Pharmacy and therapeutic committee I.pptx

IV PHARM D

1. Pharmacy and therapeutic committee Ravindra B N Assistant Professor SACCP

2. INTRODUCTION In these days modern medicines (Allopathic medicines) are used mostly. A careful selection of drugs for use in hospital has become an issue. Since , there is multiplicity of drugs available and complexities surrounding their effective use, it is necessary for the hospital to establish a system to bring the best medicinal agents. One of the methods for ensuring the proper rationality in the use of drugs is that the hospital organize and constitute “PHARMACY AND THERAPEUTIC COMMITTEE”.  

3. DEFINITION The Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers essentially all the matters related to the use of drugs in a hospital including evaluation of drugs & dosage forms and safe use of investigational drugs. The purpose of this Committee is to formulate and review policies regarding the selection, intra-hospital distribution, storage, and safe use and administration of drugs within the Hospital.

4. PHARMACY AND THERAPEUTIC COMMITTEE (PTC ) PTC is a advisory group for the medical staffs. It serves as a means of communication between the healthcare professional and pharmacy department . One of the most important functions of PTC is to prepare and update hospital formulary, which provides information on various drugs to be used in the hospital. The committee composed of Physicians, Pharmacist and other Health care professionals. The other name of PTC are Pharmacy committee, Formulary committee, Therapeutics committee.

5. OBJECTIVES OF PTC a) ADVISORY It recommends the adaptation of polices / assist in the formulation of board professional policies regarding evaluation, selection and therapeutic use of drugs in the hospital. It also recommends for purchase, storage, distribution of the medicines. Advice the Pharmacy in the implementation of effective drug distribution & control procedures.

6. b) EDUCATION It recommends or assists in the preparation of programs designed to meet the needs of the Healthcare professionals for complete current knowledge on matters related to drugs & drug use. It establishes or plans suitable educational schemes like teaching programs for the hospital’s professional staff with new drugs and to teach the student nurses the basic course of pharmacology. c) DRUGS SAFETY & ADVERSE DRUG MONITORING The function is assigned to or taken up by PTC to ensure safety to patients by keeping continues vigilance. The P&T Committee maintains a formulary of medications approved for routine patient care, reviews drug use and adverse drug reactions, and establishes procedures for prescribing, dispensing, and administering drugs in the hospital

7. RESPONSIBILITY: Preparation of hospital formulary Publishing of a pharmacy education bulletin The supervision of Investigational use of drugs “Automatic stop order” for dangerous drugs Assisting in preparation of emergency kits or carts Reporting and investigation adverse drugs reactions

8. COMPOSITION/ ORGANIZATION OF PTC It varies from hospital to hospital. It composed of : At least three Physicians from the medical staffs. A pharmacist, A representative of the Nursing staff and An hospital administrator with his/her designated an ex-officio member of the committee one of the Physician may be appointed as the Chairman of PTC. The Pharmacist functioning as Secretary & therefore he is designated as the “SECRETARY” of the committee.

9. Operations of PTC The committee should meet regularly, at lest 6 times per year &when necessary. They may invite to its meetings person within or outside the hospital who can contribute specialized or unique knowledge, skills and judgement. Minutes of the meeting should be recorded by secretary &maintained permanently in hospital. The agenda and the supplementary materials should be prepared by secretary & submitted to committee members well in advance, so that the can study them before the meeting.

10. Typical Agenda consists of… Minutes of previous meeting. Review of content of hospital formulary for up-dating & deleting of products not considered as necessary for use. Information regarding new drugs which may have become commercially available. Review and/or adoption of investigational drugs currently under processing in the hospital. Review of investigational drugs currently used in hospital. Review of side effects, ADRs, drug interaction, toxic effects reported. Review of drug safety in hospital. Reports of various sub-committees. Report of medical audit. Any other matter with the permission of chair. Vote of thanks.

11. The minutes of all meeting hold should be prepared by the secretary (the pharmacist-member) and permanent records of these minutes should be maintained in the hospital. The recommendations of the committee should be presented to the medical staff or its appropriate committee for its adoption or recommendations.

12. Functions To serve in as an advisory committee to the medical staff& hospital administration regarding drugs (including investigational drugs). To develop a formulary of drugs accepted for use in the hospital and provide for its constant revision where, selection is made based on safety, cost, therapeutic benefits. To establish / plan suitable educational programs for the staff so as to update their knowledge About drugs of their use. To review ADRs occurring in hospital. To make recommendation concerning drugs to be stocked in hospital patient care area. To advice the pharmacy in the implementation of effective drug distribution and control procedure.

13. Functions…. To review drug utilization in hospital and promote optimum standards for rational drug therapy. To participate in quality assurance activities related to the distribution, administration and use of medicines. To assist the pharmacy department in the development and review of policies, rules, and regulation regarding the use of drugs in hospital. To make categories of the drugs used in the hospital.

14. Role of PTC in Drug Safety It is the moral, legal and professional obligation of the pharmacist. Drug safety includes responsibility from dispensing of drugs to drug-administration and to observe possible adverse effect. PTC can play a major role in ensuring drug safety. Following guidelines may serve the committee in ascertaining the adequate safety factor of the hospital pharmacy drugs safety: The hospital must employ a qualified and registered pharmacist as the chief pharmacist. The hospital must provide adequate safe work space, and storage facilities. The hospital should have the firm policy regarding the use of research drugs in the hospital and its clinics.

