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Part 5: Data Entry & EHR Mastery (New Track)
Module 19: Meditech (Expanse) — Order Entry & Verification
19.4 Compounding & Labels: From Digital Order to Physical Product
Mastering the Meditech workflow for generating, queuing, and verifying sterile and non-sterile compounded medications.
Your clinical verification of an order is the critical first step, but it is not the last. For any medication that is not a pre-packaged unit dose, your “Verify” click initiates a complex physical manufacturing process within the pharmacy. This is where the digital instruction becomes a tangible, patient-specific product. This masterclass will illuminate the often-unseen world of the pharmacy’s compounding workflow as managed by Meditech. You will learn how the system generates compounding requests, how these requests are organized into dedicated work queues for pharmacy technicians, and how the Meditech-generated label serves as a comprehensive “worksheet” for safe preparation. Most importantly, you will understand your own crucial role in this process, from setting the initial parameters like Beyond-Use Dating (BUD) to performing the final physical check of the compounded product. This knowledge is essential for every hospital pharmacist, as it connects your clinical decisions directly to the safety and integrity of the physical medications leaving the pharmacy.
Retail Pharmacist Analogy: The Handwritten Recipe Card vs. The Digital Kitchen Display System
In your retail practice, when you need to compound “Magic Mouthwash,” the process is often manual. You might have a recipe card taped to the cabinet. You write the prescription label, hand-calculate the ingredient quantities, and perhaps make a manual log entry in a compounding notebook. It’s a self-contained, paper-based workflow that relies heavily on your personal oversight.
The Meditech compounding workflow is like the sophisticated Kitchen Display System (KDS) in a large, high-volume restaurant. When you verify a STAT IV antibiotic, you are the “server” entering the order. Your click doesn’t just print a ticket; it sends a digital order to a specific “station” (the IV Room monitor). This digital ticket on the KDS tells the “chef” (the pharmacy technician) exactly what to make, provides the step-by-step recipe, and tracks how long the order has been pending. When the dish is ready, the chef marks it as complete, and it appears on the “expeditor’s” screen (your final check queue) for quality control before it goes out to the “customer” (the patient). Meditech transforms compounding from a manual art into a tracked, queued, and standardized manufacturing process.
19.4.1 The Genesis of a Compounding Request: The Power of the “Verify” Click
The entire compounding workflow begins the moment you, the pharmacist, verify an order in the PHA module for a medication that does not exist as a pre-packaged, ready-to-dispense product. Meditech’s medication dictionary is the “brain” that drives this process. Each entry in the dictionary is flagged with a “dispense source.” Your verification action triggers a different downstream workflow based on this flag.
19.4.1.1 The Three Primary Paths
Path 1: Unit Dose / ADC
For a simple order like “Lisinopril 10mg PO DAILY,” the dictionary knows this is a standard tablet. Your verification action “profiles” the order to the patient’s floor ADC, allowing the nurse to withdraw it. No compounding is needed.
Path 2: Sterile Compounding
For an order like “Cefazolin 1g IVPB,” the dictionary identifies this as a sterile product that must be prepared in the IV room. Your verification action generates a new task in the IV Compounding Queue and prints a detailed label/worksheet in the clean room.
Path 3: Non-Sterile Compounding
For an order like “Magic Mouthwash,” the dictionary flags it as a non-sterile compound. Your verification generates a task in the Extemporaneous Compounding Queue and prints a label in the designated compounding area.
Your single verification click acts as a triage officer, reading the order’s DNA from the medication dictionary and routing the manufacturing task to the correct department within the pharmacy.
19.4.2 The Technician’s View: Navigating the Compounding Queue
Pharmacy technicians are the skilled workforce responsible for the physical preparation of these medications. They do not work from your verification queue. Instead, they operate from dedicated compounding queues within Meditech, which are populated by the orders you verify. These queues are their primary tool for managing and prioritizing their work.
19.4.2.1 Simulated Meditech IV Compounding Queue
This queue is organized to help technicians prioritize based on urgency and due times.
-------------------------------------------------------------------------------------------- | Status | Priority | Due Time | Patient Name | Location | Medication | -------------------------------------------------------------------------------------------- | NEW | STAT | 09:15 | DOE, JANE | ICU-03 | Norepinephrine Drip | | NEW | ASAP | 09:30 | SMITH, JOHN | ED-07 | Vancomycin 1.5 g IVPB | | PREP | ROUTINE | 10:00 | WILLIAMS, SARAH | 5N-512A | Cefazolin 1 g IVPB | | CHK | ROUTINE | 10:00 | DAVIS, KAREN | 3S-304B | Potassium 20mEq IVPB | | NEW | ROUTINE | 12:00 | MILLER, ROBERT | 4W-401A | Metronidazole 500mg IVPB | --------------------------------------------------------------------------------------------
19.4.2.2 Decoding the Compounding Statuses
| Status | What It Means | Technician’s Action | Pharmacist’s Role |
|---|---|---|---|
| NEW | A new, verified order is waiting to be prepared. | Select the order, print the label/worksheet, gather ingredients. Change status to PREP. | Your verification created this task. |
| PREP | “In Preparation.” An item is actively being compounded. | Physically prepare the medication according to the worksheet. | Situational awareness. You know the product is being made. |
| CHK | “Check.” The product is fully prepared and is awaiting a pharmacist’s final physical check. | Bring the finished product, the original worksheet, and all used vials/syringes to the checking pharmacist. | This is your next action item. These items form your “product verification” queue. |
| DISP | Dispensed / Verified | Place the checked product in the correct delivery bin. | You assign this status after your final physical check, documenting that the product is safe to leave the pharmacy. |
19.4.3 Masterclass: The Meditech Label as a Compounding Worksheet
In Meditech, the label that prints in the IV room is far more than a simple dispensing label; it is a comprehensive, multi-part “worksheet” that serves as the blueprint for the entire compounding process. It is the primary tool the technician uses to ensure they are making the product exactly as you verified it.
