Hospital Formulary PDF

duplicative Introduction questionable value As many as 70 percent of all drugs on the market today are either quality This forces hospitals to institute its own complex screening methods to provide the most effective and costefficient drugs. By establishing a proper ‘ FORMULARY SYSTEM How to a...

duplicative Introduction questionable value As many as 70 percent of all drugs on the market today are either quality This forces hospitals to institute its own complex screening methods to provide the most effective and costefficient drugs. By establishing a proper ‘ FORMULARY SYSTEM How to achieve that? A continually updated list of medicines approved for use in the health care system by authorized prescribers. Formulary Formulary is very educative and useful to all members of health care team. A system of periodically evaluating and selecting medicines for the formulary, maintaining the formulary, and providing information in a suitable manual or list. Terminologies An ongoing process whereby a healthcare organization, through its physicians, pharmacist, and other healthcare professionals, establishes policies on the use of drug products and therapies and identifies drug products and therapies that are the most medically appropriate and cost-effective to best serve the health interests of a given patient population. Formulary System Drugs are selected based on the needs of the local community. Drugs selected for the formulary are “drugs of choice” The formulary list should have a limited number of drugs FORMULARY MANAGEMENT PRINCIPLES Efficacy Safety Drugs are selected based on explicit criteria that include proven Quality Cost The formulary must be consistent with national formulary Only the most effective and safe products are included. Drugs selected for the formulary are “drugs of choice” . Included drugs have been evaluated in a systematic manner. Approved and efficacious drugs that all practitioners will be required to use Drugs are selected based on the needs of the community. Physicians will develop better experience with fewer drugs. most effective drugs will be included BENEFITS OF FORMULARY SYSTEM TO HOSPITALS resulting in fewer visits, improved outcomes Training will be easier as there will be fewer drugs. lower costs. Inventory cost will be reduced. Drug therapy at a lower overall cost Ineffective high-cost drugs will not be included. Enhanced price competition Consistent supply of drugs Less money will be wasted. More consistent in purchasing essential drugs increasing availability of drugs. Request for Addition/Deletion form. which can be made only by a physician or pharmacist A request for addition or deletion of a drug to the formulary List of specific pharmacological actions of the drug Information on why the drug is superior to current formulary drugs Information needed from the physician or pharmacist Specific literature support for use Background on any financial support received from the supplier or other organization Provides most current information Technical reports Primary Source / Literature Dissertations Include analysis of data collected in the field or laboratory Conference proceedings & symposia Original research published as articles in peer-reviewed journals. Present original research Offer analysis or restatement of primary sources. Aim to summarize, interpret, reorganize, or otherwise provide an added value to primary sources. Usually broader and less current than primary literature Literature review articles Secondary Source / Literature Medical letters Medical Letter (USA) Meta analysis Newsletters Drug & Therapeutics Bulletin (UK) Bulletins produced by national bodies Contain extensive bibliographies The International Society of Drug Bulletins Administration of intravenous (IV) medications Trissel’s: Handbook of Injectable Drugs Compatibility between IV medications or solutions Categorized as Obtain drug information resources Summarizes literature and rates the safety of drugs in pregnancy and lactation Briggs Drugs in Pregnancy and Lactation Also states the pharmacokinetic effect of drugs in pregnant and lactating mothers Books monographs on drugs of abuse and cigarette smoking Endorsed by the American Pharmacists Association (APhA) More than 1,800 drug monographs, each offering up to 44 fields of information specific to a particular medication. Drug Information Handbook Inhibitors and Inducers of Cytochrome P450 Enzymes. Immunization Schedules Oral Medications that should not be crushed or altered. Information obtained from primary and secondary source and arranged in a manner to represent a composite of the available information. Sources that index, abstract, organize, compile, or digest primary or secondary sources. Good place to look up facts or get a general overview of a subject. Dictionaries Cochrane Library Lexi-Comp Online FDA and off-label use Tertiary Source / Literature Treatment Micromedex Care Notes System Information for patients on Follow-up care Laboratory tests Continuing health and drugs Databases PHARMACY DATABASES Examples Micromedex Healthcare Series Pharmacokinetic data Drug-drug / Food / Supplements interactions PubMed USP-NF Online PROCESS FOR SELECTION OF A NEW DRUG Dietary supplements Excipients Food Chemicals