The following topics have been developed to represent a continuum of activities in practice that hospital pharmacists will be familiar with. Participants will be able to empathize with the topics and locate their personal and counties level of engagement with aspects of compounding.

The topics will also be used to specify the learning for the plenary sessions.

1. Small scale compounding for individual patients.

Compounding for (individual) patients used to be the core business of all pharmacists. To date it is a unique service that can be provided for daily care if registered drugs do not fit with the individual need of a patient. Generally the more complicated and dedicated the product the less likely there is to be a commercial alternative. There is, however, a move to dose banding, which may facilitate greater involvement of industry or commercial scale production by pharmacy.

For this service a facility requires several work places for sterile and non sterile processes. Validation of the products and the processes is a difficult task and training of personnel is mandatory. Both standardized and non-standardized designs of products are used.

Critically, such products (e.g. ointments, capsules, eye drops) are non-standardized. There is little data on which to base compounding. Less is generally known about stability than would be known for commercial well used product. There is an expectation that products are compounded within a tight time frame.

2. Aseptic preparations, including TPN, for a limited number of patients

At is most simple the halving of a tablet alters the pharmaceutical product. More complicated are the implications of sterility and a stability, which must be achieved for commonly used medicine given IV, such as; Total Parenteral Nutrition (TPN) and antibiotics that are reconstituted in vials or made available in 100ml mini-bags or in syringes for infusion pumps. It is cost efficient to produce small batches of these preparations according to local need.

Compounding can be done in the pharmacy or on the ward. The facilities in the pharmacy and on the ward are different. However, in all cases the intrinsic quality of the drug has to be maintained and cannot be jeopardized. The organizational aspects, responsibilities and quality control of these differ from classical compounding. There are, for example, issues of tracking and audit. The use of bar coding and labelling are key considerations.

Manipulating the components for TPN has to be done in a class ‘A’ environment. Adding drugs can affect the stability of the emulsion, which needs to be supported by analytical and physical data. Although much is known about standardized TPN regimens, less is understood about mixing of concurrent medicines in traffic lines and ‘Y’ sets. Automation of preparation is developmental; however, robotics has the potential for automation in the future. At its most complex, TPN for neonates requires specialist knowledge.

3. Cytotoxic drugs

In the preparation of cytotoxic drugs both the product and the operator have to be protected. Environmental contamination of connected rooms and the wards has to be avoided by containment measures. This requires a special design for the facility, thorough interpretation of the possible risks during preparation, the transport and the administration.

Variation occurs in the preparation of cytotoxics from an aseptic centralized pharmacy service to specialized satellite facilities and the use of ward isolators by nurses. This is further complicated by emerging use of robotic dispensing dedicated to cytotoxics and commercial closed system products.

Therapies tend to be complicated and products expensive and pharmaceutically unstable.