CHPPC Module 24, Section 6: Meeting & Committee Etiquette
MODULE 24: SPEAKING HOSPITAL: COMMUNICATION, CULTURE & POLITICS

Section 24.6: Meeting & Committee Etiquette (P&T, Safety Huddles)

Moving from a frontline clinician to a system-level influencer by mastering the hospital’s most important strategic and tactical forums.

SECTION 24.6

Meeting & Committee Etiquette

Learning the unwritten rules of the rooms where policies are made, safety is shaped, and your influence is magnified.

24.6.1 The “Why”: From Individual Impact to Systemic Influence

In your daily clinical work, your impact is profound but primarily focused on one patient at a time. You catch a dosing error for Mr. Smith, recommend a better antibiotic for Mrs. Jones, and reconcile the admission medications for Mr. Chen. This is the vital, life-saving work that defines the role of a pharmacist. However, hospital committees and meetings offer you a different, and arguably more powerful, lever of influence. These are the forums where a single, well-reasoned argument can change a policy that prevents that same dosing error from happening to hundreds of future Mr. Smiths. This is where you transition from being a practitioner to being a system architect.

For many clinicians accustomed to the fast pace of direct patient care, meetings can feel like a bureaucratic chore—a slow, talk-heavy distraction from the “real work.” This is a profound misconception. Hospital committees, particularly the Pharmacy & Therapeutics (P&T) Committee and daily safety huddles, are the brain and the nervous system of the hospital’s quality and safety apparatus. The P&T Committee is the legislative branch, writing the laws (the formulary, protocols, policies) that govern medication use. The daily safety huddle is the executive briefing, identifying and responding to immediate threats in real-time.

To be an observer in these rooms is to miss the single greatest opportunity for professional growth and systemic impact. To be an effective participant, however, requires a new set of skills. The art of persuasion in a committee setting is different from a one-on-one clinical conversation. It requires meticulous preparation, data-driven arguments, and an understanding of the political and social dynamics at play. This deep-dive section is your masterclass in the etiquette, strategy, and execution required to move from the back of the room to a respected, influential voice at the table.

24.6.2 The Analogy: From Pharmacy Advisor to Congressional Witness

A Deep Dive into the Analogy

In your community pharmacy, you are a trusted, front-line Community Advisor. Your influence is direct, personal, and highly effective on a case-by-case basis. A patient comes to you with a problem—a high copay, a side effect, confusion about their regimen. You investigate, you counsel, you solve their problem. You are, in essence, providing expert constituent services. Your power lies in your direct relationship with the individual.

When you step into a hospital committee meeting, your role transforms into that of an Expert Witness testifying before a Congressional Committee.

  • The P&T Committee is the Senate Health Committee. The members are powerful stakeholders—senior physicians who are chairs of their departments, the chief nursing officer, hospital administrators. They have been convened to debate and pass new “laws” (policies and formulary decisions) that will affect the entire nation (the hospital). Your job is to present the evidence for or against a new “bill” (e.g., adding a new drug to formulary). Your testimony (your formulary monograph and presentation) must be flawless, evidence-based, and able to withstand intense questioning from senators with different political interests (e.g., the surgeon who wants the new drug vs. the administrator who is concerned about its cost). Your goal is to shape legislation.
  • The Daily Safety Huddle is the President’s Daily Briefing in the Situation Room. The attendees are the heads of every major department (the cabinet secretaries and intelligence chiefs). The meeting is fast, tactical, and entirely focused on identifying and neutralizing immediate threats to national security (patient safety). Your role is to deliver the pharmacy intelligence briefing: “Mr. President, in the last 24 hours, we intercepted a threat (a near-miss medication error) and we are tracking an emerging situation (a drug shortage). Here is our plan.” There is no room for long stories or vague opinions. It is about delivering actionable intelligence.

This section will teach you how to prepare your testimony, how to deliver it with authority, and how to conduct yourself with the decorum and strategic thinking required to be effective in the hospital’s corridors of power.

Masterclass Part 1: The Strategic Arena — The Pharmacy & Therapeutics (P&T) Committee

The P&T Committee is the most powerful, influential, and formal committee you will likely ever participate in. It is the formal body that holds the keys to the hospital’s medication arsenal. Understanding its function and mastering your role within it is a hallmark of a pharmacy leader.

What is the P&T Committee? The Hospital’s FDA.

