Leonard Mandy C, Thyagarajan Rema, Wilson Amy J, Sekeres Mikkael A
Department of Pharmacy, Cleveland Clinic, Cleveland, OH
Clinical Services, Department of Pharmacy, Baylor Scott & White Health, Dallas, TX.
Am J Health Syst Pharm. 2018 Apr 1;75(7):451-455. doi: 10.2146/ajhp170531.
Lessons learned from the creation of a multihospital health-system formulary management and pharmacy and therapeutics (P&T) committee are described.
A health system can create and implement a multihospital system formulary and P&T committee to provide evidence-based medications for ideal healthcare. The formulary and P&T process should be multidisciplinary and include adequate representation from system hospitals. The aim of a system formulary and P&T committee is standardization; however, the system should allow flexibility for differences. Key points for a successful multihospital system formulary and P&T committee are patience, collaboration, resilience, and communication. When establishing a multihospital health-system formulary and P&T committee, the needs of individual hospitals are crucial. A designated member of the pharmacy department needs to centrally coordinate and manage formulary requests, medication reviews and monographs, meeting agendas and minutes, and a summary of decisions for implementation. It is imperative to create a timeline for formulary reviews to set expectations, as well as a process for formulary appeals. Collaboration across the various hospitals is critical for successful formulary standardization. When implementing a health-system P&T committee or standardizing a formulary system, it is important to be patient and give local sites time to make practice changes. Evidence-based data and rationale must be provided to all sites to support formulary changes. Finally, there must be multidisciplinary collaboration.
There are several options for formulary structures and P&T committees in a health system. Potential strengths and barriers should be evaluated before selecting a formulary management process.
描述从创建多医院医疗系统处方集管理及药学与治疗学(P&T)委员会中吸取的经验教训。
一个医疗系统可以创建并实施多医院系统处方集及P&T委员会,以提供基于证据的药物用于理想的医疗保健。处方集及P&T流程应是多学科的,且应包括系统内各医院的充分代表。系统处方集及P&T委员会的目标是实现标准化;然而,该系统应允许存在差异的灵活性。成功的多医院系统处方集及P&T委员会的关键点是耐心、协作、适应力和沟通。在建立多医院医疗系统处方集及P&T委员会时,各医院的需求至关重要。药房部门的指定成员需要集中协调和管理处方集申请、药物评审及专论、会议议程和会议记录,以及实施决策摘要。必须制定处方集评审的时间表以设定预期,同时还要制定处方集申诉流程。各医院之间的协作对于成功实现处方集标准化至关重要。在实施医疗系统P&T委员会或使处方集系统标准化时,耐心并给各地方机构留出实践变革的时间很重要。必须向所有机构提供基于证据的数据和理由以支持处方集变更。最后,必须要有多学科协作。
医疗系统中处方集结构和P&T委员会有多种选择。在选择处方集管理流程之前,应评估潜在的优势和障碍。