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Sub-therapeutic response to drug therapy
The clinical pharmacist is responsible for determining the sample time of the SDC.
The order for a SDC may be overridden, at any time, by the prescriber writing
“Serum Drug Concentration as Written” or other equivalent orders.
The clinical pharmacist is responsible for interpreting and evaluating the results of
the SDC and making appropriate recommendations. When evaluating the results of
the SDC, the pharmacist should take into consideration factors such as the
indication for use of the drug, the target serum concentration, the acute or chronic
nature of the drug therapy, and the patient’s clinical status. See the UWHC Adult
Pharmacokinetic Guideline for assistance in interpreting concentrations.
2.0 Procedure for Managing the Ordering of Serum Drug Concentrations
The pharmacist is responsible for monitoring drug therapy and SDC on a routine
If a patient is receiving a drug routinely monitored by SDC, the pharmacist will
determine the need for a SDC.
If a SDC is indicated, the pharmacist will:
2.3.1 Determine the appropriate time of SDC by referring to the UWHC Adult
Pharmacokinetics Guideline, UWHC Lab Handbook, MICROMEDEX®, or
current literature.
2.3.2 Write an order for the SDC along with the indication for the concentration
and the appropriate sample time and date.
2.3.3 The order shall state, “Serum Drug Concentration per protocol” and be
signed by the pharmacist.
If the physician orders a SDC and indicates “SDC as written,” then this information
will be recorded on the pharmacy monitoring notes. The pharmacist will indicate
the appropriate sampling time on the original order if not already indicated.
If the physician orders “SDC per pharmacist” or “levels per pharmacist”, the clinical
pharmacist shall determine the indication for the concentration(s), date and time.
The pharmacist shall document this in the patient’s orders and sign, date, and time
the order. If the pharmacist determines that no SDC is indicated, they shall discuss
the indication with the ordering physician. If there is agreement that no SDC is
required, then the pharmacist will write an order to discontinue the SDC. If there is
not agreement and the ordering physician is a resident who requests a SDC even
though protocol indicates otherwise, then an order by the attending physician is
required to overrule the pharmacist and the protocol.
The results and assessment of the SDC will be recorded in the pharmacy
monitoring note and the patient’s chart.
If a change in dose is indicated as a result of the SDC, the pharmacist will verbally
contact the physician to initiate the change and record this information in the
pharmacy monitoring notes and the patient’s chart on the same shift that the
results become available.