KR20010101928A - Method and apparatus for controlling the strategy of compounding pharmaceutical admixtures - Google Patents

Abstract

A method and apparatus for controlling the compounding of pharmaceutical parenteral admixtures id disclosed. The apparatus preferably comprises a computer that contains a memory for storing instructions for operating the apparatus and for controlling compounders that prepare a prescription admixture, with the memory including data relating to a plurality of the pharmaceutical components that may be transferred to prepare the prescription admixture, and data concerning the operating characteristics of the compounders that the apparatus is adapted to control. The apparatus determines the order of admixing by general rules of admixing and by categorized compatibility groups of components, so that the number of rinses that must be done are minimized.

Description

TECHNICAL AND APPARATUS FOR CONTROLLING THE STRATEGY OF COMPOUNDING PHARMACEUTICAL ADMIXTURES

Pharmaceutical parenteral mixtures are combinations of bactericidal agents that are mixed with one another and injected intravenously under sterile conditions. These mixtures can be relatively simple or very complex and the complexity increases as they contain multiple active ingredients. Nutritional mixtures are examples of complex parenteral mixtures that are formulated primarily in hospital pharmacies to treat patients in hospitals. Generally, parenteral nutritional mixtures (“PNs”) refer to most forms of nutrient solutions for intravenous feeding. Total parenteral nutritional mixture (“TPN”) generally refers to PNs that do not contain lipid components, and total nutritional mixture (“TNA”) refers to PNs that contain lipids.

In a hospital's pharmacy, pharmacy, or nursing facility, a prescription is usually made by a doctor alone or by a pharmacist or other caregiver. Pharmacists may have to prepare large amounts of PN every day. Substantial PN preparations are primarily performed by an electromechanical preparation facility, which is intended to mix different ingredients in different proportions, as set in pharmaceutical formulations, and is referred to as a highly complex and delicate compounder.

Formulators are generally high-volume formulators which have been found to occupy relatively high solubility in PN, for example by formulating PN by delivering components such as amino acids, sterile water, lipids and dextrose at a relatively high speed. Such dispensing machines include AUTOMIX 3 + 3 dispensers manufactured by Clintec Nutrition Division of Bexter Healthcare Corporation.

Dispensers also include low volume dispensers, such as those manufactured by the company, such as the MICROMIX dispenser. Micromix dispensers are generally intended to deliver exactly the components found to be relatively small in PN.

Pharmacies commonly use both micromixes and automixes, which typically add high volume components to the final container or final bag as an automix dispenser to deliver the final sacks to a micromix dispenser for transporting small volume components. Thereby producing the prescribed PN. A single component may have the ability to deliver both high volume and small volume components, either sequentially or simultaneously. Alternatively, a single dispenser could have both a high volume module and a low volume module capable of delivering fluid to a common manifold, a common delivery tube connected to a final bag or container, or to individual ports in the final bag.

In order to prepare such a PN at an appropriate cost, it is important that the PN be prepared as efficiently as possible. Efficiency is generally achieved by exploring to maximize the number or “production” of PN prepared over a period of time. However, the complexity of preparing PN properly tends to lower this yield. By determining the appropriate PN for a given prescription for a particular patient, it can be seen that it is a complex area to accurately prepare a PN, explain the PN, or write a bill. However, patient safety is of paramount importance and efficient PN preparation must be achieved while eliminating the possibility of error.

In formulating appropriate prescriptions for special patients, pharmacists must perform many tasks, including evaluating and determining the appropriate ingredients and their respective quantities. Specific factors of the patient, including patient type, namely the weight of the newborn, patient are taken into account. Increasing the pharmacist's ability in making these assessments and decisions increases production and reduces the likelihood of errors. For record keeping purposes, it is desirable and sometimes required for a pharmacist to record on permanent records why the prescription differs from the amount of source solution normally required.

As is known in practice, many of the complexity involved in preparing PNs is due to compatibility issues associated with the components present in the prescribed PNs. Compatibility is defined as the interrelationship between a medicament and all other ingredients including, but not limited to, the medicament to which the medicament comes into contact. Compatibility is divided into two subcategories: physical and chemical compatibility. Physical compatibility is defined as the degree of incompatibility that alters the physical appearance of a medicament and is usually manifested in visible changes such as precipitation, gas release or discoloration. Chemical incompatibility is not visually observed but should be assayed. Chemical incompatibility occurs as a result of changes in active medication such as oxidation or optical sensitivity. Factors that may affect the compatibility include, but are not limited to, the total dilution volume, concentration level, preparation sequence, and pH.

There are two stages in the evaluation of compatibility and non-curable mixtures. In the first step, the compatibility of the total PN over the period between preparation of the mixture and completion of delivery to the patient should be assessed prior to preparation. In the second step, the preparation process must be strategyed in a way that allows compatibility during the preparation process. For example, the degree of compatibility between the source solution added to the final mixing vessel or any intermediate mixing vessel and the solution present in the vessel should be evaluated. In many cases, source solutions packaged at concentrations that are not compatible with other solutions must be diluted before they contact each other in such chambers.

As can be seen, the highest dilution occurs when the maximum amount of dilution fluid is already present in the container to which the solution is added. For example, an amino acid or dextrose source solution will form most of the PN but will usually be compatible with most additives. These solutions thus appear first to be delivered to a final vessel or any intermediate mixing chamber to dilute the added source solution.

Another complexity that must be considered is to prevent contact between high concentration solutions that do not blend with each other along a common flow path in the dispenser. In an exemplary case, although the source solution may flow along separate tubes for many conveying flow paths, there may be a zone along the conveying flow path common to the two incompatible source solutions. The common flow path can be found along any portion of the flow path, such as in the intermediate mixing chamber or after the intermediate mixing chamber or after the switching valve.

One way to reduce the likelihood that a solution will not be compatible with a second solution along the common flow path is to flush the common flow path after each solution is delivered. This spill wash is achieved by a solution that is compatible with both the preceding solution and the solution to be added after the spill wash. As can be seen, frequent flush washes make them compatible by diluting the incompatible solution but reduce the yield.

There must also be a source of fluid for this flushing scheme. This source of spill cleaning solution may be a compatible source solution that forms part of the prescription or a solution present in a downstream chamber, such as a mixture in the final mixing vessel. However, in current formulation practice, the prescribed amount of solution used as a spill wash solution is typically first delivered to the final container for convenience and dilution purposes, and has no utility as a spill wash solution. In this case and of course the solution in the final bag must be compatible with the solution to be rinsed off, and the rinsing solution is withdrawn from the final container. Taking the spill treatment solution out of the final bag and returning it to the final bag reduces the yield. On the other hand, leaving the amount of dilution source solution for shed cleaning may cause the two incompatible solutions to contact each other in the final mixing chamber without properly diluting to compatible concentrations.

