Formulary Management in Pharmacy Practice

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Questions and Answers

What is the role of the health-system board?

To review clinical data on new therapies

To govern the affairs of the hospital or health-system (correct)

To evaluate individual patient medications

To manage the financial aspects of drug procurement

What is a stop order in a medical context?

An automatic termination of physician orders after a designated time (correct)

A directive to change prescriptions to over-the-counter drugs

A reminder for physicians to check for drug interactions

A permanent ban on medication use

Which of the following best describes therapeutic interchange?

Replacement of a medication with any available alternative

A process limited to generics and brand-name medications

Authorized exchange of therapeutic alternatives under established guidelines (correct)

Random substitution of drugs without predetermined criteria

What is a key factor for the committee to consider when determining an action plan for formulary management?

The cost impact of the medication Signup and view all the answers

What does a therapeutic class review evaluate?

Similarities and differences within a group of medications Signup and view all the answers

Which two formulary techniques saw a decline according to the 2007 national survey?

Therapeutic interchange and nonformulary medication management Signup and view all the answers

What is the primary function of a medical executive committee?

To establish hospital medication policies Signup and view all the answers

What type of information do pop-ups generally contain?

Clinical information such as drug interactions and monitoring Signup and view all the answers

How has computerized prescriber order entry improved the management of drug therapy?

By facilitating implementation and compliance with drug therapy guidelines Signup and view all the answers

What is the primary focus of Drug Use Evaluation (DUE)?

Assessing the appropriateness of drug therapy Signup and view all the answers

What criteria does therapeutic class review potentially evaluate?

Comparative cost and adverse effects Signup and view all the answers

Which aspect is NOT included in formulary management oversight?

Price negotiations with manufacturers Signup and view all the answers

What is typically included in the decision-making for pop-up alerts in hospital information systems?

Rules based on specific actions taken by users Signup and view all the answers

What outcome is emphasized in Medication Use Evaluation (MUE)?

Improving patient outcomes Signup and view all the answers

What role does the P&T committee play in formulary management?

Determining responses to order entry rules Signup and view all the answers

Which of these elements is not part of the critical information for the committee to consider?

Pharmacy employee satisfaction Signup and view all the answers

What should the task force develop as part of the action plan?

An action plan and criteria for monitoring Signup and view all the answers

Which of the following may be included in the action plan?

Professional staff education Signup and view all the answers

What type of guidelines could be developed as part of the action plan?

Drug use guidelines Signup and view all the answers

Which of these is NOT mentioned as part of the potential action plan?

Insurance policy modifications Signup and view all the answers

What is a key element of ongoing monitoring mentioned in the action plan?

Preprinted orders Signup and view all the answers

What combination of actions might the task force consider in the action plan?

Formulary changes and professional education Signup and view all the answers

Which process is specifically highlighted in the document for improvement?

Medication order entry Signup and view all the answers

Why is professional staff education included in the action plan?

To ensure compliance with new guidelines Signup and view all the answers

What might be a consequence of limiting the use of an antibiotic?

Increased health care costs due to more physician visits Signup and view all the answers

How might formulary restrictions affect antibiotic resistance?

They allow microbes to adapt to fewer antibiotics Signup and view all the answers

What is the purpose of drug therapy guidelines?

To outline the indications and dosage regimens for a specific medication Signup and view all the answers

According to the Institute of Medicine, what was a finding regarding the VA National Formulary?

It generated savings of approximately $100 million over two years Signup and view all the answers

What does the drug use evaluation (DUE) process assess?

The appropriateness of drug therapy based on predetermined criteria Signup and view all the answers

Which type of DUE focuses specifically on patients with a certain disease state?

Diagnosis-related DUE Signup and view all the answers

What should be considered prior to implementing formulary product restrictions?

The potential impact on overall healthcare costs Signup and view all the answers

What is a possible unintended consequence of strict formularies?

Higher utilization of alternative antibiotics Signup and view all the answers

What is a primary goal of medication use review?

To evaluate and improve medication-use processes Signup and view all the answers

What is a potential risk when limiting the number of antibiotics used in hospitals?

Increased antibiotic resistance development Signup and view all the answers

Who might a prescriber-related DUE focus on?

Patients managed by a specific physician or group Signup and view all the answers

Why is it important to monitor the impact after implementing formulary restrictions?

To assess if the intended cost savings are achieved Signup and view all the answers

What does the term 'mode(s) of administration' refer to in drug therapy guidelines?

The various methods through which medication is given to patients Signup and view all the answers

In the context of DUE, what does the term 'criteria and standards' imply?

Benchmarks for evaluating the appropriateness of drug use Signup and view all the answers

How does the FDA define drug product equivalence?

Based on the chemical entity or generic equivalent Signup and view all the answers

What aspect does a DUE process help to enhance in a healthcare environment?

