PHARMACY AND THERAPEUTIC COMMITTEE IS VERY IMPORTANT IN RECENT DAYS TO MAKE SURE DRUG FORMULARY MAINTENANCE

1. PHARMACY AND THERAPEUTIC COMMITTEE
SUBMITTED BY: UNDER THE GUIDANCE OF:
P.MONIKA Dr. G.RAMESHPHARM.D
15AB1T0019 DEPARTMENT OF PHARMACY PRACTICE
IV PHARM.D
VIGNAN PHARMACY COLLEGE
(Approved by AICTE & PCI Affiliated to JNTU KAKINADA)
VADLAMUDI, GUNTUR DIST-522213,ANDHRA PRADESH, INDIA.

2. Introduction :
 To be effective, medication-use policies must have the concurrence of individuals
involved in the medication-use process. Such consensus is achieved by developing
medication use policies through a properly organized and representative pharmacy and
therapeutics (P&T) committee or equivalent body and ensuring that those policies are
approved by the organized medical staff. The P&T committee is composed of actively
participating physicians, other prescribers, pharmacists, nurses, administrators, quality-
improvement managers, and other health care professionals and staff who participate in
the medication-use process.

3. ORGANISATION :
 Composition of pharmacy and therapeutics committee (PTC) might vary from hospital to hospital. The following
scheme is suggested for general adoption:
 The PTC may be composed of:
 At least three physicians from the medical staff
 A pharmacist
 A representative of the nursing staff
 An hospital administrator with his/her designated an exofficio member of the committee one of the physicians may
be appointed as the chairman of PTC.

4. PTC
Medical staff:
Chairman
Co-chairperson
Hospital administrators :
director
Pharmacist :
Secretory
Nursing staff

5. Sub committees
Neo-
plastics
Anti-
infectives
CVS
DRUGS:
Diuretics
Hypertensive
s
Vasodilators
Spasmodics
GI drugs :
Autonomics
laxatives
CNS agents :
Analgesics
Anti-
convulsants
Endocrinolog
y:
Anti diabetic
hormonal

6. GOALS  The goal of a DTC is 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.
 In order to achieve this goal a DTC will have the following objectives:
 To develop and implement an efficient and cost-effective formulary system which includes
consistent standard treatment protocols, a formulary list and formulary manual
 To ensure that only efficacious, safe, cost-effective and good quality medicines are used
 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 develop and implement interventions to improve medicine use by prescribers, dispensers
and patients; this will require the investigation and monitoring of medicine use.

7. OBJECTIVES  The PTC has 3 major roles to play :
 1.advisory
 2.educational
 3.drug safety and ADR monitoring
Advisory :
 The committee recommends the adoption of policies
or assists in the formulation of broad professional
policies regarding evaluation, selection and
therapeutic use of drugs in the hospital
 The committee serves in anadvisory capacity medical
staff and hospital administration in all matters
pertaining to use of drugs

8. Education :
 The committee recommended in formulation of function, design to meet the need
of professional staff (physician, nurses, pharmacist other health care practitioner
for complete current knowledge of matters related to drugs and its usage.
Drug safety and monitoring :
 Pharmacist has an increased responsibility and also develop a moral or legal and
professional functions of ensuring safety in handling and administration of drugs.

9. FUNCTIONS
 There are many possible functions of a DTC, and the committee
must decide which to undertake as a priority; this decision may
depend on local capacities and structure. Furthermore, certain
functions will require liaison with other committees or teams, for
example the infection control committee or the procurement team.
The most important DTC functions are summarized below.

10. 1.Advisory committee to medical staff, administration and pharmacy
 The PTC is a valuable resource that can provide advice to medical staff, nurses, administration,
pharmacy and other departments and groups within the hospital. The PTC can advise on all issues,
policies and guidelines concerning the selection, distribution and use of medicines. Usually a DTC will
provide advice and an executive body, usually the pharmacy or hospital management, will implement
it.
2 Development of drug policies
 The PTC is the most appropriate body to develop drug policies within a hospital or group of health
facilities, since the committee members will have the most experience and training in drug therapy and
supply.

11.  Drug policies may vary in different hospitals and countries, but all hospitals should have specific
policies concerning:
 Criteria for inclusion of medicines on the formulary list (essential medicines list (EML))
 Standard treatment guidelines and treatment algorithms, which should be the basis of formulary
selection
 Periodic use of medicines not on the formulary list, for example restricting their use to specified
prescribers on a named patient basis only, or only allowing 10% of the hospital medicines budget to be
spent on them
 Expensive or dangerous medicines, such as third-generation antibiotics or oncological drugs, which
are restricted to certain practitioners, departments or patients (structured order forms may be used to
implement this policy)
 Drugs that are under investigation for safety or efficacy
 Generic substitution and therapeutic interchange
 Drug representatives and promotional literature.

