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 Medical Record
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 ‘‘Off-Service" months
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 coverage.