15. The Pharmacy and Therapeutics Committee shall review processes and errors for 1) Compliance and improvement. 2) Administrative processes The Pharmacy and Therapeutics Committee will review reports from the Medical Director, Clinical Director, or designee regarding documentation of effects of Medications including benefits and side effects. The Pharmacy & Therapeutics Committee will review all adverse drug reactions for appropriate response and preventable reaction. The Pharmacy and Therapeutics Committee will review audits for use of specific medications associated with 1) Substantial risk 2) Significant side effects 3)Abuse potential for appropriate prescribing and monitoring practices.

16. The PTC will direct medical staff and pharmacist, in review of prescribing practices to ensure adherence. The pharmacy should have an adequate reference library which contains text on pharmacology, toxicology, posology and journals with adequate newer developments.

17. Role of PTC in ADR monitoring An adverse reaction is defined as any unusual or unexpected harmful reaction from a drugs. Every case of adverse drug reaction must be first reported by attending physician to chairman of PTC. The ADR including acute drug poisoning of any drug like narcotics, barbiturates and amphetamine. The Attending Physician Should Complete the “ADR Report form”.

18. PROFORMA FOR MONITORING OF ADRIN INDIA   CENTRE NAME:- TYPE OF PATIENT: - (a) INPATIENT (b) OUT PATIENT SERIAL NO: - DATE:- NAME OF THE PATIENT:- ADRESS:-   AGE:- SEX :- OCCPATION:- HOSPITAL ORDER NO:- DIETRY HABIT:- SMOKING:- ALCOHOLIC DRINKING:- RELEVANT MEDICAL HISTORY:- if yes, details(allergy; previous drug reaction; environmental exposure; family history of ADR) BACKGROUND SIGNS SYMPTOM:-   PROVISIONAL DIAGNOSIS:-   TREATMENT SCHEDULE               DATE OF END TREATMENT:-   OUT COME OF TREATMENT:-

19. Automatic stop order All drug order for narcotics, sedatives, hypnotics, anticoagulants and antibiotics shall be automatically discontinued after 48 hours. (a) Unless the order indicates an exact no. of doses to be administered. (b) Exact period of time for medication is specified. (c) Attending physician records the medication. All orders for narcotics, sedatives and hypnotics must be written every 24 hours. All P.R.N (pro re nata) and standing order for all medications except narcotuics, sedatives and hypnotics shall expire at 10.00 am on the 7 th day unless renewed.

20. Role of PTC in developing Emergency drug list It is absolutely necessary for the PTC of a hospital to get prepared boxes i.e. “Emergency drug boxes” containing emergency drugs which shold be always available readily use at bed-side. These emergency boxes or “kits” should be checked daily either by hospital pharmacist or nursing superior responsible for the ward. These emergency boxes should be placed in all the wards.

21. supplies to be maintained in emergency box A) 1) Syringes :1ml,2ml… 2) Needles : 16’, 18’… 3) Files for breaking the ampoules. 4) Tourniquets 5) Airway equipment 6) Ryle tube. B) Drugs for emergency box: Aminophylline 0.25g/ml Amylnitrates glass capsules Atropine suphate 0.4mg/ml Calcium glconate 1g/10ml Digoxin 0,25mg/ml. etc…

22. Supplies for cabinet utility room Venous cannulation set Each set of 12&17 venous catheters Oxygen catheters Sterile suction catheters Razor with blades Package sterile gelatin sponge Resuscitation tube Other emergency supplies Resuscitation cards Phlebotomy sets Oxygen equipments Tracheotomy sets Dextran and tubing Burn sheets

23. ROLE OF IN DRUG UTLIZATION REVIEW Drug utilization includes prescribing, dispensing, administering and ingesting of prescription of drugs. Hospital pharmacist should take medication history that should include following information: (1) Medication being taken at the time of admission, during admission home remedies (OTC drugs) (2) Drug- allergies and idiosyncrasy towards food products.

24. PATIENT MEDICATION PROFILE DATE DRUGS DOSE ROUTE STARTED DIS CONTINUED REMARK XYZ HOSPITAL PATIENT MEDICATION PROPILE RECORD NO:- NAME OF THE PATIENT: ADDRESS: DATE OF ADMISSION: ADMISSION DIAGNOSIS: OTHER PATHOLOGY: PREOPERATIVE MEDICATION USED :

25. ROLE OF PTC DRUG PRODUCT DEFECT REPORTING The drugs purchased by hospital maybe defective in quality it is for the committee to get information about the defective drug products and to inform it first to the manufacture for appropriate action. If satisfactory answer is not obtained from the manufacture or supplier then it should be reported to FDA

26. Drug defect form XYZ HOSPITAL   Address ------------------------------------------ Date received----------   HOSPITAL PHARMACIST’S DRUG DEFECT REPORT Reference No-------   1. Trade Name------------------ Dosage form------------- Strength -----------------. 2. Lot No. ------------------- EXP Date------------------- 3. Date of purchased----------- 4. Name of supplier--------------------------- 5. Name and address of the manufacturer-------------------   6. Reporting pharmacist’s name. ------------------------------ 7. Defects Noted or suspected----------------------------------   Signature of the Chairman Date----------------- Pharmacy and Therapeutics Committee

27. Reference A text book of Hospital pharmacy, by Merchant and Qadry,Tenth edition:2008-2009. Page no:28-38. http://www.ncbi.nlm.nih.gov/pubmed/10260199 . http://drugs.about.com/od/pdrugandmedicalterms/g/PandT_Comm.htm http://www.allacademic.com/meta/p_mla_apa_research_citation/2/6/1/5/4/p261549_index.html

28. Thank you