Clinical Pharmacokinetics Service Policy/Procedures - University of ...

1UNIVERSITY OF KENTUCKY HOSPITALPOLICY NUMBER: PH-02-05CHANDLER MEDICAL CENTER FIRST ISSUED: 1/88Department of Pharmacy Policy CURRENT AS OF: 6/10SUBJECT:PURPOSE:FUNCTIONSAFFECTED:GENERAL:Clinical Pharmacokinetics Service Policy/ProceduresTo establish a standardized pharmacokinetic monitoringapproach for patients receiving drugs that are routinelymonitored utilizing serum drug concentrations at theUniversity of Kentucky Hospital.Clinical Pharmacist Specialists, Clinical Staff Pharmacists,Pharmacy Residents, and Pharmacy StudentsThe Clinical Pharmacokinetics Service (CPS) Guidelineswere developed to ensure safe and efficacious dosageregimens through the application ofpharmacokinetic/pharmacodynamic principles and thedetermination of drug serum concentrations. Thepolicy/procedure manual outlines standard guidelines whichshould be followed when providing clinical pharmacokineticmonitoring of the following drugs: aminoglycosides,carbamazepine, digoxin, fosphenytoin, lidocaine, lithium,phenobarbital, phenytoin (free and total), procainamide,quinidine, theophylline, valproic acid, and vancomycin. Inaddition to the above list, the CPS will also providemonitoring for warfarin for patients without assignedpharmacists.Monitoring ResponsibilityWithin the pharmaceutical care process, the primary pharmacist/resident whoattends rounds or precepts pharmacy students on the primary medical team isresponsible for providing appropriate and cost-conscious therapeutic drugmonitoring and provision of clinical pharmacokinetic evaluations. The CPS isresponsible for overseeing the kinetic monitoring process for all patients andproviding pharmacokinetic assessments for any patient that does not have anassigned primary pharmacist/resident. This responsibility is met through a teamapproach including a faculty member who serves as the Manager of ClinicalPharmacokinetics Service along with Pharmacy Practice Residents, PY4pharmacy students, and clinical staff pharmacists.Patients with serum drug concentrations are identified on a daily basis utilizingSunrise Clinical Manager (SCM). Also, the Therapeutic Drug Monitoring (TDM)Laboratory provides an electronic report of all completed serum drugconcentrations of patients admitted to the hospital twice daily. This allows for

45. The pharmacist will be responsible for follow-up monitoring and/or doseadjustments if the pharmacist deems such actions necessary as documentedin the progress notes.Pharmacokinetic GuidelinesRefer to Clinical Pharmacokinetics Service and Anticoagulation Guidelines(updated annually)Approved:__________________ Authorized:_________________George Davis, PharmD John Armitstead, MS, RPhDan Lewis, PharmDDirector, Pharmacy ServicesClinical Pharmacist Specialists