In this section
Our manufacturing workload may be divided into two types - sterile and non-sterile
Different processes of manufacture are used:
Three cross-flow laminar cabinets are used, and located inside a
positive-pressure clean-room. Operators wear Clean Room gowns,
gloves, boots and masks, and follow washing-up procedures before
entering the clean room. Regular checks of various quality control
(QC) procedures are undertaken including: Horse Blood Agar plates
(HBA), Addicheks, Tween 80 plates, assays, pyrogen testing.
Patient specific parenteral nutrition is a hallmark product of
the sterile suite.
The senior pharmacist in manufacturing attends the Nutrition
Support Service ward rounds twice weekly to assist in coordinating
and streamlining manufacture and planning nutritional goals and
Prescribers are able to vary the volume of fluid, the amino acid
content, the carbohydrate (glucose) concentration and the amounts
of various electrolytes, based on 6 standard formulas.
Vitamin additions vary according to the age and weight of
patients. Other optional additives include selenium, carnitine,
ascorbic acid and zinc. A solution of necessary trace elements is
manufactured by the department and added to each nutrition formula.
Biochemical parameters are monitored to reconcile electrolyte
orders in the TPN solutions and ensure the formula is appropriate
with respect to renal and liver function, blood glucose and serum
triglyceride measurements. Infusion rates are calculated and
monitored to ensure manufacture of an adequate supply whilst
All solutions are prepared under aseptic conditions in laminar
flow cabinets and undergo final filtration. A computer program,
developed by the pharmacy department, allows the printing of
worksheets to facilitate TPN preparation.
Other sterile preparations include:
Numerous other items are made and 'once-off' products may be
prepared following research into stability and sterility
All bulk-manufactured products are kept in quarantine until all
quality control results have been received and are
Cytotoxic additives for inpatients and outpatients are made in
downflow cabinets in the oncology pharmacy. Drugs to be
administered via a central line for immunosuppressed haematology
and oncology patients are made in the oncology pharmacy.
Pharmaceutical requirements in a paediatric hospital are unique
as smaller doses are required and the difficulties in administering
those doses make it necessary to produce a large number of
non-standard formulations. The department compounds a wide range of
products for oral, topical or rectal use. Many standard products
use official formulas, but for others 'non-standard' formulas
exist. These may be products that have been effectively used in
other institutions, quoted in journals or supplied by drug
The department manufactures many oral liquid preparations (i.e.
mixtures) of commonly used drugs. When products are insoluble or
unstable in mixture form, powders may need to be made. Individual
powder preparation requires considerable time and effort. In other
cases, doses can be packed into empty gelatin capsules.Often
tablets or capsules need to be crushed to be incorporated into a
compound preparation. Other products such as paracetamol and
diazepam are formulated into suppositories or enemas to facilitate
Please contact Drug Information on 03 9345 5208 for more