Monitoring and Responsibility
Within the pharmaceutical care process, the primary pharmacist/resident
who attends rounds or precepts pharmacy students on the primary medical
team is responsible for providing appropriate and cost conscious
therapeutic drug monitoring and provision of clinical pharmacokinetic
evaluations. The CPS is responsible for overseeing the pharmacokinetic
monitoring process for all patients and providing assessments for any
patient that does not have an assigned primary pharmacist/resident.
This responsibility is met through a team approach including a faculty
member who serves as the Director of Clinical Pharmacokinetics Service
along with Pharmacy Practice Residents and PY4 pharmacy students as part
of a resident/student rotation in Clinical Pharmacokinetics.
Patients with serum drug concentrations on non-covered
services are identified by two daily printouts (midnight and noon)
provided by the Therapeutic Drug Monitoring (TDM) Laboratory. Also, drug
profiles are reviewed at least 3 times/week for all patients on
non-covered services to identify any noncovered patients who are
prescribed monitorable drugs which have not obtained serum concentrations.
Physicians may also initiate a request for pharmacy to provide a clinical
pharmacokinetic evaluation by verbal or written communication.
Documentation in the Patient
When a patient has serum drug concentration, the primary pharmacist should
write a "Clinical Pharmacokinetics" note in the patient’s chart within 24
hours for a normal or subtherapeutic concentrations. For concentrations
that are supratherapeutic, the medical team should be notified immediately
if clinical warranted and a chart note should be written as soon as
possible, but no more than 12 hours after the concentration was reported.
The chart note should contain all relevant patient information and
pharmacokinetic parameters necessary to produce the dosing and monitoring
recommendations. Please refer to the
CPS Policy/Procedure Manual for guidelines for documentation of
pharmacokinetic evaluations for specific monitorable drugs. Notes written
by students and non-licensed pharmacists/residents must be co-signed by a
Kentucky-licensed pharmacist within 24 hours.
CPS coverage during
During months that the Manager of CPS is off service, the CPS
responsibility will be divided among the clinical faculty, clinical
staff pharmacists, pharmacy residents and pharmacy students on routinely
covered services. The Director of the CPS will provide a list of service
coverage so that all non-covered patients will be provided clinical
pharmacokinetics service as a minimum of pharmaceutical care.
Pharmacists, residents, and students on all pharmacy services (including
Pharmacy Administration and Drug Information) may be assigned to follow
pharmacokinetic patients on non-covered services. For residents and
students, the pharmacokinetics service will be provided under the
preceptorship of a clinical faculty member. Two pharmacists/residents
will also be assigned to retrieve the TDM list each day and notify the
primary pharmacist each day by pager and by posting a centrally located
list of the non-covered patients with serum drug concentrations. A list
of monitorable drugs, including warfarin, will be printed daily and
separated by service. These profiles will be provided to the primary
pharmacist to review in order to identify any patients on monitorable
drugs. Notes written by students and non-licensed pharmacists/residents
on non-covered patients must have their notes signed by a licensed
pharmacist or the faculty member responsible for the pharmacokinetics