Hospital Pharmacy · Short notes

Hospital Formulary and P&T Committee: Short Notes & Cheat Sheet

What a formulary is, open and closed formularies, the Pharmacy and Therapeutics Committee's members and functions, and essential medicines lists.

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Short notes

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What the P&T Committee does

The formulary is the committee's best-known product, but its safety and audit roles matter as much.

The formulary

A formulary is a continually updated list of medicines approved for use in the hospital, with policies on how they are used.
In a closed (restrictive) formulary only listed drugs can be used routinely; non-formulary drugs need special approval. An open formulary allows any drug.
Drugs are listed by generic name, usually grouped by therapeutic class, with strengths, dosage forms and any restrictions.
A drug is added after evaluating its efficacy, safety, cost and evidence against existing alternatives.
A good formulary improves rational prescribing, reduces cost and simplifies stock management.

The P&T Committee

The Pharmacy and Therapeutics (P&T) Committee is the policy-making link between the medical staff and the pharmacy.
Members: physicians from major specialties (a senior physician usually chairs), the chief pharmacist (usually secretary), a nursing representative and an administrator.
It meets regularly and keeps minutes; its decisions become hospital policy.
Functions: maintaining the formulary, drug use evaluation, ADR and medication-error review, antibiotic policy, investigational drug policy, and staff education.

Related concepts

Essential medicines satisfy the priority health needs of the population. WHO published its first Model List in 1977, and Pakistan has its own National Essential Medicines List.
Drug (medication) use evaluation is a structured review of prescribing against agreed criteria, followed by action and re-audit.
Therapeutic interchange lets the pharmacist substitute an approved equivalent drug under a policy agreed by the P&T Committee.
The pharmacist also serves on the infection control and antimicrobial stewardship committees.

Cheat sheet

High-yield facts in one place. Cover the right-hand column and test yourself.

P&T Committee at a glance

Item	Detail
Chair	Senior physician
Secretary	Chief pharmacist
Other members	Specialist doctors, nurse, administrator
Main output	The hospital formulary
Other roles	DUE, ADRs, antibiotic policy, errors

Open vs closed formulary

Type	Meaning
Open	Any drug may be prescribed
Closed	Only listed drugs without special approval
Non-formulary request	Special approval for an unlisted drug
Therapeutic interchange	Approved substitution within a class

Memory aids

P&T: Physician chairs, Pharmacist writes: A physician usually chairs the committee and the chief pharmacist acts as secretary.

Exam traps

The P&T Committee is advisory and policy-making; it does not buy drugs itself.
Formulary drugs are listed by generic name, not brand name.
A closed formulary still allows non-formulary drugs through an approval process.
WHO's first Model List of Essential Medicines was published in 1977.

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