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Hospital Formulary or Formulary System

HOSPITAL FORMULARY
It is a continually revised compilation of pharmaceuticals that reflects the current clinical judgment of the MS A Hospital formulary is useful to the Medical Staff since without this, they would become dependent on the exaggerated claims of the medical salesman.

HOSPITAL FORMULARY SYSTEM


It is a method whereby the Medical Staff of an institution, working through a PTC, evaluates, appraises and selects from among numerous available medicinal agents and dosage forms those that are considered most useful in patient care Important terms for understanding the Basic nomenclature of the Hospital Formulary 1. GENERIC NAME OR GENERIC TERMINOLOGY Is the identification of drugs and medicines by their scientifically and internationally recognized active ingredients or by their official generic name as determined by the BFAD of the DOH 2. INN is an abbreviation for international non-proprietary name (generic name) 3. CHEMICAL NAME Is the description of the chemical structure of the drugs or medicine and serves as the complete identification of a compound 4. ACTIVE INGREDIENT Is the chemical component responsible for the claimed therapeutic effect f the pharmaceutical products 5. BRAND NAME Is the proprietary name given by the manufacturer to distinguish its product from its competitors

PURPOSE OF THE HOSPITAL FORMULARY SYSTEM


1. EDUCATION Serves to educate the physicians concerning the relative merits of the multitude of available drugs and thus provide rational therapeutics and eventually promote better patient care. Serves as a teaching aid to the interns and other Medical staff by providing a well classified arrangement of therapeutically known medicinal, which have been chosen after careful consideration by experienced members of the hospital staff. Supplies essential information to the medical/nursing staff on the multitude of available therapeutic agents, which they cannot be expected to remember. Serves as a valuable teaching tool to the interns, resident physicians, pharmacists, students and graduate nurses and provide some semblance of standards nomenclature for medical records.
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2. ECONOMICAL Prevents unnecessary duplication, waste, confusion and thus, promote economy both to the hospital and to the patient 3. THERAPEUTIC Promote safe, intelligent and effective therapy in the hospital

HOSPITAL FORMULARY
Formulary service gives the hospital Pharmacist the following opportunities: 1. Time to work with the medical staff in the selective evaluation of new drugs. 2. Time to organize and plan for interesting and stimulating meetings of the PTC. 3. Time to work with the nursing staff in the elimination of practices and procedures, which may lead to medication errors. 4. Time to encourage the medical staff to undertake an objective audit of the discriminate use of the therapeutic agents and to enter other areas for promotion of rational drug therapy. 5. Time to cooperate with the medical staff and nursing staff in numerous areas involving broad policies concerning the use of drugs in the hospital.

FORMULARY CONTENT AND ORGANIZATION


1. 2. 3. 4. The primary objective of the formulary is to provide the hospital staff with the following: Information of what drug products have been approved by the PTC for the patient use. Basic therapeutic information about each approved item. Information on hospital policies and procedures governing drug use. Special information about drugs.

DETAILED PARTS OF THE FORMULARY


1. Hospital policies and procedures concerning drugs: 1.1 Categories of drugs including in the formulary drug and investigational drug. Investigational drug include such items as restriction on the use and procedures for requesting that drug should be added to the formulary. Categories of Hospital Formulary drugs 1. Formulary Drugs BFAD Approved Essential For Good Patient Care Well established usage 2. Drugs approved on a conditional trial period BFAD Approved For general use Evaluated for 6 or 12 months period 3. Specialized Formulary Drug BFAD Approved
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4.

For specialized patient Investigational Drug BFAD approved for specific use by principal investigator Not commercially available

1.2 1.3

1.4

1.5

Brief description of the PTC, including its membership, responsibilities and operations. Hospital policies governing the prescribing, dispensing and administration of drugs including policies to be followed by pharmaceutical company/ suppliers representative, standard administration, reporting of ADR and medication errors Pharmacy operating procedures such as hours of service, out-patient prescription policies, pharmacy charging system, prescription labeling and packaging practices, in-patient drug distribution procedures, the handling of drug information request and other services as patient education programs and pharmacy bulletins Information on using the formulary, including how the formulary entries are arranged, the information contained I each entry and the procedures for looking up a given drug product. Reference to source of detailed information on the formulary drugs should be included here.

