Hospital Formulary - Definition, Procedure for Development and Use of Hospital Formulary

Hospital Formulary - Definition, procedure for development and use of hospital formulary

A hospital formulary is a list of medications to be stocked in the hospital pharmacy along with all information about each drug. The pharmacy therapeutic committee develops a hospital formulary in consultation with a physician, pharmacists, and nursing staff.

“Hospital formulary is a continuously changing list of preferred medicaments that reflects clinically proven and improved pharmacological medicaments”.

“Ideally, a hospital formulary is a list of carefully selected medicament to guide medical practitioners in choosing the safest, most effective agents to treat specific medical problem”.

Advantages

• 1. Efficacious medicines: They provide approved and efficacious medicines to the practitioner to treat disease

• 2. Economical: It reduces the inventory cost of the drugs. It regulates the number of medicines by improving procurement and inventory management.

• 3. Quality assurance: It improves quality assurance and is easier to dispense.

• 4. Improved care: It gives stress on medicine information and focuses on patient’s education efforts

• 5. Adverse Drug Reaction: It removes the irrational combinations of drugs and also improves adverse drug reaction management.

Disadvantages:

• 1. Physician restriction: It stops the physician from prescribe drug of his choice

• 2. Pharmacist monopoly: The pharmacist acts as the sole judge to select the brands of the drugs to be purchased and dispensed.

• 3. Inferior quality: It may allow purchasing inferior quality drugs and

• 4. Expensive: It may also not reduce the cost of drug dispensed to the patient or the third-party payer.

PROCEDURE FOR DEVELOPMENT AND USE OF HOSPITAL FORMULARY

A hospital formulary system is a process to select and evaluate medicinal agents and their dosage forms by hospital staff in consultation with the pharmacy and therapeutic committee. The hospital formulary system includes the most useful medicaments decided on the basis of quality, efficacy, therapeutic index, toxicity, untoward effect, bioequivalence, etc. There shall be special criteria to standardize drugs. This will help to reduce wastage, error, and personnel time.

“Hospital formulary is the cornerstone of the hospital formulary system to ensure rational drug therapy and controlled drug cost”.

Principles:

The hospital formulary includes medicines as “recommended for use”. The following principles shall be a guideline for medical practitioners, pharmacists, administrators, and hospital board members to develop a hospital formulary under the hospital formulary system:

• 1. Generic name: Prescribers shall use the generic name of drugs in the prescription.

• 2. Brand name: Branded drugs shall be included on their safety, efficacy, etc

• 3. Nursing staff: Administrator, Board member, or PTC must provide information to nursing staff regarding the existence of a hospital formulary system.

• 4. Pharmacist: The pharmacist shall dispense branded medicines only in the absence of approved medicines.

• 5. Substitution: Words like substitute should not be included in hospital formulary

• 6. Drugs availability: All medicaments and medical devices shall be readily available in the hospital pharmacy.

• 7. Labelling: Drugs shall be labeled with the following information: generic name of the drug, manufacturer name and address, and Prescriber name.

• 8. Expert consultation: PTC shall consult all experts regarding drug details.

• 9. Revised formulary: The decision of PTC regarding the revised hospital formulary shall be informed to all hospital staff.

• 10. PTC Authority: Medical practitioners alone shall not be allowed to decide policies, or prescribe branded or generic drugs without prior approval from PTC.

Criteria

Hospital formulary preparation discourages the use of expensive drugs for optimal drug therapy. It promotes the inclusion of generic drug names in the hospital formulary list. Generic drug inclusion also helps to stop the stocking of banded drugs as a substitute for generic drugs.

The hospital formulary also states the cost of generic drugs and their substitute. It helps to compare the relative costs of these products.

Various new drugs and drug therapies are available to treat a disease. This develops a more complex situation for medical practitioners to recommend the best therapy or medicine. Preparation of hospital formulary eases this situation for the medical practitioner.

Size, physical structure, and physical appearance of hospital formulary play an important role in influencing medical practitioners. It should not be expensive but it must have a professional look as it is to be used by professionals. Hospital formulary should be visually pleasing, easily readable, grammatically correct, correct spelling, neatly designed, etc.

