1. What is the Drug and Therapeutics Committee?
Drug and Therapeutics Committee (DTC) is the committee that evaluates the clinical use of medicines, develops policies for managing pharmaceutical use and administration, and manages the formulary system.
2. Need of a drug and therapeutics committee
Essential medicines are one of the most cost-effective ways of saving lives and improving health, constituting 20-40% of health budgets in many developing countries. Increasing cost and lack of resources causes efficient and rational use of medicines. These problems are due to:
- Poor selection of medicines without consideration for relative efficacy, cost-effectiveness, or local availability
- Ineffective procurement procedures lead to a shortage, poor quality, waste, or usage of needlessly costly medications
- Prescription not by standard treatment protocols
- Poor dispensing practices resulting in medication errors and patient's lack of knowledge about dosing schedules
- Patients not adhering to dosing schedules and treatment advice
Irrational and ineffective use of medicines results in insufficient therapeutic effect, adverse drug reactions, preventable side-effects and interactions from medicines, and increasing resistance of bacterial pathogens to antimicrobial drugs. These may result in increased or prolonged hospital admissions, which are expensive.
DTCs are a forum to bring together all stakeholders involved in decisions about drug use. It is achieved by establishing the documented rules and policies for all aspects of drug management, including selection of formulary list medicines, agreement of treatment protocols, continuing education, conducting drug utilization reviews, and monitoring ADR and medication errors.
3. Goals and objectives of the DTC:
DTC aims to ensure that patients are provided with the best possible cost-effective and quality of care by determining what medicines will be available, at what cost, and how they will be used.
4. Objectives of DTC:
- to create and execute a formulary system that is economical, efficient, and effective
- to ensure that only productive, safe, cost-effective, and good-quality medicines are used
- to ensure the best possible drug safety through monitoring, evaluating, and preventing adverse drug reactions (ADRs) and medication errors
- to develop and implement interventions to improve medicine use by prescribers, dispensers, and patients
5. What are the functions of the drug and therapeutic committee?
The most important DTC functions are mentioned below.
a. Advisory to committee medical staff, administration, and pharmacy:
The DTC is a valuable resource that can advise medical staff, nurses, administration, pharmacy, and other departments and groups within the hospital. Regarding the choice, administration, and use of medications, the DTC is qualified to offer advice on all matters, regulations, and guidelines.
b. Development of drug policies:
The DTC is the most appropriate body to develop drug policies. All hospitals should have specific policies concerning:
- criteria for inclusion of medicines on the formulary list, essential medicines list (EML)
- Formulary selection ought to be predicated on standard treatment guidelines and treatment algorithms.
- periodic use of medicines not on the formulary list
- expensive or dangerous medication, such as third-generation antibiotics or oncological drugs
- medications whose safety or efficacy are being investigated
- generic substitution and therapeutic interchange
- drug representatives and promotional literature
c. Evaluating and selecting medicines for the formulary list:
It is the most important function of a DTC. Drugs should be selected based on the standard treatment guidelines. Documented evidence must be examined for the efficacy, safety, quality, and cost of all drugs under consideration for inclusion in the formulary list. A periodic review is required due to changing costs and indications, updated safety data, and the introduction of novel medications.
d. Developing standard treatment guidelines:
Standard treatment guidelines (STGs) or protocols are proven to promote the rational use of medicines.
DTC plays an important role in the development of STG.
e. Assessing medicine use to identify problems:
Appropriate methods to identify drug use problems include:
- Aggregate drug consumption data review including ABC, VEN, and use of defined daily dose (DDD)
- Monitoring indicators of medicine use, including adherence to standard treatment guidelines
- Drug use evaluation (DUE)
- Monitoring adverse drug reactions and medication errors
- Antimicrobial resistance surveillance
f. Conducting effective interventions to improve medicine use:
The drug and therapeutic committee provides drug information to the healthcare staff and conducts interventions to promote the rational use of the drugs. Some important interventions include monitoring and supervision, audit and feedback, educational programs, in-service training, standard treatment guidelines, and unbiased drug information.
g. Managing adverse drug reactions:
Several factors, including poor drug quality, unknown drug combinations and interactions, and unknown effects of new or older drugs, can cause adverse drug reactions.
DTCs must make sure patients receive the safest care possible.
Monitoring and minimizing adverse drug reactions is an essential part of this function.
h. Managing medication errors:
Medication errors occur in all healthcare settings, no matter how good the healthcare staff are at prescribing, dispensing, and administering medicines. Even if there is no error on the part of the healthcare staff, patients may take drugs incorrectly. It may be due to a lack of knowledge, tiredness of staff, careless work attitudes, poor procedures, lack of policies, unfamiliar dosage forms, and human error. DTCs can reduce such errors by monitoring, analyzing, reporting errors, and implementing corrective action.
i. Information dissemination and transparency:
The DTC must disseminate information about its activities, decisions, and recommendations to the staff members who must implement the DTC's decisions. A loss of credibility results from inadequate information dissemination. It is also essential that the DTC operates in such a way as to ensure transparency of all its decisions and to avoid conflict of interest.
6. Structure of Drug and Therapeutic Committee:
The following points must be considered while setting up a DTC.
1. A DTC must have a multidisciplinary approach.
2. A DTC must be transparent and committed to good service.
3. A DTC must have appropriate technical competence.
4. DTC should have sufficient administrative support to implement its decision.
Formation of DTC:
- a representative clinician from each major specialty, including surgery, obstetrics and gynecology, internal medicine, pediatrics, infectious diseases, and general practice
- a clinical pharmacologist, if available a nurse, usually the senior infection control nurse or the matron
- When a pharmacist is not available, a pharmacy technician or the chief or deputy chief pharmacist generally works.
- A clinical microbiologist, or in the absence of a microbiologist, a laboratory technician; an administrator representing the hospital administration and finance department
- A member of the hospital records department.
Members of the Drug and Therapeutics Committee:
Hospital Pharmacy Service Guidelines 2072 state the provision for establishing a Hospital pharmacy and therapeutics committee consisting of the following members.
1. Chief of a hospital or the person appointed by him: Chairperson
2. Departmental heads from each major specialty: Members
3. Matron: Member
4. Administrator, Hospital administration: Member
5. Administrator, Finance department: Member
6. Chief pharmacist, Hospital pharmacy: Member Secretary
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