Pharmacy and therapeutic committee

PHARMACY AND THERAPEUTICS COMMITTEE (PTC)

1. Introduction

One of the important methods of ensuring the rational and appropriate use of drugs in a hospital is to organize and constitute a Pharmacy and Therapeutics Committee (PTC).

The PTC plays an important role in the selection, evaluation, safe, effective, rational and economical use of medicines in the hospital.

2. Definition

The Pharmacy and Therapeutics Committee (P&T Committee) is an interprofessional advisory and policy-recommending committee that assists the medical staff and hospital administration in matters related to the selection, evaluation, safe, effective, rational and economical use of medicines.

According to ASHP, the P&T Committee is generally responsible for managing the formulary system and providing evaluative, educational and advisory services concerning medication use.

In Simple Words

P&T Committee = The hospital's expert group that decides and recommends how medicines should be selected and used safely and rationally.

3. Why is a P&T Committee Necessary?

The P&T Committee is necessary because hospitals have:

3.1 Large Number of Medicines

There may be several medicines available for the treatment of the same disease.

3.2 Different Therapeutic Alternatives

For example, hypertension can be treated with:

• ACE inhibitors
• ARBs
• Calcium-channel blockers
• Beta blockers
• Diuretics

Therefore, the hospital must determine which medicines should be routinely available.

3.3 Safety Concerns

Medicines can cause:

• Adverse drug reactions (ADRs)
• Drug interactions
• Medication errors
• Toxicity
• Contraindications

3.4 Increasing Drug Costs

Some medicines are extremely expensive. Therefore, hospitals need evidence-based and economically responsible drug selection.

3.5 Need for Rational Drug Use

The aim is to ensure:

Right patient + Right medicine + Right dose + Right route + Right duration + Right monitoring

4. Relationship of P&T Committee with Other Hospital Departments

The P&T Committee acts as a bridge between different healthcare departments.

Medical Staff
↓
P&T Committee
↓
Pharmacy + Nursing + Hospital Administration
↓
Safe Medication Use
↓
Improved Patient Outcomes

The committee promotes communication and coordination between:

• Medical staff
• Pharmacy department
• Nursing staff
• Hospital administration
• Other healthcare professionals

5. Composition of Pharmacy and Therapeutics Committee

The composition of the P&T Committee may vary from hospital to hospital. It may include:

1. At least three physicians from the medical staff.
2. A pharmacist.
3. A representative of the nursing staff.
4. A hospital administrator, generally serving as an ex-officio member.
5. One of the physicians may be appointed as the Chairperson of the P&T Committee.
6. The pharmacist usually functions as the Secretary of the Committee.

   

Chairperson and Secretary

Chairperson

Usually selected from the physician/medical staff representatives.

Secretary

Usually a pharmacist or pharmacy representative.

Important for Students

Chairperson → Physician

Secretary → Pharmacist

Functions of the Secretary

The Secretary may be responsible for:

• Preparing the agenda
• Preparing minutes of meetings
• Circulating documents
• Coordinating meetings
• Maintaining committee records
• Following up committee decisions

6. Major Roles / Purposes of P&T Committee

The major roles of the P&T Committee can be remembered as:

A – Advisory

E – Educational

E – Evaluative

P – Policy

F – Formulary

S – Safety

The P&T Committee also plays an important role in:

• ADR monitoring
• Emergency drug-list development
• Drug product defect reporting
• Drug utilization review

7. Advisory Role

The P&T Committee advises:

• Medical staff
• Hospital administration
• Pharmacy department
• Other healthcare professionals

Areas of Advice

The committee provides advice regarding:

• Drug selection
• Drug evaluation
• Medication policies
• Drug distribution
• Medication safety
• Therapeutic interchange
• Drug restrictions
• Formulary management

Example

Suppose a new expensive antibiotic is proposed for use in the hospital.

The P&T Committee evaluates the available evidence and provides a recommendation regarding whether the drug should be included in the formulary and under what conditions it should be used.

8. Educational Role

The P&T Committee helps provide education regarding medicines and medication use.

Target Professionals

• Physicians
• Pharmacists
• Nurses
• Pharm.D students/interns
• Other healthcare professionals

Educational Topics

• New drugs
• New indications
• Drug interactions
• Adverse drug reactions
• Medication errors
• Antibiotic stewardship
• Safe prescribing
• Therapeutic drug monitoring
• Formulary changes
• Rational drug use

Education regarding medications and medication use is an important responsibility of the P&T Committee.

9. Evaluative Role

Before a medicine is included in the hospital formulary, it should be appropriately evaluated.

Important Evaluation Criteria

E – Efficacy
Does the medicine work?

S – Safety
What are its adverse effects and risks?

Q – Quality
Is the product of appropriate quality?

T – Therapeutic Value
Does it offer an advantage over existing therapy?

C – Cost
What is the acquisition and overall treatment cost?

Therefore:

Drug Evaluation = Efficacy + Safety + Quality + Therapeutic Value + Cost + Patient Factors

10. Policy-Recommending Role

The P&T Committee develops or recommends policies related to medication use.

