The Hospital Formulary Flashcards
A continually revised compilation of pharmaceuticals, which reflects the current clinical judgment of the medical staff and the relevant policies on medication.
Hospital Formulary
The hospital formulary is tailored to fit the particular requirements of the hospital and reflects departmental consensus on first choice treatment from the national list essential drugs. It should be ___ , ___ , ___ and ___ .
handy, complete, concise, easy to use
The process in which the list of drug products or formulary of the hospital is developed. It is the method whereby the medical staff of an institution, working through the Pharmacy and Therapeutics Committee, ___ , ___ , and ___ from among the numerous available medicinal agents and dosage forms those that are considered most useful in patient care.
evaluates, appraises, selects
It is multidisciplinary process that is based on ___ and ___ to guide organizations on providing medications to patients.
research, evidence
The system provides the hospital pharmacist time to work with:
The medical staff in the ___ , ___, and in the ___
selection, evaluation of new drug products and critical use of therapeutic agents, promotion of rational drug therapy
The system provides the hospital pharmacist time to work with:
The nursing staff to ___ which may lead to medication errors
avoid practices and procedures
The system provides the hospital pharmacist time to work with:
The medical and nursing staff in the ___ concerning the use of the drug products in the hospital.
implementation of policies
OBJECTIVES
It serves to ___ concerning the relative merits of the multitude of available medicines to provide rational therapeutics and promote quality patient care
educate the physicians
OBJECTIVES
It serves as a teaching aid to ___ , and ___ by providing essential information on a well-classified arrangement of therapeutically known medicines, which have been chosen after careful consideration by the medical staff.
the interns and other medical staff
OBJECTIVES
It prevents ___ , ___ , and ___ thus promote savings both to the hospital and to the patient.
unnecessary duplication, wastage and confusion on prescribed medications
OBJECTIVES
It promotes ___ , ___ , and ___ therapy in a hospital.
safe, intelligent, and effective
Potential Benefits of the Hospital Formulary
- Therapeutics
- Economic
- Educational
POTENTIAL BENEFITS
It provides the greatest benefit to the patient and physician in that only the most efficient products are listed and available.
Therapeutics
POTENTIAL BENEFITS
Merit a double benefit in that the formulary eliminates the duplication thus reducing inventory duplication and the opportunity for volume purchasing means lower charges to the patient.
Economic
POTENTIAL BENEFITS
Significant for the resident staff, nurses and medical students because many good formulates contain various prescribing tips and additional drug information of educational value.
Educational
CRITERIA
Up to how many Guiding Principles for the selection of drugs
1-5 (5)
CRITERIA
As Guiding Principles for the selection of drugs
Whether or not the local general and specialty staff considered the drugs to be proven clinical value based upon their experience with it.
FIRST
CRITERIA
As Guiding Principles for the selection of drugs
May be that the drug must be recognized by the USP, NF, or their supplements.
SECOND
CRITERIA
As Guiding Principles for the selection of drugs
May be that the manufacturer of the drug must be one of proven integrity and dependability as well as having the reputation of initiating and supporting research activities of merit.
THIRD
CRITERIA
As Guiding Principles for the selection of drugs
May be that no preparation of secret composition will be considered or admitted to the formulary.
FORTH
CRITERIA
As Guiding Principles for the selection of drugs
May be deal with products of multiple composition.
FIFTH
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
A formulary list should be ___
limited to conserve resources
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
It is necessary to stock ___ , generic duplication should be eliminated
Medicines listed in the Philippine National Drug Formulary
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
___ should be selected based on disease and conditions treated at the health facility
Medicines
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
Medicines of choice should be selected comparing ___ , ___ , ___ , ___ , ___ , ___ and ___ .
efficacy, safety, toxicity, pharmacokinetic properties, bioequivalence, pharmaceutical and therapeutic equivalence
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
___ should be a primary consideration
Cost equivalence
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
Once medicines of choice are selected, they form the ___ .
basis for standard treatment guideline and for therapeutic substitution
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
___ may be included when necessary.
Second line alternatives to medicines of choice
FACTORS TO CONSIDER IN PREPARING A HOSPITAL FORMULARY
The hospital formulary should correspond with the ___ and to the ___ .
current edition of the PNDF, approved standard treatment guidelines
CONTENT AND ORGANIZATION
The Pharmacy and Therapeutics Committee of a hospital is responsible for ___ , ___ , and ___ its formulary.
