Extemporaneous Compounding in Queensland Hospitals

Background Extemporaneous compounding is common pharmacy practice when commercially‐available registered products do not exist. While extemporaneously compounded preparations provide access to medication, there are concerns about the quality, safety and efficacy of these products. Aim To examine the extent and quality of extemporaneous compounding within Queensland public hospital pharmacy departments from an organisational perspective. Method An e‐mail questionnaire was sent to all Queensland public hospital pharmacy departments staffed by pharmacists requesting details of their extemporaneous dispensing activities. A computer search of manufactured formulations on the Queensland Health pharmacy information management system was used to supplement data obtained from the questionnaire. Results 95 formulations were prepared by 28 hospital pharmacies. Different formulations of the same active ingredient were recorded in 7 instances. Stability data supporting assigned expiry dates was available for 74 (78%) preparations. Other issues with potential to impact on patient safety included extrapolation of stability data from other formulations and product type, multiple presentations and strengths of the same formulation, and the use of alternative dosage forms as a source for active ingredient in 70% of preparations (90% of mixtures and suspensions). Conclusions The results identified areas for improvement to the quality of extemporaneous compounding. These include use of stability data to assign expiry dates, standardisation of formulation, and use of raw material as a source of active ingredient. Utilisation by hospital pharmacies of a resourced, central manufacturing facility is identified as a potential vehicle to achieve these improvements.