Extemporaneous Sterile Compounding of Intravenous Additives

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Abstract
This paper describes the pharmacy-centralized intravenous additive program at the Clinical Center of the National Institutes of Health, Bethesda, Maryland. About half of the intravenous solutions administered at the Clinical Center contain additives; of these, about 58 percent contain one drug, 27 percent contain two drugs, 9 percent contain three drugs, 5 percent contain four drugs, and 1 percent contain five or more drugs. Intravenous additive orders during a 13- month period totaled 41,914 individual containers. Pharmacists used 59,447 vials of drug, 45,075 of which required reconstitution. Ninety-eight percent of the orders over the 13- month period were filled during 12-hour weekday schedules and 81/2-hour weekend and holiday schedules. Three pharmacists and two technicians are required to provide the service. Personnel requirements, therefore, may be based roughly on five bottles per hour per pharmacist or pharmacy technician. The use of a laming flow hood and the steps in processing intravenous additive orders are described and the advantages of such a pharmacy-centralized service are enumerated.

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