Before you start practicing, review the details listed below. These details will be important to keep in mind in the work environment. The list below is not all inclusive.

If you are new to sterile compounding always refer to the manufacturers package insert for important details regarding the drug you are compounding. Other factors to consider include.

Reconstitution
⁃ When reconstituting a powder vial make sure the diluent is compatible with the powdered drug in the vial.
⁃ Make sure the base solution such as sodium chloride or dextrose in which you will be injecting the reconstituted or non-reconstituted solution is compatible with the drug you are injecting.

Dilution of the compounded drug in a base solution

⁃ Ask yourself. What should the maximum concentration of the drug in the base solution be? For Vancomycin shown below the maximum concentration must be 5 mg/ml if diluting 500 mg in a base solution of sodium chloride, for example. So you would dilute the 500 mg in 100 ml of sodium chloride to achieve the concentration above. This is to prevent thrombophlebitis or inflammation and clotting in the vein.

Storage requirements

⁃ Consider whether the drug you are compounding should be the only drug in a IV solution or can it be mixed with other drugs depending on what the physician has ordered. In other words, find out the IV compatibility of the compounded drug with the base solution and other drugs that may be injected into the same base solution (IV bag) if the physician order calls for it.

Single dose vs Multi-dose
⁃ Make sure you’re not drawing multiple doses out of single-dose vials which are included in the supplies.
⁃ A multi-dose vial which is bigger may be used to withdraw multiple doses.
⁃ Ensure you have the correct size syringe and correct size needle.
⁃ See below.

Practice Labs

Complete the practice labs below and email me your answers and document your practice hours. Let me know whether you practiced on your own at home OR at your facility if applicable and send me the documentation via email as a text attachment.

• Complete ALL the labs below using the supplies you received.
• Also, if you received a filter straw instead of a filter needle then draw the liquid from the ampule with the straw first and then remove, and secure a regular needle and inject into the appropriate bag.
• Pharmacists must spend a minimum of 2 hrs practicing and documenting the practice.
• The 2 hrs also includes the final evaluation which takes about 30-40 minutes to complete.
• Pharmacy Technicians must spend a minimum of 22 hrs practicing and documenting the practice. 
• The 22 hrs also includes the final evaluation. See example below of documentation.

Example of documentation

Ertapenem Practice Lab
Order for Ertapenem 15mg/kg IV QD infused over 30 minutes X7 days to treat skin infection. Assume patient has normal renal function and weighs 140 lbs.
1. Total prescribed dose? X mg total for 7 day treatment
2. How much Ertapenem is required daily? Y mg daily
3. How much Ertapenem is required per dose? Z mg per dose

Hands On
1. How much Ertapenem is required based on your answer for #3 above? X grams
2. How much of the diluent is required to reconstitute the entire powder vial of Ertapenem? Y mL
3. Final concentration after reconstitution is Z 
4. How much Ertapenem should be withdrawn and injected into the sodium chloride IV bag after reconstitution? A mL
5. List supplies and quantity you will need to reconstitute the powder vial and draw out the appropriate volume and inject into the NaCl IV bag.
#1 vial Ertapenem 1gm
#1 10 ml of Sterile Water for Injection
#1 100 ml bag of 0.9% Sodium Chloride
#1 10cc syringe
#1 18G x 1.5 inch needle
#3 alcohol swabs

6. Document entire process including steps required prior to compounding and after compounding. See a partial example below.

Once finalized order is processed through Pharmacy software, print appropriate labels and compounding record.
Gather all supplies and product needed to complete compound.
Wipe down all containers and items with disinfectant product that you will be taking into the buffer room.
Place prepped supplies into ante room.
Begin by donning shoe covers (one foot at a time and once shoe cover is placed over shoe, step over line of demarcation).
Next, don a mask and a bouffant ensuring that all hair is tucked into bouffant. If facial hair is present, don a beard cover.
Using a nail pick, clean underneath each nail ensuring that water is running the entire time and nail pick is run under water after each finger.
Once nails have been cleaned, begin to wash hands. Wash up to each elbow continuously lathering for a minimum of 30 seconds.
Rinse hands and arms always keeping hands above elbows and allowing water to drain off elbows.
Dry hands with sterile lint free wipes. Pat dry and work from hand to elbow without going back up your arm.
Next, open package of sterile gown and unfold gown being sure to keep the gown from touching the floor or any carts or sink.....

**The example above isn't complete, it's to give you an overall picture of what needs to be documented. Document for each lab based on the questions for each lab and document the steps that must occur before the compounding step and during compounding.

Example of practice and documenting hours

Hours spent on the practice labs must be documented. See the example shown below.

