New Practitioners Forum
New Practitioners Forum Writing meeting minutes for a pharmacy and therapeutics committee and its subcommittees
N
ew practitioners are often called on to contribute to the function of the pharmacy and therapeutics (P&T) committee and its subcommittees by writing meeting minutes. Pharmacy residents typically take on this role as part of their residency responsibilities. A postgraduate year 2 (PGY2) drug information resident may support the P&T committee in this way, and a postgraduate year 1 resident or a PGY2 resident in a specialized area of practice may support one of the P&T subcommittees (e.g., a critical care, infectious diseases, or cardiology and thrombosis subcommittee) throughout the year. Other pharmacists in the department may also write minutes as part of their responsibilities in serving as a secretary of a subcommittee. Preparation and practice are key in developing this valuable skill. Various purposes of meeting minutes. Meeting minutes serve several purposes. As a record of discussion points and actions taken, the minutes provide a history of the committee’s activities.1 This record can assist in reminding members of prior actions and in determining future agenda items.1 Additionally, the minutes serve as a mechanism to identify and track changes that are needed within the medication-use system. For example, the record of formulary additions and deletions provides the basis for updating an online formulary. In addition to these changes, the approval of new order sets prompts updates to an institution’s computerized prescriber order-entry (CPOE) system. Discussion of guidelines that are approved or revised
can trigger updates to a hospital intranet where those guidelines are located. The minutes also are an important tool for staff communication and education. At Thomas Jefferson University Hospital (TJUH), once the P&T committee minutes are approved, they are e-mailed
to the entire pharmacy staff. This step keeps everyone informed of formulary changes, new or revised guidelines and
protocols, and upcoming revisions to the CPOE system. This communication is especially important considering that front-line pharmacy staff will likely be the first to field questions from house staff and medical staff regarding changes in how medications are used. Notifying staff of approved guidelines and protocols (and their publication on the hospital intranet) allows the opportunity for pharmacy staff to educate themselves on these changes and to alert colleagues in other departments as well. In addition, meeting minutes assist in project management.1 The minutes serve as a report of milestones and progress, especially for committee initiatives that may take some time to develop and implement. They can also be used to detail the follow-up needed from various committee members and potential timelines for completing steps along the way. With extensive drug shortages during the past several years, P&T committees have undoubtedly approved various restrictions on the use of particular drugs on shortage. The shortages of some of these medications may improve but subsequently worsen, at which time the prior P&T committee–approved restrictions may more easily be reinstated. Documenting such decisions in the minutes of the P&T committee is very helpful in managing recurring shortages. Finally, the minutes serve as a legal record of the committee’s activities.1 As part of a legal deposition or trial, committee minutes may be subpoenaed as evidence to verify compliance with particular rules and regulations.1
The New Practitioners Forum column features articles that address the special professional needs of pharmacists early in their careers as they transition from students to practitioners. Authors include new practitioners or others with expertise in a topic of interest to new practitioners. AJHP readers are invited to submit topics or articles for this column to the New Practitioners Forum, c/o Jill Haug, 7272 Wisconsin Avenue, Bethesda, MD 20814 (301-664-8821 or [email protected]).