In an effort to increase efficiency, pharmacists typically classify solution containers according to the operating schedule of the dispenser so that the ingredients that are compatible with each other (at the source solution concentration) are sequentially added to each other between the rinses set by the pharmacist. do. After making a decision regarding the compatibility of the various solutions, the pharmacist sorts the set of compatible solutions at stations 1 to 4, and the station 5 is set with cleaning after the station 4, station 8, etc. To 8) and the like, the second set of compatible solutions can be classified. However, special mixtures may require five solutions that are compatible. Since setting up the cleaning requires more time and effort, the pharmacist may add the fifth component at the station having the cleaning before and after rather than adjusting the station alignment and cleaning schedule. However, this is not the best.

Another thing a pharmacist should consider when formulating multiple formulations containing a mixture of TNA and TPN is lipid hazing, where trace amounts of lipids will be present in the final solution that does not contain lipids. Hazing may be produced by lipids present in amounts as low as 1 to 3 ppm (part per million). Such hazing typically occurs when a formulation containing lipids is formulated immediately prior to a formulation containing no lipids. Lipid hazing is generally not considered to be dangerous to health, but lipid hazing in the PN to be injected can be wrong for PN by causing unacceptable precipitation when formulating a compatible PN solution later. The hazing solution may be disposed of incorrectly.

If lipid hazing is a problem, the pharmacist can seek to prevent this problem by flushing the dispenser after each prescription containing lipids has been formulated. However, such shedding reduces production and is not entirely effective. To increase production, pharmacists can reduce this shedding by sorting lipid prescriptions, but this sorting has a negative impact on flexibility. If lipid hazing is not a problem, the possibility of the occurrence of lipid hazing should be communicated to the person preparing the solution and the person administering PN to the patient in order to prevent the operator from mistaken thinking that the mixture has stabilized.

Other methods have been used to prevent lipid hazing to completely separate the flow path for lipids to the final mixing vessel. However, once the lipid is present in the final vessel, flushing or rinsing with the solution from the final vessel may introduce the lipid into the flow path and cause lipid hazing in subsequent PNs.

In addition to the complexity of the preparation, the pharmacist must take into account the precision limit of the dispenser so that prescriptions with ingredients at a volume level below the precision limit of the dispenser are easy to add by hand using a syringe. This manual addition reduces production. Inherent inefficiencies in administering PN to patients, such as the residual volume in the dosage set, should also be considered. Thinking about complexity is time consuming and makes activities and tasks inefficient.

For the purpose of reimbursement and record keeping, the formulated mixture must be described, which is generally achieved by manually or electrically recording the conveying information in the facility's descriptive system. The steps that the pharmacist must perform to ensure that the mixture has been properly described should be minimized to increase efficiency.

The present invention generally relates to methods and devices for preparing and describing pharmaceutical mixtures. More particularly, the present invention relates to strategies for formulating prescriptions for parenteral admixtures, controlling compounding apparatus, and properly describing the prepared mixtures, when installed in computer software. .

1 is a block diagram showing a device operatively connected to a dispenser and a printer as the device of the invention as seen in a hospital environment with a central billing and patient computer networked to the device of the invention.

FIG. 2 is a perspective view of a representative dispenser that can be controlled by the method and apparatus of the present invention, in particular a dispenser having a funnel or intermediate container in which the source components are placed sequentially or simultaneously before being delivered to the final bag; FIG. .

3 is a perspective view of a second exemplary dispenser that can be controlled by the presented method and apparatus.

4A to 4H are flowcharts for controlling the preparation operation of the prescription mixture according to the present invention.

Accordingly, it is a primary object of the present invention to provide an improved method and apparatus for preparing and describing parenteral nutrient solutions. It is another object of the present invention to provide a method and apparatus for preparing a non-curable mixture to reduce the case of incompatibility, which will preferably accommodate many known active ingredients and other ingredients set in various prescription mixtures. Software means of the method. In particular, a related object is to provide a strategy for formulating a formulation for a parenteral mixture, controlling the dispensing device, and properly describing the prepared mixture, according to a strategy incorporated into the computer software.

Another main object of the present invention is to provide an improved method and apparatus for preparing a non-curable mixture by increasing the output of the dispenser, in principle by minimizing the wash water to be carried out.

A related object of the present invention is the order or reordering of a plurality of mixture solutions or compatibility groups that may be present in a prescription to more efficiently formulate the prescription, such as maximizing the number of prescriptions that can be formulated for a set period of time. It is an optional decision.

A more detailed object of the present invention is to provide an improved method and apparatus for controlling a dispenser in the form of an intermediate mixing chamber such as a funnel for mixing the ingredients prior to conveying the contents of the chamber to a final mixing chamber such as a final bag. It is.

Another object of the present invention is to provide a patient's special data to improve the ability of a pharmacist to efficiently formulate a mixture from prescriptions and to safely prepare it.

It is another object of the present invention to provide an improved method and apparatus that allows pharmacists to effectively offset the limitations and inefficiencies of the dispenser in administering PN to a patient, such as a fluid lost in a dosage set.

Another object of the present invention includes a high concentration of prescription formulations to replace the prescribed prescription formulations, but determines whether the dilution fluid can be provided by other compatible components to minimize the volume of the final mixture. It is to provide an improved method and apparatus.

Another object of the present invention is to provide an improved method and apparatus for warning the user when the proposed limit is not adhered to and for controlling the dispensing operation such that such warning is not inadvertently ignored.

It is another object of the present invention to provide a method and apparatus for alerting or reducing the likelihood of occurrence of lipid hazing and the likelihood that such lipid hazing is accidentally mistaken for unacceptable sediment.

These and other objects will become more apparent to those skilled in the art by the following detailed description with reference to the accompanying drawings.

Broadly, the present invention relates to a method and apparatus for controlling a preparation operation of a pharmaceutical mixture, wherein the preparation operation is one or more preparations that can be remotely located relative to a controller computer or processing means interconnected to the preparations. Is carried out by means. Referring to Figure 1, the controller computer or controller 10 has sufficient memory for storing pharmaceutical data in the form of a database and operational software for controlling dispensers and other peripheral devices. The computer 10 is preferably a multi-user, multi-tasking computer with a communication interface for interconnecting the dispensers 12, 14, 16, wireless or streamlined. Other peripheral devices, such as printers 18 and 20, connected by communication link 22, which may be may be a local area network, a wide area network, or a portion of the Internet, or a combination thereof. The computer 10 may have a display 23, a keyboard 25, and other accessories, with properties common to commercial computers.

Other peripheral devices include a dumb terminal 24 having a keyboard and display or other input device, such as a laptop computer 26 or other handheld device adapted to enter prescription and input commands for operating the controller computer software. can do. The dispenser may be located in different areas of a health care facility, such as a hospital, or on different floors of a hospital, or in different hospitals. In FIG. 1, the dispensers 12 and 14, the printer 18 and the terminal 24 are located in the hospital B, while the rest of the facilities are installed in the hospital A. In FIG. The printer is preferably located adjacent to each dispenser or combination of dispensers as shown for printing a label to be pasted onto the formulated formulation being formulated. The controller computer 10 is preferably interconnected to a general hospital computer 28 that can be used to prepare and record billing reports, among other functions.