19.4.3.1 Anatomy of a Meditech IV Worksheet
| Section of Worksheet | Content | Safety Purpose |
|---|---|---|
| Patient Header | Patient Name, MRN, Location (Room #), DOB. | Links the physical product to the correct patient from the moment of creation. |
| Final Product Details | Generic Name, Final Dose, Base Solution, Final Volume, Final Concentration. | Defines the goal: what the finished product should be. The final concentration is critical for drips. |
| Compounding Instructions (“Recipe”) | A clear, step-by-step list of actions. Example: 1. Withdraw 10 mL from Cefazolin 1g vial. 2. Inject into 100 mL NS bag. 3. Affix label and gently agitate. |
This is the core instruction set, removing ambiguity and standardizing the compounding process for every technician. |
| Ingredient List | A list of all required components, often with scannable barcodes next to each. E.g., Cefazolin 1g Vial [BARCODE], NS 100mL Bag [BARCODE]. | If integrated with IV workflow software, the technician must scan these barcodes, providing a hard-stop safety check to ensure the correct ingredients are used. |
| Beyond-Use Dating (BUD) | A prominent, clearly displayed field showing the precise date AND time the product is no longer stable/sterile. E.g., BUD: 10/05/2025 @ 14:30 |
Ensures compliance with USP <797> and prevents administration of an expired product. This is one of the most critical pieces of information you, the pharmacist, are responsible for setting. |
| Auxiliary Warnings | Large, bold-print warnings. E.g., “HIGH ALERT,” “CHEMOTHERAPY,” “REFRIGERATE,” “PROTECT FROM LIGHT,” “FOR CENTRAL LINE USE ONLY.” | Provides critical, at-a-glance handling and administration instructions to every person who touches the bag (technician, checking pharmacist, delivery person, nurse). |
19.4.4 The Pharmacist’s Crucial Role: Setting and Verifying Beyond-Use Dating (BUD)
Beyond-Use Dating is a fundamental concept of sterile compounding governed by USP Chapter <797>. It is not the same as a manufacturer’s expiration date. A BUD is determined by the stability of the final compounded product. As the verifying pharmacist, you are the final authority on the BUD assigned to every sterile product.
Expiration Date vs. Beyond-Use Date
Expiration Date: Set by the manufacturer for the pure, unopened drug vial. Example: Cefazolin vial expires 12/2026.
Beyond-Use Date (BUD): Set by the pharmacy based on stability data *after* the drug is mixed into a solution. Example: Cefazolin, once mixed in a D5W bag, is only stable for 24 hours at room temperature or 14 days refrigerated. The BUD reflects this much shorter stability.
Applying the manufacturer’s expiration date to a compounded product is a serious error that can lead to administration of a sub-potent or degraded drug.
19.4.4.1 The Meditech Workflow for BUD Capture
- Verification-Time Setting: When you verify an IV order in the PHA module, Meditech often presents a mandatory “BUD” field.
- System Defaults: For common products, the Medication Dictionary is pre-configured with standard BUDs based on reference data (e.g., King’s Guide, Trissel’s). The system might auto-populate “24 Hours” for a simple antibiotic.
- Your Clinical Responsibility: You cannot blindly accept the default. You must mentally verify it. Does this drug have unusual stability issues? Is it light-sensitive, requiring a shorter BUD if not protected? For complex compounds like TPNs or chemotherapy, you may need to consult stability references and manually enter a custom BUD.
- Transmission to Label and eMAR: The BUD you confirm during verification is the BUD that prints on the compounding worksheet. This same data is also often transmitted to the eMAR in PCS. This provides a final safety check at the bedside; the nurse’s scanning system may alert them or prevent administration if they attempt to scan a product whose BUD has already passed.
19.4.5 The Final Check: Your Last Line of Defense
After a technician has prepared a product, they change its status to “CHK.” This is your summons. The physical product, the compounding worksheet, and all the “pullbacks” (the empty vials and syringes used) are brought to you for the final product verification. This is your last chance to catch a physical error before the medication leaves the pharmacy.
19.4.5.1 A Systematic Approach to Product Verification
The “Syringe Pullback” Method
This is a core technique for checking. The technician must present the final bag alongside the exact empty vials they drew from and the exact syringes they used, with the plunger pulled back to the volume they drew up. This allows you to visually reconstruct the entire process.
- Worksheet to Vial: Does the name on the empty vial exactly match the ingredient on the worksheet?
- Worksheet to Syringe: Is the syringe plunger pulled back to the precise volume specified in the recipe?
- Worksheet to Bag: Does the final base solution bag (e.g., D5W 100mL) match the worksheet?
- Visual Inspection: Is the final product clear, colorless, and free of any cores, floaters, or particulate matter? Is there any sign of chemical incompatibility (precipitate, color change)?
- Label to Worksheet: Does the final label accurately reflect all patient and product details? Is the BUD correct?
Only after you have confirmed every one of these steps can you safely approve the product.
Your Meditech Workflow: After completing your physical check, you return to the Meditech Compounding Queue. You find the item in the “CHK” status, select it, and perform the final action: changing the status to “Verified” or “Dispensed.” Your digital signature is now attached to that physical product, creating a permanent, auditable record that you personally approved its safety and accuracy. The product is now ready for delivery to the nursing unit.
