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DRUGS AND THERAPEUTIC
COMMITTEE
- ROLE OF HOSPITAL PHARMACISTS
DRUGS AND THERAPEUTIC COMMITTEE
 A drugs and therapeutics committee (DTC),
also called a pharmacy and therapeutics
committee, is a committee designated to
ensure the safe and effective use of
medicines in the facility or area under its
jurisdiction
 Promotes rational and cost-effective use of
medicines in hospitals
 Members represents all the major specialties
and the administration in the hospital
 A senior doctor would usually be the
chairperson and the chief pharmacist, the
secretary
www.who.int/entity/medicines/.../01-TG_DTC-Overview_final-08.pdf
NEED FOR DRUGS AND THERAPEUTIC COMMITTEE
In the absence of DTC following areas of
inefficiency and drug use problems occurs:

Poor selection of medicines, without
consideration for relative efficacy, costeffectiveness or local availability
 Inefficient procurement practices,
resulting in non-availability, inadequate
quality,
wastage,
or
use
of
unnecessarily expensive medicines
http://apps.who.int/medicinedocs/en/d/Js4882e/3.1.html
NEED FOR DRUGS AND THERAPEUTIC COMMITTEE
 Prescribing not in accordance
with
standard
treatment
protocols
 Poor
dispensing
practices
resulting in medication errors,
and patients’ lack of knowledge
about dosing schedules

Patients not adhering to dosing
schedules and treatment advice
http://apps.who.int/medicinedocs/en/d/Js4882e/3.1.html
ROLE OF PHARMACIST IN HOSPITAL
 Interact closely with the prescriber to
promote the rational prescribing and use
of drugs
 Having access to medical records,
Pharmacist can
• Influence the selection of drugs and
dosage regimens
• Monitor patient compliance and
therapeutic response to drugs
• Recognize and report adverse drug
reactions
 Assessment and monitoring patterns of
drug usage and thus recommend changes
where necessary
http://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.3.html
ROLE OF PHARMACIST IN HOSPITAL

Serves as a member of policy-making committees (Drug and
Therapeutics Committee) and thereby influences the preparation and
composition of an essential-drug list or formulary
 Educate other health professionals about the rational use of drugs
 Participates in studies to determine the beneficial or adverse effects
of drugs, and is involved in the analysis of drugs in body fluids
 Controlling hospital manufacture and procurement of drugs to ensure
the supply of high-quality products
 Planning and implementation of clinical trials
http://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.3.html
ROLE OF PHARMACIST AS A MEMBER OF DTC
Chief Pharmacist of the hospital is the secretary
of Drugs and Therapeutic committee (DTC ) so
he is actively involved in the following
responsibilities of DTC:
 Developing and adopting clinical guidelines
for the health institution under its
jurisdiction
 Electing cost-effective and safe medicines
 Implementing and evaluating strategies to
improve medicine use
www.who.int/entity/medicines/.../01-TG_DTC-Overview_final-08.pdf
ROLE OF PHARMACIST AS A MEMBER OF DTC
 Providing on-going staff education
 Controlling access to staff by
pharmaceutical
industry
with
promotional activities
the
its
 Monitoring and taking action to prevent
adverse drug reactions and medication
errors
 Providing advice about other drug
management issues, such as quality and
expenditure
www.who.int/entity/medicines/.../01-TG_DTC-Overview_final-08.pdf
ROLE AS ADVISORY COMMITTEE
 DTC provides advice to medical
staff, nurses, administration,
pharmacy and other departments
and groups within the hospital
 DTC can advise on all issues,
policies
and
guidelines
concerning
the
selection,
distribution and use of medicines.
 DTC will provide advice and an
executive body, usually the
pharmacy
or
hospital
management, will implement it
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
DEVELOPMENT OF DRUG POLICIES
It develops
concerning:
the
specific
policies
• Criteria for inclusion of medicines
on the formulary list (essential
medicines list (EML)
• Standard treatment guidelines
and treatment algorithms, which
should be the basis of formulary
selection
• Drug
representatives
promotional literature
and
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
DEVELOPMENT OF DRUG POLICIES
 Periodic use of medicines not on the
formulary list (only allowing 10% of the
hospital medicines budget to be spent
on them)
 Expensive or dangerous medicines, such
as oncological drugs, which are
restricted to certain practitioners,
departments or patients
 Drugs that are under investigation for
safety or efficacy
 Generic substitution and therapeutic
interchange
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
FORMULARY DEVELOPMENT
 Most important function of a DTC is the
evaluation and selection of medicines
for the essential medicines list or
formulary list
 Drugs should be selected on the basis of
the standard treatment guidelines
 The evaluation of medicines requires
significant
expertise
and
time
commitment
and
a
rigorous,
transparent approach
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
FORMULARY DEVELOPMENT
 Documented evidence for the
efficacy, safety, quality and
cost of all drugs under
consideration for inclusion in
the formulary list must be
examined
 Periodic review is necessary
because of changing costs and
indications, new information
on safety, and the emergence
of new medicines
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
MEDICATION USE EVALUATION(MUE)
 MUE is a quality-improvement activity, but it can also be considered a
formulary system management technique
 MUE activities should be conducted to examine the effect of
medication-use policy decisions

