Recommendations:
(1) Alternatives to powdered formula should be used whenever possible.
(2) Powdered formula should be prepared only by trained personnel.
(3) Preparation should be done using aseptic techniques in a designated preparation room.
(4) Preparation should follow the manufacturer's instructions.
(5) The reconstituted product should be refrigerated immediately.
(6) The product should be discarded if it has not been used within 24 hours of preparation.
(7) A product should not be administered ("hung") to a patient for more than 4 hours.
(8) The hospital should have written policies (SOP) for handling manufacturer recall of product. This should include notification of key persons, retrieval and quarantine of affected product, followup of exposed patients and record retention.
Use of commercial formula solutions greatly reduces the chances of preparation errors in the hospital. However, rules for storage, disposal after opening and limits on hang time still apply.
NOTE: Most of the rules for administration are familiar to those who handle blood products or other parenteral products. Four hours is the amount of time required for a bacterial inoculum to grow to significant numbers.
