Medication Managment

Medication Management
• Formulary System.
• Pharmacy and Therapeutics Committee.
Rana Itani, Rph

Rafik Hariri University Hospital
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 is implemented to provided a

mechanism to assure safe and effective use of drugs in
a cost conscious manner.
 The key to medication management is the:
FORMULARY
SYSTEM
or
Formul
Formul
ary
ary List
System
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
Better patient care and financial size
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 Therapeut
Name ic Class
Trade Combinat
Name ion
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
P
ol
ic
y Pharmacy & Therapeutics Committee
D
e
v
el
o
p
m
e 1ry
nt purpose
E
d
u
ca
ti
o
n
Formulary Management Process
Medical Staff
Professional
Pharmacy Staff
Staff
Medication Use
Drug
Management Initiatives
Review
Safety Panel
Committee
P&T Committee
Review & act on recommendations
Formulate implementation plan Medicatio
n Use
Review
Medical & Hospital Staff Notification
Newsletters
Department Meetings
Alliance with pharmaceutical representatives
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.

 Committee Membership:
Pharmacists
Quality
Nurses Improvemen
t Managers
Administrat
Physicians
ors
 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.
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.
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.
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
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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.
Thank You…
Thank You…

Medication Managment

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Medication Management

Rana Itani, Rph

 Medication management is implemented to provided a

 The key to medication management is the:

 The idea was developed in the 1950’s.

 Formulary List = list of medications routinely stocked by

 Overtime, formulary has evolved beyond a list of

The system provides a systemic method to review

Number of medication Dosage form

Pharmacist is responsible for the quality, quantity, and

 Published formulary  list of medications approved for use.

 Other Information to be included in each Drug Entry:

 Dosage form and strength.

 Pediatric or adult dosage ranges.

 The medication list should include one or more index

 Alphabetical index for generic and trade names.

 Index according to therapeutic class.

 Formulary must be published regularly.

 Formulary should be posted on the hospital website.

 Elements of the formulary often include the following:

 Medication use guidelines.

 Medication use policies.

Formulary maintenance is an ongoing process to

 New product evaluation: consider indication, kinetics, safety and

 Therapeutic class review: to obtain optimal agent within a

 Submission of request for formulary addition or deletion (Rational for

◦ Non-formulary drug use review:

 Procedure for procurement of non-formulary drug.

 Regular review of non-formulary drug use.

Who Sets the

 This committee is a policy recommending body to the

Organized Medical Staff

 The committee should meet on a regular basis to

 Frequency: Monthly meeting.

 Length: 60-90 minutes.

Note: Minimum: 10 meetings/year.

1. Formulary system maintenance:

2. Medication selection and review:

3. Medication Use Evaluation:

4. Medication Safety Evaluation:

5. Drug Therapy Guidelines:

6. Policy & Procedure Development:

 Clinical information on drugs added to formulary.

 Pharmacists are essential to the formulary

 Pharmacists guide the P&T committee activities to

 Ongoing formulary maintenance and routine drug use

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