Lecture Notes- Pharmacy and Therapeutic Committee (PTC)

Introduction

PTC is a policy framing and recommending body to the medical staff and administration of hospital on
matters related to therapeutic use of drugs. It provides an evaluative, educational, and advisory service
to the medical staff and organizational administration in all matters pertaining to the use of available
medications. PTC should be responsible for overseeing policies and procedures related to all aspects of
medication use within an institution.

The committee comprises medical staff, other prescribers, pharmacists, nurses and administrators and
are a representative sample of the organization.

It assists in the preparation of policies regarding selection of drugs, procurement, prescribing,

dispensing, administering medications, safety procedures as well as evaluation of medication use. The
committee compares the costs and benefits of each drug and decide which ones provide the most
efficacy per rupee.

PTC utilizes an evidence-based approach to drive change within health systems/plans by changing
existing policies and bringing up-to-date research to support medical decision-making.

Mission

The mission of Pharmacy and Therapeutics (P&T) Committee is to promote the appropriate use of high
quality and cost-effective pharmaceuticals by the healthcare professionals for patient care.

Goals

1. Promote the appropriate use of high quality and cost-effective medication

2. Ensure compliance with appropriate standards and state and federal regulations.

Objectives

PTC has 03 major roles to play:

 Advisory

 Educational

 Drug safety and adverse drug monitoring

Advisory

PTC recommends the adoption of policies or assists in the formulation of broad policies regarding
evaluation, selection, and therapeutic use of drugs. It serves in an advisory capacity to the medical staff
and hospital administration in all matters pertaining to the use of drugs including the investigational
drugs

PTC makes recommendations concerning the drugs to be stocked in patient care areas.

It advises the pharmacy department in the implementation of effective drug distribution and control
procedures
Educational

PTC recommends or assists in the formulation of functions designed to meet the needs of physicians,
nurses, pharmacists and other healthcare professionals for complete current knowledge related to drugs
and their use

The committee evaluate the issues related to distribution and administration of medications including
medication incidents.

PTC plans suitable educational programs for professional staff related to drug use

Drug safety and adverse drug monitoring

The P&T Committee exerts continuous vigilance on drug safety and adverse drug monitoring-
pharmacovigilance.

Organization

Proper organization structure is necessary for effective functioning of PTC

PTC composition and function of the committee varies from hospital to hospital depending on its
size/location but mostly composed of the following members:

 At least 03 physicians from various specialties like medicine, surgery, gynecology, infectious
diseases, and pediatrics. One of the physician may be appointed as chairman of the committee.
 Senior representative from hospital administration (director) will be ex-officio member of the
committee.
 Representative of the nursing staff, mostly senior nursing staff
 Pharmacist-designated as secretary of the P&T committee.

Operation

The size of hospital, variety of drugs used will dictate the frequency of PTC meetings. The committee
should meet at least thrice per year and whenever necessary. Committee can invite persons within or
outside the hospital who can contribute specialized or unique knowledge, skills or judgements in its
meeting

Agenda and supplementary materials shall be prepared by the secretary and circulated among members
well in advance before meeting. Secretary shall prepare the minutes of the meeting and maintain the
permanent record in the hospital

Recommendations of the committee shall be presented to the medical staff for its implementation or
comments

Meeting Agenda Format

• Minutes of previous meeting

• Review of special section of formulary for updating and or deletion of products
• Information of new drugs which have become commercially available
• Review of side effects, adverse drug reactions, toxic effects and drug-drug interactions reported
since last meeting
 • Review of drug safety in the hospital
• Reports of various sub-committees
• Report of medical audit
• Any other matter with the permission of the chair

Functions

PTC of a hospital is responsible for the following major functions:

1. Select and make availability of drugs in accordance with essential drugs - Formulary
2. Recommend the criteria and procedures for the procurement of the selected drugs
3. Estimate the hospital drug requirements and manage the hospital drug budget
4. Define standards for prescribing drugs and related practical requirements
5. Organize information drives on drugs for the general public
6. Regulate the commercial promotion of drugs inside and outside the hospital
7. Circulate decisions of P&T Committee to all hospital staff
8. Conduct scientific studies to update and ensure rational use of drugs
9. Investigate periodically the morbidity and mortality data to determine changes in their pattern
requiring changes in rational drug therapy
10. Monitor adverse drug reactions
11. Develop and implement dispensing procedures and practices
12. Design a strategy assuring the quality of drugs and the pharmaceutical services in the hospital
13. Develop and undertake educational activities on rational use of drugs
14. Make out and address conflict of interest issues which will obstruct practitioner’s capability due
to financial or some other reasons

