practice in the urology setting, which potentially exposing medical  personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological  Association and the Spanish Society of Hospital Pharmacy) that collects the best  available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. METHOD: We reviewed the legislation and recommendations on the handling of  dangerous drug products, both at the national and international level. RESULTS: There is national legislation and regulations for protecting workers who  handle dangerous drugs and products, as well as  recommendations for handling to protect both the product and workers. DISCUSSION: Following the strategic lines of the European Parliament for 2014- 2020 in the chapter on occupational safety and health, the Spanish Urological  Association and the Spanish Society of Hospital Pharmacy proposed a series of  actions that decrease the risks of exposure for practitioners and caregivers  involved in the handling of these products. CONCLUSIONS: After this review, 19 recommendations were established for  handling dangerous drug products, which can be summarised as the need to  train all individuals involved (from management teams to patients and  caregivers), adopt systems that prevent contaminating leaks, implement  exposure surveillance programmes and optimise available resources.

Objetivo: La administración intravesical de medicamentos peligrosos es una  práctica habitual en el ámbito de la urología, con posible exposición del personal  sanitario a dichos medicamentos. Se considera necesario disponer de un  documento de consenso entre las sociedades científicas implicadas ­Asociación  Española de Urología y Sociedad Española de Farmacia Hospitalaria­ que recoja la mejor evidencia disponible para el manejo, de la forma más segura posible,  de medicamentos peligrosos en el ámbito de los servicios de Urología.Método: Se ha realizado una revisión de la legislación y de las recomendaciones sobre el manejo de medicamentos peligrosos tanto a nivel estatal como internacional.Resultados: Se dispone de legislación nacional y de normativas para la  protección de los trabajadores que manipulen medicamentos y productos peligrosos, así como recomendaciones de manipulación para la protección tanto del producto, como de los trabajadores.Discusión: Siguiendo las líneas estratégicas del Parlamento Europeo para el  período 2014-2020 en el capítulo de seguridad y salud laboral, la Asociación Española de Urología y la Sociedad Española de Farmacia Hospitalaria proponen una serie de actuaciones que hagan disminuir los riesgos de exposición de los profesionales y cuidadores implicados en su manejo. Conclusiones: Tras esta revisión se establecen 19 recomendaciones para el  manejo de medicamentos peligrosos que pueden resumirse en la necesidad de  formación de todas las personas implicadas (desde los equipos directivos hasta  los pacientes y cuidadores), la adopción de sistemas que no permitan fugas  contaminantes, programas de vigilancia de las exposiciones y optimización de  los recursos disponibles.

Consensus SEO-SEFH of recommendations for use and compounding of ophthalmic preparations.

There are many medicinal products that, although having shown efficacy and  safety in different ophthalmological indications, they are not authorized or  commercially available for ophthalmic administration. This implies, on one hand,  that they must be used according to legislation that regulates the availability of  medicines in special situations and, on the other hand, that they must be  prepared in the pharmacy services for ophthalmic administration, according to  quality criteria to ensure its effectiveness, stability and sterility. This document  gathers the consensus between the Spanish Society of Ophthalmology and the  Spanish Society of Hospital Pharmacy about these selected preparations which  have shown enough evidence in their efficacy and safety for their ophthalmic use (off label) and ophthalmic administration. This document includes  recommendations about its use according to the current legislation. In addition,  with the aim of harmonizing the preparation of intraocular injections in the  hospital pharmacy services, general recommendations are set in this document  to ensure the compliance with standards established in the Spanish Guideline for Good Preparation Practices of Medicinal Products in Hospital Pharmacies. These  recommendations include sections such as the area of preparation, material,  technique, packaging, stability, quality control, prescription and traceability of  intraocular preparations.