MUE often focuses on medications which are :
 High risk
 High-cost
 DTC should be involved in the MUE process by establishing a
systematic plan to monitor, evaluate, and improve medication use
ASHP Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System
DRUG PRODUCT SHORTAGE
 Drug product shortages disrupt patient care and
the processing of medication orders
 DTC needs to develop strategies to address
shortages in a timely manner by
• Including designating appropriate alternatives
• Identifying strategies for rationing available
drug product
• Establishing use restrictions
• Implementing evidence-based review
procedures
 Therapeutic interchange can be useful in dealing
with critical drug product shortages
ASHP Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System
STANDARD TREATMENT GUIDELINES
 Standard treatment guidelines (STGs) or
protocols are a proven way to promote
rational use of medicines

STGs provide a benchmark of optimum
treatment in the monitoring and audit of
drug use

DTC should either develop STGs from
scratch or adapt them from elsewhere
for use in their own hospital
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
STANDARD TREATMENT GUIDELINES
 Development of STGs from scratch will result in greater local
ownership and acceptance, but is difficult and will consume time
and resources
 Adaptation of STGs from elsewhere is much easier and quicker, but
will result in less local ownership and acceptance
 STGs should be
•
Developed in a participatory way involving end-users
•
Easy to read and up to date
•
Introduced with an official launch, training, supervision and
wide dissemination
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
CONDUCTING EFFECTIVE INTERVENTIONS
The DTC is the main body within a hospital responsible for conducting
interventions to promote more rational drug use
Some important interventions are:







Monitoring and supervision
Audit and feedback
Educational programs
In-service training
Use of standard treatment guidelines
Provision of unbiased drug information
Prescribing restrictions and automatic stop orders
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
MANAGING ADVERSE DRUG REACTIONS
 Adverse drug reactions may be due to the
unknown effects of new (or older) drugs,
unknown
drug
combinations
and
interactions, or poor drug quality

DTCs are responsible for ensuring that
patients are treated as safely as possible

Monitoring and minimizing adverse drug
reactions is an essential part of this function
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
MANAGING MEDICATION ERRORS
 Medication errors occurs due to lack of
knowledge, tiredness of staff, careless
work attitudes, poor procedures, lack of
policies, unfamiliar dosage forms and
human error
 DTCs can reduce such errors by
monitoring, analyzing, reporting errors
and implementing corrective action
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
INFORMATION DISSEMINATION AND TRANSPARENCY
 The DTC must disseminate information
about its activities, decisions and
recommendations to the staff who must
implement the DTC’s decisions
 Members should either have no
relationship
with
pharmaceutical
companies or declare it openly so that
conflicts of interest can be avoided
 The only acceptable contact with
pharmaceutical companies is to ensure
the flow of information about their drug
products in a way that is as unbiased as
possible
http://apps.who.int/medicinedocs/en/d/Js4882e/3.3.html
ASSESSING NEW MEDICINES
 The assessment of new medicines is critical in order to manage a
formulary list
 It involves adding new medicines and deleting old ones
 DTCs evaluates and compares the drug on the basis of:
•
•
•
•
•
Efficacy, comparative efficacy
Effectiveness, comparative effectiveness
Safety, comparative safety
Cost of use
Quality
http://apps.who.int/medicinedocs/en/d/Js4882e/6.html
ASSESSING NEW MEDICINES
 Efficacy, effectiveness and safety can be
evaluated from a critical assessment of
the literature

