Hospital Pharmacy M2

• FORMULARY MANAGEMENT

  1. The formulary is the foundation of the formulary system

  2. The formulary is a list of medications available for use at a hospital or health-system

  3. Diligent management of this list has both patient care and financial implications

  4. Patient care considerations include medication efficacy and safety

  5. Financial considerations are the cost of the drug as well as the costs associated with stocking the medication such as shelf space, drug outdates, and handling
• Functions of the committee

  1. Establishes and maintains the formulary system

  2. Selects medications for formulary inclusion by considering the relative clinical, quality of life, safety, and pharmacoeconomic outcomes

  3. Evaluates medication use and related outcomes

  4. Prevents and monitors adverse drug reactions and medication errors

  5. Evaluates or develops and promotes use of drug therapy guidelines

  6. Develops policies and procedures for handling medications to include their procurement, prescribing, distribution, and administration

  7. Educates health professionals on the optimal use of medications
• Minimum drug entry requirements

  1. Generic name of primary active ingredient

  2. Trade or synonym name

  3. Dosage form

  4. Strength

  5. Size stocked by the pharmacy

  6. Active Ingredients for combination products

  7. Special Precautions

  8. Pediatric or adult dosage ranges

  9. Cost information
• Medication entries arrangement


  • Alphabetically by generic name
  • Alphabetically by trade (synonym) name
  • Alphabetically by therapeutic class
  • Combination
• PHARMACY AND THERAPEUTICS COMMITTEE (P&TC)


  • Medical staff committee responsible for managing the formulary system
  • Provides an evaluative, educational, and advisory service to the medical staff and organizational administration pertaining to the use of available medications
  • Responsible for overseeing policies and procedures related to all aspects of medication use within an institution
• ROLES OF THE P&TC

  • Plan future agendas
  • Gather data to create drug monographs and other necessary documents
  • Evaluate medications for formulary adoption or deletion
  • Prepare and conduct quality assurance programs
  • Prepare policies and procedures
  • Create hard copy and electronic versions of the formulary
  • Communicate P&TC decisions to other health care professionals
  • Follow up with research when necessary
• Medication use guidelines

  • Antibiotic use guidelines
  • Antibiotic use in surgical prophylaxis
  • Community acquired pneumonia clinical pathway
  • Weight-based heparin orders
  • Potassium replacement orders
  • ICU sedation guidelines
  • Thrombolytic therapy guidelines for stroke
  • Alcohol detoxification orders
• Formulary updates, revisions, and distribution

  • Agent to be considered for addition or deletion
  • Rationale for request
  • Alternative agents currently on the formulary
  • Some organizations require or permit the requesting individual to attend the P&T committee to support their request
• Special Precautions examples

  • For IM use only
  • Protect from light
• Responsibilities of the P&TC

  • Information on pharmacy operating procedures
  • Contact information
  • Other pharmacy services such as anticoagulation monitoring or pharmacy newsletters
• Topics to include in medication use guidelines

  • Nutritional products approved for use
  • Equivalent dosage tables (Example: Pain medications, corticosteroids)
  • Parenteral nutrition formulas
  • Pediatric dosages
  • Potassium content of drugs or foods
  • Antidote list
  • Advanced Cardiac Life Support (ACLS) or emergency medication list and dosages
  • Metric conversion table
  • Serum drug levels
  • Standard concentrations of drugs in IV solutions
  • Common equations used (Example: ideal body weight, estimated creatinine clearance, anion gap)
  • Antibiograms
  • Drug dosing in renal or hepatic dysfunction
  • Examples of forms that are routinely used such as nonformulary drug requests, adverse drug reaction reports
• Synonym name that is commonly used for

  • Dosage form
  • Strength
  • Size stocked by the pharmacy
  • Active Ingredients (formulation) for combination products
  • Special Precautions
  • Pediatric or adult dosage ranges
  • Cost information