Developing a hospital formulary.
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An integrated hospital information system benefits not only the pharmacy but also each department within a hospital, including the physician and patient. The Composite Health Care System (CHCS) is a fully integrated healthcare information system that has been developed for the Department of Defense's medical treatment facilities. CHCS provides modules for Patient Administration, Patient Appointment Scheduling, Radiology, Laboratory, Pharmacy, and Physician/Nursing Order Entry and Results Retrieval, which serve to integrate inpatient wards, clinical services, administrative departments, and remote outpatient clinics. CHCS provides an integrated patient profile to care givers throughout the medical facility, improving the quality of their clinical decisions. The integrated hospital information system also helps to coordinate the delivery of patient care and automates many interdepartmental transactions, which allows for more efficient use of resources and increases the turnaround time for delivery of services. This article focuses on the system's pharmacy component to demonstrate the benefits realized with an integrated hospital information system.
Nonformulary-drug requests were used to evaluate a restrictive formulary system in a large university hospital, and a telephone survey of eight similar hospitals was conducted to assess the restrictiveness of their formulary systems. Nonformulary-drug requests were evaluated by two drug information pharmacists over a 12-month period (January-December 1984) to assess the frequency with which nonformulary items were ordered, the costs associated with the procurement of nonformulary drug products, and the rationales given by physicians when ordering nonformulary products. Of all nonformulary requests, 65% were for drugs previously evaluated by the pharmacy and therapeutics committee and denied admission to the formulary. A cost savings of $1887 would have resulted if formulary alternates had been used instead of nonformulary products. Excluding 22% of nonformulary items that were requested for the continuation of preadmission drug therapy, only 13% of the rationales for the remaining requests were appropriate. Although the eight other hospitals surveyed said they had restrictive formularies, all had frequent requests and procedures for procuring nonformulary items and some formularies included most available drugs. The formulary system at the study hospital was considered restrictive, but procedures for nonformulary-drug requests limited the effectiveness of the system. If any benefit is to result from formulary systems, hospitals must strengthen their enforcement of formulary restrictions.
The spontaneous reporting of adverse drug reactions (ADRs) at the St. John's Hospital and Memorial Medical Center was well below that reported in the literature. After review of procedures for reporting of ADRs at these institutions, the authors developed a system that was approved by their joint P & T Committee. The ADR reporting program developed uses concurrent monitoring of most hospital inpatients and a retrospective review of all emergency room patients. In the year after program implementation, 162 ADR reports were documented. From this program, a group of serious ADRs to one agent was identified and reported, both to the Food and Drug Administration and to the manufacturer. A well-developed ADR monitoring program may lead to heightened physician and nurse awareness and early problem identification, possibly decreasing morbidity for hospitalized patients.