Clinical Pharmacist

Pharmacy Clinical Duties

The incumbent is responsible for analyzing real and potential drug-related problems and implementing corrective action to ensure that patients receive optimal drug therapy. The clinical pharmacist also applies standards relating to all aspects of the distribution and manages both controlled and non-controlled drugs.

The primary function of a clinical pharmacist is to assure the safe and appropriate use of medications, and to be an advocate of rational drug therapy through the following:

• Assessing the appropriateness of drug therapy.
• Individualizing drug therapy based on patient specific factors.
• Dispensing medication and providing drug information.

A pharmacist in this assignment handles routine medication-related activities in accordance with all applicable local, state, federal and Veterans Integrated Service Network (VISN) rules and regulations. This includes, but is not limited to:

Reviewing, interpreting, and verifying medication orders for appropriateness. Processing and filling medication orders. Interacting with and making recommendations to other clinical staff regarding medication therapy which ensures safe and effective care. Reviewing the patient's medications, allergies, laboratory results, and other pertinent information from the medical record to identify and solve medication-related problems by contacting providers as appropriate. Documenting recommendations and interventions. Providing refill extensions and partial medication supplies. Taking health and medication histories. Performing medication reconciliation. Assisting in formulary management including therapeutic substitutions, non-formulary reviews and medication usage evaluations. Documenting and assessing adverse drug events (ADEs). Assisting in medical emergencies. Providing oversight of technical staff in all aspects of medication preparation and distribution.

The clinical pharmacist provides appropriate drug selection based upon the principles of pharmacokinetics and pharmacodynamics, monitors for efficacy, side effects and clinical outcome, and advises prescribers as appropriate. The clinical pharmacist provides patient-specific therapeutic drug monitoring and communicates both orally and in writing relevant findings and/or recommendations. Monitoring will include prospective review and intervention in:

• Therapeutic appropriateness of a patient's drug regimen.
• Any therapeutic duplication in the patient's drug regimen.
• Appropriateness of the route and method of administration.
• Extent of patient compliance with the prescribed drug regimen.
• Drug-drug, drug-food, drug-laboratory, or drug-disease interactions.
• Clinical and pharmacokinetic laboratory data to evaluate the efficacy of drug therapy and to anticipate side effects, toxicities, or other adverse effects.
• Physical signs and clinical symptoms relevant to the patient's drug therapy.

The clinical pharmacist participates in patient care rounds, chart reviews, evaluates pertinent laboratory data, drug-drug and drug-nutrient interactions, monitors for adverse drug effects, and screens for allergies and performs medication reconciliation at all transitions of care, including updating the medication profile to reflect an accurate, active list of VA and non-VA medications and assesses drug safety and efficacy, including evaluation of physical symptoms, participates in the medical center medication utilization evaluation (MUE) program and in medical emergencies including code teams (if BLS or ACLS certified) and emergency preparedness activities. The clinical pharmacist provides pharmacokinetic consultation including dosing vancomycin and aminoglycosides in accordance with Harbor policy. The clinical pharmacist manages recalls and medication shortage situations by substituting alternate dosage strengths or suggesting alternative drugs and extends refills until the next scheduled appointment under the provider's name per Harbor policy. The clinical pharmacist serves as a role model and preceptor to pharmacy students and residents. The clinical pharmacist assumes an active role in staff development and provides educational in-services to nursing, medical staff and other ancillary services. The clinical pharmacist is responsible for maintaining professional competency by keeping abreast of current medical and pharmaceutical literature, new drugs and therapies, and applying this knowledge in daily duties.