Clinical Pharmacist Specialist

Overview:

The Clinical Pharmacist Specialist is responsible for development, implementation, and documentation of the antimicrobial stewardship program for the Medical Center. This will be accomplished through collaboration, coordination and communication with the System Clinical Pharmacy Manager, staff pharmacists, medical staff and other healthcare workers at each facility. The goals of the program to ensure clinical and microbiological effectiveness of antimicrobials; decrease the emergence of resistance; education of prescribers (including pharmacists, nurses and ancillary healthcare providers) in therapeutically efficacious and cost- effective therapy; decrease adverse reactions and predisposition to secondary infections; improve patient care by shortening length of stay, preventing ADR and secondary infections; promote conversion of intravenous therapy to oral antibiotics; consolidate antimicrobial formulary; control antimicrobial costs. This pharmacist will coordinate the pharmacokinetics service according to the most recent guidelines and recommendations published in pharmacy and medical literature.The pharmacist will assist other hospital personnel in the development of clinical pathways, protocols, polices and procedures and provide advanced education to students, residents, pharmacists, and other health care professionals.

Responsibilities:

Performs assessment/data collection in an ongoing and systematic manner, focusing on the physiologic, psychological and cognitive status of the patient.

Formulates or follows a goal directed plan of care which is prioritized and based on the medical or nursing diagnosis and patient outcomes.

Implements care in a knowledgeable, skillful, consistent and continuous manner by utilization of/adherence to pre-determined standards that define the structure, process and desired patient outcomes.

Evaluates the effectiveness of self and care given by all health care team members, contribution of systems, environment and instrumentation in progressing patients toward goal.

Proficient in dosing/monitoring of medications with an established protocol.

Recommends appropriate antibiotic therapy based upon culture and susceptibility data or suspected infection.

Makes appropriate medication therapy recommendations based upon patient specific information.

Demonstrates ability to adjust doses and choose an appropriate delivery system based on patients age/physical skills utilizing age specific references.

Performs MAR reconciliation in accordance with departmental policy.

Monitors drug therapy regimens for contraindications, drug-

drug interactions, drug-food interactions, allergies and appropriateness of drug and dose.

Acts as a resource for other pharmacists on complicated patients.

Provides the double check as needed on pharmacokinetics consults initiated by other pharmacists to detect calculations errors and assess outcome goals.

Demonstrates knowledge of budget classifications, how to access and prudently use supplies, and the linkage of proper documentation to reimbursement.

Sustains the formulary by minimizing non-formulary procurements, utilizing therapeutic substitution protocols, and promoting rational drug therapy selection.

Documents formulary recommendations for both accepted and rejected recommendations. Completes non-formulary request form as outlined in policy.

Suggests appropriate, cost-effective therapeutic alternatives to medical staff.

Follows all policies and procedures related to inventory management and control.

Tracks and documents cost-savings prospectively and retrospectively by DRG, disease states and specific patient populations and identifies accurate cost indices and accounting methods.

Develops programs that target high-cost and/or specialized antimicrobials. Develops, educates and implements programs and methods that improve antimicrobial selection.

Controls costs by obtaining serum drug levels and laboratory monitoring information when necessary and avoids the use of non-essential orders.

Demonstrates competency in selected psychomotor skills.

Interprets medication orders (verbal and written) accurately. Maintains accurate and complete patient medication profiles.

Assists physicians and nurses with medication reconciliation

Identifies patient/significant others learning needs and implements appropriate measures to meet .

Exercises ability to counsel patients regarding drug therapy when requested.

Effectively identifies and overcomes communication barriers when interacting with patients and family.

Demonstrates awareness and sensitivity to patient/significant others rights and legal issues in all aspects of patient care.

Follows hospital policy when documenting information in the medical record.

Demonstrates an understanding and completes all job functions in accordance with the five patient rights.

Maintains strict confidentiality of patient, visitor, and employee information as described in the HIPAA guidelines.

Maintains patient records containing recommendations for therapy and pertinent information to ensure continuity of care, identification of clinical outcomes and easy attainment as specified by law or department standard, whichever is longer.

Manages situations in a reduced-risk manner and performs efficiently in emergency patient situations following effective protocols/procedures.

Completes a quarterly CE quiz summarizing patient safety info from ISMP, JCAHO, FDA Medwatch and sentinel events.

Uses only approved abbreviations for all communication entered in the medical record.

Follows hospital policy in reporting medication errors and adverse drug reactions.

Reports all required sentinel and near-miss events. Participates in root-cause analyses as applicable.

Demonstrates knowledge of appropriate standards (policies/protocols/procedures) and practices in a manner that demonstrates adequate baseline knowledge. Familiar with age specific needs for the patient population served. This base of knowledge must be mastered by the end of one year.

Attends staff meetings or reads minutes of staff meetings.

Reviews written material and notices posted in the pharmacy and e-mail.

Maintains proficiency in clinical modules required by the pharmacy department.

Completes and documents a minimum of 15 ACPE accredited continuing education hours annually

Promotes critical pathways that encourages the selection of antimicrobials and antimicrobial combinations that delay or prevent the emergence of resistance.

Provides and presents drug monograph information to the P&T committee for medications being reviewed for formulary addition, which require specialized dosing and monitoring.

Develops policies or practices that encourage selection of the antimicrobial regimen for empiric therapy against epidemiologically-proven common etiologic agents (community and nosocomially-aquired) and regimens with the narrowest spectrum of activity based upon culture and sensitivity results.

Demonstrates sound professional judgment consistent with clinical/academic background. Assists pharmacy staff in situations requiring advanced knowledge or judgment in antibiotic selection and clinical pharmacokinetics.

Documents all clinical activities and interventions accurately and completely.

Ensures daily workload/responsibilities are completed as assigned. All appropriate information is handed off to the next shift.

Follows the health system and departmental policies and procedures.

Assists in medication-use evaluations and other Pharmacy and Therapeutics committee activities as requested by the Clinical Manager.

Participates actively in staff development activities for the unit, department and hospital.

Assists in the training of volunteers, students, residents, pharmacy technicians and pharmacists as directed.

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