Transcript Medication management a focus on P&T committee and formulary

MEDICATION MANAGEMENT
P&T COMMITTEE AND FORMULARY MANAGEMENT
EMTENAN ALHARBI, Msc
CLINICAL PHARMACIST
Learning Objectives
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Discuss the organization and role of the pharmacy
and therapeutic committee .
Explain how formulary management works.
Introduction
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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.
Safety
Efficacy
Cost
Formulary system
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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.
Pharmacy and Therapeutic
committee(P&T committee)
Definition.
Committee membership.
Responsibilities.
P&T committee-definition
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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.
P&T committee-definition
P&T subcommittees
Medication safety
Review ADRs and
medication errors.
Drug review panel
Focus on a particular
specialty such as
cardiology and review
drug products and
guidelines.
Medication use
review
Monitor one or
more medications
to optimize
specific drug use.
P&T committee membership
Physicians.
Pharmacists.
Nurses.
Quality improvement mangers.
P&T committee membership
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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.
P&T committee-responsibilities
Formulary
system
maintenance.
Medication
selection
and review.
Education.
Policy&
procedure
development.
P&T
committee
MUE
Drug
therapy
guidelines.
Medication
safety
evaluation.
Formulary system maintenance
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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.
Medication selection and review
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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.
Medication selection and review
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1.
2.
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.
Medication use evaluation (MUE)
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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
Medication safety evaluation
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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.
Drug therapy guidelines
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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 .
Policy& procedure development
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Guidelines development on pharmacy related
topics such as narcotics ,IV preparation and
chemotherapy handling .
Education
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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.
Formulary management
Formulary management
Formularies (by access to medications)
Open
Generally large.
Closed
Limited list of medication to
certain physicians or
indications.
Formulary restrictions
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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.
Therapeutic equivalent and
interchange
Therapeutic equivalent
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Drug products with
different chemical
structure and same
pharmacological
\therapeutic use
E.g. 1st generation
cephalosporin.
Histamine -2 blocker.
Therapeutic interchange
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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.
Formulary maintenance
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New product evaluation.
Non-formulary drug use review.
New product evaluation
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Development of slandered format for new drug
evaluation is useful in facilitating P&T committee
discussions.
The slandered element include the following:
Generic name
Indication\uses
Trade name
Adverse events
Pharmacological class
Drug interaction
Pharmacology
Dosing
Pharmacokinetics
Cost
Clinical studies
Summary, recommendation and
references .
leuprolide acetate
Non-formulary drug use review
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Unique patients needs may require the use of nonformulary agent.
the process includes the completion of nonformulary request form by the prescribing
physician.
This may take up to 24 hours delivery time. it also
permit the use of patient own medications.
Non-formulary drug use review
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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.