The present invention is made to control dispensers such as dispensers 12, 14, 16. The two machines present in hospital B indicate that two different types of dispensers can be used in combination to prepare a prescription mixture, such as by way of example such as the automix and micromix described above. Thus, the dispenser 12 may be a dispenser adapted to carry a high volume additive and the dispenser 14 may be a dispenser adapted to carry a low volume additive. In addition, dispenser 16 may be adapted to carry both high volume and low volume components.

Referring to FIG. 2, a perspective view of a low flow module dispenser is shown, adapted to carry low volume components such as micronutrients and other medications from individual source vessels 30. However, the formulation mixture may be formulated by a single dispenser 16 or multiple dispensers attached to a single final bag 46 intended to carry high volume and low volume additives.

In one embodiment, when high precision is required, such as when low volume additives are added to the PN, the fluid from the vessel 30 is suspended from the load cell assembly 36 via separate individual conduits 32. Conveyed in an intermediate container or funnel 34. The load cell assembly 36 weighs the total funnel 34 to produce an output signal indicative of the amount of fluid in the funnel 36 at any given time. The funnel 34 is closed and connected to a pressure conduit 38 connected to the pressure means and to a shutoff means such as, for example, a valve 40. The pressure means is preferably a single peristaltic pump capable of selectively generating positive and negative pressures in funnel 34 to control the direction and flow of fluid to and from funnel 34. The funnel 34 is also connected to an outlet conduit 42 extending to a second blocking means 44 interposed between the funnel 34 and the final bag or container 46. By selectively operating the shutoff means 42, 44 and the pressure means, the fluid is withdrawn from the funnel and discharged. These same portions of the machine can also control the direction of the fluid so that the fluid can be carried to the final bag 46 and removed from the final bag for the purpose of cleaning the funnel 34.

US Pat. No. 5,228,485, incorporated by reference and incorporated herein by reference, is hereby incorporated by reference and specifically incorporated herein by the same assignee, as in the case of the present invention, of a detailed description of an example of a dispenser prepared to carry low volume components as of at least April 1990. Described in Currently commercially available micromix preparations embody some improvements over the '485 patent, but are believed to be similar to those described in the invention.

The dispenser 12 may also include an assembly for carrying the additives, either singly or in combination with a volumetric method, using one or more other pumping and switching mechanisms, preferably located in Inglewood, Colorado. Combination devices, such as a dispensing device commercially supplied by BAXA Corporation.

Referring to Figure 3, another embodiment of a dispenser 50 is shown that is particularly suitable for carrying large volume additives. The dispenser 50 includes a plurality of individual pumping stations 52 with a disposable delivery set 54 to pump fluid from the individual source container 56 to the final container 58. Detailed operating procedures of one example of a dispenser prepared to carry low volume components, as of at least 1999, are described in US Pat. No. 4,712,590, assigned to the same assignee as in the case of the present invention and incorporated herein by reference and specifically incorporated herein. It is. Currently commercially available automix dispensers embody some improvements over the '485 and' 349 patents, but are believed to be similar to those described in the invention.

Prescription

In one example of the process of using a preferred embodiment of the present invention, a doctor or other health care provider or group of providers determines and prescribes the parenteral nutritional supplement required by the patient. The pharmacist then needs to convert the prescription to the specific amount and concentration of the additive of PN to be administered to the patient. These amounts vary depending on the particular patient. For example, a patient may not receive a large amount of fluid parenterally, and the necessary nutrients need to be obtained in a minimal amount of fluid. One example of a fluid confined patient is a neonatal patient. In order to administer the desired amount of additive in a smaller total volume, the level of additive concentration in the final bag 46 may be higher in PN than when a larger volume of diluent is used. Such high concentrations are likely to cause compatibility problems with other additives in the PN, and may exceed acceptable limits for the patient.

Referring to FIG. 3A in the preferred embodiment, the physician enters patient identification data, such as patient ID code, into the controller using keyboard 25 (block 70). The controller 10 requests and accepts the patient's special data from a data storage location such as the computer system 28 of the facility (block 72) to display such information on the display 23. One kind of patient specific data that is preferably used by the controller 10 in a preferred embodiment is a patient type, such as premature infant, newborn, pediatric or adult. In another embodiment, the provider enters patient specific data directly into the controller 10 or storage location therein.

The controller 10 also maintains a range of acceptable concentration levels of different mixtures in the final bag 46 in storage locations. In an embodiment, the controller 10 may store the concentration ranges of the components for various patient types in the data storage location in the data storage location and set a good concentration range of the type according to the range for the particular patient. In other embodiments, ranges corresponding to patient characteristics such as various patient ages and weights may be retained at the data storage location and the controller 10 may set a good concentration range as a constitution specific range.

In another embodiment, the controller may also incorporate an algorithm to adjust the concentration range depending on certain patient specific factors, such as the age of the patient.

Thus, depending on the patient's special data, the controller 10 may adjust the range by assessing whether the good range is appropriate for the patient's special type (block 74).

The healthcare provider then enters the prescription, for example using keyboard 25 (block 76). In entering the prescription, the provider sets the concentration level of the component solution so that the PN corresponds to the prescription at the time of preparation. The controller 10 allows prescriptions to be input in several different formats. For example, the controller 10 can accept input of the component in an amount corresponding to the percentage of the final solution, the concentration per unit volume or the unit weight of the patient.

As the provider enters the prescription, the controller 10 checks the input concentration for the determined range (block 78). If a concentration outside the range is entered, an error message is shown on the display 23. In addition, if the provider enters the ingredients in an inappropriate format, an error or warning message is displayed on the display to alert the healthcare provider. An example of an inappropriate format is when concentration is entered in units of measurement per patient weight but patient weight is not entered as part of the patient's special data.

In another embodiment, the controller 10 may review the various components after all concentrations have been entered and highlight those components that are outside the range set for that component with an error message.

In other embodiments, various prescription types corresponding to various patient types may be held at the storage location. The pharmacist or controller 10 can then recall the template to accept or adjust the template. In another embodiment, the patient's previous prescription may be held in a storage location. The doctor or controller 10 may then view or adjust the conventional prescription so that the conventional prescription is used as the present prescription.

When a warning is displayed. Even if the concentration is out of range, the concentration may continue to be required by the provider's medical judgment. The controller 10 allows the provider to override (or ignore) the alert in some cases (block 82). The controller 10 allows override when any one factor or combination of factors occurs. One argument is whether the provider entering the prescription has clearance to override the special warning. Each warning may require a different level of free space before the override is accepted. Some warnings can't be overridden.

The identification and free space level of the provider may be set by a unique password required by the controller 10 so that it can be entered at an appropriate time, such as at the start of prescription entry or when an alert occurs (block 84). Other methods for identifying the provider may be considered such as key cards, retinal scans, and the like.

In addition to installing the provider's free space, for record keeping purposes, the provider also confirms that the error message is recognized. The controller 10 may require that the basis for the override be entered into the recording screen displayed on the display 23. In any warning situation, controller 10 does not allow any overrides on the basis of block (block 86).