Am J Health-Syst Pharm—Vol 72 Jan 15, 2015
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New Practitioners Forum
Logistics of committee structure. It is important to recognize how meeting minutes make their way through the committee structure at a particular institution. Typically, the minutes of a P&T subcommittee are approved (or changes recommended) at the next subcommittee meeting, and then the subcommitteeapproved minutes are submitted for discussion at the next P&T committee meeting. The actions of the various subcommittees are then incorporated into the minutes of the P&T committee. After approval (or revisions) of the P&T committee minutes at that committee’s next meeting, the minutes are submitted to the institution’s medical executive committee (MEC). The timeline for approval of the minutes depends on how often these committees meet. For example, the subcommittee minutes discussed at a March P&T committee meeting may be approved at the April MEC meeting. In this system, items approved at the P&T committee meeting may be acted on only after MEC approval. In addition to the P&T committee and its subcommittees, other groups that are technically not part of the committee structure may nonetheless inform the work of a P&T subcommittee. A diabetes working group, for example, may suggest revisions to guidelines; the revised guidelines are then reviewed at various P&T subcommittee meetings. Practitioners should become familiar with the committee structure at their institutions to anticipate when particular agenda items may require consideration by other groups. Preparing for the meeting. If asked to prepare P&T committee or subcommittee meeting minutes, it is a good idea to ask a committee member (e.g., the secretary) for prior minutes that can be reviewed.1,2 These materials will provide examples of the variety of topics discussed as well as the format and style of the minutes. It is also important to closely review the meeting agenda, as it will become the basis for the minutes to be written.1,2 The agenda can be used to prepare an outline of the minutes before the meeting; the outline can then be elaborated based on the committee’s discussion and ultimate decisions.1-3 It is also advisable to review any supporting 96
documents,1,2 such as draft guidelines, that will be discussed. At TJUH, the assistant director of medication-use policy, clinical services, and research meets with the chair of the P&T committee before the monthly meeting to review the agenda, and the PGY2 drug information resident, who writes the minutes, joins them for the discussion; that way, the resident is aware of any relevant background information and any additional clarification the chair believes the committee may need. Attending the meeting. The task of preparing minutes can be facilitated by bringing certain materials to the meeting. For example, it is often helpful to circulate an attendance sheet2 listing the name, date, and time of the meeting1; this will also ensure the correct spelling of all attendees’ names. Decide in advance if notes will be taken on a laptop or another electronic device or will be written by hand.2 Confirm that all devices are charged, and bring extra paper and pens in case of any technical difficulties.1 Determine whether photocopies of meeting materials will be brought to the meeting or whether attendees will be expected to provide their own copies. It may be helpful to sit near the secretary or facilitator of the meeting to ask questions or request clarification on any items.1,2 During the meeting, the person preparing the minutes should document the key points that are discussed for each agenda item along with the action items approved by a vote of the committee members.1,2 At this stage, writing more is better for personal notes, and there is no need to edit; there will be an opportunity after the meeting to revise the minutes so that only the essential information remains. Tracking additional details at the outset can assist in recalling more fully what is discussed. To organize the content of the meeting, it may be helpful to create a table with appropriate column headings (e.g., agenda item, discussion, result) and space to note the parties responsible for any follow-up items and the associated timelines.2 Writing the minutes. Try to write the minutes as soon as possible after the meeting, when it is easier to recall most clearly the details of the discussion; a
Am J Health-Syst Pharm—Vol 72 Jan 15, 2015