12. 3.Evaluating and selecting medicines for the formulary list
 Perhaps the most important function of a PTC is the evaluation and selection of
medicines for the essential medicines list or formulary list. Drugs should be
selected on the basis of the standard treatment guidelines or protocols that have
been developed or adapted for use in the hospital or health facilities. The
evaluation of medicines requires significant expertise and time commitment and a
rigorous, transparent approach.
4.Assessing medicine use to identify problems
 Appropriate changes within the formulary list or other interventions may correct a
number of problems in how medicines are used. It is important for the PTC to
identify the priority problems and make appropriate recommendations

13. 5.Appropriate methods to identify drug use problems include:
• Aggregate drug consumption data review including ABC and VEN analysis and use
of defined daily dose (DDD) methodology
• Monitoring indicators of medicine use, including adherence to standard treatment
guideline• drug use evaluation (DUE), also known as drug utilization review
• Monitoring adverse drug reactions and medication errors
• Antimicrobial resistance surveillance

14. 6.Conducting effective interventions to improve medicine use
 There is no point in a PTC collecting information on drug use problems if nothing
is done to correct the problems identified. The PTC is the main body within a
hospital, or group of health facilities, responsible for ensuring that drug information
is provided to health staff and also for conducting interventions to promote more
rational drug use. Monitoring and supervision, audit and feedback, educational
programmes, in-service training, use of standard treatment guidelines, provision of
unbiased drug information, prescribing restrictions and automatic stop orders are
some important interventions.

15. 7.Managing adverse drug reactions
 Adverse drug reactions (ADRs) are serious in terms of patient harm (morbidity
and mortality) and avoidable economic costs. One large meta-analysis estimated
that ADRs cause 3-4% of all hospital admissions in the USA and that in 1994 the
incidence of ADRs was 6.7% (2.2 million events) with 106 000 fatalities
(Lazarou et al. 1998). These estimates should be viewed with caution because of
the heterogeneity among studies and small biases in the sample, but the data
nevertheless suggest that ADRs are a large and serious problem

16. 8.Managing medication errors
 Medication errors occur in all health-care settings, no matter how good the health-
care staff are at prescribing, dispensing and administering medicines. Even if there
is no error on the part of health-care staff, patients may take drugs incorrectly.
Causes are numerous and include lack of knowledge, tiredness of staff, careless
work attitudes, poor procedures, lack of policies, unfamiliar dosage forms and
human error. PTCs can reduce such errors by monitoring, analysing, reporting
errors and implementing corrective action

17. 9.Information dissemination and transparency
 The PTC must disseminate information about its activities, decisions and
recommendations to the staff who must implement the PTC’s decisions. This may
seem obvious, but it is often forgotten. Inadequate dissemination of information
leads to a loss of credibility. It is also very important that the PTC operates in such
a way as to ensure transparency of all its decisions and to avoid conflict of interest.
In particular, members should either have no relationship with pharmaceutical
companies or declare it openly so that conflicts of interest can be avoided. The
only acceptable contact with pharmaceutical companies is to ensure the flow of
information about their drug products in a way that is as unbiased as possible

18. Policy Development
 The P&T committee formulates policies regarding evaluation, selection, diagnostic and therapeutic
use, and monitoring of medications and medication-associated products and devices. The P&T
committee should establish and assist in programs and procedures that ensure safe and effective
medication therapy (e.g., clinical care plans, treatment guidelines, critical pathways, disease
management protocols). Members of the P&T committee, or their representatives from appropriate
specialties (including pharmacists), should participate in or direct the development and review of
such programs or procedures, which should be kept current.

19.  The P&T committee should participate in performance improvement
activities related to procurement, prescribing, dispensing,
administering, monitoring, and overall use of medications. The P&T
committee should advise the institution, including the pharmacy
department, in the implementation of effective medication distribution
and control procedures, incorporating technological advances when
appropriate. The P&T committee should initiate, direct, and review the
results of medication-use evaluation programs to optimize medication
use and routinely monitor outcomes (economic, clinical, and
humanistic) of formulary decisions.

20. Communication and Education
 The P&T committee ensures that mechanisms are in place to communicate with
health care professionals, patients, and payers about all aspects of the formulary
system, including changes made to the formulary or policies and how formulary
system decisions are made. The P&T committee also recommends or assists in the
formulation of educational programs designed to meet the needs of professional
staff, patients, families, and caregivers on matters related to medications and
medication use. The P&T committee should establish or plan suitable educational
programs on matters related to medication use for staff involved in the care of
patients and the use of medications.