CIVA-TPN Rotation VGH & RJH APril 19th to May 7th
Weeks 1-3
1. TPN Clinical Concepts: The resident will demonstrate their basic knowledge regarding TPN compounding and clinical application by completing an open book quiz testing information found in the pre-readings.
Answers to quiz: Adult TPN Learning Questions
2. TPN Order Editing for clinical appropriateness: The resident is able to perform Adult, Pediatric & Neonatal TPN order checking by reviewing the orders for basic clinical appropriateness.
April 20th-Reviewed adult TPN learning cases and reviewed clinical parameters to monitor with 3 adult TPN patients
April 21st-Reviewed neonatal learning tool to assess orders and adjust orders based on clinical parameters and practiced with 1 neonatal TPN patient. Also completed neonatal TPN quiz.
April 22-Attended TPN rounds and calculated orders for 2 neonates based on current lab work and clinical diagnosis.
April 26th- Checked Pediatric TPN for appropriate electrolytes & iodine content
April 27th-Checked 1 Pediatric and 1 adult TPN for electolytes and iodine content
April 28th-Checked 1 adult TPN for appropriateness based on lab values
May 7th- Checked 2 adult TPN for appropriateness based on lab values
3. TPN Order Editing for Stability: The resident will be able to check TPN for physical compatibility and stability for both 3-in-1 emulsions and 2-in-1 solutions utilizing the “Calculation Worksheets”
April 20th-3 adult patient calculations
April 21st-1 neonatal patient calculation & 1 neonatal paper case calculation
April 22-1 pediatric new TPN & 1 adult TPN
April 26th- 1 neonate new TPN & 1 adult TPN
April 27th-1 neonate new TPN, 1 adult new TPN
May 7th- 2 new adult TPNs
4. TPN Order Entry & Verification: The resident will become familiar with checking as well as entering TPN orders into the clinical computerized TPN program for the three patient populations: adult, pediatric, and neonatal. With a sterile product technician the resident will:
- Enter a minimum of 5 adult TPN orders (IIIII)
- Enter a minimum of 3 neonatal orders (III)
- Enter a minimum of 1 pediatric TPN (if available. Note: Pediatric TPN will also be covered during their pediatric rotation.) (III)
- Verify a minimum of 10 TPN orders – at least 3 of them neonatal if possible. (IIIIIIIIIIIIIIII)
Other duties:
-Entered and verified: 3 neonatal specialty bags,Sulfamethoxazole-trimethoprim desensitization protocol
-Checked products: 3 cloxacillin sets of pediatric syringes, 1 neonatal vancomycin, 2 methotrexate syringes, 1 ceftriaxone syringe, 3 neonatal specilaty bags, 1 study product (parenteral)
-Shadowed-Initiation and randomization of a study medication in CIVA
-Watched 3 videos on aseptic technique and chemotherapy medication preparation on April 29th
-May 4th-Made 24 vancomycin 250mL bags (reconstitution), 25 pre-op cataract syringes, 14 heparin bags (milking), broke 2 haloperidol ampules and transferred drug into a minibag using a filter needle, watched pip-tazo CADD bag and ceftriaxone minibag plus preparation procedures and one study drug reconstitution (ACCESS).
-May 6th-Checked 13 Vanco home IV bags, 4 ceftriaxone home IV bags, 1 adult TPN, 1 Lidocaine infusion stat, entered LYFLUDR-checked labs, protocol, orders, calculated doses, CrCl, BSA
-May 7th-Assessed blood work for 2 azacitidine patients-lab work was out of range so it was not appropriate to enter orders, made next weeks slate for IV and chemo drugs, worked on 2 adult TPNs, entered 2 mitomycin opthalmic preparations and 1 5-FU opthalmic syringe and entered patient allergies
Aseptic technique knowledge, skills and abilities.
- Demonstrates ability to make calculations related to preparation & administration of parenteral products.
Written exam: “VIHA Aseptic Compounding Certification Math Exam” (ACCE) will be carried out during CIVA rotation to solidify compounding math knowledge. Exam will be provided and will be marked and reviewed with the preceptor.
- Describe and demonstrate the correct procedure for washing hands, donning gowns and gloves for entry into the aseptic compounding room.
- Describe basic concepts/procedures such as critical site, powder displacement, venting vs. milking withdrawal techniques and demonstrates these techniques when preparing sterile products by:
- Preparing at least 10 minibags using a vial that requires reconstitution: (24 vanco bags)
- Preparing at least 1 parenteral product that requires the breaking and withdrawal of solution from an ampoule: (2 haloperidol ampoules)
Chemotherapy – The resident will become familiar with BCCA chemotherapy protocols and clinical editing procedures.
- Resident will edit a minimum of 2 BCCA chemotherapy protocol orders using the appendices to Policy 4.7.2 Cytotoxic Admixtures: Order Edit and Set Up:
Order Entry of Parenteral Products – The resident will become familiar with entering infusion orders with single ingredients and multiple ingredients.
- Resident will enter a minimum of 3 chemotherapy or other infusion orders that are entered in CIVA format with the sterile products pharmacist preceptor: (entered: , LYFLUDR, 2 mitomycin opthalmic preparations, 1 5-FU opthalmic syringe ), (helped enter: SMX-TMP desensitization protocol, LYRITUX, infliximab), (assessed 2 azacitidine orders from monogrpah [no protocol yet] but bloodword was out of range so they could not be entered)
Automated equipment – The resident will become familiar with automated equipment used to facilitate aseptic compounding such as repeater pumps, syringe fillers, and the automated TPN compounder.
- Resident will set up the automated syringe filler with a technician to compound a minimum of ~100 syringes.
- Resident will prime and calibrate the automated TPN compounder in the presence of a certified technician checker or a trained pharmacist.