Hospital Formulary Contents

The hospital formulary provides a list of medicines along with their all information.

• 1. Drug Product Index: The index is an alphabetically arranged list of contents. It may be at the start of documents/books or the end of the document/book.

• The index may be on the basis of the generic/trade name of the drug, a separate page number is assigned to each drug product. The index may also be on the basis of therapeutic effect. The page number is assigned as per therapeutic uses. Drugs of one therapeutic category are included in one place. Examples are antacid drugs, antihistaminic drugs, antihypertensive drugs, etc.

• 2. Details of Drug Products: It consists of all information on approved drugs. It is called a monograph of the drug approved by PTC. The information is the generic/brand name of the drug, drug dosage form, route of administration, Name of active constituents, an Adult dose of the drug, retail price, date of procurement, date of manufacturing, expiry date, dispensing date, batch number, name of the manufacturer, quantity in stock, etc.

• 3. Hospital policies: PTC approves hospital policy. This policy also regulates hospital formulary, entry of drugs in hospital formulary, proper arrangement of entries in hospital formulary, etc.

• 4. Any other special information: Hospital formulary information shall be useful for hospital staff. This information varies from hospital to hospital. It will be approved by the PTC of the hospital. Information includes special precautions regarding uses of the drug, bioequivalency, approved abbreviation, pediatric dose, sugar-free drugs availability, control on poison dispensing, detail of drug interaction, reported ADR, emergency boxes details, warning, etc.

The hospital formulary will have different pages arranged in the following orders

• 1. Title page

• 2. Pharmacy therapeutic committee members name and designation

• 3. Contents

• 4. Hospital policies and procedures related to

  • a. PTC,

  • b. Objectives and operations of hospital formulary system,

  • c. Rules, regulations, and procedures to prescribe medicines,

  • d. Services and procedures of hospital pharmacy,

  • e. instructions and methods to use hospital formulary,

• 5. Medicines and medicinal devices included in hospital formulary,

  • a. Name of medicines and medicinal devices added and deleted,

  • b. Generic name and brand name,

  • c. Therapeutic index,

  • d. Relative cost,

  • e. Therapeutic uses,

• 6. Appendix

  • a. Paediatric dose calculation,

  • b. Central service equipment,

  • c. Standard drug administration schedule

The monograph of drugs in the hospital formulary should have at least the following information: Name of drug, synonym, therapeutic uses, contraindication, pregnancy risk factor, precautions and warning, adverse reaction, adult dose, pediatric dose, and drug interaction. Route of administration, patient information, brands available, formulation, strength, cost

REVISION OF HOSPITAL FORMULARY

Pharmacy and therapeutic committee (PTC) members are not competent enough and skilled enough to evaluate drugs in hospital formulary and new drugs introduced in the market. Thus PTC invites other experts to evaluate drugs included in hospital formulary and new drugs available in the market. PTC developed some policies and guidelines to delete the name of drugs and to add the name of any new drugs in the hospital formulary.

Recommendations from invited experts, policies, and guidelines developed by PTC decide to add or delete drug names in the hospital formulary. PTC also decides on a timeline to revise the hospital formulary. In normal practice, the hospital formulary is revised once a year. The hospital formulary should be revised at regular intervals to make cost-effective treatment of diseases in the hospital. Usually, the following criteria are adopted in hospital formulary revision

• 1. Drug is included and deleted only after prior approval from a competent expert

• 2. The drug should be of pharmacopeia standard

• 3. Drug to be procured from a licensed source. The license should be issued as per the Drugs and Cosmetics Act 1940

• 4. Drug that does not disclose its original formula shall not be included in hospital formulary

• 5. Drug formulations containing irrational ingredients shall not be included in the hospital formulary.

The revised list may be attached to the last page of the hospital formulary or the hospital may publish another revised edition of the hospital formulary. Usually, hospital administration changes the cover page color in each edition to avoid confusion.

Alok Bains