list of information items to include and exclude is provided in the appendix.1,2 A sample template for meeting minutes that may be modified for a committee’s needs is provided in the figure. Essentially, the minutes should be written so that members unable to attend can understand what was discussed and decided.4 A reference often cited for details on taking meeting minutes is Robert’s Rules of Order Newly Revised.5 This reference states that the minutes should mostly include a record of what was done rather than what was said. Such guidance is helpful in determining the level of detail to include in the meeting minutes. It is not necessary to document which committee member stated what during the course of the meeting3; the important point is to document what actions were taken. While the action items must clearly be documented in meeting minutes, the discussion points should also be summarized.1,2 It is often helpful to include the rationale for ultimate decisions. For example, Food and Drug Administration (FDA) MedWatch safety alerts may lead the committee to propose changes to the institution’s CPOE system, such as adding warning screens or modifying particular fields in default medication orders. The FDA MedWatch safety alert for zolpidem in May 20136 led the P&T committee at TJUH to recommend adding a pop-up screen in the CPOE system regarding the lower dose recommended for women receiving immediate-release products (i.e., 5 mg versus 10 mg). Notifications by the Institute for Safe Medication Practices or changes in Joint Commission standards that prompt action items likewise should be clearly stated so that the reason for such changes is recorded. This is useful information if agenda items are revisited in the future and subsequent changes are proposed. Documenting the rationale and outcomes of particular decisions is very important when the P&T committee approves cost-saving strategies. The committee should justify and document that those changes have not adversely affected particular outcomes. For example, when my institution switched from enoxaparin Continued on page 98
New Practitioners Forum Continued from page 96
to subcutaneous heparin for prophylaxis of deep vein thrombosis in certain medically ill patients, the P&T committee indicated that rates of heparin-induced thrombocytopenia (HIT) would be assessed. A subsequent committee review found, and the meeting minutes reflected, that this change did not result in increased rates of HIT. As health systems increasingly strive to identify cost-saving opportunities that will help reduce the drug budget, confirming and documenting the effect on outcomes help support those initiatives. Some agenda items may require consideration by several subcommittees. It is important to note in the meeting minutes the status of these discussions and any actions proposed by the other subcommittees. Pharmacists sitting on various committees may share agenda items before meetings to discuss the potential overlap in topics. As an example, the use of concentrated albuterol solution 0.5% was discussed at TJUH during meetings
of the women and children subcommittee and the critical care subcommittee. The subcommittees recommended reserving this concentrated formulation for use in pediatric patients for continuous nebulization and in mechanically ventilated patients. General tips on writing effective meeting minutes. As pharmacists write the minutes of meetings they attend, it is helpful to follow these guidelines: 1. The writing style of meeting minutes should be objective and concise; avoid lengthy details and flowery language.1-3 2. Recognize that some agenda items will be controversial and could generate substantial discussion; neutrally phrase the key concerns expressed from a balanced perspective. 3. As much as possible, write in the active voice so that it is clear who is responsible for taking action. For example, write “The Committee decided . . .” rather than “It was decided that . . . .” Using the active voice also ensures that those individuals
identified to follow up on any items are specified. 4. For readability, avoid excessively long paragraphs; consider separating the text into “chunks” of information that will be easier for the reader to follow. 5. When discussing specific medications, use generic names; a brand name may be used as necessary to differentiate specific formulations. 6. When applicable, discussion of formulary additions should include the specific criteria for use associated with a particular medication (this has become especially important when referring to the oral anticoagulants dabigatran, rivaroxaban, and apixaban). 7. When referring to institution-specific guidelines, protocols, or policies, include the complete name and/or number associated with these documents. Readers may then refer easily to the source document for further information. Such detail will also differentiate the items in question from any national or association guidelines that may be referenced in the meeting minutes.
Figure. Sample template for use in preparing meeting minutes.
Pharmacy & Therapeutics Committee Meeting Minutes Members Present: Members Excused: Guests Present: called the meeting to order at .
Topic
I. II. Old business III. Formulary changes IV. Update on drug shortages V. Subcommittee reports A. B. VI. Medication safety alerts
Discussion
Approval of the prior month’s minutes
The meeting adjourned at with plans to meet on Respectfully submitted,
98
Action
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New Practitioners Forum
8. Remember to use the spelling- and grammar-checking features of word processing software, keeping in mind that these features will not capture all errors. 9. For additional general writing tips, The Elements of Style, by Strunk and White,7 is a valuable resource.
