Hospital formulay development by nitin.pptx

it describe about importance of formulary.. how to develop a hospital formulary.. advantages and disadvantages of hospital formulary

1. Hospital Formulary Development Presenter-Dr. Nitin Kumar Singh (JR-2) Moderator- Dr. Ashish Dixit (SR) Peer Support- Dr. C. Vignesh (JR-2) Department of Pharmacology & Therapeutics King George’s Medical University Lucknow, UP(India)226003 E.mail - [email protected]

2. Contents Introduction Importance & Components of a Hospital Formulary Advantages & Disadvantages of Hospital Formulary Types of hospital formulary Members involved in the preparation of hospital formulary Criteria in medicine selection Guideline for Hospital Formulary Steps involved in the preparation of hospital formulary

3. Learning objectives At the end of this teaching & learning session we all are able to know about- What is hospital formulary ? Important components of hospital formulary Different types of hospital formulary Members involved in making hospital formulary How to prepare hospital formulary? How INDIA will benefit from it?

4. Introduction to Hospital Formulary Definition : it is a dynamic compilation of approved medications and associated information , consistently updated to align with the evolving needs of a healthcare institution Purpose : serves as a pivotal guide for healthcare professionals, offering insights in to appropriate prescribing practices, facilitating accurate dispensing, and ensuring safe medication administration

5. Hospital formulary provides information for Procuring Prescribing Dispensing Administration of drugs

6. Importance of Hospital Formulary Optimizing Patient Care: Ensures availability of essential medications Cost-Effective Prescribing: Efficient management of healthcare resources Standardization: Promotes consistent prescribing practices Safety: Enhances patient safety with drug information

7. Components of a Hospital Formulary Drug List: Inclusion criteria, categorization, updates Dosage Forms: Specify approved formulations Therapeutic Guidelines: Evidence-based recommendations Drug Information: Details on pharmacology, interactions, etc Review Process: Mechanism for periodic evaluation

8. Origin of hospital formulary: 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, Trivandrum, Kerala.

9. Advantages of Hospital Formulary Ensures Rational Drug Therapy: Most effective method for rational drug therapy Cost-Effective Solutions: Offers simple and cost-effective solutions for various medicines Reflects Clinical Judgment: Continually revised compilation reflecting current clinical judgment Sets Standards for Best Practice: By promoting high-quality, evidence-based prescribing

10. Contd.. Reduces Treatment Variation: Reduces variation in treatment levels, controlling drug costs Utilized by Medical Staff: Vehicle used by medical, pharmacy, and nursing staffs Complete and Updated: Complete, concise, updated, and user-friendly formulary Significant Impact on Practice: Implementation has a significant impact on healthcare professionals clinical practice

11. Disadvantages of Hospital Formulary Restriction on Physician's Choice: Deprives physicians of the freedom to prescribe their preferred brands Pharmacist as Sole Judge: Allows pharmacists to act as the sole decision-makers on drug brands Potential for Inferior Quality: Risk of purchasing lower-quality drugs, particularly in the absence of a staff pharmacist

12. Types of hospital formulary: There are three basic types of formularies: 1. Open formulary 2. Closed or restricted formulary 3. Incentive based formulary

13. 1. Open formulary: S erves merely as a guide; a physician may prescribe any drug, but is encouraged to use the formulary list in prescribing decisions 2.Closed or restricted formulary: In contrast, a closed or restricted formulary lists the drugs that will be reimbursed by the healthcare provider; non-formulary drugs will be reimbursed only if they are authorized prior to prescribing 3.Incentive based formulary: R epresents a hybrid between the open and closed formularies patients pay a higher price for non formulary drugs

14. Members involved in the preparation of hospital formulary : DTC's Vital Role: Drugs and Therapeutics Committee (DTC) plays a crucial role in formulary preparation and implementation Representative Membership: Committee includes members from major clinical departments, administration, and pharmacy to represent diverse stakeholders Position-Based Selection: Members chosen based on positions and responsibilities Diverse Clinical Representation: Includes clinicians from major specialties, clinical pharmacologist, nurse, pharmacist, administrator, clinical microbiologist, and records department member

15. Members involved in the preparation of hospital formulary :

16. Criteria in medicine selection : Selection of drugs depends on many factors, such as the Pattern of prevalent diseases Treatment facilities Training and experience of available personnel Financial resources Genetic Demographic and environmental factors

17. WHO Medicine Selection Criteria (1999) Data-backed Selection Select medicines with robust data on efficacy and safety from clinical studies Quality Assurance Ensure selected medicines are available in a form guaranteeing adequate quality, including bioavailability Comparative Evaluation When medicines are similar, evaluate based on relative efficacy, safety, quality, price, and availability

18. 4. Cost Consideration Consider the total treatment cost in cost comparisons, not just the unit cost 5. Additional Influencing Factors Consider pharmacokinetic properties and local factors (e.g., storage facilities) in decision-making 6. Formulation Preference Prefer single compounds for most essential medicines Allow fixed-ratio combination products if proven advantageous in therapeutic effect, safety, or compliance