2. Drug Product Listing This part is the heart of the formulary. It consists of one or more descriptive entries for each formulary items plus one or more indexes to facilitate use of the formulary. Formulary Item Entries can be arranged in several ways: 1. Alphabetically, generic name 2. Alphabetically, within therapeutic class 3. A combination of the two systems whereby the bulk of the drugs are contained alphabetically in a general section which is supplemented by several special sections such as ophthalmic/ otic drugs, dermatological and diagnostic agents. 4. Dosage form as oral tablets and capsules, oral liquids/ syrups/suspension/ parenteral injectables as ampules/ vials, etc. Each drug entry must include the following information: 1. Generic name of the basic drug entity or product/combination products. 2. Dosage form(s), strength(s), packaging (s) and size(s) stocked by pharmacy. 3. Formulation (active ingredients) of a combined product Indexes to the Drug Products Listing There are two indexes which can be included which will facilitate the use of the formulary: 1. Generic name of drug items 2. Therapeutic / Pharmacologic index
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Index is a listing of all drug items within each therapeutic category. It is useful in ascertaining what therapeutic alternatives exist for a given situation such as patient allergy to a particular drug. 3. Specific Information The material to be included should be of general interest to the hospital staff not readily available in other sources such as: 1. List of Hospitals-approved abbreviations 2. Rules for calculating pediatric dosages 3. Table of sodium content of antacids 4. List of the contents of emergency cart/boxes/cabinets 5. Dosage guides for patients with impaired renal functions 6. Metric conversion scales and tables 7. Examples of formulary request forms and prescription blanks 8. Important provisions of the Generic act on prescribing and dispensing especially thorough erroneous, violative and impossible prescriptions 9. Tables of drug interactions 10. Poison antidote chart

Format
The format is extremely important since it will determine the practicality of daily use of the formulary as well as the publishing costs Experience has shown that a formulary which is sufficiently small in size to permit its being carried in a uniform or laboratory coat pocket will, in all probability, enjoy widespread use in the hospital. A small sized book also can be carried in the doctors bag along with his prescription. The most important of these is the ease by which a loose-leaf formulary can be kept current. A bound volume is difficult to keep up- to date and therefore requires more frequent revision A printed formulary is obviously more esthetic in appearance, easier to read and imparts to the user the impression that the hospital considers the formulary as an extremely important document and therefore of the cost printing

Size

Loose-Leaf Vs. Bound

Printed Vs Mimeographed

A typical formulary have this composition: 1. Title page 2. Names and titles of the members of the PTC 3. Table of contents 4. Information on hospital policies and procedures concerning drugs a. Objectives and operation of the formulary system. b. Hospital regulations and procedures for prescribing and dispensing drugs c. Hospital pharmacy services and procedures. d. Directions on how to use the formulary
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5. Products accepted for use at the hospital a. Items added, deleted and requested for inclusion to PNDF consistent with the revision made by the NDF. b. Pharmacologic/ Therapeutic indexes. c. Description of FD products by pharmacologic/ therapeutic class 6. Appendix a. Rules for calculating pediatric doses b. Schedule of standard administration times c. Forms of addition to/ deletion from formulary and other important forms

Typical Format and Appearance of Hospital Formulary


The formulary should be visually pleasing, understandable, and must appear professional. The need for proper grammar, punctuation, correct spelling and neatness is obvious. Making use of different colors of paper for each section of the formulary Make use of an edge index Developing a pocket- size formulary that can fit laboratory coat/uniform pockets. A small sized book formulary is also recommended since it can be carried in the physicians bag along with prescriptions blanks Printing the generic name of each drug entry in bold face using some other method for making it stand out from the rest of the entries. Distribution of the Formulary 1. Patient care unit (ER, OR, OP, ICU) 2. Division of Pharmacy 3. Heads of Departments providing direct patient care 4. Hospital administration 5. Members of the medical staff 6. Nursing department

KEEPING THE FORMULARY CURRENT


Generally, the formulary will need to be revised annually. Additions and deletions to the formulary, changes in the drug products, removal from/ addition to PNDF of current edition and changes in DOH policies, laws, rules, and regulations related to drugs, hospital policies and procedures will necessitate periodic revision of the hospital formulary. Any changes in the current sheets can be attached to the inside back covers of the formulary. Criteria for Selecting Drugs in the Formulary 1. Efficacy and Safety the selection must always be evidence based
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2. Quality- each selected drug must be available in a form in which adequate quality, including bioavailability can be assured. 3. Relative Benefits applied to drugs which appear to be similar in the above respects. 4. Cost Benefit considers the cost of the total treatment and not only the unit cost of the drug. 5. Pharmacologic Advantages and Availability consider factors such as comparative pharmacokinetic properties or by local considerations such as availability of facilities for manufacture and storage. 6. Rational Formulation most essential drugs should be as single compound formulations. Fixed-ratio combination products are acceptable only when the dosage of each ingredient meets the requirements of a defined population group and when the combination has proven advantage over single compounds administered separately in therapeutic effect, safety and compliance.

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