Monitoring drug therapy: Three steps for pharmacists

MTM pearls


On the health care team, the pharmacist is the key member who provides ongoing drug therapy monitoring. Pharmacists have the skills and knowledge to perform and embrace this role.

Drug therapy monitoring is an ongoing process in which pharmacists actively review patients’ records, identify and resolve drug therapy problems such as adverse drug events (ADEs), and communicate with prescribers when problems occur. Pharmacists educate patients and their caregivers about potential adverse effects and work with patients to ensure adherence to therapy and attainment of therapeutic goals.

Drug therapy monitoring should be routine but is not always done consistently or systematically. In a recent paper, researchers discussed the importance of medication monitoring, the deficiencies of our current system, and three steps to take when monitoring drug therapy to improve patient outcomes.1

Key points

In reducing problems with drug therapy, appropriate prescribing has received more attention than ongoing monitoring. Appropriate prescribing—selecting the most appropriate medication for a particular patient—is an important aspect of patient care; monitoring therapy to detect and mitigate medication-related problems is just as important.

Patients’ responses to medications are complex. With multiple medications, the complexity increases. Even if the right medication was prescribed, the patient may still suffer from an adverse drug event. Drug therapy monitoring uncovers problems as they occur. In turn, health care providers take actions that resolve the problems.

Medication monitoring is optimized by a team approach that includes pharmacists. Following are the three steps of monitoring:

  1. Educate patients about their therapy, potential adverse effects, and actions to take if problems occur. Make patients active partners in their medication management and their own health decisions.
  2. Regularly assess patients’ drug therapy. Ensure that patients take their medications as prescribed, proactively identify and resolve ADEs as they occur, and assess therapeutic effectiveness. Ensure that appropriate labs are done and assessed.
  3. Adjust drug therapy as needed based on information from the monitoring process.

The authors provided compelling statistics demonstrating that inadequate monitoring of drug therapy leads to increased ADEs and hospital admissions. They also indicated that many such ADEs could be identified and resolved at an early stage with appropriate patient assessment.

The authors noted that a number of factors make drug therapy monitoring challenging, including fragmentation of the health care system, lack of a team-based approach, health information technology that is less than ideal and not integrated among members of the health care team, and conflicting evidence in the literature on appropriate monitoring of medications.

Practice pearl

The article reinforced the importance of ongoing drug therapy monitoring. As part of the health care team, pharmacists should provide monitoring in their medication therapy management services. Pharmacists already educate patients about their drug therapy—namely, potential adverse effects, what signs and symptoms to look for, and what action to take if they do experience a problem. But proactively informing patients is just the first step. Pharmacists need to be actively engaged and incentivized to take the next step of regularly reviewing their patients’ drug therapy.

Pharmacists in the community setting may see their patients more frequently than physicians do, enabling pharmacists to identify drug therapy problems before they become apparent to other providers. Pharmacists can intervene to resolve the issue, communicate closely with prescribers, and—the third step—make clinical recommendations to improve their patients’ therapeutic outcomes.

Drug therapy monitoring can be challenging in a busy community setting without adequate personnel, workflow processes, or reimbursement. Pharmacists need time to educate patients; prospectively review patients’ drug therapy, especially with refills; and communicate with prescribers as needed. Monitoring may require changes in the dispensing system.

While the health care system benefits from the optimal use of pharmacists, ultimately the patient benefits the most.


  1. Steinman MA, Handler SM, Gurwitz JH, et al. Beyond the prescription: medication monitoring and adverse drug events in older adults. J Am Geriatr Soc. 2011;59:1513–20.