TOPIC:-
HOSPITAL FORMULARY
Dr.Rabeea Khan
RIPS
FORMULARY CONTENT AND
ORGANIZATION
• The contents of a formulary will depend ,
largely on its purpose.
• The formulary intended to merely use as a
control that what drugs may be used by a
medical staff , requires a drug listing with
ancillary information that the pharmacy and
therapeutic committee deems desireable.
• On the other hand if purpose of the formulary
in addition to its control value is to function as
an informative tool in the clinicians daily
practice , then its contents should be
expanded to meet this goal.
• To meet the objectives as mentioned before ,
a typical formulary essentially have the
following three parts:
FORMULARY CONTENTS
• Part 1: INFORMATION ON HOSPITAL POLICIES
AND PROCEDURES CONCERNING DRUGS
• Part 2: Drug Products Listing
• Part 3: Special Information
PART 1
• INFORMATION ON HOSPITAL POLICIES AND
PROCEDURES CONCERNING DRUGS
Though the material to be included in this
section will vary from hospital to hospital yet
generally , the following items may be
included:
1. Information on using the formulary ,
including arrangement of formulary entries .
The information contained in each entry and
the procedure for looking up a given drug
product.
2. Formulary policies and procedures ,
including restrictions on drug use (if any) and
procedures for requesting addition of a drug
to the formulary.
3. Brief description of pharmacy and
therapeutic committee , including its
membership , responsibilities and operations.
4. Regulations governing prescribing , dispensing and
administration of drugs including
I. writing of drug orders and prescriptions .
II. Controlled substances and considerations.
III. Generic and therapeutic equivalency policies and
procedures.
IV. Automatic stop orders.
V. Verbal drug orders.
vi) Patient use of their on medications
vii) Self administration of drugs by patients
vii) Use of drug samples
viii) Policies relative to stat and emergency drug
orders.
ix) Use of emergency carts and kits
x) Use of floor stock items
Xi) Requests by staff for medications for their
own use
xii) Standard drug administration and time and
xiii) Reporting of drug adverse reactions and
medication errors.
5. Pharmacy operating procedures such as:-
• hours of service
• outpatient prescription policies
• charging systems
• prescription labeling
• and packaging practices
• inpatient drug distribution procedures
• the handling of drug information requests and
specialized services of the pharmacy (e.g
patient education programs , pharmacy
bulletins).
Part 2 – Drug Products Listing
• Core of a formulary
• Comprised of one or more descriptive entries for each
formulary item along with indices to facilitate use of
formulary.
Arrangements of Formulary entries
1) Alphabetically by generic name, with entries for
synonyms and brand name containing only generic
name
2) Alphabetically within therapeutic class
3) A combination of the two systems whereby bulk of
the dugs are contained ( alphabetically) in a general
section which is supplemented by several special
sections such as
– Ophthalmic/otic drugs
– Dermatological
– Diagnostic agents
Type of information included in entries
a) Generic name of basic drug product; combination
products may be listed by generic, common or
trade names.
b) Common synonym and trade name, there should be
a note in the “ direction for use” section of the
formulary explaining that inclusion or omission of
a given brand does not imply that it is or is not
stocked by pharmacy
c) Dosage form , strength, packaging and size
stocked by pharmacy
d) Formulation (active ingredients) of a combination
product.
Dosage form
Strength
Packaging
Part 2:Additional information
• Part of drug entries and may include:
a) Usual adult or pediatric dosage ranges or both.
b) Special cautions and notes such as: ‘ do not
administer I/V’ or ‘refrigerate’
c) Controlled substances symbol.
d) Cost information where therapeutic classification
system is used,Lists of similar drugs (e.g, oral
steroids) showing relative cost data.
e) Indexes to drug product listing.
Generic name- brand/synonym cross index
Therapeutic/pharmacological index
Generic name-brand/
synonym cross index
• This index could be integrated into the drug
products listing rather than being a separate
entity.
• The listing, in this event, must be arranged
alphabetically.
Therapeutic/pharmacological index
• This index is the list of all formulary items within
each therapeutic category.
• It is useful in ascertaining what therapeutic
alternatives exist for a given situation such as patient
allergy to a particular drug.
Therapeutic alternatives
• Drug products containing different active
ingredients that are indicated for the same
therapeutic or clinical objectives. Active
ingredients in therapeutic alternatives are from the
same pharmacologic class and are expected to have
the same therapeutic effect when administered to
patients for such condition of use.
• For example, ibuprofen is given instead of
aspirin; cimetidine may be given instead of
ranitidine.
Usual pediatric dosage ranges
Special precaution
Special precaution
Controlled substances symbol.
Part 2: Information on prescription writing
• It is Valuable asset for physicians
• It should cover thr following important parts:
1. Cover the important parts of the prescription
2. Use of metric system
3. A list of acceptable abbreviations
4. Essentials of a narcotics prescription
Information on prescription writing
1. All prescription must be written clearly and
correctly and must bear the following information:
a) Name and address of patient
b) Date
c) Medication prescribed
d) Strength of prescribed medication
e) Total amount to be dispensed
f) Signa,
Containing the instructions to patient,
Should be
Clear
Concise
Simple terminology
2) Physician should avoid mixing Latin and English
abbreviations.
3) the term ‘as directed’, should seldom, if ever, be
used . When refills are desired the number
wanted should be indicated if this is not done, the
prescription will not refilled.
4) Prescription calling for a controlled substance
Other important data such as:
a) Normal laboratory values
b) Tables of heights and weights
c) Tables for calculation of percentages, milli-
equivalents and dosages
d) Formulas of various diagnostics
e) Other necessary information
• All of inclusions are not possible without making the
publication unacceptability at large and expensive.
• There fore, the judicious evaluation of each entry by
pharmacy and therapeutic committee is vital.
Part 3- special information
• Types of items found in special information are:
• 1. nutritional products list
• 2. tables of equivalent dosages of similar drugs
• 3.list of hospital-approved abbreviations
• 4. rules for calculating pediatric dosages
• 5. list of sugar-free drug products
• 6. list of items available from central supply
• 7. list of the contents of emergency carts
• 8. list of dialyzable poisons
• 9. pharmacokinetics, dosing and monitoring
information
• 10. metric conversion scales and tables
• 11. examples of blank or completed hospitals
forms such as prescription blank, request for non-
formulary drug forms an adverse drug reaction
report forms
• 12. tables of drug interactions, drug interference
with diagnostic tests and parenteral drug
incompatibilities
• 13. poison control information
