Clinical Pharmacist- Anticoagulation

Note: This is a long-term assignment, and candidates will be offered all the federal benefits, including PTO's

Work Schedule: Monday through Friday between the hours of 07:00-17:00

Job Description:
Clinical Pharmacist – Anticoagulation and Pain Management

Degree/Education Doctor of Pharmacy (Pharm.D.). Graduate from a college or university accredited by the Accreditation Council on Pharmaceutical Education (ACPE). The pharmacist must hold a Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy with an Anticoagulation (AC) Therapy Management Certification or continuously employed in the practice of AC. Certification in Diabetes Management or continuous employment in the practice of diabetes therapy is also preferred.

Certifications: Candidate shall hold and maintain Basic Life Support (BLS) is required. Certifications must be through American Heart Association or client guidelines. Member must present proof of current certification(s) through American Health Association or client. Computer- based training does not constitute fulfilling the training requirements. Must maintain currency at NO cost to the government.

Experience: As required to meet clinical competency requirements specified in the Service-specific credentialing instructions. Minimum 12 months experience working with chronic pain and/or palliative care medicine. Must have minimum of one year of experience AC service and shall have been actively employed in the practice of pharmacy or in training for 24 of the last 36 months. Must also have sufficient experience within the past 24 months in actively performing as a pharmacist.

Board Certification: Board certification in one or more of the pharmacy specialties recognized by the Board of Pharmaceutical Specialties, or completion of a clinical pharmacy residency or fellowship accredited by the American Society of Health System Pharmacists or American College of Clinical Pharmacy, or documentation of appropriate education, training, and/or CME in the practice of clinical pharmacy.

Licensure/Registration: A current, valid, unrestricted license to practice Pharmacy in any one of the fifty States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, or the U.S. Virgin Islands.

Roles and Responsibilities:

• Assess patient's response to drug therapy and planning drug therapy based on physician-established diagnoses.
• Order and evaluate laboratory tests necessary to evaluate drug therapy effects and outcomes.
• Initiate, modify, or discontinue medications for ongoing therapy of chronic disease states (e.g., pain, AC, hypertension, hyperlipidemia, diabetes, asthma, polypharmacy, tobacco cessation, refill clinics), in cooperation with the medical staff.
• Work specifically with the chronic pain patient population to initiate, modify, or discontinue chronic pain medications based of clinical response, side effects, and interactions with other medications.
• Assist in developing chronic pain medicine weaning protocols.
• Monitor and manage pharmacotherapy requiring periodic adjustment due to specific or changing pharmacokinetic characteristics (e.g., aminoglycosides, phenytoin, antithrombotic).
• Administer prescription or non-prescription drugs according to established agreements or MTF protocols.
• Assess metabolic needs and order therapeutic enteral or parenteral nutrition products in the inpatient setting.
• Evaluate medical and medication histories for drug-related problems and adjusting drug therapy accordingly.
• Consult with other healthcare providers (e.g., physicians, dietitians, nurses, physical therapists) about patient treatment needs or options.
• Perform a full range of pharmacist procedures.
• Review patient profiles at the time of dispensing to closely monitor medication therapy.
• Ensure prescription directions for use, dose, medication interactions, therapeutic duplications or overlaps, allergy information, age-specific dosage, and other pertinent data are appropriate for individual patients.
• Ensure accuracy of all pharmaceutical products prepared or processed by technical staff.
• Provide education and healthcare related in-service training to clinical staff on new medications on the market; appropriate use of medications; comparison of current medication therapies; and other topics as deemed appropriate by the department head.
• Consult with other specialty practitioners to provide optimal patient pharmaceutical care.
• Document significant medication interactions, and pharmacy interactions with prescribers. Conduct Adverse Drug Reaction (ADR) reporting in accordance with The Joint Commission (TJC) or the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) standards as appropriate.
• Facilitate medical staff drug utilization reviews (DURs) as deemed necessary.
• Participate in facility projects to ensure policy compliance regarding opioids and other initiatives.
• Provide outpatient AC therapy that is consistent with regulatory, accreditation, and professional standards, and provide further services that relate to AC therapy, upon request, to the other members of the medical staff.
• All AC services rendered by the contractor must adhere to current American Society of Health-System Pharmacists (ASHP) and American College of Chest Physicians (ACCP) guidelines.
• • Provide outpatient diabetes therapy that is consistent with regulatory, accreditation, and professional standards, and provide further services that relate to diabetes therapy, upon request, to the other members of the medical staff.
• All diabetic services rendered by the contractor must adhere to pharmacist-managed diabetes care guidelines and protocols, and current American Society of Health-System Pharmacists (ASHP), American Association of Clinical Endocrinologists (AACE), and American Diabetes Association (ADA) guidelines. For all services, the contractor will adhere to DHAPM 6025.13, Department of Air Force Instruction (DAF) 44-102 and (DAF) 44-119 as well as related DHA policies and local Military Treatment Facility (MTF) Instructions.
• Complete unit specific annual training on AC therapy and be cognizant of changes to AC therapy in ASHP and ACCP guidelines and on diabetic therapy and be cognizant of changes to diabetes therapy in ADA and AACE guidelines. The contractor shall provide systematic outpatient AC services and diabetes management services that consist of, but are not limited to, the following authorized activities:

Provide patient assessment for AC therapy including indications for AC therapy, International Normalized Ratio (INR) range and values, concomitant medications and herbal/supplements, recent alterations in diet and alcohol use, medication compliance, patient's level of understanding of therapy, other medical history, lab values pertinent to the patient's AC status, and signs and symptoms of thrombosis or serious bleeding and determine need for physician evaluation. Patients with adverse physical findings will be referred to Emergency Services.