Much of the information may be biased
so it is important that the members of
DTCs evaluating new medicines have the
necessary skills and time to assess the
literature critically
 Once efficacy and safety are established,
medicines should be compared according
to cost of use and cost-effectiveness
http://apps.who.int/medicinedocs/en/d/Js4882e/6.html
GENERIC EQUIVALENTS
 The DTC must establish policies and procedures governing the
dispensing of generic equivalents
 These policies and procedures should include the following points:
• The pharmacist is responsible for selecting from available generic
equivalents
• The prescriber has the option, at the time of prescribing, to specify
the brand of the drug to be dispensed for that particular medication
order if considered clinically justified
• The prescriber’s decision should be based on pharmacologic or
therapeutic considerations (or both) relative to that patient
ASHP Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System
ENSURING MEDICINE SAFETY AND QUALITY
 A significant amount of harm to
patients and wastage of resources is
caused through the use of unsafe,
poor-quality medicines
 The DTC has a role to ensure that all
medicines prescribed and dispensed to
patients are safe and of good quality
 A DTC may have a significant impact on
preventing and managing drug safety
problems
http://apps.who.int/medicinedocs/en/d/Js4882e/7.html
ENSURING MEDICINE SAFETY AND QUALITY
This involves:

Monitoring and addressing medication errors
 Ensuring medicine quality through ensuring good practices concerning
procurement, storage and distribution and monitoring and addressing
drug quality problems
 Monitoring and addressing adverse drug reactions, which may be caused
by the chemical entity itself or may be due to medication errors or poor
drug quality
http://apps.who.int/medicinedocs/en/d/Js4882e/7.html
PROMOTING THE RATIONAL USE OF MEDICINES
Aim of DTC is to ensure that medicines are
used in the most effective way
 Strategies to promote the rational use of
medicines:
• Educational strategies that aim to
inform prescribers
• Managerial strategies that aim to
guide the decisions of prescribers
• Regulatory strategies that aim to
restrict the decisions of prescribers
http://apps.who.int/medicinedocs/en/d/Js4882e/9.html
ANTIMICROBIALS AND INJECTIONS
 Antimicrobials and injectable drugs are
amongst the most expensive of all drugs
 The use of antimicrobials contributes to the
development of antimicrobial resistance
 Poor infection control contributes to the
spread of resistant pathogens
 Unsafe injections can transmit blood-borne
diseases such as hepatitis B and C and
HIV/AIDS
http://apps.who.int/medicinedocs/en/d/Js4882e/10.html
ANTIMICROBIALS AND INJECTIONS
Drug and therapeutic committees (DTCs) should:
 Monitor the use of antimicrobials and
injections to ensure appropriate and safe use
 Ensure that appropriate infection control
policies and practices are implemented,
through an infection control committee or
team
 Ensure that appropriate surveillance
antimicrobial resistance is conducted
of
http://apps.who.int/medicinedocs/en/d/Js4882e/10.html
CONCLUSION
 Irrational use of medicines is a widespread problem at all levels of
health care, but especially in hospitals
 A drugs and therapeutic committee(DTC) provides a forum, allowing all
the relevant people to work together to improve health care delivery
 Hospital pharmacists being a part DTC serves in an evaluative,
educational, and advisory capacity to the medical staff and
organizational administration in all matters pertaining to the use of
medications
http://archives.who.int/tbs/rational/s4882e.pdf