Clinical Pharmacist - Inpatient

Pharmacy Clinical Duties

Duties include, but are not limited to: Clinical: The primary function of a clinical pharmacist is to assure the safe and appropriate use of medications and be an advocate of rational drug therapy through the following list of examples and activities:

1. Provides appropriate selection of drug therapy based upon the pharmaceutical principles of pharmacokinetics and pharmacodynamics; monitoring for efficacy, side effects and clinical outcome, and advises prescribers as appropriate.
2. Provides patient-specific therapeutic drug monitoring and communicates relevant findings and/or recommendations to other health care providers in charge of the patient both orally and in writing. Monitoring will include prospective review and intervention in:
• Therapeutic appropriateness of a patient's drug regimen
• Therapeutic duplication in the patient's drug regimen
• Appropriateness of the route and method of administration
• Degree of patient compliance with the prescribed drug regimen
• Drug-drug, drug-nutrient, drug-laboratory, or drug-disease interactions
• Allergies
• Clinical and pharmacokinetic laboratory data to evaluate the efficacy of drug therapy and to anticipate side effects, toxicity, or adverse effects
• Physical signs and clinical symptoms relevant to the patient's drug therapy
3. Performs continuous evaluation of prescribed medications to assure optimal drug therapy, safety, and efficacy.
4. Provides medication counseling to patients. Medication counseling may include, depending on tour:
• Bedside discharge counseling
• Follow-up phone call discharge counseling
• Counseling patients at the Pharmacy pick-up window
5. Conducts comprehensive assessments of patient's health status by completing medication histories, including patient interviews.
6. Serves as a drug information resource by providing up-to-date drug information to prescribers, other health care professionals, patients and caregivers.
7. Participates in patient care rounds and reviews patient electronic health records.
8. Participates in the medication reconciliation process, in accordance with facility processes:
• Pharmacists under a scope of practice (CPP): when acting as a provider, the CPP will complete a medication reconciliation including updating the medication profile to reflect an accurate, active list of VA and non-VA medications. This may include adding non-VA medications or discontinuing duplicate medications or those the patient is not taking.
• Pharmacists not under a scope of practice: when NOT acting as a provider, pharmacists will participate in the medication reconciliation process. This may include a medication history, identifying discrepancies, coordinating with the care team to review discrepancies, processing medication orders, and providing patient medication education.
9. Reports adverse drug events (ADE), near misses, and medication errors. Documents findings according to service/facility policies and procedures.
10. Participates in the medical center medication utilization evaluation (MUE) program.
11. Completes non-formulary and medication approval consults in the acute care setting. Recommends formulary alternatives when appropriate. Reviews orders for compliance with VA Criteria for Use and non-formulary drug restrictions.
12. Implements VA medical facility policies including therapeutic interchanges and automatic substitutions (e.g., Pharmacy and Therapeutic Committee activities).
13. Manages recalls and medication shortage situations by recommending alternative dosage strengths and instructions to provide appropriate substitutions for the patient.
14. Enters supply orders appropriate for patient care per facility policy.
15. Manages various actions, as appropriate, for medication orders to include: flagging prescriptions, managing view alerts, using the "hold medication" function, and generating unsigned discontinued orders using Service Reject.
16. Extends refills until next scheduled appointment under the provider's name per facility policy.
17. Completes patient electronic health record documentation with encounter information for inclusion in Pharmacy Service workload credit for all clinical assessments, interventions, recommendations and monitoring.
18. Participates in facility and service line emergency preparedness activities.
19. Participates in antimicrobial stewardship activities outlined in guidance or medical center policy as appropriate (e.g., IV to PO conversion, aminoglycoside monitoring) and providing appropriate action (e.g., recommendations to providers, therapeutic substitution).

Work Schedule: Full-time; 1130-2200, compressed tour, with rotating weekends and holidays

Telework: Not available

Virtual: This is not a virtual position.

Functional Statement #: 000000

Relocation/Recruitment Incentives: Not authorized

Permanent Change of Station (PCS): Not authorized