Contents of Hospital Formulary

Prescription Writing

1. The prescriptions should be written, appropriately, and should include:
2. The patient’s name and address
3. The date
4. The prescribed drug is written in the terminology used in the formulary
5. The strength of the drug prescribed in the appropriate metric system
6. The total amount to be dispensed
7. The “Signa” with instructions for the patient should be mentioned clearly in simple terms so that the patient can understand it easily
8. If any drug is to be repeated, the physician should mention the number of times the drug is to be taken. If this is not done, the pharmacist may not dispense the prescription again.

The prescriptions for narcotic drugs, apart from the above information should also have the patient’s age. The prescribing physicians should sign the prescriptions, and should prepare three copies of the prescription; one copy of which is retained by him, and the other two copies are given to the patient. Normal laboratory values, tables of weights and measures, tables for the calculations of percentages, milliequivalents and dosages, formulas of various diagnostic stains, and reagents commonly used in hospitals should be included in the formulary.

Format

The daily use and publishing cost of the formulary depends on its format. The hospital pharmacist collects the formularies of various hospitals and decides the format.

After the formulary is published, two copies of it are sent to the American Society of Hospital Pharmacists. The formulary depending on the local need of the hospital should be of a specific size to make it convenient to use for the physicians. Smaller size formularies are always preferred.

Size, Loose Leaf or Bound, Printed or Mimeographed

A formulary of sufficiently small size can be carried by clinicians, nurses, etc., easily in the pockets of their uniform or laboratory coats. A small-sized formulary can also be carried by the physician in his/her bag along with the blank prescription forms. Many physicians use the formulary in their private clinics. The hospitals generally determine the size of their formulary.

The hospital authorities along with the PTC decide whether the formulary should be in the form of a loose-leaf volume or a bound book. A loose-leaf type formulary can be easily kept and can be revised whenever required by printing, distributing, and inserting necessary pages. Bound volumes are prepared using paper and cardboard covers, or plastic or leather binding.

It is also decided whether the formulary will be printed or mimeographed (a modified version of the cyclostyled volume). The appearance of printed formulary is more attractive and is easier to read. However, a study of many formularies has shown that some better formularies are mimeographed.

Some formularies are developed by individuals with a goal of publication or advertisement. They include drawings using colored inks and colored paper. This approach however should be avoided as formulary is a professional publication and should reflect the high ethical standard of the hospital and its staff. Therefore, a white or slightly off-white paper and the use of black ink is recommended.

Indexing and Assigning Categories

While compiling a formulary, the authorities consider an approach that will aid the physician in locating an item in the formulary. A formulary contains all the required information, but sometimes data are not easily found due to improper indexing. The index thus is the key to the formulary, and the pharmacist should spend efforts and time to make it useful so that the desired data can be easily located.

Formularies mostly have a general index at the end of the text. This index is arranged alphabetically by generic names of the drugs and cross-indexed with brand names in the text portion of the formulary. The general index is an essential part of a formulary and cannot be missed.

For example, a physician knows the generic and brand names of several anticholinergic drugs; he/she will search the index to find a familiar anticholinergic drug. This approach is burdensome and time -taking, the general index should be supplemented with a pharmacological index which will be a matter of finding any particular data in a very short time. Therefore, key pharmacological classification with main headings is only suggested.

The pharmacists along with the PTC should classify all the drugs used in the hospital and mention them in the formulary under each heading. This compiled index should then be placed either in the front or at the back of the formulary.

Apart from the general and the pharmacological indexes, the formulary is divided into specific sections, each separated by a divider. The type of sub-division of sections can be achieved in the following pattern.

1. Ear
2. Eye
3. Nose
4. Rectal
5. Throat
6. Vaginal
7. Skin
8. Nutritional aids
9. Oral products
10. Injectables. 

This sub-division enables the physician to readily refer to the specific agent used for either automatic entry or to the broad category of oral or parenteral drugs.

Selection of Text

This is a very important part of the formulary. The selection and scope of the text under each generic drug should be given appropriately. The amount of text published depends on the goals established by the PTC. It should be appreciated by all the readers as insufficient information will not enhance the use and acceptance of the formulary by the staff. On the other hand, the busy practitioner will also not use the formulary if it is a miniature textbook on pharmacology.