POLICIES OF PHARMACY AND

THERAPEUTIC COMMITTEE

PRESENTED BY
DR.K.KARTHICK
ASSOCIATE PROFESSOR
K.K.COLLEGE OF PHARMACY
 POLICIES OF PTC

1. Policies for including Drugs into Formulary

2. Policies for In-Patient Prescriptions
3. Policies for 0ut-Patient Prescriptions
4. Policies for Automatic Stop Order
5. Policies for Emergency Drug List Preparation.
 1.Policies for Including Drugs into Formulary

 The American Society of Hospital Pharmacists (ASHP)

has Formulary Drug Listing Services (FDLS) which
provides copy of a hospital’s drug that can be replicated.
 This copy is made up of two parts:
1. Drug Listing Section:
 This part contains the Drug products whose selection
is done by subscriber and the selected drugs, selected
trade names, abbreviations and/or synonyms,
therapeutic category of drugs, specific dosage forms
and strength of drugs that are selected by hospital.
1.Policies for Including Drugs into Formulary (Contd…,)

2.Pharmacological-Therapeutic Index:
 This part contains non-proprietary drug names that
are classified in accordance with classification of
American Hospital Formulary Service(AHFS).
 The ASHP sends a checklist to the hospital that
consists of around 3000 core drugs which are
recently approved by PTC, to be used in hospitals.
 The format of checklist consists of an access number
for ASHP purposes and a check column to be used by
subscribing hospital.
1.Policies for Including Drugs into Formulary (Contd…,)

 This checklist is marked and reviewed by hospital

pharmacist alongside PTC and checks marked on
appropriate lines means the identified products will
be added on the drug list of a particular hospital.
Categorizing and Indexing:
 The pharmacological classification of drugs are only
described as main headings.
 Moreover, these drugs that are listed in hospital
formulary under each general classification headings
should be classified by Pharmacist alongside PTC.
1.Policies for Including Drugs into Formulary (Contd…,)

 These classifications can be indexed either at the

beginning or at the end of formulary.
 Generally, the index is arranged alphabetically by
generic name of drugs, however it is cross-indexed
with the names of branded drugs which are used in
text portion of formulary.
 As general index is an important part of formulary, it
cannot be exempted, so when an individual is
looking for a drug in formulary, he/she should have
an idea about classification of that particular drug.
1.Policies for Including Drugs into Formulary (Contd…,)

 However, this does not always works.

 For instance, a physician looking for anticholinergic
drugs knows the generic and brand names as well as
the classification of those drugs and even with this
knowledge, he still have to search the general index.
 So it is recommended to directly look into general
index followed by pharmacological index in order to
save time.
 1.Policies for Including Drugs into Formulary (Contd…,)

List of Drugs Present in the Index:

1.Amoebiasis
2.Analgesics
(a) Narcotic
(b) Non-narcotic
3. Anaesthetics
4.Anthelmintics
5.Antiallergenics
6.Antibacterials
(c) Antibiotic
(d) Chemotherapeutic
7.Antiepileptics
8.Antihistaminics
9.Antihypertensives
10.Antimalarials
11.Antiparkinsonism agents
 1.Policies for Including Drugs into Formulary (Contd…,)

List of Drugs present in the Index (Contd…,)

12.Antipsychotics
13.Antituberculous agents
14.Cardiovascular agents
(a) Cardiac drugs
(b) Vascular drugs
15.Central nervous system drugs
(c) Depressants
(d) Stimulants
(e) Tranquilizers
16.Dermatological agents
(f) Anhidrotics
(g) Antipruritics
(h) Antiseptics
(i) Astringents
(j) Bactericides
 1.Policies for Including Drugs into Formulary (Contd…,)

List of Drugs present in the Index (Contd…,)

(g)Caustic
(h)Cleansers
(i) Emollients
(j)Fungicides
(k)Keratolytics
(l)Parasiticides
(m)Protectives
17.Deterrent therapy
18.Diuretics
(a)Mercurial
(b)Thiazide derivatives
(c )Others
 1.Policies for Including Drugs into Formulary (Contd…,)

List of Drugs present in the Index (Contd…,)

19.Gatrointestinal Drugs
(a)Antacids
(b)Antidiarrhoeals
(c )Antinauseants
(d)Antispasmodics
(e)Cathartics
(f)Digestives
(g)Emetics
(h)Emulsifiers
20.Genitourinary agents
(a)Antibacterials
(b)Antiseptics
(c )Antispasmodics
(d)Diuretics
 1.Policies for Including Drugs into Formulary (Contd…,)

List of Drugs present in the Index (Contd…,)

