Participate in all aspects of comprehensive clinical pharmacy services including rounds with medical teams, pharmacokinetic consultations, parenteral nutrition consultations, anticoagulation management, antimicrobial stewardship monitoring, medication reconciliation, discharge counseling, documentation of clinical interventions in the identified data base, and compliance with clinical pathways and protocols. Process prescriber orders in the identified pharmacy information systems in an effective, efficient, timely, safe and accurate manner to ensure the appropriateness of the indication, dose/frequency, route, interactions, dose adjustment, physical and therapeutic incompatibilities, side effects, duplicate therapies, and cost-effectiveness.