compiling, maintaining, updating
CONTENT AND ORGANIZATION
The committee consists of ___ , ___ , ___ and other healthcare providers, as well as ___ . The committee chooses medications based on their effectiveness, their cost and the need for them at each particular hospital.
staff physicians, pharmacist, nurses; hospital administrators
CONTENT AND ORGANIZATION
The primary objectives of the formulary is to provide the hospital staff with following:
___ of what drug products have been approved for use by the Pharmacy and Therapeutics Committee.
Information
CONTENT AND ORGANIZATION
The primary objectives of the formulary is to provide the hospital staff with following:
___ about each approved item.
Basic therapeutic information
CONTENT AND ORGANIZATION
The primary objectives of the formulary is to provide the hospital staff with following:
___ and ___ governing the use of drugs.
Information on hospital policies, procedures
CONTENT AND ORGANIZATION
The primary objectives of the formulary is to provide the hospital staff with following:
___ about drugs such as dosing rules and nomograms, hospital-approved abbreviations, sodium content of various formulary items, etc.
Special information
DETAILED PARTS
In accordance with these objectives, the formulary should consist of three (3) main parts;
- Information on Hospital Policies and Procedures concerning drugs
- Drug Product Listing
- Special Information
DETAILED PARTS
- Information on Hospital Policies and Procedures concerning drugs (5)
- Categories of drugs
- Brief Description of the PTC
- Hospital Policies governing the Prescribing, Dispensing and Administration of drugs
- Pharmacy Operating Procedures
- Information on using formulary
DETAILED PARTS
- Information on Hospital Policies and Procedures concerning drugs
Categories of drugs, including:
- Formulary drugs
- Investigational drugs
DETAILED PARTS
- Information on Hospital Policies and Procedures concerning drugs
Brief Description of the PTC, including its:
- Membership
- Responsibilities
- Operation
DETAILED PARTS
- Information on Hospital Policies and Procedures concerning drugs
Hospital Policies governing the Prescribing, Dispensing and Administration of drugs, including:
- Policies to be followed by pharmaceutical company/supplier representatives
- Standard drug administration times
- Reporting of adverse drug reactions
- Medication errors
DETAILED PARTS
- Information on Hospital Policies and Procedures concerning drugs
Pharmacy Operating Procedures, such as:
- Hours of service
- Out-patient prescription policies
- Pharmacy charging system
- Prescription labelling and packaging practice
- In-patient drug distillation procedures
- Handling of drug information requests and other services
- Patient education programs
- Pharmacy bulletins
DETAILED PARTS
- Information on Hospital Policies and Procedures concerning drugs
Information on using formulary:
- How the formulary entries are arranged
- Information contained in each entry and the procedures for looking up the drug product
- Reference to sources of detailed information on formulary drugs
DETAILED PARTS
- Drug Product Listing
*Formulary Item Entries
- Alphabetically, by generic name
- Alphabetically, within the generic class
- Combination of the two systems whereby the bulk of the drugs are contained alphabetically in a general selection which is supplemented by several special sections such as ophthalmic/otic drugs, dermatological and diagnostic agents
- Dosage forms, as oral tablets and capsules, oral liquid/syrups/suspension, parenteral injectables as ampules/vials, etc.
DETAILED PARTS
- Drug Product Listing
*The type of information to be included in each entry will vary. At a minimum, each entry must indicate the following:
- Generic name of the basic drug entity or product/combination products
- Common synonyms and Brand name
- Dosage form/s, strength/s, packaging/s, and size/s stocked by Pharmacy
- Formulation (active ingredients) of a combined product
DETAILED PARTS
- Drug Product Listing
*Additional Information which may be part of the drug entries include:
- Usual adult dose/pediatric range, or both
- Special caution and notes such as “do not administer IV” or “refrigerated”
- Controlled substances symbol
- Cost information: this generally will be most useful where the therapeutic classification system is used or, alternatively, list of similar drugs (oral steroids) may be represented showing relative cost data.
DETAILED PARTS
This is a listing of all drug items withing each therapeutic category. It is useful in ascertaining what therapeutic alternatives exist for a given situation such as patient allergy to a particular drug.
Indexes to the Drug Listing
DETAILED PARTS
- Drug Product Listing
Two Types of Indexes to the Drug Listing
There are two indexes which can be included at the beginning or end this section which will facilitate the use of the formulary
- Generic Name-Brand/Synonym Cross Index
- Therapeutic/Pharmacologic Index
DETAILED PARTS
- Special Information
The material to be included should be of general interest to the hospital staff not readily available in other sources such as:
- List of Hospitals - approved abbreviations
- Metric conversion scales and tables
- Table of sodium content of antacids
- Rule for calculating pediatric dosages
- Dosage guides for patients with impaired renal functions
- Table of drug interaction
- Poison antidote charts
- List of content of emergency cart/boxes/cabinets
- Examples of formulary request forms and pediatric banks
- Important provisions of the Generics Act on prescribing and dispensing especially through erroneous, violative, and impossible prescriptions.