Son muchos los medicamentos que, aun habiendo demostrado eficacia y seguridad en diferentes indicaciones oftalmológicas, no están autorizados ni disponibles comercialmente en una forma adecuada para esta vía de  administración.Esto implica, por un lado, que se deban utilizar según la legislación que regula la disponibilidad de medicamentos en situaciones especiales y, por otro, que se  deban preparar en los Servicios de Farmacia para su administración por vía  oftálmica, conforme a unos criterios de calidad que aseguren su efectividad,  estabilidad y esterilidad. Este documento recoge un consenso entre la Sociedad  Española de Oftalmología y la Sociedad Española de Farmacia Hospitalaria sobre  aquellas preparaciones con suficiente evidencia respecto a su eficacia y  seguridad para su uso no autorizado en indicaciones y vía de administración  oftálmicas. Se incluyen recomendaciones para su utilización de acuerdo con la  legislación vigente. Además, con el ánimo de armonizar la preparación de  inyecciones intraoculares en los Servicios de Farmacia Hospitalaria, se  establecen unas recomendaciones generales para su elaboración siguiendo los  estándares establecidos en la Guía de Buenas Prácticas de Preparación de  Medicamentos en los Servicios de Farmacia Hospitalaria. En estas  recomendaciones se incluyen apartados como el lugar de preparación, el  material, la técnica, el envasado, el periodo de validez, el control de calidad, la  prescripción y la trazabilidad de las preparaciones intraoculares.

[Platelet-rich plasma: updating of extraction devices]. / Plasma rico en plaquetas: actualización de los sistemas empleados para su obtención.

UNLABELLED: Propose: To describe PRP extraction devices, through a review of kits available in Spain, taking into account AEMPS and SEFH working groups (GPS, Farmacotecnia, Hemoderivados groups) contributions. METHODS: Three independent searches about PRP extraction devices were carried out. Device suppliers were contacted and an individually meeting was called with each one. Characteristics of each device was reviewed by virtual demonstration. A kits comparison chart was made with all the information acquired. Kits were classified as Closed-Technique and Opened- Technique in accordance with the AEMPS technical committee report. RESULTS: Ten devices were found: ACP®; Angel®, Cascade®, Endoret ®, GPS®, Magellan®, Minos®, Ortho-pras®, Smart-prepr® and Tricell®. However, we could found out the mechanism in detail of seven of them. Information about Cascade®, Magellan ® and Smart-prepr® kits was not enough. CONCLUSION: The review provided the main PRP extraction devices available with CE marking and its distinguishing characteristics, however, it is crucial to pay attention to PRP extraction procedure and administration, to guarantee the final product quality. Pharmacy Department must get involved in the device selections due to the close link with the manufactured drug quality. Working together with the AEMPS will contribute to defining extraction procedure specifically.

Objetivo: Describir los dispositivos para la obtención de Plasma Rico en Plaquetas (PRP) mediante la revisión de los productos existentes en España, teniendo en consideración las aportaciones de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) y los grupos de trabajo de Productos Sanitarios (GPS), Farmacotecnia y Hemoderivados de la Sociedad Española de Farmacia Hospitalaria (SEFH). Método: Se realizaron tres búsquedas independientes sobre dispositivos de fraccionamiento de plasma. Se contactó con los proveedores y se estableció una reunión con cada uno de ellos. Se revisaron las características de cada dispositivo mediante una demostración del proceso de fraccionamiento virtual y se elaboró una tabla de comparación de kits. Los dispositivos se clasificaron como Técnica cerrada y Técnica abierta de acuerdo al informe del comité técnico de inspección de la AEMPS. Resultados: Se localizaron diez dispositivos: ACP®; Angel®, Cascade®, Endoret®, GPS®, Magellan®, Minos®, Ortho-pras®, Smart-prepr® y Tricell®, pudiendo conocer de forma detallada el funcionamiento en siete de ellos. Sin embargo, de Cascade ®, Magellan® y Smart-prepr® no se consiguió información suficiente. Conclusión: La revisión permitió conocer los principales dispositivos de extracción de PRP disponibles con marcado CE y sus características diferenciales; sin embargo, para garantizar la calidad del producto final es crucial poner atención en el propio proceso de extracción y administración del PRP. El Servicio de Farmacia debe implicarse en su selección por la estrecha relación que mantiene con la calidad del medicamento elaborado. El trabajo conjunto con la AEMPS permitirá definir de forma más específica el proceso correcto de elaboración.

