Unit 2b-Hospital Formulary & its preparation

B. Pharmacy
pharmacy practice
7th Sem
unit 2b
PCI syllabus
Hospital formulary
Definition of hospital formulary
contents of hospital formulary
differentiation of hospital formulary and drug list
preparation and revision of hospital formulary
addition and deletion of drug from hospital formulary
advantages and disadvantages, etc.

1. HOSPITAL FORMULARY Pharmacy Practice (Unit II-b) Ms. Munjewar Seema C. Assistant Professor Department of Pharmacology

2. What is Hospital Pharmacy? Hospital formulary is nothing but the Hospital’s own Pharmacopoeia .

3. Why does a hospital need its own pharmacopoeia when the government publishes pharmacopoeia for the entire country? A national pharmacopoeia is big in volume. It contains monographs for a lot of drugs for which government fix standards. However, a hospital does not necessarily need a long list of drugs.

4. The pharmacopoeia does not contain all the information required by different health care professionals like physicians, pharmacists, nurses, dieticians, and laboratory technicians. Hence, the hospital formulary comes into the picture. It contains the list of drugs approved by the hospital concerned. It was prepared by the expert members of the committee formed by the PTC of the hospital. The pharmacopoeia does not contain all the formulations used by the hospital which are separately published in books like National formulary, Pharmaceutical codex, etc. It cannot be used as a ready reference in a hospital set up where information about a drug may be required on the spot and it cannot be made available to everybody.

5. Def inition: Th e hospital formulary system is a method whereby the medical staff of a hospital with the help of Pharmacy & Therapeutic Committee selects and evaluates medical agents and their dosage form which are considered to be the most useful in the patient care. Hospital formulary reflects the current clinical views of the medical staff. The hospital formulary system provides the information for procuring, prescribing, dispensing and administrating of drugs under proprietary (brand) names in instances where drugs have both names. The first hospital formulary in India was published in 1968 by the department of pharmacy, Cristian Medical College, Vellore. E.g. Kasturba hospital (Manipal), KLE hospital (Belgaum), Government medical college (Kerala), Christian medical college, Vellore, etc. Definition of Hospital Formulary

6. Aim: The ultimate aim of publishing a hospital formulary is to give the best treatment to the patient at a lower cost. Objectives: The hospital formulary, has following primary objectives: Information on drug (name and details about the drugs approved by the hospital) special information such as dosing rules, abbreviations, etc. Information on Hospital policies and procedures concerning above drugs Aim & Objectives of Hospital Formulary

7. In accordance with previous objectives, the formulary should consists of three main parts: Drug product listing Special information Hospital policies and procedures Contents of Hospital Formulary

8. Formulary item entries: Alphabetically by generic name Alphabetically within therapeutic class Type of information: Dosage form, strength, packaging Active ingredients Adult/pediatric dose Route of administration Cost Indexes to the drug product listing: Generic name/brand name Therapeutic/pharmacological index 1. Drug Product Listing :

9. Equivalent dosage of similar drugs Hospital approved abbreviations Rules for calculating pediatric dosages List of sugar free drugs List of dialyzable poisons Metric conversion tables Poison control information Table of drug interactions 2. Special information:

10. Drug use Description of PTC Hospital regulations about prescribing, dispensing and administration of drug, rules for Medical Representatives, emergency drug products, etc. Pharmacy operating procedures Information on using formulary 3. Hospital Policies and Procedures:

11. Formulary Drug List Drugs are listed by their generic names followed by information on strength, form, posology, toxicology, use & recommended quantity to be dispersed. Drugs are listed by generic names followed by data on strength & form Prepared locally by it’s own clinical staff Prepared by country’s outstanding clinicians, pharmacologists and pharmacists Information provided is subject to local needs and desires Information provided is according to their pharmacological properties Published in convenient size Size is big Addition or deletion of drug with greater frequency Addition or deletion of drug with less frequency Differentiation of Hospital Formulary and Drug List

12. Preparation of a hospital formulary is a main responsibility of the PTC. The committee is free to make necessary decisions, regarding the material to be included in the formulary Role of pharmacists in preparation of formulary: 1. The pharmacists collects information on various drugs to be included in the formulary from different pharmacopoeias. 2. Set various drugs as per the guidelines of PTC 3. He is mainly involved in preparation of the formulary under the guidance of PTC 4. He is responsible for annual revision of the formulary Preparation of Formulary

