Clinical Pharmacist Inpatient Transition of Care

Position Summary

The Transitions of Care ( TOC ) Inpatient Pharmacist plays a key role in ensuring safe, accurate, and patientcentered medication management across the continuum of care. This position focuses on admission medication history, admission medication reconciliation support for providers, prior to discharge medication review, and comprehensive discharge medication education. The TOC Inpatient Pharmacist collaborates closely with interdisciplinary teams to reduce medicationrelated errors and improve patient outcomes during care transitions.

The Clinical Pharmacist is responsible for the safe, effective, and fiscally responsible use of medications through the application of clinical knowledge, skills, and professional judgment. The Clinical Pharmacist serves as a patient advocate when planning and implementing pharmacy care by considering each patient's disease states and background. These activities occur in all areas of pharmacy practice throughout the enterprise. The Clinical Pharmacist is legally responsible for the review and approval of all activities related to the dispensing of patient specific medications pursuant to a valid prescription or medication order from a practitioner as defined in ORC 4729, 4715, 4731, and/or 4741.

What You Will Do
Obtain, review, and verify the prior to admission med history list.

• Documenting the compiled medication list, thoroughly analyzing possible drug interactions, evaluating patient compliance, and any medication adherence barriers.
• Implement and operate an evidence-based medication reconciliation system that optimizes available resources, and promote admission and discharge med list review as a focus of performance-improvement activities.
• Support providers with admission order reconciliation and resolve discrepancies between home medications and admission orders.
• Complete discharge medication reconciliation review to ensure accuracy and a clear, errorfree medication list on discharge,
• Provide individualized discharge medication education to patients and caregivers.
• Supervise and guide pharmacy technicians; review and cosign technician documentation and clinical notes.
• Communicate effectively with physicians, nurses, case managers, and other care transitions team members to promote safe and coordinated post- discharge continuum of care.
• Being a productive and efficient team member to meet daily goals and expectations
• Accurate order verification
• Accurate dispensing
• Minimize order turnaround time
• Medication monitoring and documentation
• Documentation of clinical activities
• Documentation and performance of medication reconciliation
• Inventory control and adherence to Hospital Formulary policies

• Adherence to local and system Policies and Procedures

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.