A hospital formulary is a list/manual of pharmaceutical preparations including important information which reflects the current clinical investigation for the medical staff. In every hospital, Hospital and Therapeutic Committee (HTC) prepares a list of drugs to be used in the hospital. This list of drugs is called a Hospital Pharmacy.
A hospital formulary is a method whereby the medical staff of a hospital evaluates and selects agents from among numerous available medicinal agents and dosage forms that are useful in inpatient care in a particular hospital. It assists in procuring, prescribing, dispensing, and administrating drugs.
- The hospital formulary system should not contain any guidelines or procedures for prescribing and dispensing non-proprietary drugs.
- The medical staff should adopt the policy for the inclusion of drugs by their nonproprietary names.
- In the absence of written approved guidelines by the medical staff, the pharmacist should dispense the brand prescribed.
- The labeling of medicine with non-proprietary names should always be done properly.
- To develop an effective formulary system, HTC has to check with various references on a drug regarding its pharmacokinetic profile, drug-food interactions, poisoning, etc.
Objectives of Hospital Formulary System:
The primary objectives of the hospital formulary are to provide the hospital staff with:
- To provide essential information about the drug which are approved by HTC to physicians and nurses.
- To update the knowledge/hospital guidelines and procedures to the medical staff regarding drugs, their use, their merits, and demerits.
- To avoid unnecessary use of medicine in hospitals during treatment.
- To reduce the cost burden on the patient.
- To prevent duplication and wastage of drugs in hospitals.
- To help the hospital pharmacist in the procurement of new drugs.
Contents and Organization of Hospital Formulary
Following are the contents approved by PTC to formulate the Hospital Formulary:
1. Information on Drug Product:
It is the main and important part of the formulary:
(a) Entries in Formulary:
- Common names.
- A generic name or basic drug.
- Dosage strength, packaging, and sizes stocked.
- Formulation (active ingredients) is a combination of products.
- Adult or pediatrics dose.
- Route of administration.
- Special caution.
- Symbol of Controlled substance.
- Cost of drugs.
(b) Indexes to the Drug Product Listing:
There are two ways for the indexing of the drug products and that can be the beginning or ending section:
- According to generic name/brand name: The proper reference to page number should be included in each entry.
- Therapeutic/Pharmacological Index: This index is according to a therapeutic category, e.g. anti-hypertensive drug.
2. Information on Hospital Policies:
- Various policies and procedures of restrictions imposed by hospitals regarding drug use, and request to add the drug in its formulary.
- Brief discussion of Pharmacy and Therapeutics Committee, containing membership responsibilities and operations.
- Hospital rules and regulations in prescribing, dispensing, administration of drugs, generic drug names, drug orders, rules to be followed by medical representatives, emergency drug products, use of floor stock items, etc.
3. Pharmacy Operating Procedures:
Hours of service, outpatient prescription policies, pharmacy charging systems, inpatient drug distribution procedures, and patient education programs and pharmacy bulletins.
4. Special Information:
In hospital formulary, there is also indicating the information regarding the list of nutritional products, an equivalent dosage of a similar drug, list of super free drug products, tables of drug interactions and adverse drug reaction reports, list of dialyzable poison, list of abbreviation, poison control distribution.
Distribution of the Formulary: Copies of the formulary should be located at each patient care unit including; clinics, outpatient care areas, and emergency room.
Legal Significance: The pharmacist should follow him and dispense only the brands which are prescribed by the physician and mention in the formulary. Many times, the prescriber is not aware of the hospital formulary in such cases the pharmacist should inform him about the same. For every hospital, it is desirable to believe in a formulary that provides extensive choice for the physician to execute the needs of patients.
Differentiation of Hospital Formulary and Drug List
Table.1: Differentiation of Hospital Formulary and Drug List
|In the formulary, there is a listing of drugs according to their generic names followed by strength, dosage form, posology, adverse reactions, drug interactions, pharmacological uses, and recommended quantity to be dispensed.||In the drug list, listing of drugs according to their generic names followed by information on strength and dosage form.|
|It is prepared by the local clinical staff of a hospital.||The drug list is prepared by exceptional clinicians, pharmacologists, and pharmacists of the country.|
|The information which is given in the formulary is subject to local requirements and needs.||The information which is given in the drug list is based on the pharmacological properties.|
Preparation and Revision of Hospital Formulary
The hospital formulary is prepared by identifying the most common diseases being treated in the hospital by referring all medical staff of the hospital. For each disease, there is a suggestion of the first choice of treatment using standard treatment guidelines. The suitable committee that is preparing the hospital formulary is brought together to identify the appropriate treatment for each of the common health diseases.
Another method for the preparation of formulary is to review of WHO model listing of essential medicines. While during preparation, the hospital and its staff should not forget to add the specific drug during the selection process.
Drafts on the drug list must be prepared and given to each department for any comments on the drug list. The hospital and therapeutic committee must.
A draft of the list must be prepared and must be given to each department to comment on the list. The Drugs and Therapeutics Committee cautious check each comment given on the respective drug list and provide feedback on it. The committee discussed all the information given in the formulary with the evidence-based review where possible.
After the finalization of the drug list, the monograph for each drug is prepared without comprising any unbiased information.
In the formulary, entry of the new drug is a very complex procedure. There is needed to take help from various experts for the inclusion of new drugs in the list. Reference books such as Indian Pharmacopeia, British Pharmacopeia, United State of Pharmacopeia, and National Formulary are used while preparation of drug list for entry of new drugs. If there is no information or whose formula is not disclosed in official Pharmacopoeia then the entry of new drug is not made in the formulary.
There are policy guidelines and opinions of the medical staff are taken for inclusion or deletion of drugs in a formulary. Usually, formularies need to be revised annually and there should be a certain system for revision. One method for the revision is to attach supplementary sheets to the back covers of formulary books and the second method of revision is the inclusion of sheets by different colour pages for the cover of each edition of the formulary, this method will help to reduce any confusion between the current and past condition of the formulary.
Managing A Formulary List (Adding and Deleting of Drugs)
For the addition of new drugs into the hospital formulary, the hospital and therapeutic committee should consider the therapeutic potency and equivalency to existing drugs in terms of their safety, efficacy, or suitability of administration. For the addition and deletion of drugs in the formulary, there is a need to consider and compare the total cost for a course of the treatment with new medicine with the existing listed medicines.
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