Confirm the process to obtain approval of the minutes, allowing enough time to revise a draft and seek input from colleagues as needed. It may be advisable to send the minutes to the secretary and other committee members for review before circulating the document to the entire committee for approval (some committees may have more than one secretary or several members responsible for submitting minutes). At this stage, the document should clearly note that it is a draft of the minutes.3 Actively seek feedback on the minutes, as this will confirm the writers’ interpretation of the committee’s decisions and also help further develop and improve their writing skills. With time, writers of minutes can adjust their approach to the task based on the feedback received. Also note that even experienced writers often welcome a “second set of eyes” when writing meeting minutes. After the draft of the minutes has been circulated and feedback from the reviewers is incorporated, the minutes may be sent to the committee for review. Confirm with the committee members the preferences or process for how minutes are distributed for review before the next meeting. Follow-up activities. The meeting minutes are typically reviewed and, if necessary, amended at the next committee meeting. Follow up as necessary to identify when subcommittee minutes are approved by the P&T committee and MEC. After the minutes have been approved by all of the relevant subcommittees, the minutes may be used as the basis for communications with staff within and outside the pharmacy department. The same text may be used to draft memos to pharmacy staff about approved initiatives. For example, when the acute care subcommittee at TJUH recommended an i.v.-to-oral interchange for levothyroxine, the details of this plan
were included in the subcommittee minutes. That information was then reformatted into a memo for the staff, highlighting the P&T committee–approved indications for the i.v. formulation and the conversion factor. Repurposing the minutes is efficient and facilitates timely follow-up with staff. Other staff members can then begin implementing the approved action items. At TJUH, the clinical pharmacists who serve as secretaries of the various P&T subcommittees update any guideline documents with the dates of P&T committee and MEC approval; then they send these files to the physician who is authorized to post them on the hospital intranet. The informatics pharmacists can also begin to modify default medication orders in the CPOE system or activate order sets based on committee decisions. Closing notes. While writing meeting minutes takes time and practice, this responsibility will certainly help new practitioners further develop their writing skills, which are essential in any practice setting. These skills can serve residents and other pharmacists well when they later seek to write articles for newsletters or professional journals. Additionally, committee minutes serve many important purposes. The minutes are a key mechanism for documenting the committee’s initiatives to improve medication use. As an official source, the minutes are the basis for educating staff on medication-use changes (whether the file is sent in its entirety, repurposed in other formats, or both). The document also provides direction to others who may assist in implementing committee decisions by updating the institution’s electronic resources, including an online formulary and the CPOE system. Writing clear, concise minutes is beneficial for the committee, the pharmacy department, and the institution as a whole. 1. Smith LS. Documenting the minutes at professional meetings. Nurs Manage. 2013; 44:48-51. 2. GP Online. How to take minutes (January 27, 2006). www.gponline.com/Education/ article/587583/minutes/ (accessed 2013 Oct 6). 3. On colo g y Nu rs ing S o cie t y. O N S guidelines for taking meeting minutes. http://chapter.vc.ons.org/file_
depot/0-10000000/0-10000/1337/folder/ 14081/Minutes+Guidelines.pdf (accessed 2013 Sep 13). 4. Smith JA, Zsohar H. Business writing tips for the new nurse manager. Nurs Manage. 2008; 39:53-7. 5. Robert HM III, Robert SC, Evans WJ et al. Robert’s rules of order newly revised. 11th ed. Cambridge, MA: Da Capo; 2011:46873. 6. Fo o d a n d D r u g Ad m i n i s t r a t i on . Zolpidem-containing products: drug safety communication—FDA requires lower recommended doses. www.fda.gov/ Safety/MedWatch/SafetyInformation/ SafetyAlertsforHumanMedicalProducts/ ucm334738.htm (accessed 2013 Oct 2). 7. Strunk W, White EB. The elements of style. 4th ed. Needham Heights, MA: Longman; 1999.
Appendix—Information items to include in or exclude from committee meeting minutes1,2,a Items to include: • Committee name and meeting date, time, and location • Members present, members excused, and guests present (including pharmacy students) • Start and end times of the meeting • Note of approval of prior meeting minutes and any changes recommended • Differentiation of old business, new business, standing agenda items (e.g., drug shortages), and tabled items (e.g., due to time constraints, pending input needed from an absent committee member) • Discussion points and action items • A statement that any relevant documents were reviewed and are attached to the minutes • Date of next scheduled meeting Items to exclude: • Extraneous details beyond the main discussion points and actions taken • Specific opinions of committee members pertaining to actions taken • Patient-specific information that may have arisen during discussion (use only deidentified information when discussing adverse drug reactions or medication events) Based on references cited and author’s experience.
