1. Pharmacy and Therapeutics Committee
Drug Formulary
Drug Monographs
Newsletters

2. Who is the P&T Committee?
Under the “Medical Staff”
Made up primarily of physician specialists, Pharmacy director and clinical pharmacists, also can be representatives from nursing, administration, quality assurance, medical records, laboratory, etc.
The pharmacy and Therapeutics committee is charged with overseeing all aspects of drug therapy in institutions like hospitals. Members are mostly physcians, but usually include at least one pharmacist and often include other members from other areas of the hospital (nursing, administration, quality assurance, medical records, laboratory). The physicians are usually from a variety of practices and should always include some specialists like infectious disease, oncology, surgery, cardiology-- these groups may have special needs and concerns in the institution setting.

3. P&T Primary Duties/Functions
Determine formulary of drugs
Develop/review treatment guidelines & protocols
Establish formulary appeals process
Policies and procedures regarding drug use
Establish strategies/programs to improve patient compliance with medications
Quality Assurance activities (DUE, DUR)
Adverse Drug Reaction reporting
The P&T committee falls under the medical staff as an entity and the pharmacists on the committee often don’t have any voting privileges but will have great impact on the committee’s decisions by suggesting drug therapy, formulary changes, and additions or subtractions in what drugs are carried by the institution.
Typically the P&T committee functions include determining what drugs are available to prescribe, who can prescribe specific drugs, policies and procedures regarding drug use, quality assurance activities (drug utilizaiton review/drug usage evaluation/ medication usage evaluation), advverse drug reaction reporting and education in drug use.

4. P&T Primary Duties/Functions cont.
Provide drug use education programs to professional staff
Monitor drug delivery technology
Monitor legislative and regulatory developments
Develop/enforce drug use ethics policies
Develop policies for investigational drug use and participation in clinical trials (IRB)
Other areas included in functions include providing drug use education programs to the professional staff,
monitor drug delivery technology (robots, unit dose system, hand held systems)
monitor legislative and regulatory developments
develop/inforce drug use ethics policies
devleop policies for investagional drug use and participation in clinical trials via the IRB (investigational review board)

5. How Do Pharmacists Support the P&T Committee
Planning future agendas
medications
policies and procedures
quality assurance
Gathering data
Evaluating medications for formulary adoption or deletion
Areas where pharmacists should be supporting a pharmacy and therapeutics committee are in
planning future agendas in regards to medications, policies and procedures, quality assurance issues. Actually the pharmacist usually plan , organize the agenda and run the meeting.
Also in gathering data for due, clinical trials, etc, evaluation medications for formulary adoption or deletion

6. How do Pharmacists Support P&T Committee cont..
Preparing and conducting quality assurance programs (DUE)
Preparing policies and procedures
Communicating information from the P&T committee to other areas of the institution.
Verbally
“Dear Doctor” letter
Newsletter
The pharmacists will also be the one to prepare and conduct the quality assurance programs and DUES
We will prepare the policies and procedures for the hospital wherever drugs are involved, and
communicate information from the P&T committee to other areas of the instituion via verbal communication, “Dear Doctor letters, or Newsletters.

7. Who Requires a formulary System?
Hospitals (required by JCAHO)
Nursing homes
Health maintenance organizations (HMO’s)
State Medicaid for their customers
Insurance companies (benefits plan)

8. What are the Goals of a formulary System?
To provide a group of high quality drugs for the particular situation to ensure that drugs are available for any disease state likely to be treated and that the drugs chosen are the most:
efficacious
have the fewest side effects
cost the least

9. What Mechanisms are in Place to Restrict Physicians from prescribing Non-Formulary Drugs?
Require specific request forms to be filled out
Have a waiting period to obtain non-formulary drugs.
Be financially penalized for use or overuse of non-formulary drugs (HMO, managed care groups, insurance companies)

10. ASHP Guidelines for Recommendations to the Formulary
1. Added for uncontrolled use by the entire medical staff.
2. Added for monitored use: no restrictions placed on use, but the drug will be monitored to determine appropriateness of use.

11. ASHP Guidelines cont..
3. Added with restrictions; the drug is added to the formulary, but there are restrictions on who may prescribe it and/or how it may be used (specific indications, certain MD’s only, etc.)
4. Conditional use; available for use by the entire medical staff for a finite period of time.
5. Not added or deleted from formulary.
Read slide….
Where do you thing most drugs are added?
Most drugs should be added for uncontrolled use or not added because the three other categories cause greater work for the pharmacy or other departments.

12. Drug Newsletters
Purpose- method to communicate drug information to medical staff, physicians, nursing, pharmacy, public, etc.
Sent from hospital pharmacies, community pharmacies, nursing homes, drug companies, pharmacy organizations and government regulatory bodies.

13. Steps to Writing a Newsletter
Define the audience
Define the goals
Identify constraints

14. Tips for good Newsletters
Make it look appealing
Keep it consistent from issue to issue
Use white space properly
Design a masthead
Keep articles short and easy to read
Do not exceed 2 pages
Give documentation and references
Write clear, concise, complete. Be positive
Edit, Edit, Edit!

15. Newletter Topics Review of drug classes Adverse drug reactions
Drug usage evaluation
New informational sources
new legal requirements
new services
news from other departments

16. Newsletter topics cont...
Calendar of events
Personnel policies
clinical pearls
job related information
pharmacoeconomics
P&T Committee news
productivity information
Professional announcements