Codex Online Purity and quality standards for food ingredients International Pharmaceutical Abstracts Alt-Health Watch Pharmaceutical industry Complementary & holistic approaches Encyclopedias Handbooks Manuals Disease patterns of the country HOSPITAL FORMULARY Safety (risk-benefit ratio) Cost (cost-benefit ratio) Perform the evaluation using established criteria. Efficacy Quality Drugs that are well known Health system personnel and equipment available to manage the drug Financial resources available Availability of Lab facilities for Drug Use Monitoring. Lack of therapeutic effect Toxic and adverse reactions What is the impact of using poor-quality drugs? Waste of financial resources Loss of credibility of the health care services Identity Purity Potency How to assure good quality of drugs? What characteristics of quality to be assured? Uniformity Bioavailability Stability Pharmacology Pharmacokinetics Efficacy compared to placebo & other drugs Clinical trial analysis monograph should include: Adverse drug reactions Drug interactions Cost comparison Sources of supply (to ensure availability) Drug information monograph. costs of administration monitoring It is important to consider medication and non–medication related costs prolonged hospital stay operational costs laboratory test monitoring costs to patients and providers Develop formulary recommendations. Obtain expert opinions and recommendations. Make a formulary decision (at the PTC meeting). Disseminate the results of the evaluation and PTC’s recommendations. The use of a drug in indications, doses, routes of administration or patient group (age related) not approved in the products labeling. Definition Use of medications outside of specified populations. OFF – LABEL USE OF FORMULARY DRUGS Use for different diseases or stages of diseases. Examples Use by different routes of administration. Use after changes in dosing and/or dosing schedules. When a drug is approved as a capsule, but it is given instead in an oral solution or prepared extemporaneously. The open system allows introducing non-formulary drugs on a limited basis, usually for a single patient use. Most formulary systems are designed as an “open” system. Patients who require specialized treatments. NON-FORMULARY DRUGS Non-formulary drugs are necessary, in limited amounts, for: Patients who have been stabilized on drugs from practitioners outside of the hospital. Limiting the number of nonformulary drugs. Limiting access to appropriate prescribers. Management of non-formulary drugs includes: Reviewing frequently (close follow-up by the PTC). Policies and procedures on how these drugs will be purchased. Title Page Table of contents Information on hospital policies and procedures for uses of drugs. First part Hospital rules and regulations for distribution of drugs. Introductory information (First part of the formulary) Directions for how to use formulary. Guidance on how to write appropriate prescription. Guidance on how to effectively prescribe drugs in special conditions and cases. Notes on adverse drug reactions. Cardiovascular E.g., Endocrine GIT System.. etc Contains the main text where major therapeutic categories are listed with drug information for each individualdrug. How is the contents organized and ordered? Arrhythmia Body Organ Systems (ordered alphabetically) E.g., Hypertension Heart failure...etc CONTENTS OF HOSPITAL FORMULARY Disorder of each organ system (ordered alphabetically) E.g., Drug classes (therapeutic categories) used for various disorders (ordered alphabetically) Second part (major part of the formulary) Drug entries are arranged in the sequence of: Third part Appendix 2 Alphabetical list of hepatotoxic & nephrotoxic drugs in addition to some formulas for creatinine clearance calculation. Appendix 3 Drugs that should be stopped prior to blood donation. Appendix 4 List of drugs that should be avoided in patients with 11G6PD deficiency. Appendix 5 Child-BSA-nomogram. Appendix 6 Therapeutic drug monitoring of drugs. Appendix 7 Conversion factors and anthropometrics. Appendix 8 Common medical abbreviations. How many type of alternatives can be used? Therapeutic interchange Pharmacy department Should be placed at each patient care unit indications Alphabetical list of clinically important drug interactions for the drugs. Medical wards DISTRIBUTION OF FORMULARY Generic drug name Appendix 1 Therapeutic equivalents THERAPEUTIC ALTERNATIVES B-blockers...etc Individual drugs under each drug therapeutic class Before each therapeutic subcategory or group, there are notes preceding meant to help the reader in making rational drug selection for individual patients. APPENDICES a-blockers Out-patient clinics Emergency rooms Definition Definition contraindications Drug products with different chemical structure but are of the same pharmacologic and/or therapeutic class and are expected to have similar therapeutic effects and adverse effects. cautions E.g., side- effects and doses first generation cephalosporins histamine-2 blockers Authorized exchange of therapeutic alternatives in accordance with previously established and approved written guidelines. The approved dosage forms, strengths and pack sizes (if known) are stated under preparations. E.g., Atenolol Bisoprolol...etc