a
Ellena Anagnostis, M.S., Pharm.D., BCPS, Drug Information Specialist/Education Coordinator Thomas Jefferson University Hospital Philadelphia, PA [email protected]
The author has declared no potential conflicts of interest. DOI 10.2146/ajhp130639
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New Practitioners Forum Writing meeting minutes for a pharmacy and therapeutics committee and its subcommittees
N
ew practitioners are often called on to contribute to the function of the pharmacy and therapeutics (P&T) committee and its subcommittees by writing meeting minutes. Pharmacy residents typically take on this role as part of their residency responsibilities. A postgraduate year 2 (PGY2) drug information resident may support the P&T committee in this way, and a postgraduate year 1 resident or a PGY2 resident in a specialized area of practice may support one of the P&T subcommittees (e.g., a critical care, infectious diseases, or cardiology and thrombosis subcommittee) throughout the year. Other pharmacists in the department may also write minutes as part of their responsibilities in serving as a secretary of a subcommittee. Preparation and practice are key in developing this valuable skill. Various purposes of meeting minutes. Meeting minutes serve several purposes. As a record of discussion points and actions taken, the minutes provide a history of the committee’s activities.1 This record can assist in reminding members of prior actions and in determining future agenda items.1 Additionally, the minutes serve as a mechanism to identify and track changes that are needed within the medication-use system. For example, the record of formulary additions and deletions provides the basis for updating an online formulary. In addition to these changes, the approval of new order sets prompts updates to an institution’s computerized prescriber order-entry (CPOE) system. Discussion of guidelines that are approved or revised
can trigger updates to a hospital intranet where those guidelines are located. The minutes also are an important tool for staff communication and education. At Thomas Jefferson University Hospital (TJUH), once the P&T committee minutes are approved, they are e-mailed
to the entire pharmacy staff. This step keeps everyone informed of formulary changes, new or revised guidelines and
protocols, and upcoming revisions to the CPOE system. This communication is especially important considering that front-line pharmacy staff will likely be the first to field questions from house staff and medical staff regarding changes in how medications are used. Notifying staff of approved guidelines and protocols (and their publication on the hospital intranet) allows the opportunity for pharmacy staff to educate themselves on these changes and to alert colleagues in other departments as well. In addition, meeting minutes assist in project management.1 The minutes serve as a report of milestones and progress, especially for committee initiatives that may take some time to develop and implement. They can also be used to detail the follow-up needed from various committee members and potential timelines for completing steps along the way. With extensive drug shortages during the past several years, P&T committees have undoubtedly approved various restrictions on the use of particular drugs on shortage. The shortages of some of these medications may improve but subsequently worsen, at which time the prior P&T committee–approved restrictions may more easily be reinstated. Documenting such decisions in the minutes of the P&T committee is very helpful in managing recurring shortages. Finally, the minutes serve as a legal record of the committee’s activities.1 As part of a legal deposition or trial, committee minutes may be subpoenaed as evidence to verify compliance with particular rules and regulations.1
The New Practitioners Forum column features articles that address the special professional needs of pharmacists early in their careers as they transition from students to practitioners. Authors include new practitioners or others with expertise in a topic of interest to new practitioners. AJHP readers are invited to submit topics or articles for this column to the New Practitioners Forum, c/o Jill Haug, 7272 Wisconsin Avenue, Bethesda, MD 20814 (301-664-8821 or [email protected]).
