Pharmacy Practice for Final Year B.Pharmacy Sem-VII, As per PCI Syllabus Pharmacy and Therapeutic Committee

1. PHARMACY AND THERAPEUTIC COMMITTEE
TOPIC 11UNIT 3

2. To be effective, medication-use policies must have the concurrence of
individuals involved in the medication-use process. Such consensus is
achieved by developing medication use policies through a properly
organized and representative pharmacy and therapeutics (P&T)
committee or equivalent body and ensuring that those policies are
approved by the organized medical staff. The P&T committee iscomposed
of actively participating physicians, other prescribers, pharmacists, nurses,
administrators, quality- improvement managers, and other health care
professionals and staff who participate in the medication-use process.

3. Composition of pharmacy and therapeutics committee (PTC)
might vary from hospital to hospital. The following scheme is
suggested for general adoption:
The PTC may be composed of:
At least three physicians from the medical staff
A pharmacist
A representative of the nursing staff
An hospital administrator with his/her designated an exofficio
member of the committee one of the physicians may be
appointed as the chairman of PTC.

4. PTC
Medical staff:
Chairman
Co-chairperson
Hospital
administrators :
director
Pharmacis
Secretory
Nursing staff

6. GOALS
The goal of a PTC is to ensure that patients are provided with the best possible
cost-effective and quality of care through determining what medicines will be
available, at what cost, and how they will be used.
In order to achieve this goal a PTC will have the followingobjectives:
To develop and implement an efficient and cost-effective formulary system
which includes consistent standard treatment protocols, a formulary list and
formulary manual.
To ensure that only efficacious, safe, cost-effective and good quality medicines
are used.
To ensure the best possible drug safety through monitoring, evaluating and
thereby preventing, as far as possible, adverse drug reactions (ADRs) and
medication errors.
To develop and implement interventions to improve medicine use by prescribers,
dispensers and patients; this will require the investigation and monitoring of
medicine use.

7. OBJECTIVES
The PTC has 3 major roles to play :
1.Advisory
2.Educational
3.Drug safety and ADR monitoring
Advisory :
The committee recommends the adoption of policiesor assists in the
formulation of broad professional policies regarding evaluation, selection
and therapeutic use of drugs in the hospital
The committee serves in anadvisory capacity medical staff and hospital
administration in all matters pertaining to use of drugs

8. The committee recommended in formulation of function, design to
meet the need of professional staff (physician, nurses, pharmacist
other health care practitioner for complete current knowledge of
matters related to drugs and itsusage.
Pharmacist has an increased responsibility and also develop a
moral or legal and professional functions of ensuring safety in
handling and administration of drugs.

9. There are many possible functions of a PTC, and the
committee must decide which to undertake as a priority;
this decision may depend on local capacities and structure.
Furthermore, certain functions will require liaison with other
committees or teams, for example the infection control
committee or the procurement team. The most important
PTC functions are summarized below.

10. ¶ .Advisory committee to medical staff, administration and pharmacy
The PTC is a valuable resource that can provide advice to medical staff, nurses,
administration, pharmacy and other departments and groups within the hospital.
The PTC can advise on all issues,policies and guidelines concerning the
selection, distribution and use of medicines. Usually a PTC will provide advice
and an executive body, usually the pharmacy or hospital management, will
implement it.
¶ Development of drug policies
The PTC is the most appropriate body to develop drug policies within a hospital or
group of health facilities, since the committee members will have the most
experience and training in drug therapy and supply.

11. Drug policies may vary in different hospitals and countries,but all hospitals
should have specific policies concerning:
Criteria for inclusion of medicines on the formulary list (essential medicines list
(EML))
Standard treatment guidelines and treatment algorithms, which should be the
basis of formulary selection
Periodic use of medicines not on the formulary list, for example restricting their
use to specified prescribers on a named patient basis only, or only allowing
10% of the hospital medicines budget to be spent on them
Expensive or dangerous medicines, such as third-generation antibiotics or
oncological drugs, which are restricted to certain practitioners, departments
or patients (structured order forms may be used to implement this policy)
Drugs that are under investigation for safety or efficacy
Generic substitution and therapeutic interchange
Drug representatives and promotional literature.

12. ¶ Evaluating and selecting medicines for the formularylist
Perhaps the most important function of a PTC is the evaluation and
selection of medicines for the essential medicines list or formulary
list. Drugs should be selected on the basis of the standard
treatment guidelines or protocols that have been developed or
adapted for use in the hospital or health facilities. The evaluation of
medicines requires significant expertise and time commitment and
a rigorous, transparent approach
¶ Assessingmedicine use to identify problems
Appropriate changes within the formulary list or other interventions
may correct a number of problems in how medicines are used. Itis
important for the PTC to identify the priority problems and make
appropriate recommendations

13. ¶ Appropriate methods to identify drug use problems include:
•Aggregate drug consumption data review including ABC and VEN
analysis and use of defined daily dose (DDD) methodology
•Monitoring indicators of medicine use, including adherence to standard
treatment guideline• drug use evaluation (DUE), also known as drug
utilization review
• Monitoring adverse drug reactions and medication errors
•Antimicrobial resistance surveillance

14. ¶ .Conducting effective interventions to improve medicine use
There is no point in a PTC collecting information on drug use problems
if nothing is done to correct the problems identified. The PTC is the
main body within a hospital, or group of health facilities, responsible
for ensuring that drug information is provided to health staff and also
for conducting interventions to promote more rational drug use.
Monitoring and supervision, audit and feedback, educational
programmes, in-service training, use of standard treatment guidelines,
provision of unbiased drug information, prescribing restrictions and
automatic stop orders are some important interventions.