The P&T Committee is a multidisciplinary committee mandated by regulatory bodies like The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS). Its primary responsibilities are immense:

  • Developing and Maintaining the Drug Formulary: Deciding which medications will be available for use in the hospital, based on evidence of safety, efficacy, and cost-effectiveness.
  • Creating Medication-Use Policies & Protocols: Writing the official “laws” for how medications are to be used. This includes developing clinical practice guidelines, restriction criteria for high-cost or high-risk drugs, and standardized protocols (e.g., the heparin protocol, the insulin protocol).
  • Overseeing Medication Safety: Reviewing adverse drug events (ADEs), medication errors, and developing strategies to improve the safety of the medication-use system.
  • Therapeutic Class Reviews: Periodically reviewing entire classes of drugs (e.g., all statins, all PPIs) to ensure the formulary is still optimized and cost-effective.

The bottom line: No drug can be routinely used in the hospital without the P&T Committee’s stamp of approval. The pharmacist’s role is not just to participate, but often to lead and manage this entire process.

24.6.3 The P&T Playbook: From Monograph to Minutes

Effective participation in P&T is a cycle of meticulous preparation, precise execution, and diligent follow-through. The single most important task in this cycle is the preparation of the formulary monograph—the detailed, evidence-based report that serves as the foundation for any decision.

Phase 1: Pre-Meeting Preparation — The Art of the Formulary Monograph

A formulary monograph is not a simple drug information question. It is a formal, academic-level systematic review and economic analysis. It must be objective, comprehensive, and utterly defensible. It is the ultimate expression of your evidence-based medicine skills. A great monograph makes the right decision obvious.

Anatomy of a Perfect Monograph:
  1. Executive Summary: Start with the end. This is a one-paragraph summary of the drug, its requested use, and your final recommendation. For the busy committee member who only reads one thing, this is it.
  2. Pharmacology & Mechanism of Action: A concise overview of the drug’s properties. How does it work? How is it metabolized and eliminated?
  3. Comparative Efficacy Analysis: This is the heart of the clinical review. You must critically appraise the landmark clinical trials for the drug. This includes:
    • Summarizing the study design (e.g., randomized controlled trial, cohort study), patient population, intervention, and comparator.
    • Focusing on clinically meaningful, patient-oriented outcomes (e.g., mortality, hospitalizations, symptom improvement), not just surrogate markers.
    • Comparing the drug’s efficacy directly to the current formulary alternative(s). Is it superior, non-inferior, or inferior? By how much (e.g., providing the absolute risk reduction and NNT)?
  4. Comparative Safety & Tolerability Analysis: A detailed review of the drug’s side effect profile.
    • List common adverse effects and their incidence compared to the formulary alternative.
    • Highlight any FDA Black Box Warnings or serious, life-threatening risks.
    • Discuss necessary monitoring parameters to ensure safety.
    • Provide the absolute risk increase and Number Needed to Harm (NNH) for key side effects.
  5. Pharmacoeconomic Analysis: This section addresses the critical question of value. It’s not just about which drug is cheaper; it’s about which is more cost-effective.
    • Direct Acquisition Cost: What is the cost per dose/day/course of therapy from the wholesaler? Compare this directly to the formulary alternative.
    • Budget Impact Model (BIM): A projection of the total financial impact on the hospital. You must estimate the number of patients likely to use the drug per year and calculate the total annual cost increase or decrease. For example: `(Estimated Patients/Year) x (Cost Difference/Patient) = Total Budget Impact`.
    • Cost-Effectiveness (Optional but powerful): For very expensive drugs, you might discuss the cost per quality-adjusted life year (QALY) gained, if data is available.
  6. Place in Therapy & Proposed Use Criteria: Based on all the evidence, where does this drug fit? Is it a first-line agent for everyone? Or should it be restricted to a specific patient population where it has a unique benefit? Propose clear, objective criteria for its use (e.g., “Restricted to ID specialist approval,” or “For patients who have failed therapy with formulary agents X and Y.”).
  7. The Final Recommendation: A clear, unambiguous recommendation to the committee.
    • Add to Formulary (with or without restriction).
    • Do Not Add to Formulary (due to lack of benefit, safety concerns, or poor value).
    • Add to Formulary with Deletion of Another Agent (a therapeutic substitution).

Phase 2: During the Meeting — The Art of the Testimony

You have done hours of work preparing the monograph; you now have 5-10 minutes to present your findings. This is not the time to read your monograph aloud. This is the time to deliver a compelling executive briefing.