13. Introductory information: Title page Acknowledgement Name and titles of the members of PTC List of abbreviations Table of contents Information on hospital policies and procedure concerning drugs Format and Appearance for preparation of hospital formulary:

14. 2. Basic information of the drugs: Generic name Dosage form Strength of indications Pharmacological action Precautions Side effects Frequency instructions Drug interactions

15. 3. Supplementary information on each drug: Storage guidelines Patient counselling information Brand names Price regulatory category 4 . Prescribing and dispensing guidelines: Principles regarding writing name and address of the patient in prescription Prescribed drug should be written in formulary terminology Strength of prescribed medicine must be given in accepted metric system Correct dispensing guidelines, prevention and reporting of ADRs

16. 5. Other components: Poison and their antidotes Posological tables Table of common lab values Tables for various diagnostic reagents and pathological investigational reagent, etc. Index of the drugs included in the formulary Metric units Indexes (by generic name, brand name, therapeutic category) 6. Size: It should be sufficiently small in size so that it could be easily carried by clinicians, nurses, etc. in the pockets of their uniform or lab coats. The hospitals may determine their own size of the formulary

17. 7. Format: Pharmacists decides the format before commencing work on printing and publishing in the hospital He/she has to collect formularies of some leading hospitals as well as their format Copies of finally published formularies may be sent to bodies like directorate general of health services, Gov. of India, PCI, etc. 8. Type of format: Loose leaf or bound printed or mimeographed

18. The revision of any drug to the formulary is a complex decision The PTC holds meetings to discuss about the revision of the formulary and specialized expert are invite The annual revision is necessary because of the changes in the drug products, removal of certain drugs from the market and changes in the hospital policies All steps prior to the addition or deletion of a drug must be reports to the medical staff It is done by attaching the supplement sheets at the back of the formulary or by using different color for the cover of each edition During revision, cost effectiveness and cost benefit analysis methods are used Revision of Formulary

19. For addition of drug into the hospital following things should be considered: The drug should be well accepted in market or otherwise should have ‘No Objection Certificate’ from FDA. The drug must be recognized by the pharmacopoeias and formularies and should be approved under D & C act and rules. The drug should have sufficient ‘margin of safety’ (minimum side effects and good pharmacological action with minimum dose) Addition and Deletion of drug from hospital formulary 1. Addition:

20. No drug or preparation of secret composition should be admitted in the formulary. Marketed products should maintain their license no., registration no., address of registered office of the company and essential information about the medicine. PTC checks the information about drug and the effects of drugs should be monitored and then through discussions and seminars PTC informs the physicians about the use of drugs After confirming effectivity of drug PTC permits the particular drug to enter into the hospital pharmacy.

21. The ADRs or drug interactions or unwanted side effects if observed with patients then it should be reported by physicians to PTC The information regarding ADRs should be reported to PTC by following type of form: The PTC calls meeting and the physicians should show the ADRs of the drug through seminar and discussion. After that PTC decides the deletion of particular drug. ADRs Date: Time: Dosage form: Name of the drug: Patients name: Age: Gender: Type of disease Observed side effects/ADR/interaction: Other information: Signature of applicant 2. Deletion:

22. It provides the practitioner with approved and efficacious medicines to treat disease It reduces the inventory cost of the drugs. It regulates the number of medicines by improving the procurement and inventory management It improves the quality assurance and easier dispensing It gives medicine information to resident staff, nurses and students It removes the irrational combinations of drugs and also improves adverse drug reaction management . Advantages of Hospital Formulary

23. The physician is deprived of prescribing drugs of his choice It may lead to purchase of drugs which are inferior in quality, in case of no involvement of the pharmacist in the preparation of formulary Disadvantages of Hospital Formulary

24. Describe hospital formulary. Write the advantages and disadvantages of its. Discuss the preparation of hospital formulary. (10M) Questions

25. A textbook of pharmacy practice by S. Balasubramanian , BSP books Pvt. Ltd., 2020, ISBN: 9389974380, 9789389974386. Textbook of pharmacy practice by Rakesh Saini and Sagar Singh Jough , New Delhi New Age International (P) Limited, Publishers 2022, ISBN: 9789389802344. Principles of pharmacy practice by Dr. Ramandeep Singh, Satinder Kakar and Bhumika Mangla, PV publication, 2018, ISBN: 9781543342659. Textbook of pharmacy practice by Gaurav Agarwal , CBS publishers and distributers Pvt. Ltd., 2020, ISBN: 9789389941913. References