Definition of Hospital Formulary

The hospital formulary system is a method in which the medical staff of a hospital along with the pharmacy and therapeutic committee selects and evaluate medical agents and their dosage form which are not considered useful in patient care. It is not easy for a hospital pharmacy to stock all the medications that doctors may want to prescribe to their hospitalized patients. Thus, the hospital pharmacist along with the medical staff of the hospital makes a hospital formulary, which includes a list of drugs that the hospital pharmacy stocks. The formulary also lists the information about each drug. The hospital staff along with the PTC meets regularly to make changes in the formulary and revise it periodically.

The hospital formulary is used by physicians to check whether or not the medications required to treat a particular patient are available in the hospital. They also use the formulary to avoid prescribing medications that can undergo dangerous interactions with other medications. The physicians know about specific medications to be prescribed for specific conditions, but a hospital may substitute similar drugs for those medications. For example, a formulary may contain a less expensive generic version of a commonly used medication. Also, a hospitalized patient is treated by multiple physicians, and each physician prescribes different medications for the same patient.

Objectives of Hospital Formulary

The hospital formulary aims to provide the hospital staff with the information given below:

1) Information on Drug Products: It provides information on PTC-approved drug products and their therapeutic use. This section includes descriptive entries for each item to facilitate its use like:

i) Entries in Formulary

  • Generic name of drug
  • Common names (brand names)
  • Dosage forms, strength, and packaging
  • Formulation (name of the active ingredient and formulation of the product)
  • Dose for adults and pediatrics
  • Administration route
  • Cost

ii) Indexes to the Drug Product Listing: There are two ways of making the indexes included either at the beginning or at the end of the section to facilitate the use of formulary:

  • Generic Name/Brand Name: A proper page number should be given for reference to a particular product.
  • Therapeutic or Pharmacological Index: This index is based on the therapeutic category, e.g., antihistaminic drugs, anti-infective drugs, etc.

2) Information on Hospital Policies: The formulary provides the following information regarding the hospital policies and procedures for drug usage:

  • Various policies and procedures for drug usage and restrictions on drug usage.
  • PTC and its membership responsibilities.
  • Hospital regulations governing the prescribing, dispensing, and administration of drugs, generic names, drug orders, investigational drug policies, rules to be followed by medical representatives, emergency drug products, etc.
  • Operating procedures (such as hours of services, out-patient prescription policies, prescription labeling, packaging, and practice, in-patient drug distribution procedure, patient education program
  • Information on the use of formulary, like the procedure for entry of a drug, the manner of arranging the entries, etc.

3) Special Information: The formulary provides information on the drug dosage schedule, hospital-approved abbreviation, and special information about drugs. The information provided in this section though varies from hospital -to-hospital, but should be useful to the hospital staff and should be readily available.

It includes:

  • Nutritional products list
  • Equivalent dosage of similar drug
  • List of hospital-approved abbreviations
  • Guidelines for calculating pediatric dose
  • List of sugar-free drug products
  • Number of items available for emergency boxes
  • Metric conversions and tables
  • Tables of drug interaction
  • Poison control distribution.

Limitations of Hospital Formulary

The hospital formulary system has the following limitations:

  1. It may prevent the physician’s right to prescribe and obtain the drug brand of his choice.
  2. In many cases, the system allows the pharmacist to decide which drug brand is to be purchased and dispensed.
  3. It does not provide any discount or scheme to reduce the drug cost to the patients that the hospital received while purchasing the drugs in bulk quantity.
  4. In a hospital pharmacy with no staff pharmacist, the system may allow the purchasing of inferior-quality drugs.

Contents of Hospital Formulary

The formulary is composed depending on those who are responsible for its publication. A section on prescription writing should be included in the formulary, as it will be useful for young physicians in the training period. The following contents should be included in the hospital formulary:

  1. The prescriptions should be written clearly in a correct manner, and every prescription 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 format.
  7. Size, loose leaf or bound, printed, or mimeographed.
  8. Indexing and assigning categories.

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