Compatibility classification

Preferred embodiments of the present invention evaluate the compatibility of the components with the solution that the components are in contact with during the preparation process and the solution in the final solution bag 46 after completion of the preparation.

In current practice, the evaluation of the final prepared PN is a routine procedure performed by pharmacists. The pharmacist compares the components of the final prepared mixture with a printout with information concerning the degree of compatibility. In many cases, the printout is not sufficiently specified for the exact type of ingredients in the formulated mixture, which requires the pharmacist to make a professional judgment in determining whether the final mixture is compatible.

In accordance with the present invention, the overall compatibility assessment for complex mixtures focuses mainly on the preparation of non-constituent nutrients, including PN screening and calcium phosphate solubility review.

Preferably the process includes a first review step of comparing all PN additives to the limits set by the controller 10, which may include the steps of setting a good concentration limit range as described above.

The second step includes comparing the final concentrations of amino acids, dextrose and lipid based components with a database of tested mixtures. Amino acid comparisons have quality characteristics. The database of mixtures is compiled by publications after the mixtures have been tested. These mixture databases preferably contain concentrations for both stable and unstable mixtures, quoting study conditions such as time and temperature. Preferably the database contains a mixture with identified source components, such as, for example, quality named amino acids.

In a second step, the prescribed mixture is compared to a database of mixtures. Preferably a comparison is made to the mixture with the identified source components first. If the prescribed mixture is within a predetermined range of a stable mixture, the present invention proceeds to the next step without warning the doctor. The range may be set at some varying amount, for example by the concentration level or the set percentage of the corresponding base component in the stable mixture.

However, mixtures with matches (or mixed stable and unstable counterparts) to unstable prescription formulations contained in the database (preferably to subtract a set variable amount of the amount of the base ingredient) may not be present. After the review phase, it can be pointed to as potentially unstable.

In one embodiment of the present invention, if the prescribed mixture corresponds to an unstable mixture, additional steps such as examining whether the study conditions of the corresponding mixture are the same as the current conditions may be performed. The present invention gives the pharmacist a warning that the mixture is the same as a potentially unstable mixture under the study conditions for that mixture.

In another embodiment, a mixture that does not correspond to any stable or unstable mixture included in the database is reevaluated. When this is done, amino acid quality is ignored and the mixture is compared to the entire database. This comparison result is processed according to the same steps as described above. Preferably, the pharmacist is given a warning about ignoring the amino acid quality of the database mixture. If the mixture does not match the database after reevaluation of the entire database, the present invention warns the pharmacist that no similar PN has been tested in advance.

Regarding the calcium phosphate solubility review, the solubility of calcium salts and phosphates in the same solution, although not limited thereto, depends on many variables including concentration, temperature, salt form, order of preparation, pH, amino acid concentration, other additives and time. Depends. It is a practice in the art for a pharmacist to compare the final concentrations of both calcium salts and phosphates to solubility curves specific to a given amino acid quality and final concentration.

In the present invention, the calcium phosphate solubility review in the complex preparation process is accomplished by the controller 10 by comparing the final concentration of both calcium salts and phosphates with a matrix of known compatibility. The matrix may be input to the storage location by a physician or may be pre-entered into the database. The present invention uses matrices to distinguish the degree of compatibility according to amino acid quality and final concentration. For example, the calcium phosphate solubility matrix for a particular amino acid quality may have a compatible concentration of calcium salts and phosphates for final amino acid concentrations of 1%, 2% and 4%. The present invention determines the limit of excess solubility and alerts the physician when having it.

In another embodiment, the controller 10 may generate and display a graph on the display 25 that shows a shape of calcium phosphate solubility for a particular fatty acid, and solubility to assist the pharmacist in obtaining compatible formulations. It may indicate the prescription mixture specified for the shape.

However, in addition to determining whether the formulation present in the final bag is compatible, the compatibility during the preparation process must be evaluated. For example, the degree of compatibility of the solution with the second solution upon contact should be evaluated. The second fluid can be found in a common conduit, intermediate mixing chamber or final bag. To overcome this potential problem, pharmacists can adopt overall rules for the dispensing process. For example, in practice, all diluent volumes are added to the final bag so that all the additions present in the final bag are diluted as much as possible when adding additional ingredients to the final bag. However, this practice reduces the cleaning ability from such things as diluents during the preparation process.

In accordance with an important aspect of the present invention, the controller computer 10 may utilize known compatibility of the components to allow such compatible components to be formulated in the final bag or intermediate mixing chamber simultaneously. In addition, cleaning may be accomplished using a source solution that is compatible with all of the solution flowing through the cleaned portion before and after cleaning. Thus, a large volume of additive may be delivered to the final container or bag, or simultaneously with the small volume of additive to the intermediate mixing chamber or used as a cleaning fluid. This compatibility review and simultaneous preparation operation allows the present invention to maximize the rate of mixture preparation, allowing more efficient use of the dispenser and controller computer.

According to an important aspect of the present invention, component tests for compatibility characteristics are used to establish a database comprising a plurality of groups representing concentrations depending on compatibility based on component tests. For example, there are six groups of components identified in Table 1 below based on current knowledge. Obviously, the greater the knowledge of the compatibility characteristics of the various components, the more groups of components can be defined, even if they are separate groups for the same component at different concentrations or with groups for each individual component.

Table 1

Group compatibility

group Degree of compatibility Incompatibility One 1, 2, 3, 6 4, 5, 7 2 1, 2, 3, 4, 6, 7 5 3 1, 2, 3, 4, 6 5, 7 4 2, 3, 4, 6 1, 5, 7 5 6 1, 2, 3, 4, 5, 7 6 1, 2, 3, 4, 5, 6, 7 - 7 2, 6, 7 1, 3, 4, 5

Compatibility groups can be known based on test results and are included in the database of the controller computer so that the preparation process can be performed by the information in the database. Preferably, rather than distributing the database at various locations, it can be reliably controlled, coordinated and modified with additional knowledge and the information can be obtained by adding history and subsequent tests and adding other medicines and ingredients to the database. Located on the controller computer only to be obtained.

In a preferred embodiment of the present invention, the controller logically distributes the fluid in the source vessel 30 (FIG. 2) into a compatibility group regardless of the physical placement on one of the dispensers 12, 14, 16 based on the database. Classify

In another embodiment of the present invention, the controller makes calculations for dividing the group into a special prescription and the number of existing groups and the set of compatibility groups, wherein the cleaning between the compatibility groups is such that the overall cleaning water is minimized. Required.

In another embodiment of the present invention, the controller uses other inputs, such as physical restraint of the system, to determine the proper preparation order for using the source solution more efficiently as cleaning as opposed to cleaning from the final bag. Examples of physical containment may include the volume of an intermediate chamber or funnel 34 and cleaning of such chambers.

In one example, the intermediate chamber has a funnel having a volume of 60 ml and a cleaning volume of 30 ml. If the prescription requires 5 ml group 1 and 20 ml group 2 and 20 ml group 3 and 55 ml group 4 and 40 ml group 6, the controller 10 will replace group 1, group 2, group instead of ascending order. The preparation order of 3, group 6, and group 4 can be chosen.

