Ensures safe, appropriate, cost effective medication therapies for patients according to established policies, procedures, and protocols: monitors drug therapy regiments for contraindications, drug-drug interactions, drug-food interactions, allergies, and appropriateness of drug and dose; assists with pharmacokinetics consult service and drug dosing per organizational protocol; reviews/interprets culture and susceptibility data for antibiotic appropriateness and recommends changes, as needed; reads, extracts, and interprets information in patient charts accurately; provides drug information to patients and their families; documents all clinical activities and interventions accurately and completely; participates in quality improvement and medication use review activities of the department. Identifies potential risks to patients: identifies risks to patients in order to reduce incidence of injury; identifies actions to eliminate, minimize or report risks; identifies procedures to follow in the event of an incident; reports processes for common problems, failures and user errors.