Hospital Formulary: An Introduction

INTRODUCTION

·         The Pharmacy Department consists of the Hospital Pharmacy which serves as Central stores and the Outpatient Dispensing Pharmacy.

·         The primary function of the Hospital Pharmacy is to support the drug therapy of hospitalized patients.

·         The Hospital Pharmacy is located on the ground floor of the Hospital block.

·         The outpatient pharmacy provides outpatient prescription services to ambulatory patients who receive their medical care at medical colleges.

·         Generally, the outpatient pharmacy is located on the ground floor adjacent to the Outpatient Center.

What is the meaning of hospital formulary?

·         The hospital formulary is a list of pharmaceutical agents with its important information’s which reflects the current clinical views of the medical staff.

·         For instance,

o   a formulary may include a generic version of a widely used medication,

o   Which is usually less expensive than its brand-name counterpart.

·         In addition, more than one doctor often treats a single hospitalized patient, and each doctor often orders different medications for the same patient.

·         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

o   Procuring, prescribing, dispensingand administering of drugs

o   Under non-proprietary or proprietary (brands) names in instances where drugs have both names.

·         The first scientific hospital formulary in India was published in 1968 by the pharmacy department of CMC Vellore.

·         The first hospital formulary for a Government teaching hospital in India was published in 1997 at Govt.Medical College Hospital, Trivandrum.

·         The Formulary is a listing of drugs, dosage forms, package sizes, and drug strengths stocked by the Hospital Pharmacy.

·         It is published as a quick reference to assist the physician and nursing staffs. 

The Formulary is divided into three general sections:

1.      The Introduction, a Therapeutic Index and the Drug Monographs.

·         The Therapeutic Index is

o   A listing by therapeutic category of those drugs which are carried in one or more dosage forms, by the Pharmacy.

·         The Drug Monographs Section is a straight alphabetical listing of generic names.

·         Each Complete monograph will contain the following information:

o   Official, non-proprietary or generic name.

o   Category: Therapeutic Classification which relates to the information in the Therapeutic Section of the Formulary.

o   Dosage Form: This lists of all the dosage forms which are available in the Pharmacy.

o   Indications and dose: This lists the common indications along with adult and pediatric doses.

GUIDELINES FOR HOSPITAL FORMULARY

·         Following principles serves as a guide to administration, Physician, pharmacist and nurse in hospital for their expert judgment-

1.      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.

2.      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. 

3.      PTC develops policies and procedures - medical staff adopts these - subject to administrative approval.

4.      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 hospital’s formulary or other media available to the member of medical team 

5.      Prescribers should be strongly encouraged to prescribe drugs by their nonproprietary names.

6.      Generic equivalents & therapeutic equivalents.

7.      Pharmacist is responsible for selecting from available generic equivalents.

8.      That the prescriber has the option, to specify the brand for that particular prescription.

9.      PTC is responsible for determining those drug products and entities.

10.  Medical& nursing staffs are informed about the changes in the Hospital Formulary system. 

11.  Labeling of medicine with non-proprietary names, followed by decided formats. 

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

FORMULARY CONTENT & ORGANIZATION

Primary objectives:

1.      Information on drug products-

·         This section is the heart of formulary and consist of descriptive entries for each items to facilitate its use.

Entries in Formulary :- It includes

o   Generic name of basic drug

o   Common name(the brand name)

o   Dosage form, strength, packaging.

o   Formulation(Name of active ingredient, formulation of the product)

o   Adult /paediatric dose

o   Route of administration

o   Cost

·         Entry of a drug into the formulary is a complex matter because only the members alone are not competent enough to decide each drug.

·         Clinical expert from various department s are invited for their valuable comments upon specialized drugs.

·         Selected drugs may be official in I.P., B.P., U.S.P.,or N.F. etc.

·         Any preparation whose formula is not disclosed does not qualify for its entry into the formulary.

·         The guidelines are framed by Pharmacy and Therapeutic Committee for inclusion or non-inclusion of drugs in the formulary.

·         The concerned medical staff is informed about the decision at every stage and they remain well aware of reasons for not including any particular drug.

Index to the drug product listing 

·         There are two ways of making the indexes which can be included at the beginning or the end of the section to facilitate the use of formulary.

o   Generic name/brand name:

§  The proper page number should be given for reference of a particular product

o   Therapeutic or pharmacological index:

§  This index is according to the therapeutic category,

§  e.g. antihistaminic drugs, anti-biotic drugs etc.

 

2.      Information on hospital policies & procedures

·         Various policies and procedures are framed for drug usage and restriction on drug use.

·         Brief discussion of PTC including its membership responsibilities etc.

·         Information on hospital regulation governing the

o   prescribing, dispensing, administration of drugs, generic names drug orders,

o   investigational drug policies,

o   rules to be followed by medical representatives,

o   Emergency drug products etc.

·         Operating procedures such as

o   hours of services,

o   out-patient prescription policies,

o   prescription labeling,

o   packaging and practice,

o   inpatient drug distribution procedure,

o   Patient education programme etc

·         Informationon using the formulary, including

o   how the formulary and the entries are arranged,

o   procedure for entry of a drug should be included in the system.

3.      Special information about drugs

·         The material to be included in this section vary from hospital to hospital but it should be useful to the hospital staff and should be readily available. 

·         It includes

o   Nutritional product list

o   Equivalent dosage of similar drug

o   List of hospital approved abbreviations.

o   Guidelines for calculating paediatrics dosage

o   List of sugar-free drug products

o   Number of items available for emergency boxes.

o   Metric conversions and tables.

o   Tables of drug interaction.

o   Poison control distribution

·         Although the monograph of each drug is decided by the PTC but it should include

o   its generic name,

o   formula (if any),

o   action,

o   dosage regimen,

o   side effects,

o   precautions and

o   contra-indications. 

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 

1.      Information on Hospital policies

·         Drug use

·         Description of PTC

·         Hospital regulations about

o   prescribing, dispensing & administration of drug,

o   rules for Medical Representatives,

o   emergency drug products,

·         Pharmacy operating procedures

·         Information on using formulary

2.      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:

o   Generic name/brand name

o   Therapeutic /pharmacological index

 

3.      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