Hospital Pharmacy Formulary

Definition and Purpose

• The hospital formulary is a list of pharmaceutical agents with important information, reflecting the current clinical views of the medical staff.
• The hospital formulary system provides information for procuring, prescribing, dispensing, and administering drugs.
• The purpose of the formulary is to facilitate superior patient care, achieve therapeutic goals, improve patient safety, and curtail expenses.

Objectives

• To provide information on drug products approved by the Pharmacy and Therapeutic Committee (P&TC)
• To provide basic therapeutic information
• To provide information on hospital policies and procedures governing the use of drugs
• To provide special information such as hospital-approved abbreviations and sodium contents

Development of the Formulary

• The formulary offers one or more therapeutic options per disease category
• It facilitates purchasing and prescribing
• It helps manage costs by reducing duplication
• Formularies are often used as a negotiating tool with drug manufacturers
• Drug manufacturers may offer discounts (i.e., rebates) for drugs placed on the formulary

Content and Organization

• The formulary has three parts:
  • Part One: Information on therapeutic policies
  • Part Two: Drug product listings
  • Part Three: Special information

Part One: Information on Therapeutic Policies

• Regulations regarding prescribing, dispensing, and administration of drugs
• Automatic stop orders
• Restricted antibiotic use
• Information on the use of formulary
• Stat orders, emergency kits
• Out prescription policies
• Arrangement of non-formulary medications
• Request of addition of new drugs to formulary

Part Two: Drug Product Listings

• Contains the list of approved medications/products from P&TC
• Includes generic name, common synonyms or trade name, dosage form, strength, formulation, and identification number (if any)

Part Three: Special Information

• Can be part of drug product
• Varies hospital to hospital
• Includes dosage range, special caution, controlled or uncontrolled medicine, monitoring information, and conversion metrics scales or tables

Preparation

• Prepared by the Pharmacist in Chief (Director)
• Prime responsibility of P&TC (approval)
• Selection is based on the need of the hospital
• Type of format: loose leaf or bound, open or closed formulary
• Policies on prescribing and procedure of dispensing medications

Selection of Medicines

• Proven efficacy and use in the healthcare setting
• Drug should be recognized by national formulary
• Manufacturer should be one with proven integrity and dependability
• No secret composition preparation is allowed to be included in the formulary
• Multiple medications with similar therapeutic efficacy should be incorporated
• Products with multiple compositions

Format and Appearance

• Physical appearance and structure influence its use
• Should be visually pleasing, easily readable, and professional
• Can be made attractive by using different color pages for different sections, using edge index, making pocket size, and standout letter formatting

Format and Appearance (Minimum Composition)

• Title page
• Names and title of P&TC committee
• Table of contents
• Information on hospital policies and procedures on drug use
• Products approved for use in healthcare facility

Distribution

• Each patient care unit should receive a copy
• Each division of pharmacy should receive a copy
• Each member of the medical staff should receive a copy
• HOD of each department should receive a personal copy

Potential Demerits

• Deprives the physician of their right and privilege to prescribe and obtain the brand of their choice
• Permits the pharmacist to act as the sole judge of which brands of drugs are to be purchased and dispensed
• Can be the basis of purchase of inferior medicine and supplies
• Does not transfer the cost benefit to the patients

Advantages

• Therapeutic benefits
• Economic benefits
• Educational benefits

Therapeutic Benefits

• Most efficient products are listed and available
• Rationale drug use is promoted
• Single line of therapeutics is followed through rules and regulations

Economic Benefits

• Eliminates duplication
• Beneficial for volume purchases
• Reduces drug expenses

Educational Benefits

• Has prescribing tips
• Administration education (in case of high alert medications)
• Additional information regarding pharmacodynamics and pharmacokinetics

Role of Pharmacist

• Major role in development of formulary
• Evaluating medications for inclusion in the formulary
• Evidence-based evaluation
• Pharmacoeconomic assessments
• Formulary exceptions

Role of Pharmacist (continued)

• Conducting cost-effectiveness analysis
• Conducting cost-utility analysis
• Performing generic substitution
• Conducting medication-use evaluation
• Identifying therapeutic alternatives

This quiz covers the concept of hospital formulary, its purpose, format, and preparation. It also discusses the role of pharmacists and the benefits and issues related to hospital formulary.