HOSPITAL PHARMACY

The Hospital Formulary

The Hospital Formulary

Since the treatment of patients in hospitals depend on the effective use of drugs, a program of objective evaluation,
selection, and use of medicinal agents in the hospital, should be established. Such program is the basis of rational drug
therapy and the hospital formulary concept is a method for providing such program. The formulary is the document while
the formulary system is the way by which the document is developed. It is a powerful tool for improving the quality and
controlling the cost of drug therapy in the hospital.

Hospital Formulary is a continually revised compilation of pharmaceuticals which reflect the current clinical
judgment of the medical staff.

Hospital Formulary System is a method whereby the medical staff of a hospital, working through the PTC,
evaluates, appraises. And selects from among numerous available medicinal agents and dosage forms those that are
considered most useful in-patient care.

I. Objective:

To know the importance of hospital formulary.

II. Procedures:

1. Using the reference materials in pharmacy

a. Give the advantage and disadvantage of hospital formulary.
b. Make an outline of the detailed parts of the formulary
c. List down the composition of a typical formulary

III. Data:

a. Advantage and Disadvantage of Hospital Formulary

- Advantages:
➢ it provides a systematic method to review scientific evidence on clinical effectiveness and cost effectiveness
in drug selection decision, thus potentially improving health outcomes while reducing costs
➢ Encourage the use of optimal drug therapy
➢ Provide generic product list
➢ Creation and development of policies which can prevent unnecessary products
➢ Formularies must include cost to provide relative cost data for similar drug products that are generically
equivalent
➢ Today new drugs and drug therapies are more complex, so formulary system will rely more upon
‘recommended for use’ criteria for many drugs.
➢ A drug that has specific advantages in a small number of patients will be included in the formulary.
- Disadvantages:
➢ an overly restrictive formulary system may potentially reduce the quality of care by limiting access to
clinically indicated medications
➢ Deprive the physician of his right and privilege to prescribe and obtain the brand of his choice.
➢ Permits the pharmacist to act as the sole judge of whom brands of drugs are to be purchased & dispensed.

(Ref: https://knowledgeofpharma.blogspot.com/2019/03/preparation-of-hospital-formulary.html)

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 HOSPITAL PHARMACY

The Hospital Formulary

b. Detailed parts of a Hospital Formulary
- A typical formulary must have the following composition;
1. Title page
2. Names & titles of the members of the PTC
3. Table of contents
4. Information on hospital policies & procedures concerning drugs
a. The pharmacy and therapeutic committee of hospital
b. Objective and operation of the formulary systems
c. Hospital regulations and procedures for prescribing and dispensing drugs.
d. Hospital pharmacy services and procedures.
e. How to use the formulary
5. Products accepted for use at hospital
a. Items added and deleted from the previous edition.
b. Generic, Brand name cross reference list.
c. Pharmacologic/therapeutic index with relative cost codes.
d. Descriptions of formulary drug
e. products by pharmacological therapeutic class.
6. Appendix
a. Central service equipment and supply list
b. Guidelines for calculating pediatrics doses
c. Schedule of standard drug administration.

(Ref: https://knowledgeofpharma.blogspot.com/2019/03/preparation-of-hospital-formulary.html)

c. Composition of Hospital Formulary

- Monograph should include the following:
➢ its generic name formula (if any),
➢ action dosage regimen,
➢ side effect,
➢ Precaution
➢ contra-indications.
- Introduction
- Pharmacokinetics
- Interactions
- Toxicity
- Contra-indications
- Formulary system (list of preferred drugs)
- Policies and procedures
- Prescribing guideline
- Clinical information on uses of medications

(Ref: https://study.com/academy/lesson/formulary-systems-definition-use-management.html)

