Development and implementation of clinical pharmacokinetic services

The basic issues involved in the development and implementation of pharmacokinetic dosing services are presented. A quality pharmacokinetic dosing service is activated by pharmacists immediately upon receipt of a consultation request or medication order. The patient's status is assessed, and recommendations are made for initial dosage, timing of blood sampling, and laboratory tests. Serum drug concentration data are interpreted and a maintenance dosage recommended. The patient is then monitored. The personnel selected for a dosing service need not have advanced pharmacy degrees but must be highly trainable. Their training should address basic pharmacokinetic concepts, the pharmacokinetics of specific drugs, and details on running the service and should be reinforced by extensive on-the-job training. As with other services, staffing should be tailored to workload. Continuous oral and written communication among the dosing service pharmacists and between the pharmacists and the medical and nursing staffs is essential to the smooth and expeditious operation of the service, as are complete and well-written policies and procedures. A quality dosing service cannot exist without commitment from hospital administration and the director of pharmacy and responsiveness of the nursing department and laboratory to the service's exacting requirements. Ongoing research is necessary to evaluate the pharmacokinetic models and software packages used and to find ways of conserving time. High-quality pharmacokinetic dosing services enhance patient care and the image of hospital pharmacy.