DEVELOPMENT OF A HOSPITAL FORMULARY FOR 300 BEDDED TEACHING HOSPITAL

1. Submitted By:
K.C. Ramya
15AB1T0011
IV PHARM.D
Submitted to
Dr. G. Ramesh Pharm.D
Associate Professor
Vignan Pharmacy
College,
Vadlamudi
DEVELOPMENT OF A HOSPITAL FORMULARY FOR 300 BEDDED TEACHING
HOSPITAL

2. DEFINITION
The hospital formulary is a continuously revised compilation of
pharmaceutical dosage agent and their forms etc. which reflects the
current clinical judgment of the medical staff.

3. INTRODUCTION
The hospital formulary is a continuously revised compilation of
pharmaceutical dosage agent and their forms etc. which reflects the
current clinical judgment of the medical staff.
•Hospital formulary provides information for
•Procuring
•Prescribing
•Dispensing
Administration of drugs

4. OBJECTIVES
•To Set standards for best practice, promoting high quality, evidence based
prescribing.
•To ensure rational drug therapy and control drug cost.
•To precise use by the physician and nursing staff.
•To continually revise compilation of pharmaceuticals and some important
ancillary information that reflects the current clinical judgement of medical staff

5. OPEN FORMULARY
•An open formulary serves merely as a guide; a physician may prescribe any drug, but
is encouraged to use the formulary list in prescribing decisions.
CLOSED OR RESTRICTED FORMULARY
•An closed or restricted formulary lists the drugs that will be reimbursed by the health
care provider; non-formulary drugs will be reimbursed only if they are authorised prior
to prescribing.
INCENTIVE-BASED FORMULARY
•An incentive-based formulary represents a hybrid between the open and closed
formularies; patients pay a higher price for non formulary drugs

6. MEMBERS INVOLVED IN THE PREPARATION OF HOSPITAL
FORMULARY
•The most important function of Drugs and Therapeutics Committee (DTC) is to
prepare and implement a formulary for the hospital.
•The committee should have sufficient members to represent all stakeholders, including
the major clinical departments, the administration and the pharmacy.
•Members should be selected with reference to their positions and responsibilities.
In most hospitals, the membership includes:
•A representative clinician from each major specialty, including surgery, obstetrics and
gynecology, internal medicine, pediatrics, infectious diseases, and general practice (to
represent the community).
•A clinical pharmacologist, if available.
•A nurse, usually the senior infection control nurse, or sometimes the matron.
•A pharmacist (usually the chief or deputy chief pharmacist),or a pharmacy technician
where there is no pharmacist.
•An administrator, representing the hospital administration and finance department.
•A clinical microbiologist or a laboratory technician where there is no microbiologist.
•A member of the hospital records department.

7. CRITERIA IN MEDICINE SELECTION
Selection of drugs depends on many factors, such as the
Pattern of prevalent diseases
Treatment facilities
Training and experience of available personnel
Financial resources
Genetic
Demographic and environmental factors

8. GUIDELINES
•The governing body of the hospital shall appoint a pharmacy and therapeutic
committee composed of physician and pharmacist which will prepare the hospital
formulary system.
•The medical staff in the governing body 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.
•The pharmacy and therapeutic committee shall develop policy and procedure
governing the hospital formulary and the medical staff shall adopt these policies and
procedures subject to administrative approval
•The policy and procedure 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
•To ensure the maintenance of the responsibility and procreative of the physician in the
exercise of his professional judgment.
•The medical staff shall adopt the policy formula, and procedure for including drugs in
the formulary by the non proprietary name even though proprietary names continue to
being use in the hospital physicians

9. GUIDELINES (continuation)
•In the absence of written policies approved by the medical staff related to the operation
•The hospital shall make it certain that the nursing personnel are in formed in writing
though its system of news of communication that there exits the formulary system in the
hospital and the procedure governing its operations
• In the formulation of policies and procedure the term substitute or substitution should
be avoid since these term have been used to imply the unauthorized dispensing of entire
different drug, neither of which takes place under a properly operated hospital
formulary system.
• It shall be made known to the medical staff about the changes in the working in the
hospital formulary system or in the content of the hospital system.
• Provision shall be made for the appraisal of the member of the medical staff for the
use of the drug not include in the formulary or the investigational drugs.
• The pharmacist with the advice and guidance of the pharmacy and therapeutic
committee ,shall ascertain the quantity and source of supply of all drugs, chemical,
biological and pharmaceutical preparation used for diagnosis and treatment of patient.

