UBC Theses and Dissertations
Development of a provincial drug formulary Page, Elizabeth Ann
The adoption of the Lions Gate Hospital Drug Formulary by the British Columbia Hospital Association for distribution and use in all provincial hospitals endorses the growing trend toward regionalization of drug information. Several aspects of this Formulary were investigated in the present study with the objective of designing a text even more applicable to the varied needs of the province. The format of the Formulary and a mechanism for regularly evaluating and updating the information therein were the major areas receiving consideration. One major change in format proposed is the increase in the number of drug monographs to approximately 600 from the present 300 entries. This increase is based on the requests for additional drugs from the representative hospitals sampled in the province. Changes in the format of individual monographs include an expansion of information under the heading "Mode of Action", that an additional section on "Instructions to the Patient" be added to facilitate effective instructions for self-administration in ambulatory services, that each monograph receive a Canadian Drug Identification Code reference and that the information in each monograph be referenced where possible to the primary literature source. Changes in the format of the overall Formulary include a cross-index of monographs to manufacturers' brand names, a bibliography of the referenced information and a "Mini" Formulary format for use on individual hospital wards. The latter recommendation is made in recognition of the potential bulk of the overall Master Formulary which would make it awkward for efficient and frequent use. In this respect, it is anticipated that one Master Formulary containing all 600 eventual monographs, the bibliography for each and the various indices be made available in each hospital for resource reference. On each ward a complete Formulary of all drug monographs but not the accompanying bibliographies would be available. Studies showed that something less than 100 of these drugs (less than 20 percent) were used with any frequency on any specialty ward studied. Therefore, a "Mini" Formulary containing only the monographs of drugs frequently used in a specialty area would make the information more readily available in that service. Changes in printing format also are recommended with the objective of reducing the bulk of the proposed Formulary. A regular updating mechanism must be activated to keep the information in the Formulary current. Such a mechanism related to an annual literature evaluation assignment by the senior students of the Faculty of Pharmaceutical Sciences, University of British Columbia, is proposed. Based on this academic exercise, two types of updating are identified. First, a complete evaluation and referencing of the existing monograph information is required. Second, annual updating of this information from current literature should be maintained. To evaluate, revise and condense the students' evaluations to monograph format, a "service" component of faculty instructor time and of stenographer time have been projected. It is anticipated that the provision of approximately one-half time instructor per year and one-tenth time stenographer will be required on a "service" basis to enable the regular updating of the current Formulary as defined above. The arrangement for a Medical Review Board to review the evaluated monographs from a clinical validity standpoint also should be made. The above projections are based on studies related to the evaluation and updating of 100 drug monographs during 1972-73. A final recommendation is that the basis for generating, updating and additional referencing of the Drug Formulary should be a provincial Drug Information Centre.
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