MAJOR DUTIES: This position is responsible for the clinical pharmacy functions of the military treatment facility (MTF). 1. Incumbent serves as the MTF expert on pharmaceuticals, polypharmacy and pharmacotherapeutics. Using an extensive and intensive knowledge of the drugs and other pharmaceuticals available, their nature, actions, and interactions, the incumbent provides authoritative instructions, advice, and assistance to prescribing and dispensing officials on effectiveness, suitability, hazards, appropriateness for the intended use, economy and all other aspects of their use. Prepares and dispenses medications using appropriate techniques and following the health system's policies and procedures. Serves on a variety of committees, boards, and other bodies representing the pharmacy service and providing authoritative input on pharmacy-related matters. a. Monitors the dispensing of all pharmaceuticals in the MTF and allied facilities. When called upon, analyzes patterns and trends to determine appropriate, effective, and economical prescribing and dispensing. Counsels or recommends alternatives that will still satisfy the medical needs of the situation. Looks for indications of misuse or abuse of pharmaceuticals and recommends corrective or remedial activities to ensure compliance with operating instructions and quality assurance criteria and procedures. As needed, provides pharmacy input to quality assurance reviews and similar processes b. Prepares, conducts, or oversees the training of students, physicians, pharmacists, and other health care providers on the use of drugs and other pharmaceuticals. Provides concise, applicable, and timely responses to requests for drug information from health care providers and patients. c. Provides medication use and disease state education to patients and caregivers. Designs medication use and disease state education for patients and caregivers in both individual and group settings that effectively meets their needs. Uses effective patient education techniques to provide counseling to patients and caregivers, including information on drug therapy, adverse effects, compliance, appropriate use, handling, and drug administration. Uses effective strategies for communicating with patients who are non- English speakers or who are impaired (e.g., blind, deaf, cognitively impaired, illiterate). 2. Incumbent participates in at least one of the following advanced practice activities: Conducts Medication Therapy Management (MTM) Services in the ambulatory care setting. MTM is a distinct service or group of services that optimize therapeutic outcomes for individual patients. Incumbent performs the following typical tasks in support of providing MTM services. Performing or obtaining necessary assessments of the patient's health status; formulating a medication treatment plan; selecting, initiating, modifying, or administering medication therapy; and monitoring and evaluating the patient's response to therapy, including safety and effectiveness. Performs a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events; documenting the care delivered and communicating essential information to the patient's other primary care providers. Provides verbal education and training designed to enhance patient understanding and appropriate use of his/her medications. a. Provides information, support services and resources designed to enhance patient adherence with his/her therapeutic regimens; and coordinating and integrating medication therapy management services within the broader health care-management services being provided to the patient. b. Participates as an integrated pharmacist in the acute care setting. Integrated pharmacists are responsible for the clinical and distributive activities of the pharmacy and complete the following tasks daily: Participate as part of the multidisciplinary team on daily rounds. Reviews all patients prior to rounds, assess their current therapeutic plan and document a prospective therapeutic note in the patients chart related to medication therapy and goals including recommendations for medication changes. Reviews non- emergent orders prior to the first dose and assesses these for potential adverse drug events; verifies medications ordered by providers; and completes medication reconciliation for new patients upon admission. Performs renal and hepatic dosage adjustment, if necessary; orders labs that are pertinent to current medication therapy; and completes anticoagulation teaching on patients initiated on anticoagulants in the facility. Reviews patients on antibiotics to determine if the antibiotic is the most appropriate therapy according to antimicrobial stewardship guidance. Completes any pharmacokinetic consults, reporting adverse drug reactions and medication errors. Documents medication therapy notes in the patients chart on a daily basis to address therapeutic outcomes; provides bedside discharge counseling and documents education provided in the patient chart. Contacts discharged patients within 72 hours post-discharge to address any questions the patients have regarding their medication regimens. c. Serves as a Hematology/Oncology specialist. As such, the incumbent utilizes current pharmacokinetics principles and specific patient parameters and interfaces with Hematology/Oncology physicians in the design of drug treatment plans. Prepares complex combination chemotherapy regimens for clinical protocols including new and investigational agents and biologic response modifiers. Monitors drug therapy to assure proper drug therapy and modifies the therapy when it differs from established clinical parameters or protocols. Evaluates drug therapy for proper therapeutic endpoint. Participates in daily rounds to monitor and review drug therapy for rational indications, dosing, adverse drug reactions, drug interactions, I.V. incompatibilities and complications of multiple drug therapies. Evaluates the drug literature in order to compare and contrast therapeutic regimens and use for new and existing products. Provides drug information to physicians, nurses, and patients on investigational drugs being utilized and ensures that up to date information is readily available in the patient care units. Serves as the pharmacy liaison with physicians, nurses, pharmacists, and other staff on the units to resolve any drug related problems. Is responsible for monitoring adverse drug reactions and following established procedures for the reporting of all significant findings to the appropriate oversight activities. d. Serves as an Investigational Pharmacy specialist. As such, is responsible for receipt, custody, preparation, distribution, records, and conditions of use of investigational drugs at the facility. This includes responsibility for coordination of studies within the institution and for assembling, interpreting, and disseminating information regarding investigational drugs to the medical staff, researchers, pharmacists, and nurses. Serves as a representative for the Department of Pharmacy on all committees related to clinical investigation. Serves as a subject matter expert with coordination and completion of responsibilities by investigators and pharmacy services personnel. Participates as an active member of the facility Institutional Review Board (IRB and serves as the facilitys expert for pharmaceutical product development, formulation, and preparation. Assures the safe and accurate preparation of study drugs and continuity in therapy whether personally dispensing such doses or coordinating availability and providing educational training to the medical, nursing, and pharmacy staff. Develops dispensing notebooks for all active studies in uniform format containing concise protocol summaries, dispensing instructions, lists of authorized prescribers, dispensing records, and other information needed by pharmacists; conducts in-service orientation to pharmacy staff on each active protocol. Assures that required investigational drug data records in the dispensing area are current and accurate and makes such data available, with approval through appropriate channels, to the study sponsor and Federal agencies as required. Provides medication information to patients, evaluates the likelihood of patient compliance, and provides suggestions to the patients and the practitioner for improvement of the therapeutic regimen. Counsels patients on the use, proper method of administration of medications, side effects, precautions, and other general information prior to discharge or in an ambulatory setting through verbal and written means. Establishes and maintains a comprehensive pharmaceutical dosing service. Develops individual dosing regimens based upon the pharmacokinetics of drugs employed, disease states, and medication history of the patient. Performs other duties as assigned.