PTC Role in Hospital Formulary Development

PHARMACY AND
THERAPEUTICS
COMMITTEEProf. Jyotsna P. Khedkar
M.Pharm (Pharmacology)
PSGVPM’s IOP
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Chapter-6
Prof. Jyotsna Khedkar,PSGVPM's IOP,
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LEARNING OUTCOMES
1. Understand composition and functions of PTC.
2. Explain Role of PTC
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Definition:
• Pharmacy and the therapeutic committee is a group of
person which formulate policies regarding the
therapeutic use of the drug.
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Purpose of the committee
• Advisory: The committee recommends to adopt the
policies or help in the preparation of policies regarding
evaluation, selection and therapeutic use of drugs.
• Educational: The committee recommends or helps in
the preparation of the programme through which the
need of the professional staff to complete current
knowledge on matters related to drugs and their use
will be fulfilled.
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• Drug safety and Adverse drug reactions
monitoring: As the therapeutic agents are
increasing, the scope, knowledge and
responsibility of the hospital pharmacist is also
increasing. The safety aspects are more or less
taken for granted by pharmacy, medical and
nursing staff.
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COMPOSITION OF PTC
• The pharmacy and therapeutic committee should be
composed of :
• At least three physicians
• A Pharmacist
• A nurse representative
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• A chairman should be appointed from amongst the
physician representative.
• A pharmacist usually works as a secretary.
• The meeting of the committee should be at least six
times per year and whenever necessary.
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• The meeting schedule should be prepared by the
secretary and submitted to the committee members
before the meeting.
• The secretary should prepare the minutes of the
committee meeting and maintain the permanent
records for the hospital.
• The committee recommendations should be
presented to the medical staff for its adoption or
recommendation.
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FUNCTIONS OF COMMITTEE
• Advising medical, and selecting administrative and
pharmacy department on drug-related issues,
• Developing drug policies and procedures.
• Evaluating and selecting drugs for the formulary and
providing for its periodic revision.
• Assessing drug use to identify potential problems.
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• Promoting and conducting effective interventions/
interference to improve drug use (including
educational, managerial and regulatory methods.)
• Managing adverse drug reactions.
• Managing medication errors.
• To recommend drug which needs to be stocked in the
hospital patient care areas.
• To initiate and promote the studies on drug use and
review the results of such studies.
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Responsibility of committee
• Ensure safety medication to patients.
• The preparation of a hospital formulary.
• Publishing of a pharmacy educational bulletin.
• The establishment of automatic stop orders for
dangerous drugs.
• The supervision of investigational use drugs.
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• The development of a program for reporting and
investigating adverse drug reactions
• Assisting in the preparation of emergency kits or
carts for medical emergencies.
• Committee Agenda
• Minutes of the previous meeting.
• Review of a specified of the formulary for up-dating
and deletion of products.
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• New drugs which have become commercially
available.
• Investigational use of drugs currently in use in the
hospital.
• Review of adverse drug reactions reported in the
hospital since the last meeting.
• Drug safety in the hospital.
• Slow-moving medication.
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ROLE OF PTC IN DRUG SAFETY
• The following are the guidelines for the committee in
achieving drug safety in the hospital
• The hospital should employ a qualified registered
pharmacist as a chief.
• The hospital should not permit non-pharmacy
personnel to dispense the drug.
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• The hospital should provide adequate and safe
workplace and storage facilities for the pharmacy.
• An adequate amount of equipment in good
condition should be provided to carry out practice
safety.
• A drug formulary should be in the hospital which
periodically revised and kept update.
• The poisonous materials should be kept separately
from no poisonous materials in the pharmacy and
nursing station.
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• All nursing station should be periodically inspected
removing the deteriorated and outdated drugs.
• Chief pharmacist should engage teaching
programme for the nursing staff with new drugs.
• Adequate reference library should be provided for
the pharmacy and nursing.
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ROLE OF PTC IN ADVERSE
DRUG REACTION
• The PTC, therefore, develop adverse drug reaction
report (ADR report). The ADR report includes names
of drugs, route of administration, the date of starting
and ending treatment. The indications for which the
drug was used and adverse drug reaction noted for
them and steps take to treat them.
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• The nursing station transmits this report to the
chairman of PTC in the recommended procedure.
The physician himself should place the adverse
drug reaction before the chairman of PTC. The
same is then ultimately placed with the medical
record book. The PTC interact with the bodies like
FDA and government.
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ROLE OF PTC IN EMERGENCY
DRUGS
• The certain emergency drug must be handled at the
bedside. The PTC makes the list of such drugs and
supplies and prepares emergency box or kit. The
same is then placed in the ward, the emergency box
contains different syringes, needles, ampoules, drugs
like atropine sulphate, calcium gluconate, digitoxin,
amphetamine, corticosteroids, mannitol, neostigmine,
saline for injection and other emergency equipment
which continuously review by the PTC.
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ROLE OF PTC IN AUTOMATIC STOP
ORDERS FOR DANGEROUS DRUGS
• 1) PTC develops a policy for ASOD for dangerous
drugs. PTC adopts any one of the following policies:
• All orders for sedatives, hypnotics, narcotics shall be
automatically discontinued after 48 hours unless.
• The orders indicate several dosages to be
administered.
• The exact period for treatment.
• The physician reorders medicine.Prof. Jyotsna Khedkar,PSGVPM's IOP,
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• 2) All orders for narcotics, sedatives and hypnotics
must be rewritten every 24 hours.
• 3) All orders for medicine except hypnotics,
sedative and narcotics shall expire at 10 am on the
7th day unless renewed.
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ROLE OF PTC IN DRUG PRODUCT
DEFECT REPORT
• The drugs purchased by hospitals may be defective in
quality. PTC collects reports regarding defects of the
drugs and informs to the manufacturer. If a
satisfactory answer is not obtained from the
manufacturer then committee report this matter to
food and drug control administration.