Partially charge the funnel using only Group 1, Group 2, Group 3, 10 ml of Group 6 and drain the partially charged funnel before adding the remaining Group 6 so that at least 30 after funnel 34 is first charged A ml of Group 6 fluid is left and the Group 6 fluid can act as a cleaning, eliminating the need for cleaning from the final bag.

Other examples of classification relationships or algorithms are defined by the controller to achieve the user's desires, such as minimizing the allocation of the group's volume to other compatibility groups to reduce the number of chamber drains or the number of funnels 34. Can be installed.

By repeating the above in this regard, six separate groups are included in Table 1, but it is expected that additional groups can be defined that can be based on more complex understandings and tests. The exact number of groups is eventually a function of the sophistication of the knowledge of compatibility compared to all other components used, and it is expected that a very large number of groups can be defined.

This allows the controller computer to control the preparation step more precisely, increasing efficiency and mixing speed. In addition, a database may be considered monopolistic as its sophistication increases, and database control at a single location is an important safeguard that will not exist if the database is distributed to processors, for example in each dispenser.

Pharmacy strategy

In another embodiment of the present invention, a formulation strategy or method is shown in FIGS. 4B-4H that recognizes the likelihood of occurrence of liquid hazing and preferably minimizes cleaning from the final sacks, which depicts nutritional prescriptions. A preferred embodiment of a method of limiting the operation of at least one dispenser to provide a preparation mixture is shown. The beginning of the method or process (block 100) is shown in FIG. 4B and occurs after a prescription has been entered into the controller computer.

In another embodiment of the present invention, the prescription is first reviewed by the controller 10 in one or more of the methods described above.

The next step is to determine a preparation strategy (block 102) that depends in part on the type of preparation device present.

In this regard, as discussed above, hospitals, other health care facilities, or pharmacies may only have a high flow module dispenser 12 (FIG. 1) adapted to deliver high volume fluids at relatively high flow rates. However, even if the health care facility has a low flow module dispenser 12, it can deliver the solution at a low flow rate, which generally allows very small volumes of components to be added to the bag. Thus, when specially employed high volume and low volume dispensers are used, the controller determines the preparation strategy (block 2) to determine the strategy to use. The program may, for example, control the high flow rate that will control the high flow module dispenser (block 104), or control the low flow rate that will control the low flow module dispenser (block 106), e.g. A high flow rate and a low flow rate that are used in or for both machines for a single dispenser 16 suitable for volume are controlled (step 108).

Initially referring to high flow only, the controller calculates an initial dispenser calculation for setting up a high flow only dispenser that includes several calculations that the program will perform for each large component that will be part of the final bag. Perform (block 104). If the conveying is carried out using the weight of the conveyed component rather than the conveyed volume, this includes calculations based on specific gravity to convert volume units to weight units. In this regard, the prescription may be recorded using measurements entered in grams, millimeters or percentages of the final solution, and if the dispenser is transported depending on the sensed weight of the ingredients carried, converting the measurements to weights. Software may be required. For example, the high flow module 14 and the low flow module dispenser 12 are prepared using a change in weight or weight of the intermediate or final vessel.

After the calculations have been made, line 110 extends to FIG. 4C, where a determination is made as to whether the formulation containing lipids has the lipids first carried in the final sacks, which is user set. In this regard, the user may want the lipid to enter the final bag first or last, which is strictly an option that can be specified by the user. This designation is preferably based on a formula initially established before the dispenser continues running in the facility.

This involves dividing all the additives into compatibility groups, such as compatibility groups, and is done by classifying common compatibility components as shown in Table 1 above. When the lipid is transported in the final bag for the first time, a determination is made of the number of compatibility metagroups and the required wash water (N) (block 114), and the program takes the order of the bulk transport with the first lipid. It is specified. Once the order is determined, line 118 extends to FIG. 4D, and instructions for operating the dispenser are sent to the dispenser (block 120).

Alternatively, controller 10 may deliver fluid using other user settings, including settings reflecting general TPN mixing rules (blocks 116 and 124). Regarding the general rule of mixing total parenteral nutritional supplements, these include the following.

1. Phosphate is added before calcium salt.

2. Detection of calcium phosphate solubility should be based on the volume of the TPN bag when calcium is added.

3. If lipid is not required as the final additive, calcium should be the final additive in the TPN bag and, if possible, prepare one wash.

4. Compatibility groups are counted in order to match the order of preparation, unless a specific exception is identified.

If the dispenser 14 has individual conduits to the final bag for each source solution, the controller 10 can be added to the bag with the initial determination of the fluid to be added to the final bag, the pumping sequence, with the fluid present in the bag. The pumping sequence is set to ensure that it is the degree of compatibility of the entering fluid.

Returning to FIG. 4C, if the lipid is not first in the final bag, the number of solubility groups, as well as the required wash water, is also determined (block 122), and the order of transport and cleaning with the lipid last is one or more formulations. Determination using the method is performed and in the final step shown by line 126 extending to FIG. 4D, the transport instruction is sent to the dispenser (block 120).

Returning to the low flow dedicated path, which now begins by initiating a formulating operation calculation for low flow only (block 106), it is used to formulate a mixture formulation, for example performed with a low flow module dispenser. Although high flow formulations may be present in the same area, it is common to select low flow formulations if the volume added to the final bag is relatively small, such as would occur in neonatal prescriptions or very small infusions.

An initial determination is made as to whether the final bag already contains lipids (block 130). The reason for this decision is that there may be a prescription mixed in two stages with the bulk flow component already carried in the bag and then the bag is placed on the low flow module to transport the micronutrients there. to be. If the lipid is already in the bag, the difference from how the cleaning from the final bag goes to the funnel or intermediate mixing chamber may be present in the low flow module dispenser.

The program determines whether lipids are included in the bag from the prescription, and if so, the entire mixture prescription is checked to determine whether or not the lipid is in the final bag. If there is lipid, a question is asked as to whether the user is concerned about whether there is lipid hazing in the subsequent mixture formulation (block 132). This is due to the fact that some of the lipids remain in the funnel when the cleaning is performed with fluid from the final bag. These lipids can be transported to a number of subsequent bags in an amount sufficient to produce visible hazing in solution. If the current bag has lipids and the next bag has no lipids and no cleaning is done on the surface that comes into contact with the contents of both of these bags, especially if the previous bag uses the cleaning from the final bag, the lipids will lose the next bag. There is a possibility of resignation. If the facility does not want lipid hazing, then the preparation is not prepared but remains in order to be dispensed at other times (block 134). If the hospital accepts the lipid hazing, a warning is printed by the printer (or visible display) instructing that the lipid hazing may be present in the funnel (block 136).

If the final sacks do not contain lipids (block 130), or if they contain lipids but are not concerned about lipid hazing (block 136), solubility and solubility plots are used and washing from the final sacks is performed. Proceed with the mixture calculation, noting that there may be (block 138). This step will perform calculations designed to minimize the wash water in order to maximize efficiency, and may use one of the methods described above. When this step is performed, line 140 extends to FIG. 4D, so that a transport instruction to the dispenser is sent to the dispenser (block 142).

