Medication Therapy MonitoringEnsures that drug regimen is consistent with all Sharp medication use guidelines and policies (or other evidence-based guidelines in the absence of Sharp-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 resultsAppropriateness of antimicrobial therapy regimens which may include anticipated/planned stopped dates.Potential drug-drug, disease-drug, food-drug interactions, or contraindications.Adherence with Sharp 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.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. Services (dealing with internal customers within the pharmacy department):* Clearly communicates goals and instructions to other staff members* Provides relevant handoffs between shifts (written/oral)Effectively intercepts and troubleshoots problems, as demonstrated by effective problem solving, prioritization of issues with respect to level of significance and impact to patient care, safety, workflow, and communication.When faced with complex situations, has knowledge of and applies the appropriate policies and procedures including but not limited to Chain of Command escalation.Effectively evaluates ongoing workflow issues and directs daily workload to achieve efficiency and maximize resource utilization as business needs require.Attends and participates in staff meetings or reviews staff meeting communications.Reads work related email at a minimum on assigned workdays, responding in a professional and reasonable timeframe.