19. Guideline for Hospital Formulary 1 .Committee Appointment Hospital's governing body appoints a pharmacy and therapeutic committee which includes physicians and pharmacists for the hospital formulary system 2.Sponsorship and Purpose The medical staff outlines the purpose and functions of the hospital formulary system 3.Policy Development 4. Guidance in the Formulary Policies provide guidance on appraisal, selection, procurement, storage, and use of drugs

20. Physician's Responsibility Formulary Inclusion Adopt policies for including drugs by non-proprietary names, even if proprietary names are used. Avoidance of Terms Formulation of policies should avoid terms like "substitute" or "substitution." Terms may imply unauthorized dispensing, not aligned with a properly operated formulary. Communication of Changes Notify the medical staff of changes in the formulary system or its content.

21. STEPS INVOLVED IN THE PREPARATION OF HOSPITAL FORMULARY: Identify Common Diseases Consult Medical Departments Use Standard Treatment Guidelines Form Expert Committee or Refer to WHO List Identify Appropriate Treatment Consider Hospital's Capability Draft Formulary List

22. Contd.. Distribute to Departments for Comments Drugs and Therapeutics Committee Deliberate and Provide Feedback Evidence-Based Review Discuss Information and Reviews Prepare Final Formulary List Develop Monographs with Unbiased Information

23. Contents of drug monograph: Indications Contraindications Precautions Dose Pregnancy risk factors Adverse effects Interactions Non-proprietary name of drug Synonyms Available brands Cost Administration Dosage forms

24. Improving adherence to a formulary: Non-Formulary Review Action on non-formulary drugs -Add, educate, or ban as needed Prohibit Sample Use No non-formulary samples use Therapeutic Interchange Establish approved lists Easy Access Formulary at ordering locations In pocket manuals for staff

25. Contd.. Medical Staff Involvement Engage in formulary decisions Advertise Changes Promote formulary updates Clinical Trials Procedures Set guidelines for non-formulary trials

26. Examples of Formulary: WHO Formulary, British National Formulary, Indian National Formulary are some of the formularies used as standard references in many hospitals Many hospitals in India have developed their own Hospital Formularies like Kasturba Hospital at Manipal, Christian Medical College Hospital at Vellore

27. How India will benefit from it? March 2013, CDSCO declared 1091 formulations of 344 fixed dose combinations irrational but due to legal aid taken by the pharmaceutical companies, CDSCO was not able to ban these irrational FDCs Such drugs could be harmful to human health ; Presence of hospital formulary can check the dispensing of such contaminated , substandard drugs to the patients Promotion of dispensing of generic drugs As per recent directive of Medical Council of India under code of medical ethics 1.5 which states “ Every physician should as far as possible, prescribe drugs with generic names and ensure that there is a rational prescription and use of drugs ”

28. In India, even the generic drugs are sold under Brand names given by the manufacturer, which leads to confusion among the generic and brand drugs Reduction in disease burden : As per WHO Global Disease Burden Data , India is a major contributor to global disease burden due to poor availability of right medication at right cost Availability of cost effective drugs : Numerous drugs are available under numerous brand names in India Consumers are at the mercy of the pharmacist that which drug is dispensed to them Since the medicines which are overpriced out - number those that are cost-effective, thus the consumers often end of paying more

29. Summary A hospital formulary is a dynamic list of approved medications that guides healthcare professionals in prescribing, dispensing, and administering drugs safely and effectively. It optimizes patient care by ensuring the availability of essential medicines, promotes cost-effective prescribing, standardizes treatment practices, and enhances medication safety. Development Process – Formulary preparation involves a *Drugs and Therapeutics Committee (DTC)*, selection criteria based on disease patterns, treatment guidelines, financial resources, and periodic review for updates Relevance to India – A well-implemented hospital formulary can reduce the use of irrational drug combinations, promote generic prescriptions, and improve the availability of cost-effective medicines, addressing India's high disease burden

30. REFERENCES: 1.Matlala M, Gous AGS, Meyer JC, Godman B. Formulary Management Activities and Practice Implications Among Public Sector Hospital Pharmaceutical and Therapeutics Committees in a South African Province. Front Pharmacol . 2020 Aug 18;11:1267. doi : 10.3389/fphar.2020.01267. PMID: 32973508; PMCID: PMC7466677. 2.D'Almeida RJ, Acharya LD, Rao PG, Jose J, Bhat RY. Development of hospital formulary for a tertiary care teaching hospital in south India. Indian J Pharm Sci 2007;69:773-9. 3. Sushilkumar P L, Baishnab S, Johnson G, John J A, Philip L A, Philip M S, Chaitanya K T, Sam G K . Development and implementation of a drug formulary for the medicine department of tertiary care teaching hospital. Indo American Journal of Pharmaceutical Research. 2015 July 31; 5(7):2626-33. 4. Sridhar et al., Development of A Hospital Formulary In A Tertiary Care Hospital . American Journal of PharmTech Research 2019.

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