The overall quality and efficacy of drug therapy Signup and view all the answers

Which of the following bodies might require a Pharmacy and Therapeutics (P&T) committee?

State Department of Health Signup and view all the answers

What is the primary purpose of a formulary in a healthcare setting?

To provide a list of medications available for use Signup and view all the answers

Which of the following best describes a closed formulary?

It is a limited list subject to restrictions Signup and view all the answers

What role do pharmacists play in the formulary management process?

They guide the activities of the P&T committee Signup and view all the answers

What kind of information does the pharmacists analyze for the P&T committee?

Scientific, clinical, and health economic information Signup and view all the answers

What are formulary restrictions designed to do?

Limit drug use based on specific criteria Signup and view all the answers

What is a primary financial consideration in formulary management?

The cost of the drug and handling necessities Signup and view all the answers

Which organization is NOT mentioned as an accrediting body requiring P&T committee activities?

Centers for Disease Control and Prevention (CDC) Signup and view all the answers

Study Notes

Learning Objectives

Able to describe the purpose of a formulary system in managing medication use in institutions
Able to discuss the organization and role of the pharmacy and therapeutics committee (P&T committee)
Able to explain how formulary management works
Able to list the principles of a sound formulary system
Able to define key terms in formulary management

Key Terms and Definitions

Closed formulary: A medication list limiting practitioner access to certain drugs. Restrictions can be assigned to specific physicians, patient care areas, or disease states
Drug formulary: A continually updated list of medications and related details. Represents clinical judgment for the diagnosis and treatment of diseases, and the promotion of health
Drug monograph: A comprehensive, unbiased evaluation of a specific medication. Contains detailed information on the drug name, therapeutic class, pharmacology, indications for use, clinical trials, pharmacokinetics/dynamics, adverse effects, drug interactions, dosage regimes, and cost
Drug therapy guidelines: A document detailing indications, dosage, administration methods, monitoring, and special considerations for specific medication use
Drug use evaluation (DUE): A process measuring the appropriateness of drug therapies within a health care setting against predetermined standards.
Diagnosis-related DUE: DUE performed on a specific medication linked to a known diagnosis
Prescriber-related DUE: DUE focused on medication use patterns of particular physicians or groups
Drug-specific DUE: Evaluation focusing on the use of a single medication
FOCUS-PDSA: A performance improvement model in hospitals and health systems that includes performance improvement elements for measuring outcome outputs and modifying processes to improve outcomes
Formulary restriction: Limitation of specific formulary medications to certain physicians based on their expertise, patient type, or specific location (department)
Formulary system: An ongoing method used by healthcare facilities to evaluate medication use, establish guidelines for optimal medication use, and develop policies and procedures related to prescribing, dispensing, and administering medications.
Health-system board: A committee of hospital and community members governing the hospital or health-system
Medical executive committee: A committee of the hospital medical staff primarily responsible for self organization governing responsibilities, and for performance improvement.

Introduction

Medication use management is a process to safely and effectively use drugs in a cost-conscious manner.
A formulary system is key to medication management in a health system. It’s a system for ongoing evaluation of available medications.
The formulary system is managed by a committee of experts (health professionals).

The Formulary System

It's a continually updated list of medications and related information.
Represents the clinical judgment of pharmacists, physicians and experts.
Initially developed for hospitals in the 1950s for medication acquisition and supply consistency.
Modern formularies include medication use policies, pharmacy and therapeutic committees, medication use evaluations, and formulary management.

Key Points

Formularies have evolved from lists of medications to comprehensive systems that manage drug use.
Standard definitions consider formularies as static lists, not recognizing their dynamic nature.
Formulary systems manage medications with continuous updates considering clinical effectiveness, cost-effectiveness, and safety

The Pharmacy and Therapeutics Committee (P&T Committee)

This committee oversees medication management within a health-system.
It is often required by regulatory or accrediting organizations for confirmation.
The committee must have the support of individual experts and the system's medical staff.

Organization

Typically a policy recommending body to the medical staff (through the medical executive committee).
Responsible to the medical staff and the routine administrative processes.
Sometimes reporting directly to a non-medical advisory committee (e.g., health-system board)
Meeting frequency is typically monthly to maintain currency with medications.
Subcommittees or task forces for efficiency (e.g., medication safety, drug reviews, medication use review)

Formulary System Maintenance

The committee develops lists of medications for the facility.
It can also develop guidelines and regularly review the list and guidelines to ensure currency and meeting the staff and patients' needs.

Medication Selection and Review

The committee should have established methods for selection and review.
The assessment should include clinical use, indication, pharmacokinetics, safety, and cost.
Committee members and invited guests should discuss any potential conflicts of interest.

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Description

This quiz focuses on the principles and practices of formulary management in an institutional setting. Participants will learn about the organizational role of the pharmacy and therapeutics committee, as well as key terms and definitions related to drug formularies. The quiz will test knowledge on closed formularies, drug monographs, and effective formulary systems.