The Do’s of P&T Presentation The Don’ts of P&T Presentation
Start with your recommendation. Lead with the bottom line. “Good morning. Today I am presenting on Drug X. After a full review, the pharmacy department recommends adding Drug X to the formulary for the treatment of Y, restricted to Z.” Build up to a surprise ending. The committee members are busy. Tell them your conclusion first, then spend the rest of the time justifying it.
Use a simple, clear slide deck. One key idea per slide. Use graphs to show efficacy and cost comparisons. Keep text to a minimum. Read from dense, text-heavy slides. If the slide is unreadable from the back of the room, it’s a bad slide.
Anticipate questions. Know your audience. The cardiologist will care about cardiovascular outcomes. The surgeon will care about bleeding risk. The administrator will care about the budget impact. Be ready to answer their specific questions. Get defensive or flustered. A challenge to your data is not a personal attack. It’s part of the scientific process. Respond calmly and with data. “That’s an excellent question. The study did show a higher rate of X, but the absolute risk increase was only 0.5%, which the authors did not find to be statistically significant.”
Stick to the evidence. Your power in this room comes from your objective command of the scientific and economic data. Rely on anecdotal evidence or personal opinion. “I had a patient once who…” has no place in a P&T discussion.

Phase 3: Post-Meeting — Implementation & Communication

The work is not over when the meeting ends. The decisions of the P&T committee must be documented and implemented.

  • Writing the Minutes: The pharmacist (often the secretary of the committee) is responsible for writing clear, concise minutes that accurately reflect the discussion, the key decision points, and the final vote for each agenda item. This is a critical legal and regulatory document.
  • System Implementation: If a drug is added, the pharmacy informatics team must build it into the EHR, the automated dispensing cabinets, and the smart pump library. If a policy is changed, it must be updated and published on the hospital intranet.
  • Communication: The decisions of the committee must be communicated to the entire medical staff, typically through a pharmacy newsletter or a hospital-wide broadcast message.

Masterclass Part 2: The Tactical Arena — The Daily Safety Huddle

If P&T is the strategic, slow-moving legislative body, the daily safety huddle is the fast-paced, tactical command center. It is a brief (often 15 minutes or less), standing-room-only meeting of department leaders designed to provide a rapid-fire overview of the hospital’s safety status.

What is the Daily Safety Huddle? The Situation Room Briefing.

The core principles of a safety huddle are speed, standardization, and a focus on systems, not people.

  • Purpose: To identify and address any patient safety events from the last 24 hours and to anticipate and mitigate any potential safety risks for the next 24 hours.
  • Format: A standardized, round-robin report-out from each department leader (e.g., Nursing, Pharmacy, Lab, Environmental Services, etc.). Each leader gets 30-60 seconds to report.
  • The Mantra: “No names, no blame.” The focus is on identifying and fixing system flaws that lead to errors, not on punishing individuals.

24.6.4 The Huddle Playbook: Scan, Script, and Report

Phase 1: Pre-Huddle Prep — The 5-Minute Safety Scan

You have very little time to prepare. Your prep should be a rapid, focused scan of key medication safety data sources.

  • Review the Event Reporting System: Quickly scan for any medication-related safety events (near misses or actual errors) reported in the last 24 hours. Look for trends. Was it a LASA (look-alike/sound-alike) error? A wrong dose?
  • Check ADC Override Reports: Review the list of medications that were removed from an automated dispensing cabinet on override. This can signal urgent needs or system workarounds that may be unsafe.
  • Review Critical Pharmacy Communications: Are there any new, critical drug shortages? Is there a problem with a batch of a compounded product? Is there an EHR or smart pump library issue?

Phase 2: During the Huddle — The 30-Second Pharmacy Briefing

When it is pharmacy’s turn to report, your communication must be exceptionally concise. You will typically report on three things:

  1. Looking Back (Last 24 Hours): Report any significant medication events and any “Great Catches” where an error was prevented.
  2. Looking Forward (Next 24 Hours): Report any anticipated risks or system issues.
  3. Stating the Plan: Briefly state what is being done to mitigate any identified risks.
Word-for-Word Huddle Scripts

Scenario 1: Reporting a Near Miss

“Good morning. From Pharmacy, in the last 24 hours we had one significant near miss. A nurse on 7 East caught a transcription error where a 10-fold overdose of an opioid was ordered. This was an excellent catch by the nurse, and it highlights a potential vulnerability in our CPOE order set, which we are now investigating.”

Scenario 2: Announcing a Shortage

“Good morning. Pharmacy is reporting no significant safety events in the last 24 hours. Looking forward, we have been notified of a critical national shortage of IV sodium bicarbonate. We have implemented conversation protocols and are directing providers to use alternative agents. We anticipate having enough supply for true emergencies but will be monitoring closely.”

Scenario 3: No Events to Report

“Good morning. Pharmacy is reporting a safe 24 hours with no significant events to report.”