Examples

• Antibiotic-use policies
• High-alert medication policies
• Medication restriction policies
• Therapeutic interchange policies
• Drug-use guidelines
• Medication safety procedures
• Formulary policies

The final approval of such policies depends on the hospital's governance structure and appropriate medical/organizational authority.

11. Formulary Role

The P&T Committee plays an important role in the management of the hospital formulary.

Its activities may include:

• Selection of medicines for the formulary
• Evaluation of new medicines
• Addition of appropriate medicines
• Removal of medicines that are no longer necessary
• Establishment of restrictions for selected medicines
• Periodic review and updating of the formulary
• Promoting adherence to the formulary

12. Operation of the P&T Committee

The P&T Committee should:

1. Meet regularly, at least six times a year, and whenever necessary.
2. Invite persons from within or outside the hospital who can contribute specialized or unique knowledge, skills and judgment.
3. Have the agenda and supplementary materials prepared by the Secretary.
4. Supply the agenda and supporting materials to committee members well in advance.
5. Allow committee members sufficient time to study the agenda and related materials before the meeting.

13. Typical Agenda of P&T Committee Meeting

A typical P&T Committee meeting agenda may include:

1. Minutes of the previous meeting
2. Review of the Hospital Formulary to update it and delete products that are no longer considered necessary.
3. Information regarding new drugs that have become commercially available.
4. Review of side effects, adverse drug reactions, toxic effects and drug interactions reported by various hospital units and brought to the notice of the committee by the Drug Information Centre (DIC).
5. Review of drug safety in the hospital.
6. Reports of various sub-committees.
7. Report of medical audit.
8. Any other matter with the permission of the Chairperson.
9. Vote of thanks.

Minutes of the Meeting

The minutes of every meeting should be prepared by the Secretary and maintained as permanent hospital records.

14. Role of P&T Committee in Drug Safety

Drug safety includes responsibility from:

Dispensing of drugs → Administration of drugs → Observation for possible adverse effects

The P&T Committee plays an important role in ensuring drug safety within the hospital.

Measures to Ensure Drug Safety

1. A registered pharmacist/chief pharmacist should be available.
2. Non-pharmacist personnel should not be permitted to perform duties requiring qualified pharmacy personnel.
3. A sufficient number of qualified personnel should be employed.
4. Adequate and safe workspace and storage facilities should be provided.
5. Necessary equipment should be available.
6. Automatic stop orders should be used for selected dangerous drugs according to hospital policy.
7. A firm policy should be established for investigational/research drugs.
8. A drug formulary should be maintained.
9. Arrangements should be made for pharmacy services outside normal working hours.
10. Poisonous and non-poisonous materials should be appropriately separated.
11. External-use and internal-use drugs should be properly differentiated.
12. Appropriate quality-control measures and GMP should be followed during processing.
13. Appropriate teaching programmes should be conducted.
14. Periodic inspection should be carried out.
15. An adequate reference library should be maintained.

15. Role of P&T Committee in Adverse Drug Reaction (ADR) Monitoring

An Adverse Drug Reaction (ADR) is a harmful and unintended response to a medicine occurring at doses normally used for prophylaxis, diagnosis or treatment.

The P&T Committee plays an important role in:

• Establishing ADR reporting procedures
• Reviewing reported ADRs
• Identifying possible causes and contributing factors
• Promoting awareness regarding ADR reporting
• Recommending measures to prevent recurrence
• Communicating important safety information to appropriate authorities when required

16. Procedure for Reporting ADRs

The procedure described in the source includes:

1. Every suspected ADR should first be reported by the attending physician to the Chairperson of the P&T Committee or clinical pharmacologist.
2. The attending physician should complete the Adverse Drug Reaction Report Form for the patient experiencing the reaction.
3. After patient discharge, the medical record room removes the report from the medical record and forwards it to the Chairperson.
4. The Chairperson periodically forwards essential information to the appropriate central committee or drug-control authority.

17. Automatic Stop Orders for Dangerous Drugs

Automatic stop orders are used as a medication-safety mechanism for selected medicines that require close monitoring.

The source describes the following system:

·        Orders for narcotics, sedatives, hypnotics, anticoagulants and antibiotics are automatically discontinued after 48 hours, unless:

• the order specifies an exact number of doses, or
• the attending physician re-orders the medication.

·        Orders for narcotics, sedatives and hypnotics must be rewritten every 24 hours.

Important Note

These specific 24-hour and 48-hour time limits are source-specific/historical requirements and should not be considered a universal current hospital policy. Actual stop-order requirements depend on institutional policy and applicable regulations.

18. Role of P&T Committee in Developing Emergency Drug Lists

Because time is critical during emergency situations, the P&T Committee should ensure that prepared emergency boxes/kits containing essential medicines and supplies are readily available.

The committee should:

• Compile a list of emergency drugs and supplies.
• Determine the medicines required according to hospital needs.
• Ensure that essential medicines are included in emergency kits.
• Periodically review and update the emergency drug list.

