Hospital Formulary Notes PDF

Preview

Summary

Reviewer note...

Description

Hospital Formulary Objectives: 1. Discuss the importance of hospital formulary 2. List each component of formulary 3. Describe how a drug is evaluated objectively for formulary addition 4. Demonstrate the areas of formulary distribution

Formulary 

 

It is continually updated list of medications and related information, representing the clinical judgment of physicians, pharmacists, and other experts in the diagnosis, prophylaxis, or treatment of disease and promotion of health. The P&T committee is responsible for managing the formulary system. A formulary includes, but is not limited to: - a list of medications & medication associated products or devices - medication-use policies - important ancillary drug information - decision-support tools - organizational guidelines

Formulary System? 

An ongoing process through which a health care organization establishes policies regarding the use of drugs, therapies, and drug-related products and identifies those that are most medically appropriate and cost-effective to best serve the health interests of a given patient population.

Purpose of Hospital Formulary 1. 2. 3. 4.

Serves to educate physicians on the relative merits of the drugs available Serves as a valuable teaching tool to the interns, residents and other healthcare professionals Promotes safe, intelligent, and effective drug therapy Supplies essential information to the medical/nursing staff on the available therapeutic agents, which they cannot be expected to remember 5. Prevents unnecessary duplication and confusion

FORMULARY CONTENT & ORGANIZATION The primary objective of the formulary is to provide the hospital staff with the following: 1. Information of what drug products have been approved by the PTC for the patient use. 2. Basic therapeutic information about each approved item. 3. Information on hospital policies and procedures governing drug use. 4. Special information about drugs

DETAILED PARTS OF THE FORMULARY 1. Hospital policies & procedures concerning drugs: 1.1 Categories of drugs including in the formulary drug and investigational drug. o Categories of Hospital Formulary drugs A. Formulary Drugs FDA Approved Essential For Good Patient Care

Well established usage B. Drugs approved on a conditional trial period FDA Approved For general use Evaluated for 6 or 12 months period C. Specialized Formulary Drug FDA Approved For specialized patient D. Investigational Drug FDA approved for specific use by principal investigator Not commercially available 2. Drug Product Listing - This part is the heart of the formulary. - It consists of one or more descriptive entries for each formulary items plus one or more indexes to facilitate use of the formulary. o

Formulary Item Entries can be arranged in several ways: 1. Alphabetically, generic name 2. Alphabetically, within therapeutic class 3. A combination of the two systems whereby the bulk of the drugs are contained alphabetically in a general section which is supplemented by several special sections such as ophthalmic/otic drugs, dermatological and diagnostic agents. 4. Dosage form as oral tablets and capsules, oral liquids/ syrups/suspension/ parenteral injectables as ampules/ vials, etc.

o

Each drug entry must include the following information: 1. Generic name of the basic drug entity or product/combination products 2. Dosage forms, strengths, packagings and sizes stocked by pharmacy 3. Formulation (active ingredients) of a combined product

o

Indexes to the Drug Products Listing There are two indexes which can be included which will facilitate the use of the formulary: 1. Generic name of drug items 2. Therapeutic / Pharmacologic index *Index is a listing of all drug items w/in each therapeutic category. It is useful in ascertaining what therapeutic alternatives exist for a given situation such as patient allergy to a particular drug.

3. Specific Information a. List of Hospitals-approved abbreviations b. Rules for calculating pediatric dosages c. Table of sodium content of antacids d. List of the contents of emergency cart/ boxes/cabinets e. Dosage guides for patients with impaired renal functions f. Metric conversion scales and tables

g. Examples of formulary request forms and prescription blanks h. Important provisions of the Generic act on prescribing and dispensing especially thorough erroneous, violative and impossible prescriptions i. Tables of drug interactions j. Poison antidote chart

Format The format is extremely important since it will determine the practicality of daily use of the formulary as well as the publishing costs.

Size Experience has shown that a formulary which is sufficiently small in size to permit its being carried in a uniform or laboratory coat pocket will, in all probability, enjoy widespread use in the hospital. A small sized book also can be carried in the doctor’s bag along with his prescription.

Loose-Leaf Vs. Bound The most important of these is the ease by which a loose-leaf formulary can be kept current. A bound volume is difficult to keep up- to date and therefore requires more frequent revision

Printed Vs Mimeographed A printed formulary is obviously more esthetic in appearance, easier to read and imparts to the user the impression that the hospital considers the formulary as an extremely important document and therefore of the cost printing

A typical formulary have this composition: 1. 2. 3. 4.

Title page Names & titles of the members of the PTC Table of contents Information on hospital policies and procedures concerning drugs. a. Objectives and operation of the formulary system. b. Hospital regulations and procedures for prescribing and dispensing drugs c. Hospital pharmacy services and procedures. d. Directions on how to use the formulary 5. Products accepted for use at the hospital a. Items added, deleted and requested for inclusion to PNDF consistent with the revision made by the NDF b. Pharmacologic/ Therapeutic indexes c. Description of FD products by pharmacologic/therapeutic class 6. Appendix a. Rules for calculating pediatric doses b. Schedule of standard administration times c. Forms of addition to/ deletion from formulary and other important forms

Typical Format and Appearance of Hospital Formulary  The formulary should be visually pleasing, understandable, and must appear professional. The need for proper grammar, punctuation, correct spelling and neatness is obvious.  Making use of different colors of paper for each section of the formulary

 Make use of an edge index  Developing a pocket- size formulary that can fit laboratory coat/uniform pockets. A small sized book formulary is also recommended since it can be carried in the physician’s bag along with prescription’s blanks  Printing the generic name of each drug entry in bold face using some other method for making it stand out from the rest of the entries

Distribution of the Formulary 1. 2. 3. 4. 5. 6.

Patient care unit (ER, OR, OP, ICU) Division of Pharmacy Heads of Departments providing direct patient care Hospital administration Members of the medical staff Nursing department

KEEPING THE FORMULARY (CURRENT) Generally, the formulary will need to be revised annually. Additions and deletions to the formulary, changes in the drug products, removal from/addition to PNDF of current edition and changes in DOH policies, laws, rules, and regulations related to drugs, hospital policies and procedures will necessitate periodic revision of the hospital formulary. Any changes in the current sheets can be attached to the inside back covers of the formulary.

Criteria for Selecting Drugs in the Formulary a. Efficacy and Safety b. Quality - Each selected drug must be available in a form in which adequate quality, including bioavailability can be assured. c. Relative Benefits - Applied to drugs which appear to be similar in the above respects. d. Cost Benefit - Considers the cost of the total treatment and not only the unit cost of the drug. e. Pharmacologic Advantages and Availability - Consider factors such as comparative pharmacokinetic properties or by local considerations such as availability of facilities for manufacture and storage...