Medication Management
Outline

Medication Management.

Formulary System vs. Formulary List.

Publishing your Formulary.

Formulary Maintenance.

Pharmacy & Therapeutic Committee:
 Definition.
 Members.
 Responsibilities and Role.
Pharmacy Challenges
Medication
Safety
Medication
Cost
Medication Management

Medication management is implemented to provided
a mechanism to assure safe and effective use of drugs
in a cost conscious manner.
Medication Management

The key to medication management is the:
Medication Management
or
or
Formulary List vs. System

The idea was developed in the 1950’s.

Formulary List = list of medications routinely stocked by
the health care system.

Overtime, formulary has evolved beyond a list of
medications into a system for medication management.
Formulary System
Ongoing assessment of medications available for use
The system provides a systemic method to review
scientific evidence on clinical and cost effectiveness in
drug selection decisions, thus potentially improving
health outcomes while reducing the cost.
Formulary Management
Optimizing
Number of
medication
Dosage form
Strength
Package size
Better patient care and financial benefits
e.g. selection of single generic product reduces cost and error in dispensing or administration
Formulary System
Pharmacist is responsible for the quality, quantity, and
source of all medications, chemical, biological and
pharmaceutical preparations used in diagnosis and
treatment of patients.
Formulary System:
Medication List

Published formulary  list of medications approved for use.

Medication entries may be arranged alphabetically by:
Generic
Name
Therapeutic
Class
Trade Name
Combination
Formulary System (cont’d)
Medication List

Other Information to be included in each Drug Entry:
 Dosage form and strength.
 Special precautions.
 Pediatric or adult dosage ranges.
 Undesirable Effects.
 Cost information.
Formulary System (cont’d)
Medication List

The medication list should include one or more index
to assist the user in locating medication entry.
 Alphabetical index for generic and trade names.
 Index according to therapeutic class.
Publishing the Formulary

Formulary must be published regularly.

List should be available to all personnel involved in the
medication process e.g. nurse stations, clinics, ER, outpatient areas.

It should be easy to use and visually pleasing e.g. pocket size,
electronic version.

Formulary should be posted on the hospital website.
Publishing the Formulary (cont’d)

Elements of the formulary often include the following:
 Title page.
 Table of contents.
 Medication List.
 Medication use guidelines.
 Special information.
 Medication use policies.
 Indexes.
Formulary Maintenance
Formulary maintenance is an ongoing process to
assure relative safety and efficacy of agents available
for use in health system. These include:
 New product evaluation: consider indication, kinetics, safety and
cost, drug storage, mode of administration...
 Therapeutic class review: to obtain optimal agent within a
therapeutic class in terms of efficacy, safety and cost.
Formulary Maintenance (cont’d)
◦ Formulary changes:
 Additions and deletions to the formulary.
 Submission of request for formulary addition or deletion (Rational for
request and alternative agent available in formulary).
◦ Non-formulary drug use review:
 Policy for use of non-formulary drugs.
 Procedure for procurement of non-formulary drug.
 Regular review of non-formulary drug use.
Setting the Formulary List?
Maintenance of Formulary List?
Publishing Formulary List?
P&T
Committee
Who Sets the
Formulary
List?
Pharmacy & Therapeutics Committee

This committee is a policy recommending body to
the medical staff. All the recommendations of the
committee are subject to approval from:
Organized Medical Staff
Administration
Pharmacy & Therapeutics Committee
Policy
Development
1ry purpose
Education
Formulary Management Process
Medical Staff
Pharmacy Staff
Medication Use
Management Initiatives
Safety
Committee
P&T Committee
Review & act on recommendations
Formulate implementation plan
Medical & Hospital Staff Notification
Newsletters
Department Meetings
Alliance with pharmaceutical representatives
Professional
Staff
Drug
Review
Panel
Medication
Use
Review
Pharmacy & Therapeutics Committee (cont’d)

The committee should meet on a regular basis to
discuss the rapidly changing drug products and
medical literature.
 Frequency: Monthly meeting.
 Length: 60-90 minutes.
Note: Minimum: 10 meetings/year.
Pharmacy & Therapeutics Committee (cont’d)

Committee Membership:
Pharmacy & Therapeutics Committee (cont’d)

Responsibilities:
1. Formulary system maintenance:
 Develop list of medications for use.
 Guidelines for optimal use of medications.
 Review list & guidelines on regular basis.
2. Medication selection and review:
 Medication selection criteria should be set and should include
medication efficacy, safety and cost.
Pharmacy & Therapeutics Committee (cont’d)

Responsibilities:
3. Medication Use Evaluation:
 E.g. overuse of antibiotics  resistant infections and increased cost.
 Approve drugs to be kept under restriction.
4. Medication Safety Evaluation:
 Adverse drug reaction reports.
 Medication error reports.
 Review drug intervention reports.
Pharmacy & Therapeutics Committee (cont’d)

Responsibilities:
5. Drug Therapy Guidelines:
 Evaluates optimal use of drugs e.g. dosage, frequency, patient selection,
length of therapy and combination.
 Guidelines should be updated routinely.
6. Policy & Procedure Development:
 Medication procurement, selection and distribution.
 Medication for specific settings e.g. ICU.
 Develop policies e.g. automatic stop order, drug recall.
Pharmacy & Therapeutics Committee (cont’d)

Responsibilities:
7. Education:
 Newsletter is often employed to communicate the committee decisions.
 Newsletter includes the following:
 Clinical information on drugs added to formulary.
 Drug therapy guidelines developed.
 Medication safety information.
Pharmacist Role in
Pharmacy & Therapeutics Committee

Pharmacists are essential to the formulary
management process.

Pharmacists guide the P&T committee activities to
assure optimal medication management.
Pharmacist Role in
Pharmacy & Therapeutics Committee (cont’d)
Summary

As the drug expert, the pharmacist can assure safe,
efficacious, and cost effective drug use through the
formulary system.

Ongoing formulary maintenance and routine drug use
evaluations are key elements in this process.