Formulary Exam Flashcards
What is a drug formulary?
Drug formulary is an official list of prescribable medicines and related products that are constantly updated.
Give two examples of different types of drug formularies used in practice?
- National formularies eg BNF
- Personal Prescribing formularies
- Wider local formularies or hospital formularies like the pan Mersey formulary
What is a national formulary, and can you give an example?
- Formularies that are used across the country to prescribe medication
- BNF
What is a personal formulary?
List of medication that the person who has written the personal formulary is able to prescribe
What is a local formulary, and can you give an example?
For individual trusts or primary care organisations eg anti microbial formularies
What is a wider local formulary (joint formulary), and can you give an example?
- For larger areas of counties
- eg pan Mersey formulary is used across the whole of Merseyside
What is a closed formulary system?
Closed formulary system is a restricted system where only the medicines included in the drug list can be prescribed.
What is an open formulary system?
Open formulary system is where there is a list of recommended drugs but drugs that aren’t on the formulary (non-formulary drugs) are still available for prescribing
What are the potential advantages of drug formularies?
- Minimises range of drugs - - results in better knowledge of drug use
- Encourages use of protocols, consistent prescribing
- Better stock management
*Ensures cost-effective drug therapy and prescribing
*Promotes seamless care between hospital practitioners and primary care practitioners.
What are the potential disadvantages of drug formularies?
- Limit patient - centered care
- Management of formularies is time consuming
- Deprives the prescribers of the freedom of prescription
- Does not always reduce the cost to the consumer
What are the main roles of a local formulary decision making group (e.g Drug and Therapeutics Committee)?
Make decisions regarding new drugs and therapies based on evidence of efficacy, safety and cost effectiveness.
Who should be part of a local formulary decision making group (i.e what roles)?
- Senior Hospital Consultants from multiple specialities including microbiology
- Medicines Management Pharmacists
- Chief Pharmacist
- Lead Nurse practitioner
- GPs and representatives from local primary care organisation
- Senior Finance managers
Can you outline some scenarios where a drug formulary would need to be updated?
If there is any change in:
- Patient safety
- Clinical effectiveness
- Strength of evidence
- Place in therapy relative to available treatments
- National guidance and priorities
- Local health priorities
- Equity of access
- Stakeholder views
- cost effectiveness or resource impact
Can you outline the pharmacist’s role in formulary development?
- Organising agendas for meetings, responding to new drug applications, communicating decisions
- Help with writing new drug applications
- Critical appraisal of evidence submitted in new drug applications
- Provide help to colleagues whenever prescribing issues arise
- General maintenance of the formulary
Can you give an overview of the decision criteria used when deciding whether a new drug should be accepted into a formulary or not?
- Main decisions are if the new drug has evidence that it works?
- If it is safe for the patient?
- If it is effective and accessible?
- Apart from that some other decisions may be National guidance and stakeholder views
What is a RAG system?
- RAG system categorises medications to ensure that patient care and monitoring required is appropriate for the healthcare setting
- Give guidance on the prescribing of drugs in the appropriate healthcare settings.
What does it mean if a drug has GREEN RAG status in the Pan Mersey formulary?
- Medicines for which Primary Care prescribers take full responsibility for prescribing and monitoring.
- Green status does not imply superiority over first-line drugs or formulary preference
What does it mean if a drug has RED RAG status in the Pan Mersey
formulary?
Drug should ONLY be prescribed by a Specialist Clinician
What does it mean if a drug has AMBER RECOMMENDED RAG status in the Pan Mersey formulary?
Requires Specialist Assessment and recommendation to GP to prescribe in Primary Care
What does it mean if a drug has AMBER INITIATED RAG status in the Pan Mersey formulary?
- Requires specialist initiation prescribing and continued prescribing until the dose and patient’s condition are stabilised and reviewed by a Specialist
What does it mean if a drug has AMBER PATIENT RETAINED RAG status in the Pan Mersey formulary?
- Requires specialist initiation prescribing and continued prescribing until the dose and patient’s condition are stabilised and reviewed by a Specialist
- Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required
What does it mean if a drug has PURPLE RAG status in the Pan Mersey formulary?
Medicines are suitable for Primary Care prescribing and management after specialist initiation of therapy , with ongoing communication between the Primary Care prescriber and specialist under a Shared Care Agreement.
What does it mean if a drug has GREY RAG status in the Pan Mersey formulary?
- Medicines still being evaluated according to local processes and a decision on whether to commission their use is pending
- SHOULD NOT BE PRESCRIBED IN ANY SETTING
What does it mean if a drug has BLACK RAG status in the Pan Mersey formulary?
Medicines NOT RECOMMENDED for use due to LACK of EVIDENCE of clinical effectiveness, cost prioritisation and safety concerns
What is a shared care agreement and who does it involve?
- Signed written agreement between a patient, their GP and specialist service.
- Allows care and treatment received to be safely shared between the hospital and their GP
What information does a shared care agreement need to contain?
- Patient details ( Name, NHS number ect)
- Diagnosed Condition of Patient
- Medication
- Details of specialist and contact info
