Drug and Therapeutics Committee

Erkiso Sh [Bpharm, Mpharm]

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Objectives

• Understand role of the Drug and Therapeutics Committee

• Understand DTC structure and organization and its

relationship to other hospital committees

• Understand the DTC’s

• Discuss the importance of the DTC in promoting rational

use of medicines

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Outline

• Key Definitions

• Introduction

• Role and Functions of the DTC

• Organization and Structure of the DTC

• Summary

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Key Definitions

 DTC–also called a Pharmacy and Therapeutics Committee

 Committee designated to ensure the safe and effective

use of medicines in the facility

 Evaluates the clinical use of medicines

 Develops policies for managing medicine use

 Administers and manages the formulary system

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 Key Definitions…
• Formulary–A list of medicines that are approved for use in
the health care system by authorized prescribers

• Formulary committee–The committee dedicated to selecting,

developing, and maintaining a list of approved medicines for
the hospital or clinic

• Formulary system– A system of periodically evaluating and

selecting medicines for the formulary, and maintaining it;
also providing information in a suitable manual or list
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Key Definitions…

• Formulary manual—The document that describes

medicines that are available for use in a hospital or clinic
(i.e., indications, dosage, length of treatment,
interactions, precautions, and contraindications)

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 Background
 Many countries spend 30-40% of their health budget on
drugs
 Pharmaceuticals are the cornerstone of health care delivery
system
 Wastage due to inefficient and irrational use of Drugs is
common
 Poor Selection of drug
 Inefficient procurement practice, resulting to non-
availability, wastage, use of unnecessarily expensive
drugs
 Prescribing not in accordance to STG
 Poor dispending resulting in medication error.
 Non Adherence by patients to dosing schedules and
treatment advices.
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 According to WHO

• “Rational drug use (RDU) requires that patients receive

drugs appropriate to their needs in doses that meet their
individual requirements

– right dose,

– right interval and

– right duration.

• These drugs must be of acceptable quality and

available and affordable, at the lowest cost to
patients and the community”.
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 If not:

 Undesirable health and economic outcomes. Ex.

 insufficient therapeutic effect,

 ADR,

 preventable side effects,

 Drug interactions and

 bacterial resistance.

 Drug and Therapeutic Committee are solutions to

this

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Important benefits of a DTC

• Selection of effective, safe, high quality, cost-effective

medicines for the formulary

• Monitoring and identification of medicine use problems

• Improved medicines use, including antimicrobial use

• Improved quality of patient care and health outcomes

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Important benefits of a DTC…

• Management of antimicrobial resistance

• Increased staff and patient knowledge

• Management of ADRs and medication errors

• Improved medicine procurement and inventory

management

• Management of pharmaceutical expenditures

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Role of the DTC

 The committee that

• evaluates the clinical use of medicines,

• develops policies for managing medicine use and

• administration, and

• manages the formulary system

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Country Experience

Many countries (Developed or Developing) have DTCs EX.

A. Developed countries

• Australia more than 92% of Hospitals

• UK more than 86% Hospitals

• In USA DTC or similar committee is a requirement for

accreditation

B. Developing countries

• India, Moldova, South Africa, Zambia, Zimbabwe, Kenya

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DTC Involves

 Sufficient staff

 Incentive (recognition, allocation of work

time)

 Accountability of the hospital and its staff

for the money spend on drugs and quality
of care.
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Drug and therapeutics committee
• Definition of DTC

 DTC is an advisory group of the medical staff which serves

as the organizational line of communication b/n the
medical staff and the pharmacy section of the health
institution.

 A forum to evaluate & discuss all aspects of drug therapy,

advise the medical, nursing administration & Pharmacy
sections on drug-related issues

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 Goals and objectives of DTC

 Goal:

 To ensure that patients are provided with the best

possible, cost effective and quality of care through
determining what medicines will be available at what
cost and how they will be used.

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Membership of DTCs

a. Health institution (Hospital and Health center)

• Medical Director-Chairperson

• Head of Pharmacy-Secretary

• Head Nurse/matron

• Heads of Departments (at least four)

• Head of Finance and Administration-Exofficio

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 Functions of DTC
1.0 Advisory

 Medical, Nursing and pharmacy staff

 Administration and others.

