2. Goal of DTC
• To ensure that patients are provided with the best possible
cost-effective and quality of care through determining what
medicines will be available, at what cost, and how they will be
used.
Objectives :
• To ensure the best possible drug safety through monitoring,
evaluating and thereby preventing, as far as possible, adverse
drug reactions (ADRs) and medication errors
• To ensure that only efficacious, safe, cost-effective and good
quality medicines are used.
• To develop and implement an efficient and cost-effective
formulary system which includes consistent standard treatment
protocols, a formulary list and formulary manual
3. Role of DTC in Drug Management Cycle
• The drug management cycle illustrates the
necessity for coordination of managerial and
technical support with appropriate drug
policies and guidelines, in order for any drug
system to run smoothly .
• The figure highlights the coordination between
the DTC and the drug purchasing and
inventory control body
4. Role of DTC in Drug Management Cycle
• The DTC would not normally do the procurement itself.
• Its role would normally be to ensure that the formulary system and other drug
policies developed by the DTC are implemented by the procurement
department.
Section
use Procurement
Distribution
5. Structure and organization of a drug
and therapeutics committee
• Administrative support can provide the executive
authority needed,to gain the cooperation of senior
medical staff.
• The administration can also provided the funds
needed to undertake many of the DTC’s activities.
6. Steps in setting up & managing of DTC
committee
• 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.
7. STEP2: Determine the objectives and functions of
the committee
• The first thing a DTC should do is to agree its terms of
reference, which specify the DTC’s place in the organizational
structure of the hospital, its goals, objectives, scope of
authority, functions and responsibilities.
Once basic functions, such as a formulary system, are
implemented, the DTC can move on to other activities
8. STEP3: Determining how the committee will operate
• Regular meetings of the DTC, at least quarterly and preferably
monthly.
• Regular attendance.
• The agenda, supplementary materials and minutes of the
previous meeting should be prepared by the secretary.
• These documents should be kept as permanent records of the
hospital and should be circulated to chairpersons/directors of all
clinical departments.
• All DTC operating guidelines, policies and decisions should be
documented
9. • Liaison of the DTC with other hospital committees and regional
or national committees is important, for two reasons:
To harmonize related activities (for example, surveillance of(AMR)
and antimicrobial use)
To share information concerning common activities (for example,
monitoring of adverse drug reactions and educational strategies
such as continuing medical education).
10. STEP4: Seeking a mandate
• The mandate of a DTC should specify:
Its roles and functions
Its place in the organizational structure
Its membership
Its scope and lines of authority.
11. STEP 5: Identifying budgetary sources
STEP 6: Forming subcommittees to address specific
issue
STEP 7: Assessment of the DTC’s performance
12. Managing the formulary process
• The formulary list (essential medicines list)
• Criteria in medicine selection
• Developing and implementing a formulary list
• Managing a formulary list (EML): adding and
deleting drugs.
• Maintaining a formulary.
• Assessing new medicines
• Ensuring medicine safety and quality
13. Getting started
• The way to get started will depend on the varying
circumstances and context in different countries,
health-care systems and hospitals.
• Many countries do not have DTCs in their hospitals or
facilities.
• Three areas are covered:
How to start a DTC where none exists
How to improve the functioning of an existing DTC
How to use this manual in solving problems
14. Stepwise approach to starting a DTC where none
exists
STEP 1: Do your groundwork
STEP 2: Gain a friend in authority
STEP 3: Meet all the senior staff and stakeholders
STEP 4: Measure your medicine use problem
STEP 5: Present your findings and plan next steps with
your stakeholders
STEP 6: Undertake a detailed drug use investigation
STEP 7 :Present your detailed findings and plan an
intervention
STEP 8: Implement and evaluate an intervention to
correct the problem
STEP 9 :Present the results of your intervention to
senior prescribers
STEP: 10 Plan the start of a DTC
