Protocol Development and Quality Improvement

Both methods should be available for documenting pharmacotherapeutic interventions, and criteria

should be established to determine which method is most appropriate.

Pharmacists should have the authority to document pharmacotherapeutic interventions in the EHR.

Pharmacists should be trained and educated to document in the EHR. The ASHP Clinical Skills

Certificate program is a tool that can be used to train pharmacists to document in the EHR.

Documentation methods may include standard format documentation methods such as:

SOAP (subjective, objective, assessment, plan)

TITRS (title, introduction, text, recommendation, signature)

FARM (findings, assessment, resolution, monitoring)

Wording for solicited consultations should be direct. Unsolicited pharmacist interventions should be

documented subtly, allowing the primary provider to decline the recommendation without incurring

liability. Phrases that can be used include:

“May consider”

“Suggest”

“May recommend”

communication with the clinician; this allows for any patient data discrepancies to be corrected and

for agreement and confirmation between the prescriber and the pharmacist to execute the intervention.

include patient progress or new interventions, when needed.

Pharmacists should provide their contact information.

Co-signatures should be required for pharmacy residents (until deemed competent according to

pharmacy department standards), interns, and students.

Continual physical presence during and after direct patient care rounds should be provided to

support the physicians, advanced practice providers, and nursing team with triaging medication-

related questions.

pharmacotherapeutic interventions and cost savings. Ideally, these are documented in the patient’s EHR

for the reporting of weighted metrics.

Patient Case

During ICU rounds, the team is recommending a cost-prohibitive non-formulary drug with controversial

outcomes as a last line vasopressor for a patient with septic shock. You review the chart and think there

are safer formulary options to try before resorting to this new therapy. You are required to document your

interventions in the patient chart for tracking purposes. Which wording is the most appropriate to use?

used in this patient.

formulary and have a proven benefit in patients with septic shock.