Hospital formulary Definition, contents of hospital formulary, Differentiation of hospital formulary and Drug list, preparation and revision, and addition and deletion of drug from hospital formulary

1. HOSPITAL
FORMULARY
- Miss Vedika Narvekar

2. DEFINITION
Formulary is an official or
authorized publication of an
approved list of medicines.
Hospital formulary is a list of
pharmaceutical preparations
including important information
which reflects the current clinical
views of the medical staff.
Hospital formulary is the list of the medicines including
◦ Ancillary information related to toxicity
◦ Unwanted side effects
◦ Beneficial effects of some drugs which are considered most useful and safe in
patient-care by a hospital.

4. ❖ Hospital Formulary is updated time to time based on the opinions of
1. Physicians
2. Surgeons
3. Pharmacists
❖ Compilation of HF: by Pharmacy & Therapeutic Committee (PTC)
❖ Used By: Health Care Team.

5. Hospital Formulary System
◦ Method whereby Medical Staff of hospital with help of PTC select and
evaluate medical agents and their dosage form.
◦ Selection criteria
Toxicity
Quality,
Efficiency
Bioavailability
Hospital formulary system assist in
procuring, prescribing, dispensing
and administering a drug.
1. Non- Proprietary (Generic)
2. Proprietary ( Brand names)

6. NEED (Hospital Formulary)
1. Pharmaceutical companies – Increasing manufacturing /marketing of New
drugs.
2. Increasing influence of advertisement.
3. New sales promotion.

7. Benefits of Drug Formulary System
—
Therapeutic- Benefit to patient/physician (most efficient
products)
—
Economic – Lower charges to patient
—
Educational – for Staff, Nurses/ Medical students
—
Rational drug use

8. Advantages of hospital formulary
1. It provides the practitioner with approved and efficacious medicines to treat
disease .
2. It reduces the inventory cost of the drugs.
3. It improves the quality assurance and easier dispensing.
4. It gives medicine information to resident staff, nurses and students
5. It removes the irrational combinations of drugs and also improves adverse
drug reaction management.

9. Disadvantages
The physician is
deprived of prescribing
drugs of his choice.
It may lead to purchase
of drugs which are
inferior in quality, in
case of no involvement
of the pharmacist in
the preparation of
formulary

10. GUIDELINE FOR HOSPITAL
FORMULARY
The governing body of the hospital
should appoint a pharmacy and
therapeutic committee composed
of physician and pharmacist which
will prepare the hospital formulary
system.
PTC shall sponsor and outline the
purpose, organization function and
scope of the hospital formulary
system, as per the need of particular
hospital.
PTC develop policies and
procedures - medical staff adopt
these - subject to administrative
approval.
The policy and procedures shall
afford guidance in the appraisal,
selection, procurement, storage,
distribution, use, safety procedures
and other matter relating to drug in
the hospital and shall be published
in the hospital’s formulary.

11. Contents of HF
◦ Hospital Formulary provides useful information to the prescribers.
◦ Prescription writing
◦ Important part/section of HF
Section consists of
a. Cover
b. Parts of prescription
c. Metric system
d. Abbreviation
e. Information etc.

12. ◦ Prescription contains:
◦ Name, age, sex
◦ Date
◦ Adress of patient
◦ Name of drug ( mentioned in formulary)
◦ Direction for patient
For repeat
prescription,
clear
instructions
are given
Prescription
containing
Narcotic,
psychotropic
Prepared &
signed by
prescriber.
Prepared in
triplicate (3)
1 copy: Physician
2 copies: Patient

13. Primary objectives:
a)Information on drug products approved by PTC
b)Information on hospital policies & procedures --- for use of drugs
c)Special information about drugs. In accordance with these objectives, the
formulary should consist of three main parts:
A. Drug dosage schedule.
B. Hospital approved abbreviations
C. Special information

14. A. Information on Drug products
This section is heart of formulary and consist of descriptive entries.
Entries in formulary such as
1. generic name of basic drugs;
2. common name (Brand name);
3. dosage form,
4. strength,
5. packaging;
6. dose for various age group;
7. route of administration;
8. cost.
Drug product
listing/Indexing by 2 way-
at the beginning /end of HF.
• Generic name/brand name
• Therapeutic or
pharmacological index