Am J Health-Syst Pharm—Vol 72 Jan 15, 2015
95
New Practitioners Forum
Logistics of committee structure. It is important to recognize how meeting minutes make their way through the committee structure at a particular institution. Typically, the minutes of a P&T subcommittee are approved (or changes recommended) at the next subcommittee meeting, and then the subcommitteeapproved minutes are submitted for discussion at the next P&T committee meeting. The actions of the various subcommittees are then incorporated into the minutes of the P&T committee. After approval (or revisions) of the P&T committee minutes at that committee’s next meeting, the minutes are submitted to the institution’s medical executive committee (MEC). The timeline for approval of the minutes depends on how often these committees meet. For example, the subcommittee minutes discussed at a March P&T committee meeting may be approved at the April MEC meeting. In this system, items approved at the P&T committee meeting may be acted on only after MEC approval. In addition to the P&T committee and its subcommittees, other groups that are technically not part of the committee structure may nonetheless inform the work of a P&T subcommittee. A diabetes working group, for example, may suggest revisions to guidelines; the revised guidelines are then reviewed at various P&T subcommittee meetings. Practitioners should become familiar with the committee structure at their institutions to anticipate when particular agenda items may require consideration by other groups. Preparing for the meeting. If asked to prepare P&T committee or subcommittee meeting minutes, it is a good idea to ask a committee member (e.g., the secretary) for prior minutes that can be reviewed.1,2 These materials will provide examples of the variety of topics discussed as well as the format and style of the minutes. It is also important to closely review the meeting agenda, as it will become the basis for the minutes to be written.1,2 The agenda can be used to prepare an outline of the minutes before the meeting; the outline can then be elaborated based on the committee’s discussion and ultimate decisions.1-3 It is also advisable to review any supporting 96
documents,1,2 such as draft guidelines, that will be discussed. At TJUH, the assistant director of medication-use policy, clinical services, and research meets with the chair of the P&T committee before the monthly meeting to review the agenda, and the PGY2 drug information resident, who writes the minutes, joins them for the discussion; that way, the resident is aware of any relevant background information and any additional clarification the chair believes the committee may need. Attending the meeting. The task of preparing minutes can be facilitated by bringing certain materials to the meeting. For example, it is often helpful to circulate an attendance sheet2 listing the name, date, and time of the meeting1; this will also ensure the correct spelling of all attendees’ names. Decide in advance if notes will be taken on a laptop or another electronic device or will be written by hand.2 Confirm that all devices are charged, and bring extra paper and pens in case of any technical difficulties.1 Determine whether photocopies of meeting materials will be brought to the meeting or whether attendees will be expected to provide their own copies. It may be helpful to sit near the secretary or facilitator of the meeting to ask questions or request clarification on any items.1,2 During the meeting, the person preparing the minutes should document the key points that are discussed for each agenda item along with the action items approved by a vote of the committee members.1,2 At this stage, writing more is better for personal notes, and there is no need to edit; there will be an opportunity after the meeting to revise the minutes so that only the essential information remains. Tracking additional details at the outset can assist in recalling more fully what is discussed. To organize the content of the meeting, it may be helpful to create a table with appropriate column headings (e.g., agenda item, discussion, result) and space to note the parties responsible for any follow-up items and the associated timelines.2 Writing the minutes. Try to write the minutes as soon as possible after the meeting, when it is easier to recall most clearly the details of the discussion; a
Am J Health-Syst Pharm—Vol 72 Jan 15, 2015