***The practice lab documentation may differ from what is shown below. However, use the same overall format as below.

Name/ Title:	Shelby W., Pharmacy Technician
Day & Date	Activity Performed	Number of Hours
Wednesday 07/20/2022	Hand Hygiene, Garbing, Practice Aseptic Technique by making Gentamicin Irrigation for bladder in IV room.	3
Thursday 07/21/22	Hand Hygiene, Garbing, Practice Aseptic Technique by making Vancomycin in Elastomeric Pump	3
Wednesday 07/27/22	Hand Hygiene, Garbing, Practice Aseptic Technique by making Vancomycin in Elastomeric Pump	3
Wednesday 07/27/22	Hand Hygiene, Garbing, Practice Aseptic Technique by making Gentamicin Irrigation for bladder in IV room.	3
Wednesday 08/10/22	Hand Hygiene, Garbing, Practice Aseptic Technique by making Gentamicin Irrigation for bladder in IV room.	3
Wednesday 08/17/22	Hand Hygiene, Garbing, Practice Aseptic Technique by making Gentamicin Irrigation for bladder in IV room.	3
Wednesday 08/24/2022	Hand Hygiene, Garbing, Practice Aseptic Technique by making Gentamicin Irrigation for bladder in IV room.	3
Wednesday 08/24/2022	Hand Hygiene, Garbing, Practice Aseptic Technique by making Ceftriaxone IV push in IV room	0.5

Ertapenem Lab

The physician wrote an order for Ertapenem 15mg/kg IV QD infused over 30 minutes X 7 Days to treat a patient’s skin Infection. Assuming the patient has normal renal function, weighs 140 lbs and is an adult.

*Round the weight in KG up or down to the nearest tenth when converting lbs to kg and answer the following questions.

1. What is the total prescribed dose?
2. How much of the Ertapenem is required daily?
3. How much of the Ertapenem is required per dose?

Hands-on Practice

**Look up dilution information for Ertapenem here: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=468105b9-48b3-4477-82c7-e7fb92460e28&type=display

1. Calculate how much Ertapenem is required based on your answer for #3 above?
2. How much of the diluent is required to reconstitute the entire powder vial of Ertapenem?
3. What is the final concentration in the vial after reconstitution?
4. How much Ertapenem should be withdrawn and injected into the sodium chloride IV bag after reconstitution?
5. List the supplies and quantity (how many syringes, needles etc.) you will need to reconstitute the powder vial and draw out the appropriate volume and inject into the NaCl IV bag that is provided.
6. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Vancomycin Lab

The physician wrote an initial order for Vancomycin 15mg/kg IV Q8H to be infused over 30 minutes and subsequent doses to be determined per pharmacy protocol to treat a patient’s MRSA (Methicillin Resistant Staphylococcus Aureus) infection.

Assuming the patient has normal renal function, weighs 70 lbs and is an adult.

*Round the weight in KG up or down to the nearest tenth when converting lbs to kg and answer the following questions.

1. What is the total prescribed dose?
2. How much of the Vancomycin is required initially?
3. How much of the Vancomycin is required per dose?

Hands-on Practice

*Look up the dilution information for Vancomycin here: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=07834f80-a546-47b0-b899-8649fb1a5fbc&type=display

1. Calculate how much Vancomycin is required based on your answer for #3 above.
2. How much of the diluent is required to reconstitute the entire powder vial of Vancomycin?
3. What is the final concentration in the vial after reconstitution?
4. How much Vancomycin should be withdrawn and injected into the sodium chloride IV bag after reconstitution?
5. List the supplies and quantity you will need to reconstitute the powder vial and draw out the appropriate volume and inject the volume into the IV bag that is provided.
6. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Tranexamic Acid Lab

The physician wrote an initial order for Tranexamic acid 15mg/kg IV Q8H over 16 hrs to be infused over 15-30 minutes and subsequent doses to be determined per hospital protocol for a patients knee surgery.

Assuming the patient has normal renal function, weighs 100 lbs and is an adult.

**Round the weight in KG up or down to the nearest tenth when converting lbs to kg and answer the following questions.

1. What is the total prescribed dose?
2. How much of the Tranexamic acid is required per initially?

Hands-on Practice
1. Calculate how much Tranexamic acid is required based on your answer for #2 above.
2. How much Tranexamic acid should be withdrawn and injected into the sodium chloride IV bag?
3. List the supplies and quantity you will need to draw out the appropriate volume and inject the volume into the IV bag that is provided.
4. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Ampule manipulation

For this lab you will be performing a straight draw from an ampule and drawing out the entire contents of the ampule and injecting into the IV bag.

1. List the supplies and quantity required to perform this manipulation.
2. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Final Evaluation Lab - ONLY TO BE DEMONSTRATED IN FRONT OF THE INSTRUCTOR

For this lab…

The physician ordered the following meds to be added to the 100 mL NaCl bag (or the TPN bag) if you received that instead.

⁃ 12mM of sodium phosphate (based on the phosphate content)
⁃ 500 mg calcium gluconate
⁃ 2 mL of trace elements from the ampule
⁃ 2 mL of the reconstituted powder solution IF you received a small powder vial OTHERWISE IF you received a 10 mL powder vial reconstitute it to a concentration of 300 mg/ml.

Based on the details above and the supplies provided for this lab… 
1. How many mLs of sodium phosphate are required?
2. How many mLs of calcium gluconate are required?
3. How much diluent is required to reconstitute the powder vial? This question applies if you received a 10 mL powder vial. If you received the small 2 mL powder vial then add 2 mLs of diluent to the powder vial.
4. What is the final concentration of the solution in the reconstituted vial? (will not apply if you received the small 2 mL powder vial)
5. List the supplies and quantity required to perform this manipulation.
6. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Email me your answers for everything above and the documentation as explained above.