DEVELOPMENT OF HOSPITAL FORMULARY FOR 300 BEDDED TEACHING HOSPITAL

1. DEVELOPMENTOFHOSPITALFORMULARYFOR300
BEDDEDTEACHINGHOSPITAL
SUBMITTED BY UNDER THE GUIDANCE OF
A.SANDHYA RANI Dr. G.RAMESHPHARM.D
15AB1T0001 DEPARTMENT OF
IV PHARM. D PHARMACY PRACTICE
VIGNAN PHARMACY COLLEGE
(Approved by AICTE & PCI Affiliated to JNTU KAKINADA)
VADLAMUDI, GUNTUR DIST, ANDHRA PRADESH, INDIA, PIN: 522 213

2. contents
 Definition
 Guidelines
 Objectives
 Types of hospital formulary
 Members involved in preparation of hospital formulary
 Criteria in medicine selection
 Steps involved in preparation of hospital formulary
 Managing a formulary list
 Role of pharmacist in hospital formulary

3. Definition:-
•The hospital formulary is a list of
pharmaceutical agents with its important
informations which reflects the current
clinical views of the medical staff.

4. HOSPITAL FORMULARY SYSTEM:
Hospital formulary provides information for
Prescribing
Procuring
 Dispensing
 Administration of drugs

5. ORIGIN OF HOSPITAL FORMULARY:
 The first hospital formulary in india was published
in 1968 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.

6. GUIDLINE FOR HOSPITAL FORMULARY:
 The medical staff in the governing body shall sponsored 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 .

7. Prescribers should be strongly encouraged to
prescribe drugs by their non-proprietary names :-
a) Pharmacist is responsible for selecting from available generic
equivalents.
b) That the prescriber has the option , to specify the brand for that
particular prescription.
c) PTC is responsible for determining those drug products and
entities.
d) Medical and nursing staffs are informed about the changes in the
HF system.
e) Labelling of medicine with non-proprietary names, followed by
decided formats.

8. Objective:
To set standards for best practice, promoting high quality,
evidence based prescribing.
 To ensure rational drug therapy and control drug cost
 To presice use by the physician and nursing staff.
To continually revise compilation of pharamaceuticals and
some important ancillary information that reflects the
current clinical judgement of medical staff.

9. Advantages:-
Most effective methods for ensuring rational drug therapy and controlling
drug coast.They can offer simple and cost-effective solutions for many medicines.
Formulary is a continually revised compilation of pharmaceuticals and some
important ancillary information that reflects the current clinical judgement of
medical staff.
Set standards for best practice, promoting high quality,evidence based
prescribing.
Reduces the variation in the level of treatment provided to the patients and
controlling drug cost.
Hospital formulary is the vehicle by which the medical, pharmacy and
nursing staffs make use of the system.
It is complete, concise, updated and easy to use.
It is complete, concise, updated and easy to use.

10. DISADVANTAGES:
Doesn’t promote good health /narrow view of health
 Doesn’t encourage people to live healthy lives as they are
treated to fix problems as they arise.
 The focus is on the condition and not the determinants that caused
it.
Not every condition can be treated
 Cancer is an example – advances have been made, but treatment
not always successful
Affordability – not always affordable
 Not all countries can afford the medical technologies and
resources that are part of the biomedical model of health –an important
factor contributing to differences experienced in health status.

11. TYPES OF HOSPITAL FORMULARY:
There are three basic types of formularies
1. Open formulary
2. Closed or restricted formulary
3. Incentive based formulary
 OPEN 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.

12.  CLOSED OR RESTRICTED FORMULARY:
In contrast, a 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.
 INCENTIVE BASED FORMULARY:
formularies; patients pay a higher price for non formulary
drugs An incentive-based formulary represents a hybrid
between the open and closed

13. MEMBERS INVOLVED IN THE PREPARATION OF HOSPITAL
FORMULARY:
In most hospitals, the membership includes:
 A representative clinician from each major specialty,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.
 A pharmacist (usually the chief or deputy chief pharmacist),or a pharmacy
technician where there is no 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.

14. CRITERIA IN MEDICINE SELECTION :
Selection of drugs depends on many factors such as the Pattern of
prevalent diseases.
• Treatment facilities.
• Training and experience of available persons.
• Financial resources.
• Genetic.
• Demographic and environmental factors

15. WHO (1999) has developed the following selection criteria:
 Only those medicines should be selected for which sound and adequate
data on efficacy and safety are available from clinical studies, and for which
evidence of performance in general use in a variety of medical settings has
been obtained.
 Each selected medicine must be available in a form in which adequate
quality, including bioavailability, can be assured; its stability under the
anticipated conditions of storage and use must be established.
 When two or more medicines appear to be similar in the above
respects, the choice between them should be made on the basis of a careful
evaluation of their relative efficacy, safety, quality, price and availability.
 In cost comparison between medicines, the cost of the total treatment,
and not only the unit cost of the medicine must be considered. Where drugs
are not entirely similar, selection should be made on the basis of a cost
effectiveness analysis.

16. Steps involved in preparation of hospital formulary:

17. Contents of the monograph:
The drug monograph consists of following subheadings such as
• Non – proprietary name of drug
• Synonyms
• Available brands
• Cost
• Reconstitution
• Administration

18. • Dosage forms
• Indications
• Contraindications
• Precautions
• Dose
• Pregnancy risk
• Adverse effects
• Interactions

19. Maintaining formulary:

20. • 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).

21. Examples of formulary:
• 1. WHO Formulary, British National Formulary, Indian
National Formulary are some of the formularies used as
standard references in many hospitals.
• 2. Many hospitals in India have developed their own
Hospital Formularies like Kasturba Hospital at Manipal,
Christian Medical College Hospital at Vellore and KLE
Hospital at Belgaum etc.

22. Role of pharmacist in the hospital pharmacy:
 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.

23. List of drugs:
s.No Generic name brands
1 CARBAMAZEPINE
CONTROLLED RELEASE TAB
200,300mg
ZIGMA CR 200 ZIGMA CR 300
2 TROPICAMIDE +
PHENYLEPHRINE HCL
TROPIDYN PLUS
3 PENTOXYPHYLLINE 400MG TRENTAL 400 MG
4 DIPHYNOXILATE ATROPIN LOMOTIL
5 CLOBAZAM 5, 10 MG CLOBA 5 CLOBA 10 FRISIUM 5 , 10
6 GABAPENTIN 300MG ,100 MG GABACENT 300 GABACENT 100 GABAPI N 100
7 LAVITRACITAM 100,250,
500MG
LEVIPIL 250 ,500 LEVIPSY 500 1000 EMLEV 750
8 PREGABALIN 75 MG +
METHYLCOBALAMIN 1500MG
MAS PG PRAGACENT M
9 SODIUM VALPROATE 500MG
10 TOPIRAMATE 25 MG TOPIRAMATE