• | Participates in rounds when scheduled in their care area |
• | Oversees Pharmacy Resident and PharmD student participation on rounds |
• | Works collaboratively with the interdisciplinary team to maximize individual patient outcomes |
• | Performs and documents medication reconciliation, comparing prescriber’s orders to the patient’s active medication list(s) and working with prescribers to make changes to orders as necessary |
• | Interviews patients upon admission and reconciles medication history against inpatient medication admission orders |
• | Upon transfer, reconciles the inpatient medication profile with medication transfer orders |
• | Reconciles discharge medication orders with inpatient pharmacy profile and admission medication history and performs discharge counseling |
• | Provides updated medication list to the patient upon discharge |
• | Documents these activities in the medical record |
• | Ensures that drug regimen is consistent with all UWHC medication use guidelines and policies (or other evidence-based guidelines in the absence of UWHC-specific guidelines) which includes but is not limited to: antimicrobial use guidelines, intravenous to oral renal dosing, and serum drug concentration protocols |
• | Adjusts regimens based on approved protocols and consultation with the interdisciplinary team |
• | Completion of a daily profile review for each patient consisting of the following elements: |
• | Age, sex, height, weight, and renal/hepatic function |
• | Pregnancy and lactation status |
• | Appropriateness of the dose, route, rate, timing and frequency of administration, indication, and therapeutic duplication of all medications |
• | Available laboratory values and microbiology results |
• | Appropriateness of antimicrobial therapy regimens which may include anticipated/planned stopped dates |
• | Potential drug-drug, disease-drug, food-drug interactions or contraindications |
• | Adherence with UWHC Pharmacy and Therapeutics Committee approved medication use guidelines/protocols |
• | Targeted or therapeutic drug monitoring and pharmacokinetics, and adjustment of drug regimens if necessary |
• | Review documented adverse drug reactions/allergies and report new occurrences via Patient Safety Net (PSN) |
• | Review for disease progression and resolution of symptoms (e.g. pain) |
• | Communication of necessary information to pertinent health care providers, patients, caregivers, and encourage health promotion and prevention |
• | Assesses the patient’s progression to achieving desired medication treatment goals |
• | Reviews all medication orders for appropriate dose, duration, frequency, dosage form and indication |
• | Monitors therapy for potential or actual drug interactions (e.g. drug-drug, drug-disease, drug-allergy, etc.) |
• | Compliance with inpatient drug formulary |
• | Performs patient education |
• | Assesses patient understanding of medication regimen and provides education tailored to the patient through the following modalities: first dose teaching, food-drug interaction counseling, discharge counseling, medication classes, and compliance aids |
• | Answers general and patient specific drug information questions |
• | Provides in-services and lectures to health care team members |
• | Promotes the research mission of the organization |
• | Contributes to the profession by participating in scholarly activities (e.g. professional publications, podium presentations, poster presentations, practice-based research) |
• | Mentors Pharmacy Residents and PharmD students in their pursuit of scholarly activity |
• | Provides didactic training at UW School of Pharmacy as a lecturer and/or faculty in the Pharmacotherapy Lab |
• | Serve as the liaison for inpatient information for central and ambulatory pharmacies |
• | Coordinate drug delivery and documentation |
• | Coordinate the preparation and distribution of all medications |
• | Understand investigational drug protocols and procedures for investigational drug research studies, implementation, administration and record keeping |
• | Understand safety precautions, including hazardous materials handling and proper precautions against blood-born pathogens, as it relates to areas of practice |
• | Monitor medication use system is providing the right patient, right drug, right dose, right route, and right time |
• | Personal continuing education and professional development |
• | Identify and report adverse drug events (adverse drug reactions and medication errors) in the Patient Safety Net |
• | Assure compliance with hospital, integrated health system and department policies and procedures |
• | Monitor compliance with state and federal laws and regulations related to the practice of pharmacy as well as standards and regulations for other regulatory agencies |
• | Participate in department and hospital committees |
• | Provide direct supervision of pharmacy assistant, technician, intern and student daily activities |
• | Assist with the education, training, and development of these individuals |
• | Precept and evaluate Pharmacy Residents and PharmD students on residency/clerkship rotations |
• | Provide community service presentations, drug information and disease prevention programs to consumer and patient groups |