ASHP Guidelines on the Safe Use of Automated Compounding Devices for the Preparation of Parenteral Nutrition Admixtures

Automated compounding devices are frequently used by pharmacists for the extemporaneous preparation of parenteral nutrition admixtures. This continuing shift from manual compounding procedures comes as a result of significant advances in automated technology, as well as in response to changing health care demands to provide admixture compounding in a safer, more efficient, and more accurate manner. Approximately 65% of the hospitals in the United States currently use automated compounding devices for parenteral nutrition admixtures on a daily basis. Compounders are also used for other types of intravenous admixtures and in other settings, including home care and long-term-care facilities; therefore, the overall magnitude of their use may be substantial. As with other automated systems or devices, the benefits can be realized only when the technology is used appropriately. Significant patient harm may occur when safety and quality assurance measures are overlooked or circumvented. The purpose of these guidelines is to outline the key issues that should be considered to safely and cost-effectively incorporate this technology into the pharmacy operations of health care organizations. The guidelines focus on parenteral nutrition admixtures, but the safety issues are also applicable to the use of compounders for other types of i.v. admixtures. The term “health care organization” is used throughout the guidelines as a general descriptor and is intended to be inclusive of any of the practice settings and types of facilities in which compounders are used, including, for example, home infusion companies. These guidelines should be used in conjunction with the ASHP Guidelines on Quality Assurance for Pharmacy-Prepared Sterile Products and device manufacturers’ instruction manuals and training materials. Pharmacists should use professional judgment in assessing their health care organization’s needs for automated compounding devices and in adapting these guidelines to meet those needs.