15. ¶ Managing adverse drug reactions
Adverse drug reactions (ADRs) are serious in terms of patient harm
(morbidity and mortality) and avoidable economic costs. One large
meta-analysis estimated that ADRs cause 3-4% of all hospital
admissions in the USA and that in 1994 the incidence of ADRs was
6.7% (2.2 million events) with 106 000 fatalities (Lazarou et al. 1998).
These estimates should be viewed with caution because of the
heterogeneity among studies and small biases in the sample, but the
data nevertheless suggest that ADRs are a large and serious
problem

16. ¶ .Managing medication errors
Medication errors occur in all health-care settings, no matter how
good the health- care staff are at prescribing, dispensing and
administering medicines. Even if there is no error on the part of
health-care staff, patients may take drugs incorrectly.
Causes are numerous and include lack of knowledge, tiredness of
staff, careless work attitudes, poor procedures, lack of policies,
unfamiliar dosage forms and human error. PTCs can reduce such
errors by monitoring, analysing, reporting errors and implementing
corrective action

17. ¶.Information dissemination and transparency
The PTC must disseminate information about its activities, decisions and
recommendations to the staff who must implement the PTC’s decisions.
This may seem obvious, but it is often forgotten. Inadequate dissemination
of information leads to a loss of credibility. It is also very important that the
PTC operates in such.
a way as to ensure transparency of all its decisions and to avoid conflict of
interest. In particular, members should either have no relationship with
pharmaceutical companies or declare it openly so that conflicts of interest
can be avoided. The only acceptable contact with pharmaceutical
companies is to ensure the flow of information about their drug products in
a way that is as unbiased aspossible.

18. The P&T committee formulates policies regarding evaluation,
selection, diagnostic and therapeutic use, and monitoring of
medications and medication-associated products and devices.
The P&T committee should establish and assist in programs
and procedures that ensure safe and effective medication
therapy (e.g., clinical care plans, treatment guidelines, critical
pathways, disease management protocols). Members of the
P&T committee, or their representatives from appropriate
specialties (including pharmacists), should participate in or
direct the development and review of such programs or
procedures, which should be kept current.

19. The P&T committee should participate in performance
improvement activities related to procurement, prescribing,
dispensing, administering, monitoring, and overall use of
medications. The P&T committee should advise the
institution, including the pharmacydepartment, in the
implementation of effective medication distribution and
control procedures, incorporating technological advances
when appropriate. The P&T committee should initiate,
direct, and review the results of medication-use evaluation
programs to optimize medication use and routinely
monitor outcomes (economic, clinical, and humanistic) of
formulary decisions.

20. Communication and Education
The P&T committee ensures that mechanisms are in place to communicate with
health care professionals, patients, and payers about all aspects of the formulary
system, including changes made to the formulary or policies and how formulary
system decisions are made.
The P&T committee also recommends or assists in the formulation of educational
programs designed to meet the needs of professional staff, patients, families, and
caregivers on matters related to medications and medication use. The P&T
committee should establish or plan suitable educational programs on matters
related to medication use for staff involved in the care of patients and the use of
medications.

21. ROLE OF PHARMACY AND THERAPEUTIC
COMMITTEE IN EMERGENCY LIST:

22. B.DRUGS FOR EMERGENCY BOX:
• Digoxin 0.25mg/ml
• Heparin 10,000 units/ml These may selected in
consultation with the physician but the following list:
• Aminophyillin 0.25 gm/ml
• Atropine sulphate 0.4mg/ml
• Calcium gluconate 1gm/ml

23. C. SUPPLIES FOR CABINET UTILITY
ROOM:
• Venomous cannulation set.
• Each set 12 & 17 venomous catheter.
• Oxygen catheter
• Sterile suction catheters.

24. D. OTHER EMERGENCY
SUPPLIES:
• Resuction carts
• Phelebotomy sets
• Oxygen equipments
• Tracheotomy

25. REFERENCES:-
1. A Text book of Pharmacy Practice by the author Sourabh Kosey
Nirali Prakashan. Page No.11.1-11.12
2. A Text book of Pharmacy Practice by the author Dr. Sachin V.
Tembhurne, Dr. Ashwini R. Madgulkar, Dr. Virendra S. Ligade
Nirali Prakashan. Page No.11.1-11.6
3. www.Google.com