hospital formulary

hospital formulary is developed under the guidance of pharmacy and therapeutic commitee of the hospital.pharmacist working in a hospital should play an important role in the preparation of the hospital formulary

1. HOSPITAL FORMULARY 1 HOSPITAL FORMULARY

2. CONTENTS INTRODUCTION ORIGIN IN INDIA OBJECTIVES TYPES WHO????? GUIDELINES PREPARATION IMPROVING ADHERENCE ADVANTAGES AND DISADVANTAGES ROLE OF PHARMACIST 2

3. INTRODUCTION The hospital formulary is a continuously revised compilation of pharmaceutical dosage agent and their forms etc. which reflects the current clinical judgment of the medical staff. Hospital formulary provides information for Procuring Prescribing Dispensing Administration of drugs HOSPITAL FORMULARY 3

4. ORIGIN IN INDIA The first hospital formulary in India was published in 1968 by the Department of Pharmacy , CMC,Vellore . The first hospital formulary for the development of government hospital teachings was published in 1997 at Government Medical College , Trivendrem,Kerala 4

5. OBJECTIVES To Set standards for best practice, promoting high quality, evidence based prescribing. To ensure rational drug therapy and control drug cost. To precise use by the physician and nursing staff . To continually revise compilation of pharmaceuticals and some important ancillary information that reflects the current clinical judgement of medical staff. 5

6. TYPES OF FORMULARY 6

7. WHO??? 7 DRUG AND THERAPEUTIC COMMITTEE

8. MEMBERS INVOLVED IN THE PREPARATION OF HOSPITAL FORMULARY 8

9. The governing body of the hospital shall appoint a pharmacy and therapeutic committee composed of physician and pharmacist which will prepare the hospital formulary system. The medical staff in the governing body shall sponsor and outline the purpose, organization function and scope of the hospital formulary system. It should adopt the principle as per the need of particular hospital. The pharmacy and therapeutic committee shall develop policy and procedure governing the hospital formulary and the medical staff shall adopt these policies and procedures subject to administrative approval The policy and procedure shall afford guidance in the appraisal, selection , procurment , storage,distribution , use, safety procedures and other matter relating to drug in the hospital and shall be published in the hospital’s formulary To ensure the maintenance of the responsibility and procreative of the physician in the exercise of his professional judgment. The medical staff shall adopt the policy formula, and procedure for including drugs in the formulary by the non proprietary name even though proprietary names continue to being use in the hospital physicians 9

10. In the absence of written policies approved by the medical staff related to the operation the hospital shall make it certain that the nursing personnel are in formed in writing though its system of news of communication that there exits the formulary system in the hospital and the procedure governing its operations In the formulation of policies and procedure the term substitute or substitution should be avoid since these term have been used to imply the unauthorized dispensing of entire different drug, neither of which takes place under a properly operated hospital formulary system. It shall be made known to the medical staff about the changes in the working in the hospital formulary system or in the content of the hospital system. Provision shall be made for the appraisal of the member of the medical staff for the use of the drug not include in the formulary or the investigational drugs. The pharmacist with the advice and guidance of the pharmacy and therapeutic committee ,shall ascertain the quantity and source of supply of all drugs, chemical, biological and pharmaceutical preparation used for diagnosis and treatment of patient. 10

11. STEPS INVOLVED IN THE PREPARATION OF HOSPITAL FORMULARY 11

12. STEPS INVOLVED IN THE PREPARATION OF HOSPITAL FORMULARY 12

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14. CONTENTS Introduction polices and procedures list of abbrevations List of drugs monographs Additional information of drugs storage guidelines patient counseling information prescribing and dispensing guidelines dose adjustments poison information and antidotes 14

15. CONTENTS OF DRUG MONOGRAPH Non-proprietary name of drug Synonyms Available brands Cost Reconstitution Administration Dosage forms Indications Contraindications Precautions Dose Pregnancy risk factors Adverse effects Interactions   15

16. MAINTAINING A FORMULARY   Formulary may become a collection of older, less effective drugs. The entire formulary should be reviewed every 2–3 years. This can be done by evaluating all the formulary medicines within each therapeutic class in a systematic way on a regular basis and comparing them to other new non-formulary medicines within that class Requests for the addition of new medicines and deletion of old medicines. Systematic review of a therapeutic class of medicines. Review of programmes to identify and resolve medicine use problems. All decisions of the DTC should be documented ( minuted ). 16

17. MANAGING A FORMULARY LIST (Adding and deleting drugs) For a new medicine to be added into the hospital formulary, the committee should consider the therapeutical equivalency to existing drugs in terms of efficacy, safety, or convenience of dosing/administration. For the addition and deletion of drugs the total cost for a course of treatment with new medicine should be compared with the already listed medicines If a new medicine is added to the list for reasons of improved efficacy, safety or lower price, serious consideration should be given to delete the medicine which was previously on the formulary list for the same indication, for two reasons: 17

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19. FORMAT AND APPERANCE SIZE: The formulary which is sufficiently small in size to fit in apron is acceptable and convenient 4” x 7” or 10cm x 18cm APPERANCE: use of different colors to differentiate different categories of drug. Attractive designing of the cover page It should be visually pleasing, easy to read and have a professional appearance 19

20. DISTRIBUTION All doctors Wards of the hospital Head od the departments of paitent care Outpatient departments and casualities Drug information centers Administrative office 20

21. IMPROVING ADHERENCE TO A FORMULARY   Reviewing and taking action on all non-formulary medicine use; action may include adding the medicine to the formulary, educating the prescriber about the nonformulary status of the medicines or banning use of the medicine within the hospital. Prohibiting the use of non-formulary drug samples in the hospital. Establishing procedures and approved drug product lists for therapeutic interchange or substitution. Providing easy access to the formulary list, with copies at each drug ordering location and in pocket manuals for staff. Involving medical staff in all formulary decisions. Advertising and promoting all formulary changes. Establishing agreed procedures for clinical trials with non-formulary medicines   21

22. ADVANTAGES AND DISADVANTAGES It deprives the physician of his right and prerogative to prescribing and obtained the brand of his choice. pharmacist act as the sole judge of which brands of drugs are to purchased and dispensed. The system allow for the purchase of inferior quality of drugs particularly in institutions where there is no staff pharmacist. The system does not reduce the cost of drug to the patient or the third party payer 22

23. ROLE OF PHARMACIST IN HOSPITAL FORMULARY Pharmacist in the DTC has a key role in developing policies and procedures governing the hospital formulary. The chief pharmacist has the primary responsibility for the preparation of hospital formulary. Pharmacist with the advice and guidance of DTC shall as certain the quantity and source of supply of all drugs, chemicals, biological and pharmaceutical preparations used for the diagnosis, and treatment of patients. Pharmacist should ensure that quality of drugs is not compromised by economic considerations 23

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