Composition of pharmacy and therapeutics committee (PTC) might vary from hospital to hospital. The following scheme is suggested for general adoption:

The PTC may be composed of:

• At least three physicians from the medical staff

• A pharmacist

• A representative of the nursing staff

• An hospital administrator with his/her designated an ex‐officio member of the committee one of the physicians may be appointed as the chairman of PTC.

Sultan,

It is very necessary to include nurses. Particularly, in the Western world, advanced nursing practitioners are now commonly pharmacological prescribers. They are not beholden to or reliant on medical practitioners to oversee their practice. Take Nurse Practitioners in New Zealand. It doesn't require a huge 'leap of faith' to envisage when undergraduate nurse training will be extended to include the safe prescribing of common drugs i.e. antibiotics, low-range pain relief etc; then all nurses will able to prescribe in those countries. It would be nonsense not to have a nursing representation on such committees. 

Yes, a nurse is nevertheless better part of health care system, in PTC it is at utmost important to include a nurse and a pharmacist as well

Thanks RG cohorts,

There is a separate PNC (Pharmacy Nursing Committee) in some hospitals and that is the reason the nurses are not part of the P&T Committee. 

I suppose added some points to the discussion.   

My vote is "Yes", as the nurses play the huge role in the administration of drugs and taking continuous care of the patient, thus their experience and thoughts can be useful in the Hospital administration as well as therapeutic committee.

I agree with Dean Whitehead's comments above.  It is imperative to have all the parties involved in patient care when deciding on issues related to Pharmacy and Therapeutics.  Decisions made within these meetings impact the entire healthcare team - when considering the pros/cons of a therapy it is important to realize that each individual will be able to add dimension to these decisions - otherwise myopia may not take into consideration all the variables related to delivery of a product / therapy (which would be considered the scope of Nursing). The decisions made in Nursing committees often are related to policy, education, monitoring parameters etc.

A nurse should be included because a nurse can provide very useful information on the use of medicines in everyday practice, e.g. issues with adminsitration, and feedback from patients.

Having said that, I do sincerely hope that nurses will not be allowed to prescribe antibiotics! Given the widespread, totally unresponsible, uncritical use of these precious drugs and the rising problem of bacterial resistance, the number of prescribers should actually be limited to specially trained physicians.

Arne - if you do not mind me saying - your response seems quite ill-informed. Medical practitioners have routinely and, often randomly, prescribe antibiotics for many years - without scrutiny from other health professionals and the public. Nurse prescribers, as research has clearly shown, have added a layer of informed, skilful, considered, and safer practice to prescribing. They are far more likely to resolve the situation - than to exacerbate it.

It's not that nurses should be included as a 'support mechanism' for doctors to give information. In many countries, and I thought that Norway would be one of them, highly skilled nurses are the equivalent of doctors - working to the same quality care aims - with similar clinical skills. 

Dean, you may have misunderstood me. If you read my post again, you will notice that I in fact do accuse doctors for their prescribing practice. And I am neither the first nor the only one doing so.

Specially trained nurses may have the same or even better clinical skills than doctors in many fields, although I would not go as far as you and generally state that they are the equivalent of doctors (then we would not need doctors anymore, right?). I can assure you that they are highly appreciated in Norway.

When I wrote that nurses should not be allowed to prescribe antibiotics, this was under the presumption that the current prescribing routines would not be improved. Which - to me - implies that the unresponsible prescribing of these drugs would even increase, not decrease. I would love to be convinced that I am wrong.

Dear Dean Whitehead,

Your point on the prescription rights for the nurses, particularly for the antibiotics i would like to point out it is very relevant to state considering huge resistance/irrational use of the antibiotics and also there are just few new antibiotics in the pipeline, it should be strictly restricted to the clinicians , and that too empirical usage of the antibiotics should be avoided.

Even for the clinicians who want to prescribe antibiotics ,first they should get the culture report and based on the sensitivity to the pathogens they should prescribe the right medications apart from the careful clinical examination/judgement . There are many cases antibiotics are prescribed irrationally and in a non judicious way leading to the resistance and end up in wasting the resources.

I hope you understand the concerns and appreciate.   