FORMAT AND APPEARANCE
The ___ and ___ is an appearance which would exert an influence on its users although elaborate, expensive artwork and materials are unnecessary.
physical appearance and structure of a formulary
FORMAT AND APPEARANCE
The formulary should be visually pleasing, understandable, and must appear ___ .
professional
FORMAT AND APPEARANCE
The need for proper grammar, punctuation, correct spelling and neatness is obvious. There is no ___ which all formularies must follow.
one single format or arrangement
FORMAT AND APPEARANCE
A Typical Appearance might have the Composition (6)
- Title page
- Names and Titles on the members of the PTC
- Table of Contents
- Information on hospital policies and procedures concerning drugs
- Products accepted for use at the hospital
- Appendix
FORMAT AND APPEARANCE
A Typical Appearance might have the Composition
- Information on hospital policies and procedures concerning drugs
- Objectives and operation of the formulary system
- Hospital regulations and procedures for prescribing and dispensing drugs
- Hospital services and procedures
- Directions on how to use the formulary
FORMAT AND APPEARANCE
- Product accepted for use at the hospital
- Items added, deleted and requested for inclusion to PNDF consistent with the revision made by the NDC
- Pharmacologic/therapeutic index
- Description of formulary drug products by pharmacologic/therapeutic class.
FORMAT AND APPEARANCE
Appendix
- Rules for calculating pediatric doses
- Schedule of standard drug administration times
- Forms for addition to/deletion from formulary and other important forms
FORMAT AND APPEARANCE
Several techniques/Suggestions that can be used to improve the appearance and ease of use of the formulary are:
- Making use of different colors of paper for each section of the formulary
- Making 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 physician’s bag along with prescription blanks
- Printing the generic name of each drug entry in boldface type using some other method for making it stand out from the rest of the entries.
FORMAT AND SIZE
The format is extremely important since it will determine the ___ of the formulary as well as its publishing costs.
practicality of daily use
FORMAT AND SIZE
There is ___ size can be recommended at the present time, experience has shown that a formulary which is a sufficient ___ in size to permit it is being carried in a uniform/laboratory coat pocket or a small pocket book that can be carried int the doctor’s bag along with his prescription blanks.
no specific; small
PUBLICATION AND DISTRIBUTION
A ___ 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 worthy of the cost of printing.
printed formulary
PUBLICATION AND DISTRIBUTION
Copies of the formulary should be placed at each patient care unit including:
- Clinics and other out-patient care areas such as the emergency room
- Each division of the pharmacy service
- Heads of the departments providing patient care
- Hospital administration
- Each member of the medical staff
KEEPING THE FORMULARY CURRENT
Generally, the formulary will need to be revised ___ . Additions and deletions to the formulary, changes of 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
annually
KEEPING THE FORMULARY CURRENT
Any changes in the current edition of the hospital formulary and formulary supplement sheet can be attached to the ___ of the formulary book
inside back covers
KEEPING THE FORMULARY CURRENT
For ease of the information regarding brand names, the pharmacist can put up a list of brand name drugs ___ with that of the generic index of the hospital formulary.
cross-indexed; generic index
KEEPING THE FORMULARY CURRENT
Another means of keeping the formulary current is through an ___ in the formulary from the medical staff
organized system of soliciting changes
USE OF NON-FORMULARY DRUGS
In many institutions, a non-formulary drugs will not be dispensed from the out-patient pharmacy. The patients are instructed to obtain the medication from their local pharmacy. With respect to in-patients, a physician is allowed to order a non-formulary drug for a specific patient by the use of a ___ .
special non-formulary drug request form
A ___ usually consists of listing of therapeutic agents by their: Generic names, strength, form, posology, toxicology use, recommended quantity to be dispensed
formulary
___ usually consists of listing therapeutic agents by their: Generic names, strength, form, recommended quantity to be dispensed.
Drug list
___ can be kept current and can be revised at will simple by printing, distributing and inserting the necessary page or pages
Loose-leaf Formulary
___ is difficult to keep up-to-date and therefore requires more frequent revisions
Bound volume
