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Medication selection and medication review

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In Medication Selection and Review, the committee should have established methods for medication selection and review. A written medication review is prepared from available literature. The review should be unbiased, as should the discussion of the review. Meeting participants should be required to discuss any conflict of interests prior to discussion of the drug or drug class. Medication selection criteria should include medication efficacy, safety and cost. And some questions should be asked in
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the review process: Such as Is it a duplication of an existing formulary agent? How should it be used? When should it be used? Who should use it? Are there any other special concerns? Barriers to optimal formulary decisions may include physician experience with the drug under consideration. Physician preference for other agents, detailing by pharmaceutical company representatives, and unpublished or anecdotal studies and reports. Selection criteria should minimize abovementioned barriers. This flow chart represent the process of new medication application in Taipei Veterans General Hospital. In general, the Clinical requirement for a new drug is from the physician of specialty. They will request an application to the office of PTC in pharmacy.
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The staff pharmacist of PTC will make administrative review and send for professional review to three reviewers. It is the preliminary review and two reviewer are specialty physicians, one is the clinical pharmacist of related specialty. After the preliminary review, the secretary of PTC will collect the results to the advanced review in the formal PT regular meeting. If the new medication is approved, then it will proceed to the purchasing department of hospital. The meeting will be held every 3 months in our hospital.
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Medication Use Evaluation is the Method for evaluating and improving medication-use processes with the goal of optimal patient outcomes. The PTC should establish a regular process for reviewing how medication are used in the health system. Medications may be considered for the review based on their use, safety, cost or a combination of factors. For example, antibiotics represent a high use of item; overuse of a particular antibiotic may place patients at risk for the developement of resistance infections; and some antibiotic may also be costly. Setup specific criteria for use, review of compliance to the criteria and routine review of the data is the foundation of the medication use process. Key to the process is timely data to review, action plan development, and follow-up.
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The P&T committee should systematically address patient safety as its core concern. Medication Safety Evaluation is evaluated through adverse drug reaction reports and medication error reports. Such report may be local or global. The impact of such report should be considered relative to the health system population, resources and alternatives. A report of increased bleeding in patient over 65 years of age may not be critical in pediatric hospital. However, reports of infusion rate reactions may require change in nursing procedures in drug administration. Some other adverse effects such as issues in preparation, sound-alike or look-alike potential, and dosing or administration issue can be considered. The PTC should consistently review medication-event data, including data on near misses, and make recommendations to prevent future events.
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The table shows the looks like drug pairs in our hospital. We will update the list regularly and circular to all our staffs to prevent the dispensing errors. We also use Capital letters to remark the differences between two similar drugs.
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Here are some examples of looks like drugs in their appearance or packages. As you can see, they are easy to be mixed up. So, we always remind our staffs to notice it. But the best way is to inform the manufacturer to change their color or sticks or on the package.

Dr Chang elaborates on how the PTC carry out medication selection and review, and monitor adverse drug reaction.

Key points

PTC carries out medication selection and review. The review should:

  • Be unbiased, as should the discussion of the review.
  • Consider multiple criteria, including medication efficacy, safety and cost etc.

Barriers to optimal formulary decisions may include:

  • Physician experience

  • Physician preference

  • Unpublished or anecdotal studies and reports

  • Representatives of drug companies

  • Medication selection criteria should not be based on the above factors.

New medication application process using the Taipei Veterans General Hospital (TVGH) model:

  • Physician sends the application to PTC office.

  • PTC staff pharmacist makes an administrative review and sends an application for professional review.

  • Preliminary review carried out by 2 specialty physicians and 1 specialty clinical pharmacist.

  • The PTC secretary send review results for advanced review during formal PTC meeting.

  • If approved, the purchasing department will be contacted.

Medication use evaluation optimizes patient outcomes by regularly evaluating and improving medication-use processes. Medications may be reviewed based on their use, safety, cost, or a combination of factors. It is crucial to review timely data and develop action plans to follow up on potential issues.

The core concern of PTC is patient safety, thus they also perform medication safety evaluation. PTC is responsible for generating adverse drug reaction reports and medication error reports. The PTC should consistently review and record medication-event data to make recommendations to prevent future errors.

Some possible topics to report on include:

  • Adverse effects

  • Issues in preparation

  • Sound-alike or look-alike drugs

  • Dosing or administration issues

At TVGH there is a constantly updated list of look-alike drugs to remind medical staff of potential mix-ups.

Share and learn:

How does your hospital assess the purchase of new drugs?

How does your hospital keep track of look-alike drugs?

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Good Pharmacy Practice: Medication Management

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