Formulary Exam

Question 1

What is a drug formulary?

Answer 1

Drug formulary is an official list of prescribable medicines and related products that are constantly updated.

Question 2

Give two examples of different types of drug formularies used in practice?

Answer 2

• National formularies eg BNF
• Personal Prescribing formularies
• Wider local formularies or hospital formularies like the pan Mersey formulary

Question 3

What is a national formulary, and can you give an example?

Answer 3

• Formularies that are used across the country to prescribe medication
• BNF

Question 4

What is a personal formulary?

Answer 4

List of medication that the person who has written the personal formulary is able to prescribe

Question 5

What is a local formulary, and can you give an example?

Answer 5

For individual trusts or primary care organisations eg anti microbial formularies

Question 6

What is a wider local formulary (joint formulary), and can you give an example?

Answer 6

• For larger areas of counties
• eg pan Mersey formulary is used across the whole of Merseyside

Question 7

What is a closed formulary system?

Answer 7

Closed formulary system is a restricted system where only the medicines included in the drug list can be prescribed.

Question 8

What is an open formulary system?

Answer 8

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

Question 9

What are the potential advantages of drug formularies?

Answer 9

• 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.

Question 10

What are the potential disadvantages of drug formularies?

Answer 10

• 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

Question 11

What are the main roles of a local formulary decision making group (e.g Drug and Therapeutics Committee)?

Answer 11

Make decisions regarding new drugs and therapies based on evidence of efficacy, safety and cost effectiveness.

Question 12

Who should be part of a local formulary decision making group (i.e what roles)?

Answer 12

• 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

Question 13

Can you outline some scenarios where a drug formulary would need to be updated?

Answer 13

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

Question 14

Can you outline the pharmacist’s role in formulary development?

Answer 14

• 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

Question 15

Can you give an overview of the decision criteria used when deciding whether a new drug should be accepted into a formulary or not?

Answer 15

• 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

Question 16

What is a RAG system?

Answer 16

• RAG system categorises medications, for example pan Mersey uses a traffic light system, to make sure that the patient care and monitoring required is appropriate for the healthcare setting
• Give guidance on the prescribing of drugs in the appropriate healthcare settings.

Question 17

What does it mean if a drug has GREEN RAG status in the Pan Mersey formulary?

Answer 17

• Medicines for which primary care prescribers would normally take full responsibility for prescribing and monitoring
  
  • Green status does not imply that a medicine is superior to existing first-line drugs or is a recommended formulary choice

Question 18

What does it mean if a drug has RED RAG status in the Pan Mersey
formulary?

Answer 18

Drug should ONLY be prescribed by a Specialist Clinician

Question 19

What does it mean if a drug has AMBER RECOMMENDED RAG status in the Pan Mersey formulary?

Answer 19

Requires Specialist Assessment and recommendation to GP to prescribe in Primary Care

Question 20

What does it mean if a drug has AMBER INITIATED RAG status in the Pan Mersey formulary?

Answer 20

• • Requires Specialist Initiation of Prescribing
  • Prescribing continued by the specialist until stabilisation of the dose and the patient’s condition is achieved and the patient has been reviewed by the specialist

Question 21

What does it mean if a drug has AMBER PATIENT RETAINED RAG status in the Pan Mersey formulary?

Answer 21

• Requires Specialist Initiation of Prescribing
• Prescribing continued by specialist until stabilisation of the dose and the patient’s condition is achieved and the patient had been reviewed by the specialist
• Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required

Question 22

What does it mean if a drug has PURPLE RAG status in the Pan Mersey formulary?

Answer 22

Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement.

Question 23

What does it mean if a drug has GREY RAG status in the Pan Mersey formulary?

Answer 23

• • Medicines are still being evaluated according to local processes and a decision on whether to commission their use has not yet been made
  • SHOULD NOT BE PRESCRIBED IN ANY SETTING

Question 24

What does it mean if a drug has BLACK RAG status in the Pan Mersey formulary?

Answer 24

Medicines NOT RECOMMENDED for use because of LACK of EVIDENCE of clinical effectiveness, cost prioritisation or concerns over safety

Question 25

What is a shared care agreement and who does it involve?

Answer 25

• Signed written agreement between a patient, their specialist service and their GP.
• Allows care and treatment received to be safely shared between the hospital and their GP

Question 26

What information does a shared care agreement need to contain?

Answer 26

1. Patient details ( Name, NHS number ect)
2. Diagnosed Condition of Patient
3. Medication
4. Date of last prescription
5. Date of next supply of prescription.
6. Date of last blood test, date of next blood test, frequency of blood tests.
7. Name of consultant + contact details
8. Details of specialist clinician - name signature
9. The date