Definition of Hospital Formulary
A hospital formulary system is a method by which hospital staff in consultation with the P&T committee evaluates and selects drugs in the drug market which are considered most useful in patient care.
- It is a book listing recommended medicines that are to be kept in the hospital.
- Drugs are usually selected on the basis of efficacy, safety, acceptability, and cost.
- Medicines listed in the formulary should be readily available.
The primary objectives of the hospital formulary are
- To provide hospital staff information on drugs that have been selected for use in the hospital by the committee.
- To give a brief monograph of each selected drug.
- To give information on hospital policies and procedures regarding medicines.
- To give information about medicines, dosing schedules, pictograms (icons), hospital-approved abbreviations, etc.
- It promotes rational and cost-effective prescribing.
- It gives guidance on the selection of drugs and even provides price comparisons.
- It may reduce the incidence of drug-related problems like interactions, medication errors, etc.
- In the long term, it may encourage the manufacturers to direct research towards therapeutic needs rather than commercial aspects.
- It improves the relationship between prescribers and pharmacists.
Preparation of Formulary:
- Hospital pharmacists, community pharmacists along PTC members prepare hospital formulary.
- The basic ways of producing a formulary are either to prepare an independent one or modify the existing one by adapting any formularies (BNF).
- It should be presented as a document and it should be pocket-sized.
- It should be compatible with other hospital formularies.
Contents of Formulary:
The primary objective of the formulary is to provide hospital staff with information on drugs that are to be approved by the PTC with their monographs. The contents are
PART 1: Information on hospital policies and procedures related to drugs including the composition of the P&T committee.
PART 2: Products accepted for use in the hospital.
PART 3: Generic brands, therapeutic index, cost of drugs along with drugs that are deleted in the previous edition. A subject index may also be included at the end of the formulary for easy identification of drugs.
Selection Of Drugs
A formulary for use in hospitals and general practice should aim to include enough drugs to treat 80 – 90% of all common ailments.
It should include medicines that cover maximum patients either in hospital or general practice.
The factors that influence are:
- Efficacy and indications.
- Interaction profile.
- Side effects and contraindications
- Pharmacokinetic profile
- Formulations, palatability, etc.
- The governing council along with PTC formulate the principles and procedures for the preparation of the formulary as per the needs of the hospital.
- The medical staff and others shall adopt these policies and implement them correctly. Nursing staff should be well-trained for the implementation of the formulary system.
- Any chance of working on a hospital formulary system should be known to all the healthcare providers of the hospital.
- The quality, and quantity of the source supply of all the pharmaceutical products should be evaluated by the pharmacist in consultation with PTC.
- There should not be any compromise for economic reasons.
- The guidelines may be issued by the PTC regarding the labeling of proprietary and non – proprietary drugs.
Legal Aspects of Formulary System:
The compliance of the hospital formulary system is to encourage physicians to follow the basic policies and procedures of the hospital. This includes:
- Generic names within the prescriptions.
- Dispense in accordance with the hospital formulary.
Distribution of Formulary:
It should be placed at each patient care area including clinics, op’s, emergency rooms, etc. Each pharmacist should receive about it.
Annual revisions should be made and information regarding this should be provided to everyone.
Role of Hospital Pharmacy Department In Relation To Other Departments In Hospital
- With respect to the P&T committee.
- With respect to the formulary
- With respect to the ethics committee.
- With respect to the infection control committee.
- With respect to procurement and warehouse departments.
- With respect to clinical doctors – ADR, medication errors
- With respect to nursing staff
- With respect to IP, OP, and direct patient care.
- With respect to the radiology department.
- With respect to super specialties (cardiology, urology, nephrology, etc).
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