The System Pharmacy and Therapeutics Committee: Creating a Consistent Formulary
With thousands of FDA-approved medications available and more coming to market every year, how do clinicians keep track of those that are most effective, safe and cost efficient? How do they know what their hospital pharmacy stocks?
The answer to all those questions is the formulary, a Joint Commission-required listing of medications that meet all the requirements of being effective, safe, cost efficient and in stock for inpatient care.
Staci Hermann, chief pharmacy officer, and Michael Calderwood, MD, MPH, regional hospital epidemiologist, serve as co-chairs of the System Pharmacy and Therapeutics Committee. D-HH Connections talked with them to better understand this committee's efforts to create and maintain a D-HH formulary and the benefits it delivers.
Did D-HH have a formulary before the System Pharmacy and Therapeutics Committee (P&T) began its work?
Staci Hermann: The Joint Commission and Centers for Medicare & Medicaid Services require all hospitals to maintain a formulary so there was a local formulary in each member location. In 2017, the committee was established to create and maintain a formulary that is consistent across all D-HH locations focusing initially on the inpatient space, and then spreading out to the clinic areas.
Who participates in committee work?
Hermann: Chief medical officers and chief nursing officers participate along with representatives from each pharmacy across the D-HH System. Each member location also has a hospital P&T committee that collaborates with the system P&T committee.
How do the hospital and system committees collaborate?
Michael Calderwood, MD, MPH: Hospitals and the medical center all have committees and working groups that offer specific expertise in areas like antimicrobials, pain medication and chemotherapy drugs. They are able to evaluate new therapies and make recommendations, as well as review policies and procedures for how inpatient therapies are used. That collective expertise benefits patients at every member location.
Once a medication or therapy has moved through one of those committees, a recommendation about its inclusion in the formulary goes to the system committee. Recommendations are often taken after discussion and a vote, but the system committee sometimes comes back with questions.
Hermann: Local sites can also bring issues back to the system committee. Once the system-wide committee has decided to include a medication in the formulary, member hospitals can choose to stock the medication(s) at their respective sites. This allows for flexibility at the site given the different patient population seen at each one. Nothing can be added to formulary at any site without first going through the system committee.
Can you give an example of the system formulary at work?
Calderwood: During a recent Hepatitis A outbreak, we had to quickly stock a vaccine as vaccination was recommended for all community members experiencing homelessness or using drugs. We had been using a vaccine in the outpatient space and were able to add it to the formulary for inpatient stocking across the system.
Why is system-wide formulary consistency important?
Calderwood: The system formulary ensures that clinicians across all sites have access to the same information about drug efficacy, toxicity, safety and cost when making prescribing decisions.
Hermann: Patients often move across the D-HH system from the medical center to other sites or vice versa. The formulary helps ensure that medications and their uses are aligned across locations so that patients receive consistent care no matter where they are receiving treatment.