hospital formulary

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

 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
3

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

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

TYPES OF FORMULARY
An open formulary serves merely as a guide; a physician
may prescribe any drug, but is encouraged to use the
formulary list in prescribing decisions.
OPEN FORMULARY
An closed or restricted formulary lists the drugs that will
be reimbursed by the health care provider; non-formulary
drugs will be reimbursed only if they are authorised prior
to prescribing.
CLOSED OR
RESTRICTED
FORMULARY
An incentive-based formulary represents a hybrid between
the open and closed formularies; patients pay a higher
price for non formulary drugs
INCENTIVE BASED
FORMULARY
6

WHO???
7
DRUG AND
THERAPEUTIC
COMMITTEE

MEMBERS INVOLVED IN THE
PREPARATION OF HOSPITAL FORMULARY
A representative clinician
from each major specialty
A clinical
pharmacologist
A nurse, usually the senior
infection control nurse, or
sometimes the matron.
A pharmacist (usually
the chief or deputy chief
pharmacist)
A clinical
microbiologist or a
laboratory technician
where there is no
microbiologist.
A member of the
hospital records
department.
An administrator, ,
representing the hospital
administration and finance
department
8

 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

 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

STEPS INVOLVED IN THE PREPARATION
OF HOSPITAL FORMULARY
Identify the most common diseases being treated in the
hospital by consulting all medical departments. For
each disease, an appropriate first choice of treatment
should be identified using standard treatment
guidelines
An expert committee can be brought together to
identify the appropriate treatment for each of the
common health problems.The alternative method is
reviewing the WHO model list of essential medicines
may also be used as a starting point
A draft of the list must be prepared and must be
given to each department to comment on the list
11

STEPS INVOLVED IN THE PREPARATION
OF HOSPITAL FORMULARY
The Drugs and Therapeutics Committee must
deliberate on their comments and provide feedback
All information should be discussed with evidence
based reviews where possible.
After the preparation of final list, monographs for
each drug should be prepared and it should contain
unbiased information
12

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

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

 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

 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

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

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

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

ADVANTAGES AND DISADVANTAGES
 ●It is very handy for use by the
physician and nursing staff.
●It helps physicians to know about
the available drugs in the hospital
pharmacy and also helps in better
inventory control.
●Evidence based treatment
guidelines.
●It is complete, concise, updated
and easy to use.
●Improves clinical practice of
health care professionals.
●Reduces the variation in the level
of treatment provided to the
patients and controlling drug cost.
 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

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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