list of information items to include and exclude is provided in the appendix.1,2 A sample template for meeting minutes that may be modified for a committee’s needs is provided in the figure. Essentially, the minutes should be written so that members unable to attend can understand what was discussed and decided.4 A reference often cited for details on taking meeting minutes is Robert’s Rules of Order Newly Revised.5 This reference states that the minutes should mostly include a record of what was done rather than what was said. Such guidance is helpful in determining the level of detail to include in the meeting minutes. It is not necessary to document which committee member stated what during the course of the meeting3; the important point is to document what actions were taken. While the action items must clearly be documented in meeting minutes, the discussion points should also be summarized.1,2 It is often helpful to include the rationale for ultimate decisions. For example, Food and Drug Administration (FDA) MedWatch safety alerts may lead the committee to propose changes to the institution’s CPOE system, such as adding warning screens or modifying particular fields in default medication orders. The FDA MedWatch safety alert for zolpidem in May 20136 led the P&T committee at TJUH to recommend adding a pop-up screen in the CPOE system regarding the lower dose recommended for women receiving immediate-release products (i.e., 5 mg versus 10 mg). Notifications by the Institute for Safe Medication Practices or changes in Joint Commission standards that prompt action items likewise should be clearly stated so that the reason for such changes is recorded. This is useful information if agenda items are revisited in the future and subsequent changes are proposed. Documenting the rationale and outcomes of particular decisions is very important when the P&T committee approves cost-saving strategies. The committee should justify and document that those changes have not adversely affected particular outcomes. For example, when my institution switched from enoxaparin Continued on page 98
New Practitioners Forum Continued from page 96
to subcutaneous heparin for prophylaxis of deep vein thrombosis in certain medically ill patients, the P&T committee indicated that rates of heparin-induced thrombocytopenia (HIT) would be assessed. A subsequent committee review found, and the meeting minutes reflected, that this change did not result in increased rates of HIT. As health systems increasingly strive to identify cost-saving opportunities that will help reduce the drug budget, confirming and documenting the effect on outcomes help support those initiatives. Some agenda items may require consideration by several subcommittees. It is important to note in the meeting minutes the status of these discussions and any actions proposed by the other subcommittees. Pharmacists sitting on various committees may share agenda items before meetings to discuss the potential overlap in topics. As an example, the use of concentrated albuterol solution 0.5% was discussed at TJUH during meetings
of the women and children subcommittee and the critical care subcommittee. The subcommittees recommended reserving this concentrated formulation for use in pediatric patients for continuous nebulization and in mechanically ventilated patients. General tips on writing effective meeting minutes. As pharmacists write the minutes of meetings they attend, it is helpful to follow these guidelines: 1. The writing style of meeting minutes should be objective and concise; avoid lengthy details and flowery language.1-3 2. Recognize that some agenda items will be controversial and could generate substantial discussion; neutrally phrase the key concerns expressed from a balanced perspective. 3. As much as possible, write in the active voice so that it is clear who is responsible for taking action. For example, write “The Committee decided . . .” rather than “It was decided that . . . .” Using the active voice also ensures that those individuals
identified to follow up on any items are specified. 4. For readability, avoid excessively long paragraphs; consider separating the text into “chunks” of information that will be easier for the reader to follow. 5. When discussing specific medications, use generic names; a brand name may be used as necessary to differentiate specific formulations. 6. When applicable, discussion of formulary additions should include the specific criteria for use associated with a particular medication (this has become especially important when referring to the oral anticoagulants dabigatran, rivaroxaban, and apixaban). 7. When referring to institution-specific guidelines, protocols, or policies, include the complete name and/or number associated with these documents. Readers may then refer easily to the source document for further information. Such detail will also differentiate the items in question from any national or association guidelines that may be referenced in the meeting minutes.
Figure. Sample template for use in preparing meeting minutes.
Pharmacy & Therapeutics Committee Meeting Minutes Members Present: Members Excused: Guests Present: called the meeting to order at .
Topic
I. II. Old business III. Formulary changes IV. Update on drug shortages V. Subcommittee reports A. B. VI. Medication safety alerts
Discussion
Approval of the prior month’s minutes
The meeting adjourned at with plans to meet on Respectfully submitted,
98
Action
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New Practitioners Forum
8. Remember to use the spelling- and grammar-checking features of word processing software, keeping in mind that these features will not capture all errors. 9. For additional general writing tips, The Elements of Style, by Strunk and White,7 is a valuable resource.
