P&T Committees + Med Safety Resources

• Policy development

  • Policies that dictate evaluation, selection, diagnostic, and therapeutic use and monitoring of medication and associated products and devices.

• Communication and education

  • Communicates and educates health professionals, patients, admin, and payers about formulary and P&T policies

• Formulary management

  • Incorporates efficacy evaluation of medications, quality assurance activities, and ADR/ medication error reporting

P&T Committee role

• Membership

  • Physicians (and other providers)

  • Pharmacists/ pharmacy leaders

  • Nurses

  • Administrators

  • Quality-improvement managers

  • Other healthcare professionals who participate in med-use process

    • Dieticians, respiratory therapists, etc.

    • Membership varies by organization

• Officers

  • Chair (MD)

    • Develops mutual respect/ actively involves all members

    • Runs meetings, establishes sub-committees, delegates

    • Supportive of pharmacy programs and initiatives

  • Co-chair or secretary (usually PharmD)

P&T Committee composed of whom?

• Often serves as Co-chair or Secretary

• Coordinates preparation of Drug Monographs & other reports

  • Medication use evaluations (MUEs)

  • Adverse event reporting

  • Medication recalls/shortages

• Gains pharmacy consensus prior to P&T presentation

• Be proactive and fully support P&T Committee

Role of pharmacists in formulary management/P&T committee?

• Meetings are generally monthly

• Agenda

  • Review/approval of minutes from last meeting

  • Sub-committee reports

  • Review of formulary (presented as a monograph)

    • Additions

    • Extensions

    • Deletions

• Must have a quorum for decision making

P&T process/agenda

• Accreditation body that surveys hospitals and holds hospitals accountable to meeting published standards of performance.

• Health Systems not meeting these standards may lose their accreditation.

• In the US, maintaining TJC accreditation allows participating organizations to be eligible for Medicare reimbursement

What is the Joint commission?

• Don’t use abbreviations from the “Do Not Use” list, ie. QOD, U, QD

• Prevent usage of unlabeled syringes by using ones prefilled from 503B or ones that pharmacy prepared, also using medication labels

• For hazardous meds:

  • Hospital must comply with USP <800> standards for safe compounding/ handling

  • Personnel must use proper PPE

  • Hospital must conduct assessment of risk for each hazardous drug

• Sound-alike/ Look-alike drugs

  • Hospital must have a list of these

  • Must be reviewed on yearly basis based on actual or potential events

  • Ideally use tallman lettering, could store in different color bins

What are things we can in hospital pharmacies to ensure we follow joint commission standards?

• Extended-release: can result in administration of a large dose all at once.

• Delayed-release: can alter the mechanism designed to protect the drug from gastric acids or prevent gastric mucosal irritation.

• Sublingual/ buccal: alter effectiveness

• Based on certain tech (noncrystals, etc): can alter bioavailability

• Bitter-tasting: can be unpleasant for the patient.

• Irritating/ hazardous: can be harmful to individual crushing the meds

If it MUST be crushed, follow USP 800 standards

Consequences of crushing certain med types?

Part I- ISMP Confused Drug Names

Part II- NIOSH List of Hazardous Drugs in Healthcare Settings

Part III- Pharmacist’s Letter Do Not Crush List

Part IV- ISMP High-Alert Medications in Acute Care

Part V- ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations

Part VI- FDA Adverse Event Reporting (FAERS) Public Dashboard

Part VII- Utilizing Package Inserts

What med safety resources are we allowed to use?