HOSPITAL FORMULARY

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HOSPITAL FORMULARY
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DEFINITION

• The hospital formulary is a list of
  pharmaceutical agents with its important
  informations which reflects the current clinical
  views of the medical staff.
• The hospital formulary system is a method
  whereby the medical staff of a hospital with the
  help of pharmacy and therapeutic committee
  selects and evaluate medical agents and their
  dosage form which are considered to be most
  useful in the patient care. The hospital
  formulary system provides the information for
  procuring, prescribing, dispensing and
  administering of drugs under non-proprietary or
  proprietary(brands)names in instances where
  drugs have both names.

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origin

• The first scientific hospital formulary in India
  was published
• in 1968 by the pharmacy department of CMC
  Vellore.
• The first HF for a Government teaching hospital
  in India was published in 1997 at Govt.Medical
  College Hospital, Trivandrum.

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ADVANTAGES

• Cost containment
• Rational prescription
• Evidence based practice
• Cost effective prescribing
• Safety and continuous care
• Educational value

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DISADVANTAGES

• Deprive the physician of his right and privilege
  to prescribe and obtain the brand of his choice.
• It may lead to purchase of drugs which are
  inferior in quality,in case of no involvement of
  the pharmacist in the preparation of the
  formulary.

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The Need for hospital formulary

• The increasing number of new drugs manufactured
  and marketed by drug companies.
• Increasing complexity of untoward effects of
  modern potent drugs.
• The public interest in getting possible health
  care at lowest possible cost.

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GUIDELINE FOR HOSPITAL FORMULARY

• The governing body of the hospital should appoint
  a pharmacy and therapeutic committee composed of
  physician and pharmacist which will prepare the
  hospital formulary system.
• PTC shall sponsor and outline the purpose,
  organization function and scope of the hospital
  formulary system, it should adopt the principle
  as per the need of particular hospital.
• PTC develop policies and procedures - medical
  staff adopt these - subject to administrative
  approval.
• The policy and procedures shall afford guidance
  in the appraisal, selection, procurement,
  storage, distribution, use, safety procedures and
  other matter relating to drug in the hospital and
  shall be published in the hospitals formulary or
  other media available to the member of medical
  team

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• Prescribers should be strongly encouraged to
  prescribe drugs by their nonproprietary names.
• Generic equivalents therapeutic equivalents.
• Pharmacist is responsible for selecting from
  available generic equivalents.
• That the prescriber has the option, to specify
  the brand for that particular prescription.
• PTC is responsible for determining those drug
  products and entities.
• medical nursing staffs are informed about the
  changes in the HF system.
• Labeling of medicine with non-proprietary names,
  followed by decided formats.

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• To develop an effective formulary system, PTC has
  to consult various references on a drug regarding
  its pharmacokinetic profile, interactions, ADR,
  etc.,,,

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FORMULARY CONTENT ORGANIZATION

• Primary objectives
• Information on drug
• Information on hospital policies procedures
• Special information about drugs
• In accordance with these objectives, the
  formulary should consist of three main parts
• Information on hospital policies procedures
  concerning drugs.
• Drug products listing
• Special information

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HOSPITAL POLICIES AND PROCEDURES

• Drug use
• Description of PTC
• Hospital regulations about prescribing,
  dispensing administration of drug, rules for
  Medical Reps, emergency drug products,
• Pharmacy operating procedures
• Information on using formulary

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B. DRUG PRODUCTS LISTING

• Formulary item entries
• Alphabetically by generic name
• Alphabetically within therapeutic class
• Type of information
• Dosage form, strength, packaging
• Active ingredients
• Adult/pediatric dose
• Route of administration
• Cost
• Indexes to the drug products listing
• Generic name/brand name
• Therapeutic /pharmacological index

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C.SPECIAL INFORMATION

• Equivalent dosages of similar drugs
• Hospital approved abbreviations
• Rules for calculating pediatric dosages
• List of sugar free drugs
• List of dialyzable poisons
• Metric conversion tables
• Poison control information
• Table of drug interactions

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PREPARATION OF FORMULARY

• Visually pleasing, easily readable and
  professional in appearance.
• A typical formulary must have the following
  composition
• Title page
• Names titles of the members of the PTC
• Table of contents
• Information on hospital policies procedures
  concerning drugs
• Products accepted for use at hospital
• Appendix

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CONTENTS

• a. Introduction
• List of abbreviations
• List of drugs used in the formulary
• b. Basic information on each drug
• Efficacy for the treatment of specific conditions
• Safety profile of the item
• Interaction profile
• Adverse effects
• Pharmacokinetic profile
• Availability of the item
• Available dosage form
• Cost
• Acceptability to patients

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• c. Supplementary information on each drug
• Storage guidelines
• Patient counselling information
• Labelling information
• Brand names and prices
• d. Prescribing and dispensing guidelines
• Principles of prescription writing
• Reporting of ADR
• Prevention of ADR

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• e. General drug use and advice
• Use of IV drugs
• Special situations like pregnancy, breast
  feeding, liver/kidney diseases
• Poisoning information and antidotes
• Treatment of snakebites and insect bites
• f. Miscellaneous section
• Childrens dose
• Renal adjustments
• Metric units
• Diagnostic aids

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Revision of Formulary

• The PTC holds meeting to discuss about the
  revision of the formulary.
• The annual revision is necessary because of the
  changes in the drug products,removal of certain
  drugs from the market and changes in the hospital
  policies.
• The addition of details of a drug is done by
  attaching the supplement sheets at the back of
  the formulary.
• The addition of any drug to the formulary is a
  complex decision.
• All steps prior to the addition or deletion of a
  drug must be reported to the medical staff.

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Criteria for addition or deletion of drugs

• The subject drug must be present in the
  pharmacopoeia or NFI.
• The drug product is to be manufactured by a
  licensed company with a good record.
• The preparation of known composition can only be
  added to the formulary.
• The subject drug product should receive approval
  for its clinical value by the local physicians.
• The drug of established therapeutic efficacy can
  only be added to the formulary.

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Role of Hospital Pharmacist

• Drug selection
• Promoting formulary adherence
• Review and take action on all non-formulary
  drug use in the hospital.
• Provide a copy of the hospital formulary to
  all doctors in the hospital.
• Involve the medical staff in various
  formulary-implementing programs.
• Give much advertisement and publicity
  regarding formulary.
• -Revision of formulary

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FORMULARY Vs DRUG LIST

• FORMULARY

• DRUG LIST (e.g. I.N.F)

• Listing of drugs by their generic names followed
  by information on strength, form, posology,
  toxicology, use recommended quantity to be
  dispensed.
• Prepared locally by its own clinical staff.
• Information provided is subject to local needs
  and desires.

• Generic names followed by data on strength
  form.
• Prepared by countrys outstanding clinicians,
  pharmacologists and pharmacists.
• According to their pharmacological properties.

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REFERENCES

• 1. Hospital pharmacy by William E. Hassan, JR 5th
  edition. Pg no.124-153.
• 2. A textbook of pharmacy practice by K.G.
  Revikumar, B.D.Miglani . 1st edition.pg no.82.
• 3. Remington The science and practice of
  pharmacy 21st edition volume 2, pg no.2259.
• 4. Merchant and Qadrys-A text book of Hospital
  Pharmacy. Pg no.39-50

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