[Methods to obtain platelet-rich plasma and osteoinductive therapeutic use]. / Técnicas de obtención del plasma rico en plaquetas y su empleo en terapéutica osteoinductora.

INTRODUCTION: Platelet-Rich Plasma (PRP) is autologous plasma with higher concentration of platelet than basal level, because of an extracting and concentration process. PRP therapeutical use, as osteinductor role, is a controversial issue, due to there are no clinical studies with rigorous design and no firm conclusions can be drawn regarding its uses. Propose: To provide information about methods to obtain PRP, legal considerations about its extraction and use, molecular mechanism of action, as well as available evidence about security and tolerance. RESULTS: PRP can be obtained by manual procedures (opened technique) or disposable kits (closed technique), the latter being medical devices classified as type IIa. AEMPS considers PRP as a drug, establishing some minimum requirements to guarantee safety, traceability, pharmacovigilance and information. PRP provides ideal qualities to play a powerful osteoinductor role to speed up fracture healing or to produce an efficiently and quickly osseointegration of different bone implants, due to the high growth factors content. Infiltration tolerance is generally good, however, it has to be taken into account its great angiogenical potential. CONCLUSIONS: In view of its production and application characteristics, PRP is considered as a drug on restricted medical prescription by the AEMPS, so pharmacy department must, at least, supervise its management and handling.

Introduccion: El Plasma Rico en Plaquetas (PRP) es un plasma autólogo con una cifra de plaquetas superior a la del plasma basal, por haber sido sometido a algún proceso de extracción y concentración. El empleo del PRP como osteoinductor es conflictivo dado que, no existen estudios clínicos rigurosos que permita extraer conclusiones firmes respecto a su utilidad. Objetivo: Proporcionar información sobre las técnicas de obtención del PRP, las consideraciones legales sobre su obtención y empleo, el mecanismo de acción molecular, así como la evidencia disponible sobre su seguridad y tolerancia. Resultado: El PRP se obtiene de forma manual, mediante "técnica abierta", o mediante kits desechables con "técnica cerrada", siendo estos últimos productos sanitarios clasificados como IIa. La Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) considera el PRP como medicamento, estableciendo unos requisitos mínimos para garantizar su seguridad, trazabilidad, farmacovigiliancia e información. El PRP, por su elevado contenido en factores de crecimiento, reúne cualidades para ser un potente papel osteoinductor, capaz de acelerar la consolidación de fracturas o de osteointegrar rápida y eficientemente distintos tipos de implantes óseos. La tolerancia a la infiltración es generalmente buena, aunque hay que tener en cuenta su elevado potencial angiogénico. Conclusiones: El PRP, dadas las características de producción y aplicación, es considerado por la AEMPS como un medicamento de dispensación bajo prescripción médica restringida, por lo que los servicios de farmacia hospitalaria deberían, cuando menos, supervisar su gestión y manipulación.

[Recommendations for the safety preparation of sterile medicines in medical wards]. / Recomendaciones para la preparación de medicamentos estériles en las unidades de enfermería.

OBJECTIVE: To develop a recommendations guide about the preparation of sterile medicines in medical wards, and to figure out the current situation of different Spanish hospitals, regarding the preparation of sterile medicines outside the pharmacy. METHODS: The authors reviewed the available international guidelines in order to summarize the main quality recommendations. To know about the current situation in Spanish hospitals, a 30 questions survey was designed and spread to 500 different hospitals. Answers were analysed with SurveyMonkey® platform in the period February-July 2012. RESULTS: Based on the literature review, the authors agreed a recommendations list for the safe preparation of sterile medicines in medical wards, which was structured in 8 sections. Regarding the survey results, 8.4% of the hospitals answered, showing a great variability among centres in the quality requirements for sterile compounding outside the pharmacy. It should be pointed out the lack of assigned areas for drug preparation in wards, the lack of protocols to discern which kind of medicines can be compounded in wards as well as the poor recommendations about garment and aseptic technique. CONCLUSIONS: The authors confirm the absence of qualified practice standards to be applied in the preparation of sterile medicines in medical wards, as well as the great variability of diary practice. The implementation of quality and safety recommendations in the preparation of sterile medicines in medical wards may contribute to improve patient safety.