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 HOSPITAL PHARMACY

The Hospital Formulary

IV. Questions:

1. What are the core attributes of the formulary system?

- A formulary system is a system or process of periodically evaluating and selecting medicines for the formulary,
maintaining the formulary, as well as providing information of the different medication in an institution in a suitable
manual or list to best serve the health interests of a patient population. It is an ongoing process, meaning it can be
revised or changed every time there is need to do so. The core attributes of the formulary system are what holds and
forms the foundation of the formulary system itself. One of the core attributes of the formulary system are the rules
and policy statements created to ensure that all guidelines and standards are being followed. Also, the procurement
and inventory management programs are attributes of the formulary system which can greatly affect how the
formulary would run. With the right procurement and inventory management programs, it is possible to really improve
the efficacy of the whole formulary system. The medical and pharmacy staffs are also one of the core attributes of the
formulary system since they are the ones who evaluates, appraise, and select numerous medications and drugs that
are most efficacious, safest, of adequate or high quality, and available at a reasonable price. Certain principles also
contribute how the formulary system would exert its optimal purpose. Some of those principles includes; (a)
Medicines should be selected based on the needs of the community, (b) Medicines selected for the formulary should
be “medicines of choice”, (c) the formulary list should have limited number of medicines, only those necessary for the
needs of the institution, (d) Generic names should be used, and lastly (e) Medicines should be restricted to appropriate
practitioners. Lastly, the proper maintenance of a formulary system. There are two key components that independent
to the formulary maintenance process: (a) additions and deletions of medicines, and (b) therapeutic medicine class
reviews. These two main components should be effectively done is order for the formulary and formulary system to
run smoothly and to serve optimal care to the patients.
(Ref: https://www.who.int/medicines/technical_briefing/tbs/02-PG_Formulary-Management_final-08.pdf)

2. List down strategies to gain consensus of the medical community.

- There are several ways on how effective teams can strive for consensus, though this may seem a little intimidating in
the medical community since there are a lot of professionals whose ideas and values differs, consensus can still be
achieved. It is important that a leader should be present in order to facilitate the flow of ideas and opinions. A leader
should be able to manage a team wherein all are able to voice out their opinions. Another strategy is to of course,
medical practitioners should be able to pool opinions from one another, listen to what everyone has to say, discuss
all the ideas including their differences and similarities, and lastly to come to an agreement that everyone “can live
with”. Also, in order to come to an agreement, certain strategies can be done. Multi-voting can reduce the list
containing a large number of items to a manageable few, and when there are only little issues to be discussed, it will
be easier for the whole team to come up with an agreement. In a medical community, it is somehow daunting to
correct someone especially those of higher education level, but let’s face it, higher educational background does not
mean that you are always right, certain aspects and opinions should also be taken in consideration.
(Ref: https://www.opm.gov/policy-data-oversight/performance-management/teams/effective-teams-strive-for-
consensus/)
3. Give an example of how the formulary system can define policy
- A formulary system greatly affects how the policy of an institution regarding safe medication use. For example, a
formulary system includes policies that addresses the approval and procurement of non-formulary medications.
Policies in the formulary system also addresses medication shortage and outages, as well as the formulary interchange
or therapeutic equivalents. Principles of a formulary system is what defines its policies. Policies such as communicating
with appropriate staffs and prescribers, developing approved substitution protocols, educating appropriate LIPs,
health care professionals and staffs about certain protocols, and obtaining medication in the event of a disaster, falls
under the policies that address the medication shortages and outages. In a scenario that there is a need for deletion
and addition of drugs in the formulary system, it is important to follow certain policies that address the formulary
interchange or therapeutic equivalents.
(Ref: http://file.cop.ufl.edu/ce/consultwb/2012Workbook/CHAPTER%2019.pdf)

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 HOSPITAL PHARMACY

The Hospital Formulary

4. Why is it important to revise the formulary regularly?
- It is important to revise the formulary regularly because of the significant changes that can occur every time a new
drug or medicine will be available in the market or if a drug in the formulary is subject for withdrawal in the market.
Routine medicine class reviews are important to maintain the formulary. It is important to regularly check and assess
the hospital formulary in order to serve the patients with optimal care. With the on-going dilemma for the
development and usage of the right drug, it is important that the hospital will always be aware of the certain changes
that are happening the pharmaceutical industry.
(Ref: https://www.who.int/medicines/technical_briefing/tbs/02-PG_Formulary-Management_final-08.pdf)

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