The aim of the formulary
The main aim of this formulary is to promote safe, evidence-based, cost-effective prescribing.
Limiting the range of medicines included in the formulary and promoting the use of generic medicines where appropriate:-
Enhances safety through familiarity with the medicines in use in the hospital by all staff involved in the prescribing, dispensing and administration of medicines
Ensures efficient use of NHS resources
Ensures efficient use of limited storage space both within the hospital pharmacies and on the wards, enhances good stock control and reduces the pharmacy stock holding
Development of the formulary
The formulary has been drawn up following full and wide consultation with consultant medical staff, senior pharmacists and other interested parties and has been approved by the joint UHMB NHS Trust, Cumbria CCG & North Lancs CCG Drugs and Therapeutics Group.
The most up to date version will be accessible and maintained in an electronic format on the UHMB intranet. Updates are made bi-monthly following the joint Drug and Therapeutics Group meetings.
How should the formulary be used?
Formulary drugs, including the range of approved preparations for each drug, are listed according to the BNF classification system. Unlicensed drugs and preparations approved for use in the hospital are included in the most relevant section.
First, second, and occasionally third line drugs are indicated where appropriate. First line drugs should be used unless there is a contraindication; the patient has suffered an adverse effect, or has not responded to the first line drug.
The formulary is not intended to replace the BNF which will need to be referred to for information on licensed indications, contraindications, cautions, side-effects, interactions and dosage etc. (also available online at www.bnf.org ).
Does the formulary apply to out-patient prescribing including referrals to GPs?
In general yes, as it is our aim to promote safe, evidence-based, cost effective prescribing in primary care also. However there are some medicines that are not stocked by the hospital pharmacies and hence are not included in the formulary simply because we would not expect them to be initiated whilst patients are in hospital or in out-patients e.g. topical preparations for acne, drugs for smoking cessation, HRT (only a very limited range of NRT & HRT is stocked).
There are two distinct situations that may lead to the request for a non-formulary drug:-
i) Patient admitted on non-formulary drug prescribed by their GP/tertiary centre
Where appropriate the pharmacist will advise that the drug be changed to one that is on formulary. He/she will advise the prescriber on choice of drug/dose. The prescriber should ascertain that the patient has not previously had an adverse reaction to the recommended therapy or found the recommended therapy to be ineffective.
If it is deemed inadvisable to switch therapy, the pharmacy will ask the ward to use the patient’s own supply. If the patient does not have any of their own or runs out the pharmacy will obtain a small supply specifically for that patient. University Hospitals of Morecambe Bay NHS Foundation Trust FORMULARY
ii) Initiation of non-formulary drug
If appropriate; a pharmacist will suggest the use of an alternative formulary drug. If there is no suitable drug on formulary, urgent clinical need and appropriateness can be demonstrated and the cost is minimal, a senior pharmacist may authorise the purchase of a small supply specifically for that patient. If there are significant cost implications the consultant will be asked to seek permission to obtain the drug from the Clinical Director. The Consultant will also be asked to complete a New Product Request form for a D&T Group decision should the drug be required again in the future.
If there is not an urgent need for the drug the Consultant will be asked to complete a New Product Request form and the drug will not be purchased until D&T Group approval is received. This applies equally to new drugs, new formulations of formulary drugs and new uses for formulary drugs. New Product Request forms are available from the pharmacy area on the intranet. http://mbhci/C9/Pharmacy/default.aspx (UMBHT Formulary Application Form)
What do the traffic lights mean?
Many of the drugs listed will only ever be used in hospital; likewise many other drugs are suitable for prescribing in both primary and secondary care and by any grade of doctor or a non-medical prescriber. Where there is unlikely to be any doubt about a drug’s status no traffic light has been assigned to it. Some drugs however have been assigned as either RED or AMBER
RED or AMBER drugs should not normally be initiated by FY or ST doctors. Exceptions are indicated in the formulary. Non-medical prescribers should initiate these drugs only if they fall within their area of expertise.
Red medicines should be initiated by a specialist (consultant or SpR) only and prescribing retained within secondary care. GPs should not normally be asked to prescribe these drugs. Drugs that are considered suitable for initiation/prescribing by consultants only are annotated as such.
Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
with shared care guideline
Medicines in this category are identified by the superscript (SCG). These drugs require the GP to be provided with additional information about managing the patient including dose adjustment, side-effects, significant drug interactions and blood monitoring if required. The SCG also includes what actions to take in the event of abnormal blood results, when to refer back to secondary care and who to contact. GPs should be sent a copy of the SCG by the specialist when making the referral. Copies are available via the Heritage Library http://www.library.uhmb.nhs.uk/HeritageScripts/Hapi.dll/search1
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