Pharmacy and therapeutic committee (PTC)

Definition Pharmacy and therapeutic committee (PTC):

The PTC is a group of persons which formulate policies regarding therapeutic use of drugs. This committee is composed of physicians, pharmacists & other health professionals with the inclusion of the medical staff. It serves as the communication line between the medical staff & pharmacy department. Other names are Pharmacy Committee, Formulary Committee, Therapeutic committee & PTC.

Purposes of Pharmacy and therapeutic committee (PTC):

The primary purposes of the P&T committee are

1. Policy Development. The committee formulates policies regarding evaluation, selection, and therapeutic use of drugs and related devices.

2. Education. The committee recommends or assists in the formulation of programs designed to meet the needs of the professional staff (physicians, nurses, pharmacists, and other health-care practitioners) for complete current knowledge on matters related to drugs and drug use.

Organization /Membership of Pharmacy and therapeutic committee (PTC):

The PTC should be composed of

►at least 3 physicians,

► a pharmacist,

►a nurse, and

►administrator.

Committee members are appointed by governing unit or elected medical staff. A representative of physicians will act as chairman of committee & Pharmacist will be considered as secretary of the committee. The size of the committee may vary depending on the scope of services provided by the organization. They should meet regularly, at least six times per year, and more often when necessary.

Functions and Scope of Pharmacy and therapeutic committee (PTC):

 The following list of committee functions is offered as a guide:

1.      To serve as an advisory council to medical staff & hospital administration in all matters related to the use of drugs.

2.      To study problems related to the distribution and administration of medications.

3.      To make recommendations concerning drugs to be stocked in Wards & Emergency.

4.      To develop & compile a formulary of drugs and prescriptions accepted for use in various hospitals. The items are selected on their therapeutic use, safety, cost etc.

5.      To establish programs and procedures that help ensure safe and effective drug therapy and cost-effective drug therapy

6.      To establish or plan suitable educational programs for the organization’s professional staff on matters related to drug use.

7.      To participate in quality-assurance activities related to distribution, administration, and use of medications.

8.      To monitor and evaluate adverse drug (including, but not limited to, biologics and vaccines) reactions in the health-care setting and to make appropriate recommendations to prevent their occurrence.

9.      To initiate or direct (or both) drug use evaluation programs and studies, review the results of such activities, and make appropriate recommendations to optimize drug use.

10.  To advise the pharmacy department in the implementation of effective drug distribution and control procedures.

11.  To disseminate information on its actions and approved recommendations to all organizational health-care staff.

12.  The committee recommends written policies &procedures for selection, procurement, storage, distribution & use of drugs.

Role of pharmacy and therapeutics committee (PTC) in drug safety

•Drug safety is the moral, legal and professional obligation of pharmacist in western countries.

•It includes responsibility from dispensing of drugs to drug administration.

•Following guidelines may subserve the committee in ascertaining the adequate safety factor of hospital pharmacy:

• The hospital must employ a qualified, atleast, a registered pharmacist with atleast B.Pharm degree as ‘Chief Pharmacist’ and the rest are may be atleast Diploma holders in pharmacist.
• Should not permit non‐pharmacist personnel to dispense drugs and allied materials.
• Must employ a sufficient members of qualified considering the work load of a pharmacist and allow for adequate coverage (7days/week).
• Must provide adequate safe, work space, and storage facilities.
• Should have equipment necessary to safely and adequately carry out the modern practice of pharmacy.
• Must have an automatic stop order regulation for dangerous drugs. e.g: narcotics, anticoagulants etc.
• Should have a drug formulary which periodically revised and kept up to date.
• The poisonous materials are separated from non‐poisonous materials in the pharmacy.
• The external used preparations should be separated from internal used medications.
• Must have adequate quality control measures and follow good manufacturing practices.
• Should provide a teaching programme to teach students, nurses the basic course of pharmaceutical mathematics and pharmacology.
• Should be periodically inspected in order to remove deteriorated and outdated drugs as well as to check all labels for legibility.
• Should have an adequate reference library which contains texts on pharmacology, toxicology, posology, and journals containing information on newer developments in the pharmaceutical world.

Hospital Formulary

Hospital formulary is a continually revised compilation of pharmaceuticals that reflects the clinical judgment of the medical staff.

Hospital formulary system is a method where the medical staff working through the P&T committee, evaluates, appraises, and selects from the numerous available drug products those considered most useful in patient care. The selection is made on the basis of its toxicity, untoward reactions, quality, efficacy & bioequivalence.

Guiding Principles to Hospital Formulary System

Following principles serves as guidelines for physicians, pharmacist and administrator in the hospital for their professional judgment.

1) The medical staff shall appoint a multidisciplinary PTC and outline its purposes, organization, function & scope.

(2) The formulary system shall be sponsored by the medical staff based upon the recommendations of the PTC) .the medical staff shall adopt written policies and procedures governing the formulary system as   developed by the PTC.

(4) Drugs should be included in the formulary by their nonproprietary names. Prescribers should be strongly encouraged to prescribe drugs by their nonproprietary names.

(5) Limited no. of drug product should be included in the formulary for the consideration of financial benefits .For this purpose generic equivalents and therapeutic    equivalent should be considered .The institution must assure that its medical and nursing staffs are informed about the existence of the formulary system, the governing procedures, its operation and any changes in those procedures.

(7) Provision shall be made for the appraisal and use of drugs not included in the formulary.

(8) The pharmacist shall be responsible for specifications as quality, quantity and source of supply of all drugs, chemicals, biologicals and pharmaceuticals.

Legal Basis of Hospital Formulary System

A written or signed prescription or a written and signed medication order is the only legal permit to dispense or administer a prescription legend drug.

If the physician use chemical or generic name of the drug, the pharmacist may dispense the brand in his professional judgment. Problems usually arise when prescribers continues to use the propriety name for the drug desired. To avoid such situations hospitals should devise many

Ways--

1) One common method is the use of a suitably worded imprint on the prescription form. For example, “Generic Equivalent Permitted” or “Dispensed in accord with the hospital formulary system”.

(2) The 2^nd method is obtaining the prior medical consent to the operation of a hospital formulary system. In this case the physician is bound to accept the rules and regulations of hospital formulary system.

(3) The 3^rd method is to obtain the medical consent to the operation of hospital formulary in a separate documents and all physicians are requested to sign it.

Principles for Admission or Deletion of Drugs/ (Revision of Formulary) Inclusion or exclusion of a new drug in the formulary is a very complex process. The PTC frames certain policies and procedure for inclusion and deletion of drugs. The criteria followed for inclusion / deletion are as follows—

► The 1^st criteria to be established is whether or not the local general and specialty staff consider the drug to be of proven clinical value based upon their experience with it.  The 2^nd may be that the drug must be recognized by the USP/ NF or supplements.

► The 3^rd may be the manufacturer of the drug product must have proven integrity & dependability as well as having the reputation of initiating and supportive research activities of merit.

► The 4^th criteria may be that no preparation of secret composition will be considered or admitted to the formulary.

► The 5^th may be that the single agent may replace the combination therapy.

During revision of formulary cost effectiveness or cost benefit analysis methods are often used.

Formulary needs to be revised annually because addition, deletion, changes in the products, removal of drugs from the market, changes in hospital policies & procedure.

After each revision the supplement sheets could be attached to the back cover of formulary books. The 2^nd way is to use different color in each edition.

Purchasing agents are agents who responsible for buying supplies, products, materials and services at the lowest possible price while maintaining a high level of quality. Purchasing agents must be skilled in assessing current market conditions as they directly affect supply and demand for services and products.