Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

1.3.8 Sub-therapeutic response to drug therapy1.4 The clinical pharmacist is responsible for determining the sample time of the SDC.1.5 The order for a SDC may be overridden, at any time, by the prescriber writing“Serum Drug Concentration as Written” or other equivalent orders.1.6 The clinical pharmacist is responsible for interpreting and evaluating the results ofthe SDC and making appropriate recommendations. When evaluating the results ofthe SDC, the pharmacist should take into consideration factors such as theindication for use of the drug, the target serum concentration, the acute or chronicnature of the drug therapy, and the patient’s clinical status. See the UWHC AdultPharmacokinetic Guideline for assistance in interpreting concentrations.2.0 Procedure for Managing the Ordering of Serum Drug Concentrations2.1 The pharmacist is responsible for monitoring drug therapy and SDC on a routinebasis.2.2 If a patient is receiving a drug routinely monitored by SDC, the pharmacist willdetermine the need for a SDC.2.3 If a SDC is indicated, the pharmacist will:2.3.1 Determine the appropriate time of SDC by referring to the UWHC AdultPharmacokinetics Guideline, UWHC Lab Handbook, MICROMEDEX ® , orcurrent literature.2.3.2 Write an order for the SDC along with the indication for the concentrationand the appropriate sample time and date.2.3.3 The order shall state, “Serum Drug Concentration per protocol” and besigned by the pharmacist.2.4 If the physician orders a SDC and indicates “SDC as written,” then this informationwill be recorded on the pharmacy monitoring notes. The pharmacist will indicatethe appropriate sampling time on the original order if not already indicated.2.5 If the physician orders “SDC per pharmacist” or “levels per pharmacist”, the clinicalpharmacist 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 timethe order. If the pharmacist determines that no SDC is indicated, they shall discussthe indication with the ordering physician. If there is agreement that no SDC isrequired, then the pharmacist will write an order to discontinue the SDC. If there isnot agreement and the ordering physician is a resident who requests a SDC eventhough protocol indicates otherwise, then an order by the attending physician isrequired to overrule the pharmacist and the protocol.2.6 The results and assessment of the SDC will be recorded in the pharmacymonitoring note and the patient’s chart.2.7 If a change in dose is indicated as a result of the SDC, the pharmacist will verballycontact the physician to initiate the change and record this information in thepharmacy monitoring notes and the patient’s chart on the same shift that theresults become available.