Referring now to the high flow and low flow branches shown in FIG. 4B, the initial step initiates a formulation setup that causes the conversion calculations described in relation to the high flow dedicated routine (block 140) to be performed (block 108). Line 144 extends to FIG. 4C, where a compatibility group and wash water are determined (block 146). Basically, this is a decision as to whether or not a problem arises with the prescription when mixed in a recorded manner.

A determination is made as to whether the lipid is included in the final bag (block 152). If lipids are desired, a determination is made whether the lipids will be transported first, last transported or otherwise optimized (block 154). Whether the lipid is to be transported first, last transported, or otherwise optimized is user programmed programmed, meaning that once the user defines it, it does not then rely on prescription. Optimization generally means that the lipid is first placed first. Thus, the mixing formula initially set by the user determines the path of the steps adopted. If they are new or optimized, line 156 extends to FIGS. 4D and 4C until the steps described below. If the lipid is not included in the final bag, line 158 likewise extends to FIGS. 4D and 4E for the steps described below. If lipid is required to be last, line 160 extends to FIG. 4D and a determination is made as to whether the formulation is stable without lipid volume (block 162).

If the prescription is unstable without lipid volume, the program warns the user that the prescription could not be formulated if the lipid was last and that a pharmacist check may be required (block 164). The program then determines if the lipid can be transported in the final bag for the first time, and if no, it is not formulated (block 168). If the lipid can be transported for the first time, line 170 extends to FIG. 3D so that the wash water containing a large amount of lipid is calculated and the lipid is first transported to the final bag (block 172).

Returning to block 162, if the prescription is stable without lipid volume, the program calculates the total solubility including the volume of lipid and the lipid is finally delivered to the final bag (block 174) (FIG. 4D). . Calculation of solubility that does not include the volume of lipids (block 174) is performed by calculating calcium phosphate solubility based on possibly less volume than possibly not included in the original review. Thus, for example, if there is 50 ml of lipid in 200 ml total volume PN, the calcium phosphate solubility value is 150 ml.

After the compatibility classification and wash are calculated (blocks 172 and 174), the program determines whether the total volume excluding lipid is greater than the funnel volume (block 176). If yes, line 178 extends to FIG. 4F, where the program determines if the lipid is first (block 180), and if yes, the program is directed to cleaning in an order that the wash water of the underlying source cleaning is acceptable. Determine if it can be maintained (block 182). If this can be done, the program breaks into the compatibility group and continues the preparation with the required cleaning coming out of the selected source vessel (block 184) and the command is sent to the dispenser (block 186). . As mentioned above, although identified as individual steps in the flowchart, the steps described in blocks 182 and 184 are substantially substantially interrelated. This is because the wash water is a function of the compatibility groups and the compatibility groups must be determined to identify where the cleaning should occur as described above.

If the total volume excluding lipid is not greater than the funnel volume, the completion of the preparation is carried out using a low flow module and can be carried out in the funnel of the low flow module dispenser. The program determines whether the source cleaning volume in the component solution can be left for final cleaning (block 188), and if so, the source cleaning volume and all other components in the base component are prepared in the funnel and delivered to the final bag. The funnel is cleaned with the reversing base (block 190) with the cleaning being conveyed to the final bag and the transport command is sent to the dispenser (block 192).

In order to determine what source cleaning volume can be left, it is necessary to know what can be allowed to provide, i.e. to know if the final mixture is stable, to remove the fluid present during the mixing in the funnel without diluting the cleaning effect. It is necessary to review. In addition, the volume of the funnel is important in terms of the volume that can be provided for complete cleaning. For example, if the funnel volume is 50 ml and only 30 ml can be left, there will be no total funnel cleaning and a determination may be made by the user as to whether this is appropriate. In addition, the cleaning method allows the final cleaning to come from a source component such as sterile water, dextrose or amino acids, and the intermediate cleaning is done using the solution from the final bag with the source cleaning in the component volume left for final cleaning. The funnel will be cleaned as much as possible.

If the source cleaning volume is not sufficient, the program will determine if any source cleaning volume can be left for final cleaning (block 194), if yes, this is done and all other ingredients are prepared in the funnel. This is cleaned with an inverting base (block 196). The conveying command is then sent to the dispenser (block 198).

If there is no supply that can be left for final cleaning, all ingredients are prepared in the funnel without cleaning (block 200) and instructions are sent to the dispenser (block 202).

What can be seen at block 152 is that if there is a response that the final bag is free of lipids, then the route through the flowchart assuming that the total volume exceeds the funnel volume determines whether the lipid is first in block 180. This is not applicable because no lipid is present. In this case, steps 182 and 184 may be performed with the source cleaning coming out of the source container and / or the final bag. As mentioned above, the controller preferably uses a cleaning and preparation sequence that eliminates the need for cleaning from the final bag.

Returning to block 204, if the answer is no, or if the mixture contains lipids and the lipids are first transported and cleaning from the final bag is required (block 182), then the program determines whether the lipids can be finally transported. If not (block 206), the program inquires if the lipid hazing is acceptable (step 208), and if not, the preparation does not continue (block 210). If acceptable, the program warns of lipid hazing (block 212).

Once the lipid is finally delivered, the program determines whether the wash water of the source wash can be maintained during the wash and whether an acceptable order can be performed with one wash coming out of the final bag (block 214). If this can be done, the formulation is analyzed for the compatibility group, and the preparation proceeds so that the cleaning takes place at the appropriate time, preferably after the last cleaning with the final bag with all the other from the source ingredients. (Block 216). When rinsing with the contents of the final bag in this way, the components present in the final bag are diluted as much as possible while allowing for final source container cleaning. The command is conveyed to the dispenser (block 218).

If the answer from block 214 is no, following line 220 extending to FIG. 4G, the program will calculate that the source component wash is multiplied by the wash component minus 2 (N-2) in the final bag. A determination is made as to whether a cleaning can be maintained for cleaning in an acceptable order in a state in which it is determined (block 222). If yes, the compatibility classification step is performed again (block 224) and the command is passed to the dispenser (block 226). If no, another determination is made of the wash water minus three (N-3) (block 228), and if yes (block 232), with the compatibility analysis being performed, the transfer command is Sent to the dispenser (block 232). If no, a determination is made regarding N-4 (block 234). If the determination from block 234 is YES, the compatibility analysis is performed again (block 236) and the command is passed to the dispenser (block 238). If the determination is No in line 240, the program determines whether the source clean can be maintained during the final clean (block 242), and if yes, once the compatibility analysis is performed again (block 244). , A mixing instruction is generated (block 246).

