February 1997

The University of Kansas Medical Center Pharmacy and Therapeutics Committee

1995-1996 Annual Report

The charge of the Pharmacy and Therapeutics Committee at the University of Kansas Medical Center is to recommend policy to the medical staff and hospital administration regarding the therapeutic use of drugs and other related issues. The mission of the Pharmacy and Therapeutics(P&T) Committee is to promote both cost effective and rational drug therapy. The Committee also serves as a liaison between Pharmacy and Medical Staff. Recommendations made by the P& T Committee are then acted upon by the Executive Committee of the Medical staff prior to implementation. The current 1996-1997 P&T Committee at KU Medical Center includes the following members:

Pharmacy and Therapeutics Committee Publications

The P&T Committee communicates to the health care staff via the Pharmacy Key, a periodic publication prepared by the KUMC Drug Information Service. Formulary additions, trends in drug therapy, quality assurance activities, and other pertinent P&T Committee actions can be found in this newsletter. The KUMC Formulary is another P&T publication. This reference book lists the pharmaceutical agents available at KUMC, as well aspolicies and procedures, clinical references, a cost index, and other valuable clinical information. Drug Use Evaluation News is a valuable publication that discusses the results and conclusions of various drug monitoring activities at the Medical Center. Audit criteria and educational recommendations are also included. Pharmacy publications may be found on the University of Kansas Medical Center electronic network (Pulse) via:

http://www2.kumc.edu/druginfo/PharmKey.html

Pharmaceutical Expenditures for FY 1996

The P&T Committee serves as the consultant body to review the pharmaceutical manufacturer costs and to help select agents for formulary use at KUMC. The Committee also monitors the pharmaceutical budget expenditures shown below:

This graph represents $15.7 million dollars in total drug expenditures for FY96. IV solutions and administration sets were excluded.

*Biotech drugs: Epoetin, G-CSF, GM-CSF, AtgamR, OKT-3R, Human Growth Hormone, and SurvantaR.
**GI = H2 antagonists and Proton Pump Inhibitors.

Formulary Decisions

In creating the KUMC Formulary, the goal of the P&T Committee is to evaluate drug products and select therapeutic entities which are both safe and cost-effective. As medications are requested for formulary inclusion, a review of the published medical literature, and a comparison to therapeutically equivalent formulary drugs are conducted. Drug monographs, are prepared for the Committee by the Pharmacy Drug Information Service. The P&T Committee members review the literature provided and vote to accept or reject the request. In the past year there have been 33 formulary requests. The Committee's actions were as follows: 23 received full approval, 3 received restricted approval, 7 requests were denied. The Committee also deleted 8 items from the formulary.

The P&T Committee and the Executive Committee of the Medical Staff have placed restrictions on the use or ordering of certain formulary drugs. Such restrictions may limit the ordering of a particular drug to the attending staff, to a particular medical service, or approval by a specified physician or service. These restrictions are identified throughout the KUMC Formulary on a drug specific basis. The following is a list of the restricted drugs added to the KUMC Formulary during the 1995-96 and their respective services. added during the 1995-1996 year:

Quality Assurance Activities

As part of the hospital's ongoing Quality Assurance Program, the P&T Committee participates in drug use evaluations, monitors adverse drug reactions(ADR's), and reviews hospital medication error rates.

Drug Use Evaluations (DUE)
Several DUE's were reviewed by the P & T Committee during 1995-1996. Drugs reviewed by the DUE process are indicated for specific diagnoses or procedures, high risk, prone to problems, high volume or cost or new drugs.. These evaluations provide information about appropriateness of use and detect trends in drug therapy. The following drugs were reviewed:

Albumin DUE
Alendronate (FosamaxR) Patient Education DUE
Midazolam (VersedR) DUE
Carbamazepine (TegretolR) DUE
Enoxaparin (LovenoxR) DUE
Tramadol (UltramR) DUE

Adverse Drug Reaction
Adverse Drug Reactions (ADRs) are reviewed and recorded via the KUMC ADR reporting program using voluntary reporting and medical record E-code retrieval. The ADR Reporting Program generates data which is useful to the Medical Center to ensure continued safe drug therapy, to comply with JCAHO guidelines and to participate in the FDA MedWatch ADR reporting program. A total of 129 Adverse Drug Reactions were received by the Drug Information Center between July 1995 and June 1996. Patients in the age group 21-40 had the most ADRs reported at a total of 51 (39% of all ADRs reported between July 1995 and June 1996). The drug class most frequently associated wih ADRs was the Anti-infectives (34% of all ADRs reported).

Medication Errors
The following is a summary of 1995-1996 medication error information. These medication misadventures include errors in ordering, dispensing and administering medications.

If serious medication errors occur they are reviewed on a case specific basis by the Committee. The source of data used to compile medication error information is the Confidential Incident Report (formerly PERTís) filed through the Risk Management Department at KU Medical Center. The Committee also reviews the most frequent type of medication errors and makes policy recommendations to reduce or eliminate these misadventures.

Drug Policies and Procedures

Policies and procedures involving all aspects of drug therapy are reviewed by the P & T Committee. Policies adopted in 1995-1996 include:

Extended Interval Aminoglycoside Guidelines
Guidelines establishing extended interval dosing and monitoring as well as exclusion criteria were approved by the Committee.

Medical Service Representative Policy
The Committee approved a policy to control the access of drug service representatives at the Medical Center. Representatives must register in the pharmacy department, wear identification badges, and detail only during scheduled meetings in authorized areas.

GlucophageR (Metformin) Warning with Contrast Media
The Committee supported further efforts in education to avoid concurrent use of Metformin in patients receiving iodinated contrast media. A Pharmacy Key was dedicated to this subject to inform the medical staff, and a Radiology patient history form was revised to reflect this warning.

Vancomycin Pocket Reference Cards
The Committee approved the distribution of these cards to the medical staff to promote the appropriate use and monitoring of Vancomycin in the Medical Center.

Warfarin (CoumadinR) Dosing Chart Form
The Committee accepted modification to the chart form to delete monitoring guidelines. The form was modified to reflect only the patient dose history.

Antibiotic Use Subcommittee
The Committee voted to approve the creation of an interdisciplinary subcommittee to focus on issues related to antibiotic use, conduct formulary reviews,perform DUEís, review therapeutic interchange policies, and recommend healthcare professional education.

Pharmacy Quick References:

Web Addresses:
Pharmacy publications: http://www.kumc.edu/instruction/medicine/pharmacy/dept/PharmKey.html

Drug Information Center: http://www.kumc.edu/instruction/medicine/pharmacy/dept/drug info.html

Phone Numbers:
Drug Information Center: (913)588-2328
Poison Control Center: (913)588-6633
Inpatient Pharmacy: (913)588-2321
Outpatient Pharmacy (913)588-2360

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