21. Heamatinics
(a) Antianemics
(b) Anticoagulants
(c) Coagulants
(d) Expanders
(e) Hemostatics
(f) Neoplastics
22. Hormones and synthetic substitutes
(g) Adrenal hormones
(h) Ovarian hormones
(i) Pancreas hormones
(j) Parathyroid hormones
(k) Pituitary hormones
(l) Placental hormones
(m) Testicular hormones
(n) Thyroid hormones
23.Muscular relaxants
 1.Policies for Including Drugs into Formulary (Contd…,)

List of Drugs present in the Index (Contd…,)

24.Nutritional aids
(a) Albumin preparations
(b) Amino acid preparations
(c) Carbohydrate preparations
(d) Choline preparations
(e) Fat preparations
(f) Gustatory aids
(g) Mineral preparations
(h) Nutritives
(i) Protein hydrolysates
25. Parasiticides – Internal
(j) Amoebicides
(k) Malaria therapy
(l) Worms
1.Policies for Including Drugs into Formulary (Contd…,)

List of Drugs present in the Index (Contd…,)

26. Respiratory agents
(a) Antihistaminics
(b) Bronchial dilators
(c) Cough preparations
(d) Respiratory stimulants
27.Sedatives and hypnotics
(e) Barbiurates
(f) Non-Barbiturates
28. Serums and vaccines
29.Vitamin and vitamin mixtures
 1.Policies for Including Drugs into Formulary (Contd…,)

 Besides general and pharmacological index, formulary can also be divided into
specific sections and these sections are further divided into subdivisions.
 For instance, the subdivisions may look like the following,
 Ear
 Eye
 Nose
 Rectal
 Throat
 Vaginal
 Skin
 Nutritional aids
 Orals and injectables.
 The sub-divisions like these , helps the physician to easily prescribe the drugs that
are either used for anatomical purpose or the drugs of broad category used either by
oral or parenteral route.
2. Policies for In-Patient Prescriptions

 Policies laid down by PTC regarding to in-patient prescribing have been

mentioned below:
1. Routine Drug Order:
 As per the PTC guidelines, drugs meant for in-patients are to be
prescribed by the physician on in-patient order form (Prescriber’s
order form) and include the following information:
(a) Patient’s name, sex, address and contact number.
(b) Date and time of prescribing.
(c) Name, strength, route and frequency of administration of each drug.
(d) Name of the nursing unit.
(e) Signature of the prescriber ( physician)
(f) Signature of a senior member of medical staff (in case medication
order is written by medical students).
 2. Policies for In-Patient Prescriptions (Contd…,)

2. Intravenous Orders:
 Besides the information mentioned in the above section,
orders for intravenous administration need to include the
below mentioned information as well.
(a) Specific time to hang, accurate quantity, name and drip
rate of the infusate solution.
(b) Specific directions for administration and/or
continuing or discontinuing of i.v.drip or i.v.bolus or
i.v.push etc.
(c) Accurate quantity of the drug(s) to be added to the
i.v.solution.
 2. Policies for In-Patient Prescriptions (Contd…,)

3. Total Parenteral Nutrition (TPN):

 It is a method that bypasses the gastrointestinal
tract.
 Fluids are given into a vein to provide carbohydrates,
essential amino acids, and electrolytes for patients
who cannot or should not receive feedings through
mouth.
 These preparations are to be prepared
extemporaneously by the pharmacy department.
 2. Policies for In-Patient Prescriptions (Contd…,)

 These preparations may only be prescribed by an

authorized physician after consulting with a dietician.
 Once the physician prescribes TPN, the order is
forwarded to the pharmacy department where it is
verified by a senior pharmacist and then the freshly
prepared 24 hour supply is forwarded to the
respective patient room.
 The physician should prescribe the order every
morning and these orders are to be recorded on
medication card of that specific patient.
 2. Policies for In-Patient Prescriptions (Contd…,)

4. Self Medication:
 Among the list of medicines prescribed by the
physician, only nitroglycerine ( not more than 10)
and antacids may be left by the bedside of the
patient.
 The patient may take these medicines on his own,
when needed.
 However, a record of this has to be maintained on
the card.
 2. Policies for In-Patient Prescriptions (Contd…,)

5. Medications Used Prior to Hospitalization:

 Medications brought by the patient at the time of
hospitalization must be sent back home with the
patient’s friend or relative(s).
 However if it is not possible, then the medications
must not be left at the patient’s bedside,
 Rather they should be labelled and stored with the
hospital care takers and handed to the patient only
after seeking permission from the physician at the
time of discharge.
 2. Policies for In-Patient Prescriptions (Contd…,)

6.Automatic Stop Orders:

(a) Orders for Schedule II drugs are to be renewed for
every 24 hours.
(b) Orders for all drugs (except Schedule II drugs) are
to be renewed every week between Monday 4.00
pm and Tuesday 10.00 am. The tern to be effective
only after Tuesday 10.00am.
 2. Policies for In-Patient Prescriptions (Contd…,)

7. New Medication Orders:

 Any change in route or dosage of drug should be
written on a new medication order, by the physician.
 2. Policies for In-Patient Prescriptions (Contd…,)

8. Schedule II Drugs:
 Routine orders for Schedule II drugs must be mentioned
on the patient’s order form and duly signed by the
respective physician, along with his full name.
 However, in case of emergency, if the physician is not
available at the hospital, then he may instruct the nurse
on telephone.
 The nurse then makes entry of the said Schedule II
drugs on the card and it is the responsibility of the
physician to sign order on or before his next visit to the
patient.
 2. Policies for In-Patient Prescriptions (Contd…,)

 The order must include name, strength, frequency

and route of administration of the drug(s).
 prn orders of Schedule II drugs are acceptable only
when specific dose and specific minimum interval
are mentioned.
 Discharge prescription orders of these drugs must
have the complete name and address of the patient,
DEA number of the physician and the drugs are
restricted to only 30 days supply with no refills.
 2. Policies for In-Patient Prescriptions (Contd…,)

9. Methadone Prescriptions:
 According to FDA regulations, methadone
administration to hospitalized patients must be
limited to not more than three weeks in case of the
following cases.
(a) Analgesia in case of severe pain.
(b) Detoxification and temporary maintenance of
withdrawal symptoms of heroin addicts.
 2. Policies for In-Patient Prescriptions (Contd…,)

10. Alcoholic Beverages:

 The orders for alcoholic beverages like wine and
whiskey must be duly signed by the physician with the
quantity not to be exceeded 240 ml per prescription.
 These prescriptions cannot be refilled and requires a
new prescription for dispensing of each 240 ml of the
beverage.
 Any unused quantity of these beverages must be
returned back to the pharmacy rather than removing
from the hospital.
 2. Policies for In-Patient Prescriptions (Contd…,)

11. Discharge Prescriptions:

 For each medication, a separate prescription is
needed which should include,
(a) Patient’s name, address and contact number.
(b) Name, strength and quantity to be dispensed, of
the drug.
(c) Specific instructions for patients and number of
refills.
(d) Name and signature of the physician.
 2. Policies for In-Patient Prescriptions (Contd…,)

12. Emergency (STAT) orders:

 These orders should be rare and in majority of the
cases, drugs should be obtained from nursing station
emergency drug supplies.
 These orders must be written by the physician on the
pharmacy copy.
 However, in emergency cases these may be ordered
through telephonic conversations by the physician or
the nurse.
 3. Policies for Out-Patient Prescriptions

 Outpatient prescriptions are referred to those orders that are

written by the physician for drug(s) or any medical supply, for
employees, clinic patients or the hospitalized patients at the time
of discharge.
 These are to be written only on the hospital prescription forms in
compliance with all the regulatory bodies.
 These prescriptions must include,
1. Name, age, sex, address and contact number of the patient.
2. Date of prescribing.
3. Name, strength and quantity to be dispensed, of the drug.
4. Specific instructions for patients and number of refills.
5. Name and signature of the physician.
 3. Policies for Out-Patient Prescriptions (Contd…,)

6. Prescriptions for controlled drugs must have the

physician’s DEA number. The requirements of these
drugs are:
Drug class Supply period Refills

Schedule II 30 days No refills

(Narcotics)
Schedule III 30 days Upto 5 times within
6 months from the
date of issue
Schedule IV and V As needed Upto 5 times within
6 months from the
date of issue
 4. Policies for Automatic Stop Order

REFER
5. Policies for Emergency Drug List Preparation

REFER
5. Policies for Emergency Drug List Preparation (Contd…,)

Preparation :
 In order to store the emergency drugs, different types of containers
(kits) such as plastic, metal and fishing tackle boxes are used.
 To clearly recognize the drug supplies in the facility, the kits
should be visually similar and should be labelled as per the
requirement to identify the contents.
 The container kit used must be lined to avoid the breakage of their
contents.
 The content of the kits and their position shouldbe systematic.
 The selection of items to keep in the kit should be done by PTC
along with medical staff on request made by department
chairman.
5. Policies for Emergency Drug List Preparation (Contd…,)

 The way drugs are packed should be specified to

easily select the drug during emergency.
 Many manufacturers make cartilage-needle units for
quick administration during emergency.
 PTC should give approval to include essential, non-
essential drugs which are used in common
emergencies.
THANK YOU