If no, the program determines if the amount of any source solution can be left to make the required volume excluding lipids below the funnel volume (block 248). If the answer is yes, the appropriate volume remains and the ingredients are formulated in the funnel and the ingredients based on what is left are used to clean the funnel (block 250) and a transfer order is sent to the dispenser (block 252). If no, the program determines whether the lipid is prescribed (block 254), if no, the program performs the preparation with all cleaning started in the final bag (block 256) and the command is sent to the dispenser. If (Block 258) is present but the lipid is present, the program determines whether or not lipid aging is concerned (Block 258), if no, a warning is issued (Block 260), if yes, Is not provided (block 262), after the warning, a dispensing operation proceeds with all cleanings coming out of the final bag (block 256), which causes a transport order to be delivered to the dispenser (block 258). )).

In sending the command to the dispenser (blocks 192 and 186), the dispenser and controller may employ various methods and employ to perform the dispense. For example, the controller 10 may send a command to a controller included as part of the dispenser 12, 14, 16, or the controller may operate the dispenser directly or perform any combination or similar method.

In addition to the preparation strategy performed in the method described in connection with the flowcharts of FIGS. 4A-4H, there are other functions performed by the present invention. In this regard, the controller computer 10 is adapted to test the composition of each prescription mixture present in the order of these prescription mixtures and instructions for this are sent to the dispenser for preparing the mixture. By testing the components of each prescription mixture in order to determine these mixtures containing lipids, for example, the mixtures containing lipids can be classified with each other so that lipid hazing is not a problem until the final lipid containing mixture is prepared. .

As described in US Pat. No. 4,653,010, the prescription mixtures present in sequence may be classified around a common ingredient. In embodiments of the present invention, other predetermined mixture classifications, such as patient type, may be determined in a similar fashion. This rearrangement of the prescription mixtures in order may have the effect of increasing yield due to the requirements and conditions of the facility.

Another important aspect of the present invention includes the ability of the computer 10 to adjust the user defined overfill volume by increasing the volume of each component to be added to the prescription mixture by a predetermined amount to obtain a mixture of the same prescription but with a slightly larger volume. To address the concerns of precision when a prescription is made that requires the minimum concentration of the mixture to supplement the volume required to prepare the dosing set and to deliver the exact amount of ingredient to the patient in effect.

Another aspect of the invention includes the ability of the computer 10 to accommodate user switchable options such that when activated the diluted high concentration components can be replaced with the prescribed low concentration components. If the patient is not fluid forced, dilution of the high concentration solution with a compatible cleaning solution such as sterile water produces a prescribed mixture that minimizes potential instability. In another embodiment of the invention, in particular when the patient is fluid constrained, in removing or minimizing the dilution solution by considering other components as the dilution fluid, the stability of the mixture is described above to determine stability during or after preparation. One of the methods is determined by the controller 10 which may use.

In another embodiment of the method of the present invention, a formulation strategy may be performed to overfill the final bag 46. As noted above, overcharge may be required to compensate for the amount of mixture that may not be administered due to the system being administered. For example, some amount in solution may remain in the final bag even after administration.

In preserving aspects of the present invention, certain methods of setting overcharge may be specifically configured. For example, the overfill volume can be set in percent or in absolute amounts such that the final bag has a particular predetermined volume. In formulating such a prescription, the method calculates a new amount of ingredient required to obtain a mixture of substantially the same but slightly larger volume as the prescribed mixture.

When determining the appropriate amount of ingredients in the ingredients, the controller 10 can check the final mixture for various formulas to determine whether the final mixture can be administered. As an example of a fluid confined patient, overfilling may result in the mixture in an amount of fluid in excess of an acceptable amount. An alert may be generated or an error message may be displayed to the user.

In another embodiment, the controller 10 has a volume of the mixture to prevent having at least one component in an amount less than a predetermined level, such as corresponding to the minimum amount of precision suggested for the dispensers 12, 14, 16. It can be suggested or adjusted. For example, the amount of components may be 90% of the minimum suggested amount. The controller may increase the total volume of the dispenser so that the amount of ingredients reaches the minimum suggested amount and instructs the user that only a portion of the final mixture should be administered to the patient.

In various preferred embodiments of the present invention, the order of the steps may be reversed. For example, the stability of the final mixture can be determined before and after determining the appropriate formulation strategy.

report

The dispensers 12, 14, 16 may communicate to the controller during or after the preparation process. For example, an alert may be communicated if a sensing device as described in US Pat. No. 5,927,349, specifically incorporated herein, detects an incorrect source solution flowing through one of the conduits 32. Likewise, during or after dispensing, the exact amount of ingredient delivered to the final bag 46 can be delivered to the controller 10.

Upon receiving the amount of ingredient delivered during the preparation, the controller 10 provides cost data to the pharmacist or communicates such data to the hospital computer system 28. The controller 10 can adjust the cost data to reflect the actual cost of providing the mixture. For example, some components may enter a container that is only accessible before being discarded. Thus, if such ingredients are used in smaller amounts than those in the container, the controller 10 dictates the cost of the entire container as opposed to that portion of the ingredients used in the mixture.

In the above, an improved method and apparatus for controlling the preparation of non-curable mixtures has been described, which makes it possible to prepare non-curable mixtures faster and more effectively without sacrificing stability. In addition, several features provide added safety devices. The present invention utilizes extensive analysis of the mixture components and allows the known properties of the components to be reliably and safely prepared in such a manner that they conform to any user defined priority without violating known formulation rules. Use it as a new form.

Although various embodiments of the invention have been shown and described, it should be understood that other modifications, substitutions, and alternatives will be apparent to those skilled in the art.

Claims (31)

