Does a hospital formulary influence prescribing practice in an acute medical admissions unit?
OBJECTIVE
To assess the extent to which prescribing of cardiovascular medications in a busy medical unit deviates from the local joint primary and secondary care drug formulary guidelines.


METHODS
A retrospective audit of the case notes, prescription charts and discharge summaries of 150 randomly selected emergency medical admissions over a 4 month period.


RESULTS
No patient receiving a non-formulary cardiovascular drug on admission had the choice reviewed in line with formulary recommendations. One third of new cardiovascular medications commenced in hospital were not compliant with formulary recommendations. Decisions about drug therapy were rarely justfied in the written hospital record.


CONCLUSIONS
Our results demonstrate that in a busy acute medical admissions' unit there is a clear failure to amend or query non-formulary prescribing at the time of admission and a tendency to exacerbate it during the inpatient period. This potentially undermines the purpose of a joint drug formulary as a guideline for safe, evidence-based and cost-effective prescribing.
Murray
M
M
Department of Medical Sciences, University of Edinburgh.
Padfield
P L
PL
Maxwell
S R J
SR
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000145:classification / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D017723:Drug Utilization Review; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005572:Formularies, Hospital as Topic / Q000592:standards*; D006753:Hospital Records; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland; D013222:State Medicine
D002317:Cardiovascular Agents