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TitleChapter 5 Hospital Formulary
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L e c t u r e N o t e s i n I n t e r n s h i p 2


Hospital Formulary or Formulary System

 It is a continually revised compilation of pharmaceuticals that reflects the current clinical

judgment of the MS

 A Hospital formulary is useful to the Medical Staff since without this, they would
become dependent on the exaggerated claims of the medical salesman.

 It is a method whereby the Medical Staff of an institution, working through a PTC,

evaluates, appraises and selects from among numerous available medicinal agents and

dosage forms those that are considered most useful in patient care

Important terms for understanding the Basic nomenclature of the Hospital Formulary


 Is the identification of drugs and medicines by their scientifically and
internationally recognized active ingredients or by their official generic name as

determined by the BFAD of the DOH

2. INN

 is an abbreviation for international non-proprietary name (generic name)

 Is the description of the chemical structure of the drugs or medicine and serves as
the complete identification of a compound


 Is the chemical component responsible for the claimed therapeutic effect f the
pharmaceutical products


 Is the proprietary name given by the manufacturer to distinguish its product from
its competitors


 Serves to educate the physicians concerning the relative merits of the multitude of
available drugs and thus provide rational therapeutics and eventually promote

better patient care.

 Serves as a teaching aid to the interns and other Medical staff by providing a well
classified arrangement of therapeutically known medicinal, which have been

chosen after careful consideration by experienced members of the hospital staff.

 Supplies essential information to the medical/nursing staff on the multitude of
available therapeutic agents, which they cannot be expected to remember.

 Serves as a valuable teaching tool to the interns, resident physicians, pharmacists,
students and graduate nurses and provide some semblance of standards

nomenclature for medical records.

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 For specialized patient
4. Investigational Drug

 BFAD approved for specific use by principal investigator
 Not commercially available

1.2 Brief description of the PTC, including its membership, responsibilities and

1.3 Hospital policies governing the prescribing, dispensing and administration of
drugs including policies to be followed by pharmaceutical company/ suppliers

representative, standard administration, reporting of ADR and medication errors

1.4 Pharmacy operating procedures such as hours of service, out-patient prescription
policies, pharmacy charging system, prescription labeling and packaging

practices, in-patient drug distribution procedures, the handling of drug

information request and other services as patient education programs and

pharmacy bulletins

1.5 Information on using the formulary, including how the formulary entries are
arranged, the information contained I each entry and the procedures for looking

up a given drug product. Reference to source of detailed information on the

formulary drugs should be included here.

2. Drug Product Listing

 This part is the heart of the formulary.
 It consists of one or more descriptive entries for each formulary items plus one or

more indexes to facilitate use of the formulary.

Formulary Item Entries can be arranged in several ways:

1. Alphabetically, generic name
2. Alphabetically, within therapeutic class
3. A combination of the two systems whereby the bulk of the drugs are contained

alphabetically in a general section which is supplemented by several special sections such

as ophthalmic/ otic drugs, dermatological and diagnostic agents.

4. Dosage form as oral tablets and capsules, oral liquids/ syrups/suspension/ parenteral
injectables as ampules/ vials, etc.

Each drug entry must include the following information:

1. Generic name of the basic drug entity or product/combination products.
2. Dosage form(s), strength(s), packaging (s) and size(s) stocked by pharmacy.
3. Formulation (active ingredients) of a combined product

Indexes to the Drug Products Listing

 There are two indexes which can be included which will facilitate the use of the

1. Generic name of drug items
2. Therapeutic / Pharmacologic index

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 Index is a listing of all drug items within each therapeutic category. It is useful in
ascertaining what therapeutic alternatives exist for a given situation such as patient

allergy to a particular drug.

3. Specific Information
The material to be included should be of general interest to the hospital staff not readily

available in other sources such as:

1. List of Hospitals-approved abbreviations
2. Rules for calculating pediatric dosages
3. Table of sodium content of antacids
4. List of the contents of emergency cart/boxes/cabinets
5. Dosage guides for patients with impaired renal functions
6. Metric conversion scales and tables
7. Examples of formulary request forms and prescription blanks
8. Important provisions of the Generic act on prescribing and dispensing especially

thorough erroneous, violative and impossible prescriptions

9. Tables of drug interactions
10. Poison antidote chart

 The format is extremely important since it will determine the practicality of daily use

of the formulary as well as the publishing costs

 Experience has shown that a formulary which is sufficiently small in size to permit its

being carried in a uniform or laboratory coat pocket will, in all probability, enjoy

widespread use in the hospital. A small sized book also can be carried in the doctor’s

bag along with his prescription.

Loose-Leaf Vs. Bound
 The most important of these is the ease by which a loose-leaf formulary can be kept

current. A bound volume is difficult to keep up- to date and therefore requires more

frequent revision

Printed Vs Mimeographed
 A printed formulary is obviously more esthetic in appearance, easier to read and

imparts to the user the impression that the hospital considers the formulary as an

extremely important document and therefore of the cost printing

A typical formulary have this composition:

1. Title page
2. Names and titles of the members of the PTC
3. Table of contents
4. Information on hospital policies and procedures concerning drugs

a. Objectives and operation of the formulary system.
b. Hospital regulations and procedures for prescribing and dispensing drugs
c. Hospital pharmacy services and procedures.
d. Directions on how to use the formulary

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5. Products accepted for use at the hospital
a. Items added, deleted and requested for inclusion to PNDF consistent with the

revision made by the NDF.

b. Pharmacologic/ Therapeutic indexes.
c. Description of FD products by pharmacologic/ therapeutic class

6. Appendix
a. Rules for calculating pediatric doses
b. Schedule of standard administration times
c. Forms of addition to/ deletion from formulary and other important forms

Typical Format and Appearance of Hospital Formulary
 The formulary should be visually pleasing, understandable, and must appear professional.

The need for proper grammar, punctuation, correct spelling and neatness is obvious.

 Making use of different colors of paper for each section of the formulary
 Make use of an edge index
 Developing a pocket- size formulary that can fit laboratory coat/uniform pockets. A small

sized book formulary is also recommended since it can be carried in the physician’s bag

along with prescription’s blanks

 Printing the generic name of each drug entry in bold face using some other method for
making it stand out from the rest of the entries.

Distribution of the Formulary

1. Patient care unit (ER, OR, OP, ICU)
2. Division of Pharmacy
3. Heads of Departments providing direct patient care
4. Hospital administration
5. Members of the medical staff
6. Nursing department

 Generally, the formulary will need to be revised annually. Additions and deletions to the

formulary, changes in the drug products, removal from/ addition to PNDF of current

edition and changes in DOH policies, laws, rules, and regulations related to drugs,

hospital policies and procedures will necessitate periodic revision of the hospital


 Any changes in the current sheets can be attached to the inside back covers of the

Criteria for Selecting Drugs in the Formulary

1. Efficacy and Safety – the selection must always be evidence based

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