11. MAINTAINING A FORMULARY
•Formulary may become a collection of older, less effective drugs.
•The entire formulary should be reviewed every 2–3 years.
•This can be done by evaluating all the formulary medicines within each therapeutic
class in a systematic way on a regular basis and comparing them to other new non-
formulary medicines within that class
•Requests for the addition of new medicines and deletion of old medicines.
•Systematic review of a therapeutic class of medicines.
•Review of programmes to identify and resolve medicine use problems.

13. IMPROVING ADHERENCE TO A FORMULARY
The existence of a well-maintained formulary does not mean that prescribers will
adhere to it. Methods to promote formulary adherence include the following:
•Reviewing and taking action on all non-formulary medicine use; action may include
adding the medicine to the formulary, educating the prescriber about the non formulary
status of the medicines or banning use of the medicine within the hospital.
•Prohibiting the use of non-formulary drug samples in the hospital.
•Establishing procedures and approved drug product lists for therapeutic interchange or
substitution.
•Providing easy access to the formulary list, with copies at each drug ordering location
and in pocket manuals for staff.
•Involving medical staff in all formulary decisions.
•Advertising and promoting all formulary changes.
•Establishing agreed procedures for clinical trials with non-formulary medicines

14. ADVANTAGES
•It is very handy for use by the physician and nursing staff.
• It helps physicians to know about the available drugs in the hospital pharmacy and
also helps in better inventory control.
• Evidence based treatment guidelines.
• It is complete, concise, updated and easy to use.
• Improves clinical practice of health care professionals.
•Reduces the variation in the level of treatment provided to the patients and controlling
drug cost.

15. DISADVANTAGES
•It deprives the physician of his right and prerogative to prescribing and obtained the
brand of his choice.
•pharmacist act as the sole judge of which brands of drugs are to purchased and
dispensed.
•The system allow for the purchase of inferior quality of drugs particularly in
institutions where there is no staff pharmacist.
•The system does not reduce the cost of drug to the patient or the third party payer

16. ROLE OF PHARMACIST IN HOSPITAL FORMULARY
•Pharmacist in the DTC has a key role in developing policies and procedures governing
the hospital formulary.
•The chief pharmacist has the primary responsibility for the preparation of hospital
formulary.
•Pharmacist with the advice and guidance of DTC shall as certain the quantity and
source of supply of all drugs, chemicals, biological and pharmaceutical preparations
used for the diagnosis, and treatment of patients.
•Pharmacist should ensure that quality of drugs is not compromised by economic
considerations

17. CONCLUSION
standards for best practice
•promoting high quality
•evidence based prescribing.
•Rational drug therapy
•Improve patient quality of life

18. REFERENCES
•A text book of hospital pharmacy- H.P TIPINIS, AMRITA BAJAJ- Pg. no: 134- 143
•A text book of hospital pharmacy- 9th edition Dr. J.S QADRY
Dr. RAMESH K. GOYAL Pg. no: 39-52
Dr. R.K. PARIKH
•A text book of hospital pharmacy- 10th edition Dr. J.S QADRY
Dr. RAMESH K. GOYAL Pg. no: 39-52
Dr. R.K. PARIKH
•Hospital and community pharmacy- 2nd edition- S. BALASUBRAMANIAN
N. NARAYANAN Pg. no: 37-42.
1. https://www.scribd.com/doc/103489552/Chapter-5-Hospital-Formulary
2. https://www.slideshare.net/apollojames/hospital-formulary
3. www.ijopp.org/article/211

19. THANK
YOU