PTC Roles

1. Role in Drug Formulary

PTC is responsible to prepare and maintain updated formulary. The committee follows three basic
principles in the preparation of formulary based on the weightage of proven effectiveness of
medication, safety of the patient, and most important is the cost of medicine.

a) Proven effectiveness documented in medical literature

Primary concern is the consideration of degree to which a medication produces desirable clinical effects.
PTC assesses and discuss the favorable effects of new medication based on:

i) Its strength of scientific evidence in the reported literature,

ii) Its pharmacoeconomic studies,
iii) Case reports,
iv) Randomized clinical trial outcomes of research, and
v) Medical opinion on new drug

b) Maximizing safety and minimizing potential for error

PTC should assess the risk and benefit ratio of the new drug compared to the existing available
treatments.
It minimizes the potential for error in respect of name of drug product, dosage form, and packaging that
carries fears of safety for patients or potential for errors in healthcare system

c) Optimizing pharmacoeconomic

PTC compare the overall cost of the new medicinal product with the existing treatments as well as
compare the risk and medical outcome. Generally, preferences are given to those products whose safety
and efficacy profile is much better compared to the existing treatment at affordable cost to the largest
potential population

d) Prominence of the medicinal product essential to healthcare

e) Patient convenience, adherence and satisfaction

PTC review medical products to increase patient convenience, adherence, and satisfaction- convenient
dosing, various dosage forms, storage requirements, and ability to divide the dosage form themselves

f) To support the standard treatment algorithm in preparation of formulary

g) Long term stability of formulary decisions

PTC should be able to look toward the stability of formulary for long time as well as its members’
stability

It should minimize agendas for changes in the formulary

h) Formulary will serve as guideline for vast majority of patients

For optimum utilization of formulary, PTC should apply management system consisting of prior
authorization, quality limits, stepwise edition in the formulary, and age limit of the formulary

PTC undertake preparation of formulary which should be readily available and easy to use in timely
manner for patient healthcare.

2. Role in dispensing of medication to IPD and OPD

PTC establish a policy for distribution of drug products to IPD and OPD care services

In IPD and OPD services, before dispensing pharmacist should:

 Make sure about correct prescription for medication order as well as its validity with regard to
diagnosis and treatment
 Check any modification with respect to dose regimen

PTC supervises steady supply of drugs as per need of the patients. In this, IPD & OPD pharmacist
works together with inventory, drug distribution in-charge, and physician.

PTC has management and advisory role to pharmacist guiding him to supervise regarding proper
distribution of drugs across inventory to pharmacy, floor pharmacy, ward pharmacy, OPD, etc. to
avoid ambiguities or any other failure.

PTC assist/guide pharmacist to supervise purchase orders, manage logs of materials transfer across
different departments, and maintains drug distribution across hospital
3. Role in automatic stop orders for dangerous drugs

PTC frame a policy for automatic discontinuation of all medication prescriptions after 48 hours for
sedative & narcotic, anticoagulants, and antibiotic products. Alternatively, prescription strictly
indicate the number of doses to be administered and if require more, need to re-order the
medications.

There must be policy of rewrite of prescription order every 24 hours for narcotics and CNS active
drugs

4. Role in developing emergency drug list

Considering a time factor in emergency situation, PTC should compile a emergency kit/box for
patient use at the bed side. The list includes:

Supplies to be maintained in emergency box

Drugs for emergency box

Drugs for emergency box should be selected in consultation with the physician

Supplies for cabinet utility room

5. Role in drug product defect

In case of information of receiving defective quality drug product from the manufacturer/supplier,
matter is reported to the PTC. PTC inform the manufacturer/supplier and regulatory body for
necessary action. Template format for reporting defective quality drug.