Organization and efficacy of a therapeutic drug monitoring consultation service in a pediatric hospital.

On July 1, 1982, a therapeutic drug monitoring (TDM) consultation service was instituted in the hope of improving the decision-making of clinicians with respect to drug therapy. Thirteen different drugs are monitored daily, with an average load of 1,600 inpatient samples per month. The team consists of clinical pharmacology fellows and staff who are available 7 days a week to monitor all drug levels that are outside the putative therapeutic range. In order to evaluate the efficacy of this service in preventing development of potentially toxic drug concentrations, the TDM data from July 1982 to December 1983 have been reviewed. The percentage of toxic levels from the total sample load was significantly lower in the period of July-December 1983 compared with July-December 1982 at the beginning of the service (2.25% vs. 4.25%, p less than 0.01). Since January 1983, the percentage has been maintained at less than 3%. A TDM consultation service can help to optimize the use of drug monitoring data by physicians and may lead to improved prescribing in a hospital setting.