By Joyce Generali, MS, RPh, FASHP

KANSAS UNIVERSITY MEDICAL CENTER, AN ACUTE-CARE TEACHING FACILITY
with approximately 550 beds, is located in Kansas City, Kansas. Our first drug formularies were pocket-sized handbooks, which included all of the drugs on our formulary, plus additional pharmacy policies and procedures, clinical laboratory data, and pricing information. Unfortunately, the print formulary quickly became outdated, as its format was limited in capturing the dynamic nature of most formulary systems. Drug products were added and deleted, based not only on the actions of the P&T committee, but also to reflect drug shortages, removal of drugs from the market, and changes in policies and procedures. All of these occurrences necessitated a flexible format that could be updated in real time. In retrospect, our paper formulary seems archaic. On the date it was printed, though it met the minimal JCAHO requirements, it was already obsolete.

With the advent of the Internet, the electronic formulary was an obvious solution to address the problems associated with printed formularies. It offered easy access to information and the ability to make changes in a timely manner — that is, as soon as they occurred. We were also impressed with having one primary location for all types of medication information. The online formulary has become a powerful tool for optimizing drug therapy, while managing costs and ensuring patient safety.

The Selection Process
As we explored our online formulary options, we considered numerous vendors. Our top considerations were the ability to update in real time, quality customer service, and customization. With these criteria in mind, FormWeb by Formulary Productions exceeded our expectations. Readers are welcome to view our FormWeb site at www.formularyproductions.com/kumc.

As mentioned, our top requirement was the ability to update in real time. Some vendors required their customers to send revisions on a monthly basis. In contrast, FormWeb provides a user-friendly editor tool that allows us to add or delete a drug immediately after a decision has been implemented by our P&T committee. This tool is particularly important in the age of increased drug recalls and safety alerts. With real-time updates, we are able to notify health professionals within our institution about recent FDA warnings and changes in safety labeling, thus optimizing patient safety. In addition, the editor tool enables us to add specific comments or links to dosing guidelines, high-alert drugs, or special instructions regarding drug administration and/or storage.

As with any new technological advancement, the level of customer support offered by the vendor is an essential consideration. We were impressed by Formulary Productions’ free customer service, not only at the implementation phase, but on a continual basis. Service has been offered at the same level of quality throughout the five-year subscription. Initially, their willingness to spend time making the product do exactly what we needed it to do was beyond our expectations. During the last five years, we have made numerous customization changes with full support. Many of these changes were prompted by the shared library, a warehouse for all innovations made by other FormWeb user hospitals.

An additional advantage of FormWeb was its ability to serve as an umbrella product to any of our current drug information subscriptions. This flexibility was a premier consideration in selecting FormWeb. Our hospital staff could continue to use all of our existing drug information subscriptions through FormWeb.

Getting Started
In a large hospital, it can be a great challenge to convince employees to accept change. However, once we launched our FormWeb site, our pharmacists embraced it readily, because it solved so many problems. When someone asked, “Where is our heparin protocol?”, the standard reply quickly became “Check the FormWeb!”
Now we fulfill many requests from several medical and nursing departments to post new information. Links to drug and clinical information and institutional guidelines, procedures, restrictions, and ordering forms relevant to particular medications are just some of the materials now available electronically.

Additional Benefits
Information is critical in the prevention of medication errors. An online formulary can optimize medication safety by integrating current safety information with electronic access. All our health professionals have easy access to our FormWeb site via office and nursing unit computers, Palm Pilots, or other handheld devices.
Recently, we have begun to post our standardized drug order sets on FormWeb, enabling greater efficiency in prescribing and tracking drug use. We see this product as a stepping-stone toward the eventual implementation of CPOE, because it has enabled us to standardize our order sets and make them electronically available.
In a continual effort to optimize the rational and safe use of medications within our hospital, we are constantly monitoring for ways to improve and enhance access to information. As the hundreds of thousands of hits on our FormWeb site prove, we have implemented a tool that is making a difference in the way we deliver the best patient care possible.

Joyce Generali, MS, RPh, FASHP, is director of the Drug Information Residency Program and the Drug Information Center at Kansas University Medical Center. She is also a clinical professor at Kansas University and a member of the Woman’s Day Health Advisory Panel and Medzine Health Panel. She is the author of several books for doctors and pharmacists, including the Technician’s Pocket Drug
Reference, Drug Reaction Alerts, and Pharmacy Examination Review Book. She was a 2006 recipient of a Cheers Award from the ISMP for her work in creating and maintaining the first complete list of drugs with “black box” warnings.