ISMP Survey on Formulary Myths

In 1990, T. Donald Rucker and Gordon Schiff identified common myths about hospital formularies that were culled from published literature and comments made by physicians during actual Pharmacy and Therapeutic (P&T) Committee meetings (Rucker TD, Schiff G. Drug formularies: myths-in-formation. Medical Care 1990;28:928-942. Reprinted in Hosp Pharm 1991;26:507-514). Please complete this survey to let us know to what degree these statements are still heard in your facility today. To minimize duplicate responses from each facility, only the initial person who receives the newsletter (or a more suitable delegate, such as a director of pharmacy or the P&T Committee chairperson) should complete the survey. Please submit your responses by January 7th, 2005.

1. Please tell us the frequency with which comments were made during formulary deliberations at your 2004 Pharmacy and Therapeutics Committee meetings related to the following categories using the following scale: 1 = Never; 5 = Often.
Also please tell us if the comments (if made) had any impact on the final outcome of a formulary decision. Select NA/? if the category is not applicable (scored as Never) or you are uncertain of the impact of the comments you heard in that category.
Myth Categories (Illustrative Statements Follow Each Category)
A. Causal Empiricism (anecdotal observations vs. scientific evidence)
(1) I've used this in my private practice for years. (2) We want to try out this drug for 6 to 12 months to get some experience using it and see if we like it.
B. FDA Approval Implies Everyday Use for All
(1) FDA wouldn't have approved it if it weren't a good drug. (2) Patients should not be denied access to any drug approved by FDA.
C. Interferes with Clinical Freedom
(1) I'm philosophically opposed to restrictions on doctors' clinical freedoms; we need education instead. (2) Each clinician has his/her own set of drugs that he/she is comfortable with; it's best not to interfere with this with a restricted formulary.
D. Every Patient is Unique
(1) Every patient is different and we need a variety of drugs to try. (2) We need different drugs to deal with genetic or dietary differences.
E. The Specialist Knows Best
(1) For this committee to tell infectious disease specialists what antibiotics they should or should not prescribe is highly presumptuous. (2) If cardiology says they need this drug, who are we to question it? (3) The committee is just a bunch of nonsubspecialists making decisions about things they know nothing about.
F. Education Requires Experience with a Multitude of Drugs
(1) By not having access to the newest drugs, our residents are not learning state-of-the-art medicine. (2) In the real world, for which we are training our residents, they don't have all of these restrictions.
G. Widespread Use Equals Drug of Choice
(1) This is the most popular agent in this class of drugs; how can we do without it? (2) These drugs are widely used worldwide; they are the drugs of today.
H. Newer is Better/Newer is Safer
(1) The problem with formularies is that they're almost immediately out-of-date. (2) Any unknown risks are far outweighed by the benefits of this new drug.(3) This newer drug clearly has a better side effect profile than the older drug.
I. Sicker Patients Need More Drugs
(1) We need the drug for patients for whom nothing else has worked and for whom we have no other choices. (2) If you were in my shoes and a sick patient wasn't responding to a first line drug after 24 hours, you'd want other alternatives to try.
J. Formulary Sacrifices Patient Care to Cost Control
(1) While we probably have to accept drug restrictions due to cost, there is a trade-off in quality each time we do so.
K. Redundant with Drug Utilization Program (DUR) Program
(1) The formulary can be eliminated if a comprehensive DUR program is operative
2. Please choose the descriptions that best describe your facility:
A. Non-teaching Hospital Teaching Hospital
B. Hospital with less than 100 beds Hospital with 100-300 beds Hospital with more than 300 beds
3. Please indicate the description that best describes your profession
Nurse Pharmacist Physician Physician Assistant/Nurse Practitioner


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