Hi Arne,

Good repost - and I may well have 'grabbed the wrong end of the stick'. However, prescribing nurses (such as say Nurse Practitioners in New Zealand) have very specific scopes of practice and have to have explicit and extended training protocols to prescribe. So, to me, they have a very similar scope and training to doctors when they are able to prescribe. That doesn't mean to say that they replace doctors; they compliment them when, for instance, there is a shortage of GPs in this country. We need doctors - but doctors are not always available or easily recruited - especially in remote, rural areas. 

My experience, and what the research suggests, is that (currently) nurse prescribers are far more likely to spend more time with patients, be more cautious with prescribing - and look more outside the purely biomedical context of clients and families issues. They are currently far less likely to prescribe antibiotics just for the sake of it. 

I can concur with you to a point in that it is not beyond fantasy that undergraduate nurses may well, in the near future, have prescribing rights of 'common' drugs incorporated into their training. That might include antibiotics - and then there is the risk of further unresponsible prescribing - but we will not know that until it comes. 

Hi Sultan,

I do agree and appreciate your point - as implied in my last post. Regardless of who the prescriber is - we want what is best for the client and the planet - and not what is best for the pharmaceutical companies. By clinicians, I assume that you mean both doctors and nurses. 

I think it would be good to include the Nursing Representative in the Therapeutic Committee of the Hospital. Nurses are key persons in the administration of drugs to the patients and also in monitoring of drug response as well as adverse reactions in the patients. They can contribute towards enhancing drug safety and minimizing medication errors.

Regards,

Bharat Gajjar.

Bharat - agreed. It would be more than good - it is essential to include nursing representation. Nurses are not just key in the administration and monitoring of drugs; in may countries they are also key in prescribing the drugs as well. To a certain degree, one might argue that nurses are more effective practitioners than doctors. For instance, if a nurse can prescribe, administer and monitor the whole process whereas, often doctors only prescribe then leave the other important processes to others, then who is the most efficient practitioner? 

Bharat - agreed, but I strongly disagree with Dean that 'If nurse can prescribe, administer and monitor the whole process there will be more efficiency', to me that is when medication errors would be high and less drug safety, because two good heads are better than one( two experts of different specialties are better than one). To corroborate this point, it is very clear that Nurses can't replace Doctors and vice versa, therefore we have to respect the concept of specialization, so that there should be a representatives of all the key professionals working together towards patient care, which i believe can give better Pharmacy and therapeutic Committee. 

Hi Adamu,

We are both agreed here - just an elaboration on the process that has to be in place. Where nurses (or doctors) are prescribing and/or administering dugs there should be a 'checking system' in place that means that at least another registered nurse or doctor is involved. My main point is, coming back to the original question, is that nurses are a key part of the overall process - because it isn't just doctors that prescribe nowadays. Therefore to have a Pharmacy and Therapeutics Committee without nursing representation, given their expanding prescribing role, would be 'complete madness'. 

I am a nurse practitioner in a critical care area and can share that on our pharm committee needs nurse representation.  The pharm committee have taken many medications off the unit . They now have to be ordered then "verified by pharmacy" before it gets "sent" to the unit. Very often seconds count when a patient is crashing, many seconds are lost when we don't have immediate access to those meds. Countless times I have heard a surgeon calling for a med repeatedly while the nurse is trying to get the pharmacy to release the medication. A critical care  nurse on the committee would have a voice to let the committee realize that certain medications need to be immediately available. 

yes, 

because the nurse mostly take care  the patients so they know the history about the surrounding patience ,so their knowledge was use to the set up the  of what kind of dosage form and witch medication are most use in hospital what is impotency of stock in hospital they help to in  Pharmacy and Therapeutics Committee of the Hospital.

I recommend nursing representation, they are extremely important. Especially if you are reviewing a medication that has a high potential for harm or errors. In a hospital they are the front line people that do the last check.  Our P&T at my practice site is multidisciplinary, we have dietitians, APRNs, physician assistants and even IT.

Donna, you may want to make a proposal to your P&T committee and make a small list of emergency medications that can go on override without  pharmacy approval for patients that are crashing  (D50, Narcan, etc). We did this at my practice site. Make it short and reasonable. Our argument was that we cant keep opening up crash carts especially in the ICU for certain medications.

Yes, their input in the discussion is highly valuable especially for medications that has been used by the nursing team and they have certain recommendations or concerns to disclose.