19. Supplies to be Maintained in an Emergency Box

The source lists the following illustrative supplies:

Syringes

• 1 mL syringes, including tuberculin or insulin syringes
• 2 mL syringes
• 5 mL syringes
• 10 mL syringes
• 20 mL syringes

Other Supplies

• Needles of different sizes
• Files for breaking ampoules
• Tourniquets
• Airway equipment
• Ryle's tube

20. Drugs for Emergency Box

The source provides the following illustrative/historical list:

1. Aminophylline
2. Amyl nitrite
3. Atropine sulphate
4. Caffeine sodium benzoate
5. Calcium gluconate
6. Digoxin
7. Diphenylhydantoin sodium
8. Epinephrine HCl
9. Heparin
10. Hydrocortisone
11. Magnesium sulphate
12. Isoproterenol
13. Mannitol
14. Nalorphine HCl
15. Neostigmine methyl sulphate
16. Norepinephrine injection
17. Pentobarbitone
18. Pentazocine
19. Phenylephrine HCl
20. Phenergan/phenothiazine preparation as listed in the source
21. Picrotoxin
22. Procainamide
23. Protamine sulphate
24. Normal saline for injection
25. Sodium molar lactate solution
26. Water for injection

Note

This is an illustrative list from the source. The emergency-drug list should be selected and periodically reviewed according to the hospital's clinical requirements, current protocols and applicable regulations.

21. Supplies for Cabinet Utility Room

The source lists:

1. Venous cannulation sets
2. Venous catheters
3. Shock blocks
4. Oxygen catheters
5. Sterile suction catheters
6. Razor with blades
7. Sterile gelatin sponge
8. Resuscitation tube

22. Other Emergency Supplies

Other emergency supplies include:

1. Resuscitation carts
2. Phlebotomy sets
3. Oxygen equipment
4. Tracheotomy sets
5. Dextran and tubing
6. Burn sheets

Note

Each hospital may modify the list by adding or deleting items according to its requirements.

23. Role of P&T Committee in Drug Product Defect Reporting

Drugs purchased by a hospital may sometimes have quality defects.

The P&T Committee should:

1. Obtain information regarding defective drug products.
2. Inform the manufacturer/supplier about the defect and request appropriate action.
3. If a satisfactory response is not obtained, report the problem to the appropriate drug regulatory authority.
4. Recommend appropriate action regarding the affected product, including withdrawal or quarantine when necessary according to hospital policy.

24. Role of P&T Committee in Drug Utilization Review (DUR)

Drug utilization includes:

Prescribing → Dispensing → Administration → Ingestion/use of prescribed drugs

The hospital pharmacist should obtain a medication history of the patient.

Medication History Should Include:

1. Medicines being taken at the time of admission.
2. Medicines taken during admission.
3. Home remedies and OTC medicines.
4. Drug allergies.
5. Idiosyncratic reactions to drugs and food products.

25. Patient Medication Profile

A Patient Medication Profile is a record containing relevant information about the medicines used by a patient.

The medication profile helps pharmacists and other healthcare professionals identify and prevent medication-related problems.

26. Importance of Drug Utilization Review

The P&T Committee and hospital pharmacist can help to:

1. Improve drug prescribing practices by promoting safe and rational drug use.
2. Detect and help prevent drug interactions.
3. Detect and help prevent adverse drug reactions.
4. Detect and prevent IV additive incompatibilities.
5. Detect drug-induced diseases.
6. Identify possible drug-induced diseases.
7. Detect potential drug toxicities.
8. Promote appropriate and cost-effective medicine use.

27. Summary of Major Functions of P&T Committee

The major functions of the P&T Committee can be summarized as:

1. Drug Selection
Selection of appropriate medicines for hospital use.

2. Drug Evaluation
Evaluation of medicines based on efficacy, safety, quality, therapeutic value and cost.

3. Formulary Management
Development, maintenance and periodic revision of the hospital formulary.

4. Policy Development
Development or recommendation of medication-use policies.

5. Education
Providing information and education regarding medicines and their safe use.

6. Drug Safety
Promoting safe prescribing, dispensing and administration.

7. ADR Monitoring
Monitoring and reviewing adverse drug reactions.

8. Emergency Drug Management
Development and review of emergency drug lists and emergency kits.

9. Drug Product Defect Reporting
Identification and reporting of defective drug products.

10. Drug Utilization Review
Monitoring prescribing, dispensing and use of medicines to promote rational therapy.

28. Conclusion

The Pharmacy and Therapeutics Committee (PTC) is an important component of hospital pharmacy services. It contributes to the rational, safe, effective and economical use of medicines through:

• Drug evaluation
• Formulary management
• Policy development
• Education
• Drug safety monitoring
• ADR monitoring
• Emergency drug-list development
• Drug product defect reporting
• Drug utilization review

Thus, the P&T Committee serves as an important link between the medical staff, pharmacy, nursing staff and hospital administration and helps promote safe and rational medication use and improved patient outcomes.

References

1. A Textbook of Hospital Pharmacy – Quadry.
2. Textbook of Hospital Pharmacy – Paradhkar.
3. ASHP resources on Pharmacy and Therapeutics Committees and formulary management.