The history of a comprehensive pharmacokinetic service

This paper reviews the 10 years of providing a Clinical Pharmacokinetic Service (CPS) at the Ottawa General Hospital. The history of the service is followed from the early days of selective monitoring of two drugs to the present comprehensive level of monitoring of essentially all drug concentrations analyzed in the hospital. The administrative development is presented, including that of the Subcommittee on Pharmacokinetics. A justification study is described, the results of which indicated 92 percent acceptance of the CPS' recommendations. An effort to withdraw service for digoxin was unsuccessful in that a concurrent study indicated a deterioration in the appropriateness of digoxin prescribing. Several quality assurance techniques are discussed, including a recent audit on predictability. Finally, the education and research links are summarized. Based on the experience of the authors, it is concluded that a comprehensive CPS is an indispensable clinical service.