Medication Management • Formulary System.
• Pharmacy and Therapeutics
Committee.
Rana Itani, Rph
Rafik Hariri University Hospital
Outline
Medication Management.
Formulary System vs. Formulary List.
Publishing your Formulary.
Formulary Maintenance.
Pharmacy & Therapeutic Committee:
Definition.
Members.
Responsibilities and Role.
Pharmacy Challenges
Medication Safety
Medication Cost
Medication Management
Medication management is implemented to
provided a mechanism to assure safe and effective
use of drugs in a cost conscious manner.
Medication Management
The key to medication management is the:
FORMULARY SYSTEM
Medication Management
Formulary List
Formulary
System
or
or
Formulary List vs. System
The idea was developed in the 1950’s.
Formulary List = list of medications routinely
stocked by the health care system.
Overtime, formulary has evolved beyond a list
of medications into a system for medication
management.
Formulary System Ongoing assessment of medications available for use
The system provides a systemic method to
review scientific evidence on clinical and
cost effectiveness in drug selection
decisions, thus potentially improving health
outcomes while reducing the cost.
Formulary Management
Better patient care and financial benefitse.g. selection of single generic product reduces cost and error in
dispensing or administration
Number of medication Dosage form
Strength Package size
Optimizing
Formulary System
Pharmacist is responsible for the quality,
quantity, and source of all medications,
chemical, biological and pharmaceutical
preparations used in diagnosis and
treatment of patients.
Formulary System:Medication List
Published formulary list of medications approved for use.
Medication entries may be arranged alphabetically by:
Generic Name
Therapeutic Class
Trade Name
Combination
Formulary System (cont’d)
Medication List
Other Information to be included in each Drug Entry:
Dosage form and strength.
Special precautions.
Pediatric or adult dosage ranges.
Undesirable Effects.
Cost information.
Formulary System (cont’d)
Medication List
The medication list should include one or
more index to assist the user in locating
medication entry.
Alphabetical index for generic and trade names.
Index according to therapeutic class.
Publishing the Formulary
Formulary must be published regularly.
List should be available to all personnel involved
in the medication process e.g. nurse stations, clinics, ER,
outpatient areas.
It should be easy to use and visually pleasing e.g.
pocket size, electronic version.
Formulary should be posted on the hospital
website.
Publishing the Formulary (cont’d)
Elements of the formulary often include the
following:
Title page.
Table of contents.
Medication List.
Medication use guidelines.
Special information.
Medication use policies.
Indexes.
Formulary Maintenance
Formulary maintenance is an ongoing process
to assure relative safety and efficacy of agents
available for use in health system. These
include:
New product evaluation: consider indication, kinetics,
safety and cost, drug storage, mode of administration...
Therapeutic class review: to obtain optimal agent within a
therapeutic class in terms of efficacy, safety and cost.
Formulary Maintenance (cont’d)
◦ Formulary changes:
Additions and deletions to the formulary.
Submission of request for formulary addition or deletion
(Rational for request and alternative agent available in
formulary).
◦ Non-formulary drug use review:
Policy for use of non-formulary drugs.
Procedure for procurement of non-formulary drug.
Regular review of non-formulary drug use.
Who Sets the
Formulary List?
Setting the Formulary List?
Maintenance of Formulary List?
Publishing Formulary List?P&T
Committee
Pharmacy & Therapeutics Committee
This committee is a policy recommending
body to the medical staff. All the
recommendations of the committee are
subject to approval from:Organized Medical Staff
Administration
Pharmacy & Therapeutics Committee
Policy DevelopmentEducation
1ry
purpose
Formulary Management Process
Pharmacy Staff
Medical StaffProfessional
Staff
Medication Use Management
Initiatives
P&T CommitteeReview & act on recommendationsFormulate implementation plan
Medical & Hospital Staff Notification
NewslettersDepartment MeetingsAlliance with pharmaceutical representatives
Drug Review Panel
Safety Committ
ee
Medication Use Review
Pharmacy & Therapeutics Committee (cont’d)
The committee should meet on a regular
basis to discuss the rapidly changing drug
products and medical literature.
Frequency: Monthly meeting.
Length: 60-90 minutes.
Note: Minimum: 10 meetings/year.
Pharmacy & Therapeutics Committee (cont’d)
Committee Membership:
Pharmacists
Quality Improveme
nt Managers
Administrators
Physicians
Nurses
Pharmacy & Therapeutics Committee (cont’d)
Responsibilities:
1. Formulary system maintenance:
Develop list of medications for use.
Guidelines for optimal use of medications.
Review list & guidelines on regular basis.
2. Medication selection and review:
Medication selection criteria should be set and should
include medication efficacy, safety and cost.
Pharmacy & Therapeutics Committee (cont’d)
Responsibilities:
3. Medication Use Evaluation:
E.g. overuse of antibiotics resistant infections and
increased cost.
Approve drugs to be kept under restriction.
4. Medication Safety Evaluation:
Adverse drug reaction reports.
Medication error reports.
Review drug intervention reports.
Pharmacy & Therapeutics Committee (cont’d)
Responsibilities:
5. Drug Therapy Guidelines:
Evaluates optimal use of drugs e.g. dosage, frequency,
patient selection, length of therapy and combination.
Guidelines should be updated routinely.
6. Policy & Procedure Development:
Medication procurement, selection and distribution.
Medication for specific settings e.g. ICU.
Develop policies e.g. automatic stop order, drug recall.
Pharmacy & Therapeutics Committee (cont’d)
Responsibilities:
7. Education:
Newsletter is often employed to communicate the
committee decisions.
Newsletter includes the following:
Clinical information on drugs added to formulary.
Drug therapy guidelines developed.
Medication safety information.
Pharmacist Role inPharmacy & Therapeutics Committee
Pharmacists are essential to the formulary
management process.
Pharmacists guide the P&T committee
activities to assure optimal medication
management.
Pharmacist Role inPharmacy & Therapeutics Committee (cont’d)
Pharmacist’s
Establish Committee meeting agenda.Archive committee actions by keeping minutes of meetings.
Analyze scientific, clinical and economic information.Conduct Drug use evaluation.
Responsibilities
Follow up research when necessary.Communicate decisions.
SummaryAs the drug expert, the pharmacist can
assure safe, efficacious, and cost effective
drug use through the formulary system.
Ongoing formulary maintenance and
routine drug use evaluations are key
elements in this process.
Thank You…Thank You…