For controlling the operation of at least one pharmaceutical dispenser adapted to selectively deliver a prescribed amount of pharmaceutical ingredient from an individual source container to a final container via an elongated hollow delivery means for preparing a prescription mixture. In the device, The device, Calculating means having memory means for storing instructions for operating the device and for controlling the dispenser for dispensing the prescribed mixture, the memory means for a plurality of medicaments which can be conveyed for dispensing the prescription mixture; Data relating to the component, said data relating to the operating characteristics of at least one of the dispensers that the device is intended to control, Said calculating means comprises at least one communication port for achieving a communication link with each dispenser to be controlled, The calculating means may be used to receive a prescription mixture, identify a pharmaceutical ingredient, determine the compatibility of the pharmaceutical ingredient with each other, determine the order in which the ingredients are delivered in preparing the prescription mixture, and And communicate the instructions for preparing the prescription mixture. An apparatus according to claim 1, wherein said calculating means is adapted to convert the amount of each component into a unit that can be transported by a dispenser for preparing a prescription mixture. 3. An apparatus according to claim 2, wherein said calculating means is adapted to convert the amount of the component volume set in the prescription mixture by weight by multiplying the volume set in the prescription mixture by the specific gravity of the component. The method of claim 1, wherein the data related to the plurality of pharmaceutical ingredients comprises a database having a plurality of compatibility groups, wherein each group has at least one of the pharmaceutical ingredients, and the database is also another group. And having data specifying the melting and / or non-melting of each group for. 5. The device of claim 4, wherein at least a first of said compatibility groups comprises a component comprising a lipid and a second comprises a component that is sterile water. The method of claim 4, wherein the calculating means determines the order in which the components are delivered in accordance with a set of mixing order general rules, The general rule is Phosphate is added prior to calcium salt, Calcium phosphate solubility is based on the volume of the prescription mixture when calcium is added, Wherein the calcium is the last addition to the prescription mixture. 7. A container according to claim 6, wherein said calculating means determines the number and location of cleanings to be made during the delivery order of the components, wherein the cleanings are carried out using a solution compatible with the next successive component to be delivered to the final container. And at least part of the cleaning of the near elongated hollow conveying means. 7. The apparatus of claim 6, wherein the wash solution is adopted from either a separate source vessel or a final vessel. 5. The method according to claim 4, wherein said calculating means accepts input data for selecting whether the drug component comprising the lipid determines the order of delivery such that the lipid containing component is delivered either first or last for all other drug components. At least one port for the device. 2. The apparatus of claim 1, wherein the communication link can be at least one of an internet connection, a local area network connection, or a wireless connection. The device of claim 1, wherein the device is adapted for use by a user in at least two locations, each location having at least one dispenser, a printer for printing a label, a terminal with a display, an apparatus and dispenser. And an input device for inputting and selectively setting the prescription mixture in connection with the operation of the device. 12. An apparatus according to claim 11, wherein said calculating means is adapted to control two dispensers at each position, wherein one dispenser is adapted to carry the component at a much higher flow rate than the other. 10. The formulation according to claim 9, wherein said calculating means tests the prescription mixture to determine if the lipid component is part of it, and the subsequent prescription mixture to be formulated with the probability of a haze appearance due to the presence of the lipid component in the currently formulated prescription mixture. Determine whether to oppose, to terminate the preparation of the prescription mixture if the user indicates the opposition, and to warn of such a haze probability if the user does not instruct the opposition. 10. The method according to claim 9, wherein the calculating means is configured to receive a plurality of prescription mixtures and arrange them in an order for preparation, wherein the calculation means tests each prescription mixture in order and shares the predetermined components therein. And rearrange the prescription mixtures in order to determine and classify the prescription mixtures having the covalentness of the predetermined ingredients. The method of claim 1, wherein the calculating means is adapted to obtain data related to the patient profile in which the prescription mixture is to be formulated, wherein the patient profile data comprises at least the name and age and weight of the patient and wherein the calculating means is defined in each category. It is adapted to obtain data relating to a category of a plurality of patients that includes a predetermined limit of the mixture specified for the category and the calculating means compares the component amounts of the prescription mixture for patients in one of the categories to determine that the ingredients And provide a signal when outside of a predetermined limit on the component. 16. The device of claim 15, wherein said category of patients includes adult, pediatric, neonatal and premature infant patients. 16. The device of claim 15, wherein the signal is adapted to prevent the prescription mixture from being formulated. The method of claim 15, wherein the patient's profile data further comprises a history of the patient's weight and a formulation of the mixture over a period of time, wherein the treatment means includes calculating the patient's weight at any time in the future. And to prepare a relevant report. The method of claim 1, wherein the calculating means is adapted to obtain data related to the patient profile in which the prescription mixture is to be formulated, wherein the patient profile data comprises at least the name and age and weight of the patient and the calculating means is a particular patient's prescription mixture. It is intended to obtain data relating to limiting the amount of mixed ingredients that can be added to the formula and the calculating means compares the amount of ingredients of the prescription mixture to the patient to formally authorize the data to explain the basis for exceeding one or more such limits. And to request input. 20. The apparatus of claim 19, wherein the officially authorized input of data is at least an input of data by a physician or pharmacist. 20. The apparatus of claim 19, wherein the calculating means terminates the preparation of the mixture formulation if no required data describing the basis for exceeding one or more of these limits is missing. The method of claim 1, wherein the memory means comprises data relating to the amount of fluid required to provide the dispenser from the source vessel to the final vessel via the elongate hollow conveying means, wherein the processing means provides the dispenser. And increase the amount of the component by an amount required to. The method of claim 1, wherein the processing means is adapted to accept a switchable input in connection with the preparation of a mixture formulation requiring a predetermined amount of the first component and the amount of diluent for the first component and a relatively small amount of one or more additional components. And the total mixture formulation is of a predetermined total amount, and said calculating means is adapted to use the volume of said one or more additional components in relatively small amounts as a replacement for the same volume of diluent such that the predetermined total amount is not exceeded. Device characterized in that. To control the operation of at least one pharmaceutical dispenser adapted to selectively deliver a prescribed amount of pharmaceutical ingredient from an individual source container to a final container via an elongated hollow delivery means for preparing a prescription mixture. In The method utilizes calculating means having memory means for storing instructions for operating the device and for controlling the dispenser for preparing the prescribed mixture, the memory means being capable of being carried to prepare the prescription mixture. A data relating to a plurality of pharmaceutical ingredients, said data relating to an operating characteristic of at least one of the dispensers that the device is adapted to control, wherein said calculating means is adapted to achieve a communication link with each dispenser to be controlled. At least one communication port, The method, Receiving the prescription mixture in the calculating means; Identifying and determining the amount of the pharmaceutical ingredient of the prescription mixture, Determining the compatibility of the medicinal components with each other, Determining the order in which the ingredients are delivered during the preparation of the prescription mixture, Communicating instructions for formulating the prescription mixture to at least one component to be used in formulating the prescription mixture. The method of claim 24, wherein the step of determining and determining the amount comprises converting the amount of each component into units that can be delivered by the dispenser for preparing the prescription mixture. 25. The method of claim 24, wherein said data relating to a plurality of pharmaceutical ingredients comprises a database of pharmaceutical ingredients classified into a plurality of groups, wherein each group of ingredients has a common compatibility feature, and the database also includes Having data specifying the degree of compatibility and / or incompatibility of each group with respect to other groups, The determining the compatibility further comprises testing the mixture formulation to identify the compatibility characteristics of each group with respect to the identified group that is different from the special group of components present therein. 27. The method of claim 26, wherein the step of determining further comprises the step of determining the mixing order such that the ingredients in the groups compatible with each other are added to the final vessel simultaneously or in sequence in accordance with known general mixing rules. Characterized in that the method. The method of claim 27, wherein the known general mixing rule is Adding phosphate prior to calcium salt, Calcium phosphate solubility based on the volume of the prescription mixture when calcium is added, Finally adding calcium to the formulation mixture. 27. The method of claim 26, wherein the ordering step further comprises determining a mixing order such that components compatible with each other are sequentially added to the final vessel, thereby minimizing washing water, and cleaning The hollow conveying means near the final container due to the incompatibility of the components of the group with respect to the components of the other group. 25. The method of claim 24, wherein identifying and determining the amount of the pharmaceutical ingredient comprises providing the user with the option of identifying lipids as a component of the prescription mixture and terminating the formulation of the prescription mixture if the user so chooses. And further comprising a step. 32. The method of claim 30, wherein a warning is issued if the lipid containing prescription mixture is not terminated, wherein the warning is that the prescription mixture to be formulated may exhibit a hazing appearance due to the presence of lipids.