•
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HOSPITAL
FORMULARY
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Prof. Jyotsna P. Khedkar
M.Pharm (Pharmacology)
PSGVPM’s IOP
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LEARNING OUTCOMES
1. Understand hospital formulary.
2. Understand guiding principles of hospital formulary.
3. Explain role of pharmacist in the preparation of
hospital formulary.
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Definition:
• Hospital formulary is the list of pharmaceutical
Preparation along with important information, which
reflects the current clinical view of the medical staff.
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MEMBERS INVOLVED IN THE PREPARATION OF
HOSPITAL FORMULARY
• In most hospitals, the membership includes:
• A representative clinician from each major speciality,
including surgery, obstetrics and gynaecology,
internal medicine, paediatrics, infectious diseases,
and general practice ( to represent the community).
• A clinical Pharmacologist, if available.
• A nurse, usually the senior infection control nurse, or
sometimes the matron.
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• A pharmacist ( usually the chief or deputy chief
pharmacist).
• An administrator, representing the hospital
administration and finance department.
• A clinical microbiologist or a laboratory technician
where there is no microbiologist.
• A member of the hospital records department.
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NEED FOR HOSPITAL FORMULARY
• The increasing number of new drugs manufactured
and marketed by drug companies.
• The increasing influence of advertisements: on drugs
which include both scientific and unscientific, ethical
and unethical.
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• The increasing complexity of untoward effects of
modern potent drugs.
• Newer sales promotion strategies of the
pharmaceutical industry.
• The public interest in getting possible health care at
the lowest possible cost.
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GUIDING PRINCIPLES OF
FORMULARY:
• The governing body of the hospital shall appoint
pharmacy and therapeutic committee(PTC) composed
of physicians and pharmacist which will prepare the
hospital formulary system.
• The PTC shall develop policies and procedures
governing the hospital formulary and the medical staff
shall adopt these to administrative approval.
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• The policies and procedures shall afford guidance in
the appraisal, selection, procurement, storage,
distribution, use, safety procedures and other matters
relating to drugs in the hospital and shall be published
in the hospital’s formulary or other media available to
the members of the medical staff.
• The medical staff shall adopt the policy of including
the drugs by their non-proprietary names.
• In the absence of written policies approved by the
medical staff, the pharmacist shall dispense the
brands prescribed.
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• The hospital shall make it certain that the nursing
personnel must be informed in writing about the
hospital formulary system existing in the hospital for
its effective usage.
• In the formulation of policies and procedures, the
terms “substitute” should be avoided because these
terms can be used for dispensing entirely different
drugs.
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• If there is any change hospital system or in the
contents, it must be informed to the medical staff.
• The labelling of medicine with non-proprietary
names should always be done properly. The format
is as follows:
• Name of drug (non-proprietary names).
• Name of manufacturer or distributor.
• Prescription or order by the proprietary name.
• Dispensing is done according to the formulary
policy.
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PARTS OF HOSPITAL FORMULARY
• Introduction
• Basic information
• Supplementary information on each drug
• Prescribing and dispensing guidelines
• General drug use and advice
• Miscellaneous section
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PREPARATION OF FORMULARY
• A typical formulary will have the composition in the
following manner.
• A title page.
• Names and titles of the member of the pharmacy and
therapeutic committee.
• Table of contents.
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• Information on hospital policies and procedure
concerning drugs
• Size
• Format -i) Loose-leaf or bound ii) Printed or
Mimeographed
• Indexing and assigning categories-i) General index ii)
Pharmacological index
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• Title page: It includes name and title of members of
PTC
• Table of Content: There are two ways which can be
included
• A generic name or brand name: Proper page number
should be given for reference a particular product.
• Therapeutic or Pharmacological effect: This index is
according to the therapeutic committee. Example
antihistaminic drug, antitussive, laxative.
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• Information regarding drug: This section is the heart of
formulary and consists of descriptive entries for each
item to facilitates its use like-
• Generic name of the drug
• Common name or brand name
• Dosage form, strength, packaging
• Formulation (name of the active ingredient)
• Adult or paediatric dose
• Route of administration
• Cost
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• Appendix: Appendix includes the rules for calculating
paediatric dose, body surface, Reschedule of
standard drug, administration time.
• Special Information: The material to be included in
this section vary from hospital to hospital but it should
be useful to the hospital staff and should be readily
available. It includes-
• Nutritional product list
• Equivalent dosage of similar drug
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• List of hospital approved abbreviations
• List of the sugar-free drug product
• Number of items available for emergency boxes
• Metric conversion and tables
• Table of drug interaction
• Poison control distribution
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REVISION OF FORMULARY
• The PTC holds meetings to discuss the revision of
the formulary.
• 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.
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• The addition of details of a drug is done by attaching
the supplement sheets at the back of the formulary.
• The addition of any drug to the formulary is a complex
decision.
• All steps before the addition or deletion of a drug must
be reported to the medical staff.
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ROLE OF PHARMACIST IN THE PREPARATION
OF HOSPITAL FORMULARY
• The pharmacist collects information on various drugs
to be included in the formulary from different
pharmacopoeias.
• Evaluates various drugs as per the guidelines of the
PTC.
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• He is mainly involved in the preparation of formulary
under the guidance of pharmacy and therapeutic
committee.
• He is responsible for the annual revision of formulary.
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DISTRIBUTION OF FORMULARY
• Copies of formulary should be placed at each patient
care unit include clinics, outpatient care areas,
emergency room, each pharmacist ( in the patient
division, dispensing section, outpatient dispensary)
should receive a copy. Head of department and
nursing department should receive a copy.
•
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PTC Role in Hospital Formulary Development

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