15. B. Information on hospital policies and Procedures
• Drug usage and restriction on drug use
• Description of PTC including member responsibility
• Hospital regulations regarding prescribing, dispensing; administration of drug;
drug orders; investigational drug policy; rules for Medical Representatives,
emergency drug products etc
• Pharmacy operation procedures such as services, outpatients prescription,
inpatient drug distribution, labelling, packaging etc
• Information on how to use formulary
a) Entries arranged
b) Procedure for
entry of drug

16. C. Special information
Useful to hospital staff and should be readily available. Varies according to
hospitals.
It includes-
Hospital approved abbreviations
Equivalent dosages of similar drugs
Guidelines for calculating paediatric dosages
List of sugar free drugs
Metric conversion tables
Poison control information
Table of drug interactions

17. Private/Hospital Formulary National Formulary/Drug list
Listing of drugs by their generic names
followed by information on strength,
form, posology, toxicology, use &
recommended quantity to be dispensed.
Generic names followed by data on
strength & form.
Prepared locally by its own clinical
staff.
Prepared by country’s outstanding
clinicians, pharmacologists and
pharmacists.
Information provided is subject to local
needs and desires.
According to their pharmacological
properties.
Published in convenient size Size is big
Addition or deletion of drug with
greater frequency
Addition or deletion of drug with less
frequency

18. Preparation of Hospital Formulary
◦ Principal responsibility of the pharmacy and therapeutic committee.
◦ The committee is free to make necessary decisions, regarding the material to
be included in the formulary and pharmacist undertaken the production of the
formulary that is compiling and printing etc.
◦ Visually pleasing, easily readable and professional in appearance
◦ It should includes section on prescription writing; governing the use of drug;
diagnostic reagent and normal pathological investigational reagent;
pharmaceutical classification; poison and their antidote etc.
◦ It should be distributed to Each pharmacist, Head of dept and nursing dept.

19. Composition
1. Title page
2. Names & titles of the members of the PTC
3. Table of contents
4. Information on hospital policies & procedures concerning drugs
5. Products accepted for use at hospital
6. Appendix

20. CONTENTS
a. Introduction
List of abbreviations , List of drugs used in the formulary
b. Basic information on each drug: Efficacy for the treatment of specific conditions,
Safety profile, Interaction profile, Adverse effects, Pharmacokinetic profile,
Availability of the item, Available dosage form, Cost, Acceptability to patient.
c. Supplementary information on each drug: Storage guidelines, Patient counselling
information, Labelling information, Brand names and prices
d. Prescribing and dispensing guidelines: Principles of prescription writing,
Reporting of ADR, Prevention of ADR.
e. General drug use and advice: Use of IV drugs, Special situations like pregnancy,
breast feeding, liver/kidney diseases, Poisoning information and antidotes, Treatment of
snakebites and insect bites
f. Miscellaneous section: Children’s dose, Renal adjustments, Metric units, Diagnostic
aids

21. Revision of Hospital Formulary
The revision of any
drug to the
formulary is a
complex decision. The PTC holds
meetings to discuss
about the revision of
the formulary and the
specialized experts are
invited.
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.
All steps prior to the
addition or deletion of a
drug must be reported to
the medical staff.
It is done by attaching the
supplement sheets at the back of
the formulary or by using different
color for the cover of each edition
During revision,
cost effectiveness
and cost benefit
analysis methods
are used

22. Criteria for addition or deletion of drugs
◦ The subject drug must be recognised by the Pharmacopoeia or National Formulary
approved by D&C Act/Rules.
◦ The drugs of established therapeutic efficacy can only be added to the formulary
◦ The drug product should receive approval for its clinical value by the local or
specialized physicians
◦ The drug product is to be manufactured by a licensed company with a good record.
◦ The preparation of known composition can only be added to the formulary.
◦ No preparation of secrete composition will be consider
◦ No product of multiple ingredient shall be admitted if same therapeutic effect can be
achieved with single drug preparation.