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…