National study of extemporaneous preparations in English paediatric hospital pharmacies

Abstract

Background: Licensed formulations are not always suitable for young children. Pharmacy departments at paediatric hospitals produce in-house extemporaneous preparations for children. The Department of Health in England has recently announced a major investment in hospital production units to improve the manufacturing facilities. However, there is no published systematic study to investigate the extemporaneous production activities in paediatric hospitals in England in order to support future planning. Objectives: To identify the methods, frequencies and types of medications prepared extemporaneously in the pharmacies of paediatric hospitals in England and the percentage of above preparations that were available from specials manufacturers. Methods: A national survey of in-house extemporaneous preparations by the seven paediatric hospitals in England was conducted over a period of 12 months. The drug, type of product and frequency of each preparation were recorded, and analysed. Results: All seven hospitals (100%) replied to our survey. On average, 1.5 items per day per hospital were manufactured. The top 20 drugs represented more than 58% of the workload, indicating the repetitive nature of the work. 76% of the final preparations were in liquid dosage forms. Only 27% of medicines extemporaneously prepared were unlicensed chemical entities. However, 50% of the extemporaneous products made could be provided by specials manufacturers. Conclusions: The extent of extemporaneous dispensing in paediatric pharmacies was lower than anticipated. The top 20 commonly used drugs (58% of the workload) could be produced by licensed units or specials manufacturers to reduce the risk of production errors. As the diversity of strengths of the same medicines that are produced in different centres creates opportunities for medication errors, the idea of establishing a national extemporaneous formulary to standardise the strengths and presentations should be explored.