HPE HPE 85 – Spring 2017 - Page 10

Symposium report EasyComp features • Checks for compatibility and stability of a regimen • Suggests corrective measures to make an unstable regimen stable • Provides stability statement and shelf life • Prints labels, worksheets (including sequence of mixing) and prescription sheet for the patient file • Verifies regimens for current dose recommendation, if patient data is provided • Includes patient management, which allows to file and review a patient’s history • Saves and recalls standard regimens and regimens from a patient’s history • Allows organisational configuration 8 enteral route. PN has been defined as “the administration of nutrients (amino acids, glucose, +/- fat, electrolytes, trace elements and vitamins) by either a large central vein such as the superior vena cava or a peripheral vein in the arm”. In the UK, licensed PN formulations, available in multi-chamber bags (MCBs), are routinely used. For example, 2-in-1 formulations contain standard mixtures of glucose and amino-acids and 3-in-1 formulations contain glucose, amino-acids and lipids. However, these standard bags do not always match patients’ needs and so further manipulations have to be performed in pharmacy aseptic units. When undertaking such procedures in an unlicensed aseptic compounding unit, the biggest challenge is ensuring that the final mixtures are supported by suitable physico-chemical compatibility and stability data. However, it is not always easy to find the relevant information – it is not included in the Summary of Product Characteristics, he said. Often, it falls to the compounding pharmacist to make a decision and take responsibility for the final product. The PN compatibility software, EasyComp, which has been in use at NHS Tayside for more than six months, “makes the whole process straightforward”, said Mr Mavhunga. EasyComp is a validated compatibility database, providing a window of compatibility, which is based on about 12,000 laboratory tests. Before EasyComp became available, bespoke bags could not be made at weekends or over public holidays because it was not possible to hospitalpharmacyeurope.com contact manufacturers of PN solutions to confirm the stability of admixtures. EasyComp EasyComp allows the clinician to prescribe the nutrition formulation that is required. Stability is automatically verified in the pharmacy, and a worksheet can be generated and a label can be printed. The label includes all the information required for administration, including the contents and rate of administration, so that nurses know exactly what to do. The compatibility data is stored on a central server whereas the patient data is stored on local (hospital) computers so the hospital retains complete control over confidential information, said Mr Mavhunga. Another benefit of the central server is that when the database is updated with new information it is immediately available to all users, he noted. In NHS Tayside, some 2500 PN bags are compounded each year. The previous system relied on transcription of patient information from the prescription chart on to a PN order, then further transcription in the pharmacy from PN order to worksheet and into spreadsheet software to produce the label. A study in 2004 by the American Society of Parenteral Nutrition showed that the transcription error rate in PN was 39% for prescribing and 24% for administration. “Given the number of transcriptions required in the previous Tayside system, the risk of error was quite high”, said Mr Mavhunga. Now that EasyComp is in use, PN prescribed by the clinicians can be entered directly into EasyComp, and a worksheet and label are generated without any further transcription in the pharmacy. One important feature of EasyComp is