Clinical Pharmacist Medical Center

Overview

The Clinical Pharmacist delivers comprehensive, patient-centered pharmaceutical care across a variety of specialty areas, including Behavioral Health, Critical Care, Emergency Medicine, Infectious Disease, Pediatrics/Neonates, Oncology, Inpatient Transitions of Care, Investigational Drug Services, and Opioid Stewardship, and other. Responsibilities include reviewing and optimizing medication therapy, performing medication reconciliation, monitoring therapeutic outcomes, managing adverse drug events, and providing patient and caregiver education. The pharmacist collaborates with interdisciplinary teams to develop individualized care plans, participates in clinical rounds, and provides drug information and pharmacotherapy recommendations.

Additionally, the role contributes to quality improvement initiatives, policy and protocol development, and clinical projects. The Clinical Pharmacist conducts medication use evaluations and research, and ensures compliance with institutional, state, and federal regulations to support safe, effective, and evidence-based medication use.

• Reviewing patient medication regimens and providing recommendations to optimize therapy based on clinical guidelines and best practices.
• Conducting medication reconciliation to ensure accuracy and safety during transitions of care.
• Educating patients and caregivers on proper medication use, side effects, and adherence strategies.
• Collaborating with healthcare providers to develop and implement patient-specific care plans.
• Monitoring patient outcomes and adjusting therapy as necessary to achieve therapeutic goals.
• Participating in interdisciplinary rounds and providing pharmacotherapy recommendations.
• Providing drug information to healthcare professionals and patients as needed.
• Contributing to quality improvement initiatives related to medication use and patient safety.
• Documenting interventions, clinical assessments, and recommendations in the electronic health record.
• Staying current with developments in pharmacotherapy and evidence-based medicine.
• Serve as a preceptor and mentor for pharmacists, pharmacy residents and students as needed

• Participate in multidisciplinary rounds with the critical care team
• Design, modify, and evaluate medication therapy regimens for critically ill patients patient-specific factors
• Intervene on medication therapy including, but not limited to, renal dosing, anticoagulation choice, dosing, and monitoring, IV to PO interchange, concentration optimization, glycemic control, and pre-admission medication reconciliation
• Perform therapeutic drug monitoring for vancomycin, aminoglycosides, anticoagulants, anti-epileptic medications, and other high risk medications and order labs as necessary
• Prevent, detect, monitor, document and report adverse drug reactions and medication safety events
• Respond to emergency situations including cardiac arrest (Code Blue) and post-arrest targeted temperature management, acute ischemic stroke (Code Stroke), and rapid sequence intubation
• Provide drug information and education
• Patient/family education
• Participate in quality, safety and other project work related to critical care
• Conduct medication use evaluations and research projects in collaboration with other healthcare professionals to identify areas of medication use optimization with publication and/or presentation at local and/or national meetings
• Participate in site and system wide Critical Care committees
• Precept pharmacy residents and pharmacy students