 Concerning selection, procurement, distribution and use of

drugs

 To promote better quality of care and more rational use of

medicines

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Functions of DTC …

2.0 Development of drug use guidelines

 Develop guidelines for the selection, quantification and

procurement of drugs

 Periodic use of certain medicines/restricting to specified

precribers or allocation of certain percentage of budget
for certain drugs

 Generic substitution and therapeutic interchange

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Functions of DTC…
3.0 Evaluation and selection of medicines

 Evaluation of new drugs proposed for use in the hospital

Consider:

 Independent literature

 Evidence on utilization outcomes

 Economic advantage

 Comparison with existing treatment options

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 Manage ADRs/
Manage
Medication Errors
Formulary

Evaluate Clinical
Use DTCs Contribute to Interventions to
Quality of Care Improve Drug Use

Policies & Assessing

Procedures Drug Use Problems

Advising Medical
Staff 21
 DTC: Structure and Organization
Chairman Executive Secretary,
Clinical Director or
other appointed Director of Pharmacy
physician

Physician Pharmacy Nursing

Administration Public Health
Members Members Members
Drug
Surgeon Information
Specialist
Director of Administrative Officer Physician
OB/GYN
Nursing or other appointee or Nursing
Pharma-
Representative
cologist
Internal Medicine/
Family Practice

Infectious Diseases Recording

Secretary

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Functions of DTC…
4.0 Adoption and development of Facility Standards
treatment guidelines

Key instruments to promote RDU provided that they are:

• Reviews and adopts the NSTG

• Makes it Easy to read and update

• Introduced with an official launch, training, supervision

and wide dissemination

They are bench mark in optimum treatment and audit of

drug use. 23
Functions of DTC

5.0 Assessing medicines use to identify problems:

 develops a system for monitoring drug use

 Monitoring indicators of medicine use

 Periodic Drug use evaluation

 Monitors ADR, keeps records and report

 Conduction of antimicrobial resistance surveillance

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 Reading assignment

WHO drug use indicators???

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Functions of DTC…

6.0 Managing ADR

 ADR May be caused due to: unknown effects of new or

old drug, unknown drug combinations and interactions
or poor drug quality.

 DTC should ensure patients are treated as safely as

possible

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Functions of DTC…

 In USA 3-4% of Hospital admissions are due to ADR

In 1994 in USA 2.2 mill hospitalized (6.7%

incidence)=106,000 fatalities

• WHO Report of 2003

• In USA: 10.8% hospital inpatients suffer from an

ADR Annual cost ranges b/n $1.4 – 4.0 Billion

• 4th-6th most common cause of death

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Functions of DTC…

7.0 Planning and dissemination of information on activities

• DTC should prepare annual plans

• disseminate information about its activities to the

hospital staff

• DTC members should not have contacts with

pharmaceutical companies to avoid conflict of interest.

 Except upon request for product information

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Functions of DTC…
8.0 provision of Information and education

• Provision of unbiased Drug information and education to

Staff and the public

• In-service training for staff

• Restriction and automatic stop order

• Facilitation of the establishment of Drug information unit

and assessment of its impact in the promotion of RDU

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Functions of DTC…
9.0 Facilitation of Managing medication errors

 Common problem in all health facilities.

Reasons: Lack of knowledge, tiredness of

staff, carelessness, poor procedures, lack of policies, ….

DTC can minimize this through:

• Monitoring (reporting errors)

• Analyze and Implement corrective actions

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Cont…

 The DTC should have a plan to—

• Monitor

• Assess

• Report

• Correct identified problems

• Prevent ADRs

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Functions of DTC…
10. Drug Policies and Procedures
 Lack of policies will adversely affect medicine selection,
procurement, distribution, and use
 The DTC has the most expertise to develop policies on—
 New, nonformulary, restricted, investigational medicines
 Monitoring and evaluation of medicine use
 Interventions to promote rational use of medicines
 Pharmaceutical management issues in the hospital
 Pharmaceutical promotion (pharmaceutical
representatives and literature)

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 Functions of DTC…
11. Meetings

• DTC should meet regularly no less than six times a year

• Invite experts if necessary

• Agenda prepared jointly by the chair and secretary and

communicated before meetings to members

• Recommendations be presented to management

committee for approval

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Functions of DTC…

12. Scope

• DTC not intended to intervene with administrative issues

but should act on drug budget and supply management

• DTC should follow-up implementation of the management

approved recommendations

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DTCs—Guiding Principles

 Transparent and unbiased decision making

 Explicit criteria and process

 Documentation

 Absence of conflict of interest including

pharmaceutical manufacturers and suppliers

 Development and enforcement of a strict ethics policy

for all activities of the committee

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DTCs—Guiding Principles

 Objectivity—Evidence-based approach and levels of

evidence

 Consistency—Uniformity between formulary and STGs

and between regional and national health care programs

 Impact orientation —Indicators of process, impact, and

outcome

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Monitoring DTC Performance —Impact and
Outcome Indicators

• Medicine selection

 Number of medicines in the hospital formulary

 % prescribed drugs belonging to the hospital

formulary

 Number of antimicrobials in the formulary

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Monitoring DTC Performance…

 Prescribing quality

 % of patients treated in accordance with STGs

 % of pharmaceutical treatments meeting agreed

criteria of DUE

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Monitoring DTC Performance…

 Drug safety

 Mortality and morbidity rates per annum due to

adverse consequences of medicine use (ADRs and
medication errors)

 Financial sustainability

 Cost of DTC activities versus the money saved through

improving drug use and decreasing wastage
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THANK YOU

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