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.