Medication Management P&T committee and formulary management

1. Medication Management P&T committee and formulary management EMTENAN ALHARBI, Msc CLINICAL PHARMACIST

2. Learning Objectives • Discuss the organization and role of the pharmacy and therapeutic committee . • Explain how formulary management works.

3. Introduction • Medication use management describe the process used to assure the safe and effective use of drugs in a cost conscious manner. • The key to medication management is the formulary system.

4. Formulary system • Formulary system defined as an ongoing process which methodically evaluate medications for inclusion\exclusion, establishing guidelines and developing policy and procedures. • The formulary system is managed by pharmacy and therapeutic committee.

5. Pharmacy and Therapeutic committee(P&T committee)

6. P&T committee-definition • P &T committee is a group responsible for overseeing all aspects of drug therapy in an institution. • Because drug products and medical literature are continually changing ,meeting should occur at lease 4-6 times per year. • Generally , monthly meetings are needed to keep the meeting time to 60-90 minutes.

7. P&T committee-definition

8. P&T committee membership

9. P&T committee membership • Therefore, Medication management is a multidisciplinary process. • The voting members of the P&T committee in many hospitals remains to physicians only. this is changing as the committee membership is evolving.

10. P&T committee-responsibilities

11. Formulary system maintenance • The committee develop a list of medication for use on regular basis to assure that the current need of patents and staff are met. • They also develop guidelines for the optimal use of medication for specific disease management.

12. Medication selection and review • A written medication review is prepared from available literature. • The review should be unbiased, and committee members should discuss any conflict of interest prior to discussion of drug or drug class. • Medication selection criteria should be based on efficacy, safety and cost.

13. Medication selection and review • Other issues that should be considered in medication selection process such as duplication, method of administration and targeted population. • Barriers to optimal formulary decision include : • physicians experience and preference. • detailing by pharmaceutical company representatives.

14. Medication use evaluation (MUE) • MUE is the method for evaluating and improving medication use process with the goal of optimal patient outcome. • Medication considered for review are based on efficacy ,safety and cost or a combination of factors. • E.g. antibiotics

15. Medication safety evaluation • Medication safety is evaluated through ADRs and medication errors reports. • Such reports may be local i.e SFDA or global i.e literature or press release.

16. Drug therapy guidelines • Are listing of the indications, dosage regimen, duration, route of administration ,monitoring parameter and special consideration. • These guidelines are often put into via pre-printed physician order sheet placed in the patient chart .

17. Policy& procedure development • Guidelines development on pharmacy related topics such as narcotics ,IV preparation and chemotherapy handling .

18. Education • Newsletters are often employed to include clinical information on drug added to the formulary, medication safety alerts and new guidelines. • The newsletter should be visually pleasing, easy to follow and limited to 2-4 pages. • Presentations are also employed to educate staff and awareness days are held to educate patients.

19. Formulary management

20. Formulary management

21. Formulary restrictions • Do not necessarily translate to optimal medication management. • Some authors suggested that restricting formularies has resulted in increased health care cost and hospitalization i.e. antimicrobial resistance.

22. Therapeutic equivalent and interchange Therapeutic equivalent Therapeutic interchange • Drug products with different chemical structure and same pharmacological \therapeutic use • E.g. 1st generation cephalosporin. • Histamine -2 blocker. • Is the authorized exchange of therapeutic alternative in accordance to previously established guidelines. This should include dose strength ,frequency and route. • E.g. cimetdine 300 mg q 6 hour is as effective as ranitidine 50 mg q 8 hours.

23. Formulary maintenance • New product evaluation. • Non-formulary drug use review.

24. New product evaluation • Development of slandered format for new drug evaluation is useful in facilitating P&T committee discussions. • The slandered element include the following: leuprolide acetate

25. Non-formulary drug use review • Unique patients needs may require the use of non-formulary agent. • the process includes the completion of non-formulary request form by the prescribing physician. • This may take up to 24 hours delivery time. it also permit the use of patient own medications.

26. Non-formulary drug use review • P&T committee frequently assess the non-formulary requests .critical information such number of times used in the last 6-12 months, patient safety and cost should be considered. • Understanding this information will allow the committee to take an action plan such as reconsidering the agent for formulary addition or adding the drug with restrictions.