Confirm the process to obtain approval of the minutes, allowing enough time to revise a draft and seek input from colleagues as needed. It may be advisable to send the minutes to the secretary and other committee members for review before circulating the document to the entire committee for approval (some committees may have more than one secretary or several members responsible for submitting minutes). At this stage, the document should clearly note that it is a draft of the minutes.3 Actively seek feedback on the minutes, as this will confirm the writers’ interpretation of the committee’s decisions and also help further develop and improve their writing skills. With time, writers of minutes can adjust their approach to the task based on the feedback received. Also note that even experienced writers often welcome a “second set of eyes” when writing meeting minutes. After the draft of the minutes has been circulated and feedback from the reviewers is incorporated, the minutes may be sent to the committee for review. Confirm with the committee members the preferences or process for how minutes are distributed for review before the next meeting. Follow-up activities. The meeting minutes are typically reviewed and, if necessary, amended at the next committee meeting. Follow up as necessary to identify when subcommittee minutes are approved by the P&T committee and MEC. After the minutes have been approved by all of the relevant subcommittees, the minutes may be used as the basis for communications with staff within and outside the pharmacy department. The same text may be used to draft memos to pharmacy staff about approved initiatives. For example, when the acute care subcommittee at TJUH recommended an i.v.-to-oral interchange for levothyroxine, the details of this plan
were included in the subcommittee minutes. That information was then reformatted into a memo for the staff, highlighting the P&T committee–approved indications for the i.v. formulation and the conversion factor. Repurposing the minutes is efficient and facilitates timely follow-up with staff. Other staff members can then begin implementing the approved action items. At TJUH, the clinical pharmacists who serve as secretaries of the various P&T subcommittees update any guideline documents with the dates of P&T committee and MEC approval; then they send these files to the physician who is authorized to post them on the hospital intranet. The informatics pharmacists can also begin to modify default medication orders in the CPOE system or activate order sets based on committee decisions. Closing notes. While writing meeting minutes takes time and practice, this responsibility will certainly help new practitioners further develop their writing skills, which are essential in any practice setting. These skills can serve residents and other pharmacists well when they later seek to write articles for newsletters or professional journals. Additionally, committee minutes serve many important purposes. The minutes are a key mechanism for documenting the committee’s initiatives to improve medication use. As an official source, the minutes are the basis for educating staff on medication-use changes (whether the file is sent in its entirety, repurposed in other formats, or both). The document also provides direction to others who may assist in implementing committee decisions by updating the institution’s electronic resources, including an online formulary and the CPOE system. Writing clear, concise minutes is beneficial for the committee, the pharmacy department, and the institution as a whole. 1. Smith LS. Documenting the minutes at professional meetings. Nurs Manage. 2013; 44:48-51. 2. GP Online. How to take minutes (January 27, 2006). www.gponline.com/Education/ article/587583/minutes/ (accessed 2013 Oct 6). 3. On colo g y Nu rs ing S o cie t y. O N S guidelines for taking meeting minutes. http://chapter.vc.ons.org/file_
depot/0-10000000/0-10000/1337/folder/ 14081/Minutes+Guidelines.pdf (accessed 2013 Sep 13). 4. Smith JA, Zsohar H. Business writing tips for the new nurse manager. Nurs Manage. 2008; 39:53-7. 5. Robert HM III, Robert SC, Evans WJ et al. Robert’s rules of order newly revised. 11th ed. Cambridge, MA: Da Capo; 2011:46873. 6. Fo o d a n d D r u g Ad m i n i s t r a t i on . Zolpidem-containing products: drug safety communication—FDA requires lower recommended doses. www.fda.gov/ Safety/MedWatch/SafetyInformation/ SafetyAlertsforHumanMedicalProducts/ ucm334738.htm (accessed 2013 Oct 2). 7. Strunk W, White EB. The elements of style. 4th ed. Needham Heights, MA: Longman; 1999.
Appendix—Information items to include in or exclude from committee meeting minutes1,2,a Items to include: • Committee name and meeting date, time, and location • Members present, members excused, and guests present (including pharmacy students) • Start and end times of the meeting • Note of approval of prior meeting minutes and any changes recommended • Differentiation of old business, new business, standing agenda items (e.g., drug shortages), and tabled items (e.g., due to time constraints, pending input needed from an absent committee member) • Discussion points and action items • A statement that any relevant documents were reviewed and are attached to the minutes • Date of next scheduled meeting Items to exclude: • Extraneous details beyond the main discussion points and actions taken • Specific opinions of committee members pertaining to actions taken • Patient-specific information that may have arisen during discussion (use only deidentified information when discussing adverse drug reactions or medication events) Based on references cited and author’s experience.
a
Ellena Anagnostis, M.S., Pharm.D., BCPS, Drug Information Specialist/Education Coordinator Thomas Jefferson University Hospital Philadelphia, PA [email protected]
The author has declared no potential conflicts of interest. DOI 10.2146/ajhp130639
Am J Health-Syst Pharm—Vol 72 Jan 15, 2015
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