Aligning Formulary Restrictions Across a Health System and Improving Access to and Clarity of Medication Restrictions

In 2013, formulary medications were aligned among the three hospitals within our health system. However, as formulary medication restrictions were not aligned, the three hospitals continued to have inconsistent medication restrictions. This led to confusion among prescribers and pharmacists about which medications were restricted, what the restrictions were, and where to access information about the restrictions. To alleviate this confusion, we set out to align formulary restrictions and to provide medication restriction details at the points of entering and verifying medication orders.

The primary objective was to align 100% of the formulary medication restrictions at our health system. The secondary objectives were to improve ease of access to restriction information and to improve the clarity of medication restrictions for pharmacists.

The process of alignment involved completing a gap analysis to identify differences between each site's medication restrictions and site-specific interventions. The gap analysis, proposed restrictions, and proposed interventions were reviewed by the system's pharmacy, nutrition, and therapeutics (PNT) planning committee. The committee reviewed each medication, the restrictions, and the proposed modifications. The consensus of formulary medication restrictions was presented to the PNT committee for approval. Restriction information was added to each drug monograph in the online medication information database and the interventions were built into the electronic medical record (EMR). Five intervention types were included: restriction removal, "outpatient use only" added to the medication name, order-specific questions, alternative alerts, and information put into order instructions seen by both ordering providers and verifying pharmacists. Pharmacists were educated about the restricted medication-alignment initiative. A survey was administered after education to assess the ease of access to restricted medication information and clarity of medication restrictions. Because of the scope of this project, education and survey administration was limited to pharmacists only.

Aligned medication restrictions increased from 11% to 100%. Of the 110 medication restrictions that were not aligned, 17 restrictions were removed, 37 medications were restricted to outpatient use only, and 56 restricted medications were further aligned across the health system. Results from the survey showed that more pharmacists utilized the online medication information database to find information regarding restricted medications and that it was easier for more pharmacists to find this information.