Therapeutic Drug Monitoring/Internal Medicine Clinical Pharmacist ...

UNIVERSITY OF KENTUCKY HOSPITALPHARMACY SERVICESPOSITION DESCRIPTIONPOSITION TITLE:THERAPEUTIC DRUG MONITORING/INTERNAL MEDICINECLINICAL PHARMACIST SPECIALISTPH-14-40Approved 2/09POSITION PURPOSE AND SUMMARY:1.0 DESCRIPTIONTherapeutic Drug Monitoring/Internal Medicine clinical pharmacist specialist managesthe Clinical Pharmacokinetic/Anticoagulation Service and provides collaborativepharmaceutical care to Internal Medicine patients through clinical services, research, andteaching. In addition, the pharmacist(s) coordinates the Adverse Drug Reaction (ADR)prevention, detection and monitoring program.2.0 QUALIFICATIONS2.1.1 Must possess a Pharm.D. degree.2.1.2 Completion of a Pharmacy Practice Residency2.1.3 Experience and leadership in Clinical Pharmacokinetics/Anticoagulation and/orInternal Medicine preferred.2.1.4 Post-graduate training in Clinical Pharmacokinetics/Anticoagulation and/orInternal Medicine is preferred.2.1.5 Licensed (or eligible) as a pharmacist in the Commonwealth of Kentucky.2.1.6 Maintain competency in unique aspects of clinical pharmacokinetic monitoring,anticoagulation, internal medicine pharmacotherapy, and adverse drug reactionprevention, detection and monitoring.3.0 RESPONSIBILITIESThe major job responsibilities (MJRs) of this position are: management of the ClinicalPharmacokinetics/Anticoagulation Service; pharmaceutical care to Internal Medicinepatients, pharmaceutical care to hospital patients on non-covered medical servicesrequiring clinical pharmacokinetic/anticoagulation monitoring, clinical interventions,cost-effective care analysis, teaching, and pharmacy representation in Medical Centercommittees. In addition, the pharmacist coordinates the Adverse Drug Reaction (ADR)prevention, detection and monitoring program. The following activities are componentsof the position to assist in meeting the major job responsibilities:3.1 Provide cost-effective pharmaceutical care to patients receiving drugs that requireclinical pharmacokinetic/anticoagulation monitoring.3.1.1 Participate in selection of patients receiving targeted drugs and providepharmacokinetic/anticoagulation consultations as required.3.1.2 Conduct direct patient care activities using a consistent approach thatreflects the philosophy of pharmaceutical care and that is performed with

the efficiency and depth of experience characteristic of an experiencedinternal medicine pharmacist.3.1.3 Participate in patient care rounds with Internal Medicine teams throughcollaborative interactions with professional graduate year one pharmacyresidents, clinical pharmacy staff, and pharmacy students.3.1.4 Discuss medication order changes/clarifications with the prescriber,document any changes in patient and pharmacy records, and inform othersof medication order changes.3.1.5 Monitor drug therapy to evaluate appropriateness of use, dose, dosageform, regimen, route, therapeutic duplication, and drug interactions.3.1.6 Demonstrate leadership in the prevention, detection, monitoring,documentation, and reporting of adverse drug reactions and medicationserrors.3.1.7 Coordinate all aspects of the Adverse Drug Reaction (ADR) Programincluding maintenance of the ADR database, encouraging reporting bypharmacists, residents and students and reporting ADR summary reportsto appropriate committees.3.1.8 Maintain and update a patient profiles with demographics, diagnosis,allergies, and current medications.3.1.9 Promote the use of the formulary by converting non-formulary orders toformulary when possible, and coordinates procurement of nonformularydrugs when necessary.3.2 Facilitate discharge for home care patients when appropriate.3.2.1 Work collaboratively with the medical or faculty service to ensureappropriate practice in the ambulatory setting.3.2.2 Coordinate continuity of care for applicablepharmacokinetic/anticoagulation and Internal Medicine patients.3.3 Provide operational support to the pharmacy.3.3.1 Develop and maintain competency in pharmacy practice positionsincluding WORx order entry, Sunrise Clinical Manager and otherapplicable computer systems.3.3.2 Provide coverage of decentralized pharmacy practice positions asdetermined by need.3.3.3 Review select patient medication orders for monitorable drug andanticoagulation therapy for accuracy and appropriateness.3.3.4 Provide timely review of resident on-call reports relative topharmacokinetic and anticoagulation consultations.3.4 Promote and demonstrate rational, cost-effective drug therapy.3.4.1 Identify and implement drug therapy where positive pharmacoeconomicimpact could be achieved. The ultimate goal is to develop and assure costeffective use of drugs requiring clinical pharmacokinetic andanticoagulation monitoring.

3.4.2 Develop and conduct target drug programs and medication use evaluationsas needed and report results to the Pharmacy and Therapeutics Committee.3.4.3 Document clinical interventions and cost avoidance as part of thejustification for the position/service.3.4.4 Monitor the use of expensive medications to assure there is use consistentwith approved criteria.3.4.5 Anticipate changes in drug therapy and report the potential impact it willrepresent to the overall hospital and drug budget.3.5 Take a role in the teaching programs of UKCMC Pharmacy Services and the3.5.1 College of Pharmacy as they relate to clinical pharmacokinetics andanticoagulation. Provide staff development to pharmacists and residentsin the area of clinical pharmacokinetics including annual revision to theClinical Pharmacokinetics Service and Anticoagulation Guidelines.3.5.2 Precept Pharm.D. Clerkship students on the Clinical PharmacokineticsService and Internal Medicine.3.5.3 Precept and mentor professional graduate year one residents.3.5.4 Provide lectures on clinical pharmacokinetics/anticoagulation topics in theAdvanced Pharmacotherapy courses during the 3rd professional yearPharm.D. curriculum.3.5.5 Provide presentations, publications, and other informative activities onclinical pharmacokinetics/anticoagulation and Internal Medicinepharmacotherapy.3.5.6 Seek appropriate academic appointment in the College of Pharmacy.4.0 RELATIONSHIPS4.1 The position will be funded 87.5% by the hospital and 12.5% by the College ofPharmacy.4.2 Will report to the Associate Director of Clinical Services in Pharmacy Services andwill work collaboratively with appropriate medical staff and pharmacy staff.4.3 As a faculty member, will report to the Chair for the Department of PharmacyPractice & Science in the College of Pharmacy.5.0 PATIENT POPULATIONS SERVED5.1 The Pharmacy Department provides pharmaceutical care to neonatal, pediatric,adolescent, adult and geriatric populations. This position provides clinicalpharmacokinetic/anticoagulation and internal medicine services for adult and geriatricpatients.______________________________Associate Director of Clin Pharm Serv___________________________Director of Pharmacy Services