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Learning Objectives

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After completing this chapter, the reader will be able to

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  • Describe the pharmacy and therapeutics (P&T) committee.

  • Define the functions of the P&T committee.

  • Describe attributes and structure of a P&T committee likely to promote its ability to function successfully.

  • Describe where and how the P&T committee fits into the organizational structure of a health care institution or other groups.

  • Describe how the pharmacy department participates in P&T committee activities.

  • Describe and explain the concepts of drug formularies and drug formulary systems, and how pharmacy participates in their establishment and maintenance.

  • Describe how P&T committee activities contribute to the quality improvement of medication use.

  • Describe how to develop policies and procedures for the process of medication use.

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Key Concepts

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  1. A pharmacy and therapeutics (P&T) committee, or its equivalent, oversees all aspects of medication use within an institution.

  2. Although it is common for pharmacists to downplay or misunderstand the importance of P&T committee support in comparison to other clinical activities, such support is vital for pharmacy to impact patient care.

  3. A P&T committee may find it necessary to create ad hoc committees to address various issues, depending on their complexity and size.

  4. Typically, P&T committee functions include determining what drugs are available, who can prescribe specific drugs, policies and procedures regarding drug use (including pharmacy policies and procedures, clinical protocols, standard order sets, and clinical guidelines), performance improvement as well as quality assurance activities (e.g., drug utilization review/drug usage evaluation/medication usage evaluation, as well as compliance surveillance), adverse drug reactions/medication errors, dealing with product shortages, and education in drug use.

  5. A variety of topics regarding the quality of medication use, inclusive of applicable medication metrics, are normally part of the activities of a P&T committee.

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Introduction

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When considering how a pharmacist can have an impact on a patient’s drug therapy, it is common to consider the individual practitioner dealing with a specific patient or, perhaps, a small group of patients. Certainly the clinician can have a deep impact this way, but it does have the disadvantage of dealing with a very limited number of patients. In order for pharmacists to efficiently impact a population of patients, a different approach is necessary. Fortunately, pharmacists have the opportunity to participate in the activities of ❶ a P&T committee or its equivalent, which generally oversees all aspects of medication use in an institution. Physicians and pharmacists have collaborated to implement cost-effective prescribing practices and assess clinical outcomes through educational initiatives, administrative programs to restrict ordering practices, use of formularies and prescribing guidelines, and financial incentives.1 There are data to show that P&T committee actions are useful.2,3

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Before proceeding, it must be stated that while this chapter deals with the P&T committee, which is usually the group responsible for overseeing all aspects of drug therapy in an institution, there is sometimes ...

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