• Provide patient assessment for diabetes management including hemoglobin A1C monitoring, concomitant medications and herbal/supplements, recent alterations in diet and alcohol use, medication compliance, patient's level of understanding of therapy, other medical history, lab values pertinent to the patient's diabetes status, and signs and symptoms of hyper/hypoglycemia and determine need for physician evaluation. Patients with adverse physical findings will be referred to Emergency Services.

Provide education to patients and caregivers. All patients must be provided education on AC therapy and/or Diabetes Management and documented in the patient's medical record.

• For AC therapy: Education must include a review of the indication for AC therapy, INR results and terminology, specified goals and length of AC therapy, drug interactions and concurrent medications, and dietary considerations. The importance of adherence and compliance with AC regimens must also be addressed, as well as cautions regarding alcohol use. Provide AC medication dosing and follow-up instructions and ensure patient fully understands the instructions. Refer new AC patients for either a Coumadin Nutrition class and/or individual counseling, as appropriate, with Nutritional Medicine.

• For diabetes: Education must include a review of indications for treatment modifications or changes, specified goals and length of therapy, drug interactions and concurrent medications, and dietary considerations. The importance of adherence and compliance with diabetic regimens must also be addressed. Provide diabetes medication dosing and follow-up instructions, and ensure patient fully understands instructions.
• Monitor and adjust AC regimens using Outpatient Warfarin Dosing Algorithm and current ACCP and ASHP guidelines.
• Provide recommendations for dosing of AC medications, enter prescriptions for Warfarin via Provider Order Entry (POE) prescription system as needed, evaluate current INR value, and assess the need for changes in the current regimen.
• Determine the frequency of INR testing and follow-up appointments to the AC clinic.
• Monitor and adjust diabetic regimens using current AACE and ADA guidelines.
• Provide recommendations for dosing of diabetes medications, enter prescriptions into prescription system as needed, evaluate current hemoglobin A1C value and assess the need for changes in the current regimen.
• Determine the frequency of hemoglobin A1C testing and follow-up appointments to the diabetes management clinic. Notify the referring provider about patients who are noncompliant with AC regimens and clinic appointments.
• Order appropriate tests necessary to monitor the efficacy or toxicity of AC regimens/Diabetes Management via Point of Care Testing (POCT) or venous blood draws, including prothrombin time (PT)/INRs.
• Notify referring provider if there is evidence of documented or suspected major bleeding, INR levels requiring vitamin K therapy a new medical condition other than AC, hypo/hyperglycemia, and/or other abnormal lab values.
• The contractor must have an approved POCT device in the AC clinic that can produce PT/INR results within 5 minutes.
• Review electronic consults to the AC clinic from referring providers daily. Ensure every consult includes the following information and all the information correctly corresponds to the disease state: Diagnosis/indication for Coumadin therapy, pertinent medical history, current medication, and dose patient is taking, target INR range, and expected duration of AC therapy as well as diagnosis/indication for diabetes management, pertinent medical history, and current medications.
• Document all pertinent information for each patient encounter in the patient's medical record no later than 72 hours after the encounter. The contractor must adhere to coding guidelines.
• Demonstrate the knowledge, skills, and abilities necessary to manage and monitor patients receiving AC/diabetes therapies. This includes the assessment of efficacy and potential toxicity, achievement of therapeutic goals, and evaluation of patient-related variables that affect management.
• Participate in monthly peer reviews. A minimum of 10 patient encounters will be reviewed and signed each month by the assigned clinic Medical Director or their designee.
• Synthesize data from a variety of sources—computerized records, laboratory results, written and verbal information provided by the patient, verbal and written information provided from the provider, and other health care records and make appropriate clinical decisions.
• Demonstrate knowledge of computer operations and proficiency in the use of basic word processing, data entry and automated medical records.
• Participate in the orientation, training, and evaluation of duty performance of newly assigned personnel, as appropriate, by teaching newly assigned staff members unit policies and procedures, location of reference manuals and unit supplies and equipment, and working one-on-one with the new staff members. Evaluate clinical practice by demonstrating tasks and procedures and observing the performance of newly assigned personnel in accomplishing these procedures/tasks.
• Ensure compliance with standards of care and practice in accordance with all established policies, procedures, and guidelines used in the MTF. Provide care within ethical and legal boundaries.
• Effectively communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education, and to benefit the patient/family and organization. Effectively use appropriate communication format in addressing professional issues. Excellent written communication skills are required to perform accurate documentation, both written and electronic.
• Recognize adverse signs and symptoms and react/respond quickly by communicating with other members of the health care team verbally or overhead paging or via telephone in emergency situations.
• Complete orientation and competency verification programs in IAW unit guidelines.
• Only release medical information under the policy and guidelines set forth by the DoD/USAF/facility.
• Prepare all documentation to meet or exceed established standards of the MTF, to include, but not limited to, timeliness, accuracy, content, and signature.
• Complete all facility training requirements within the designated timeframes for each requirement.
• The contractor may augment out-patient pharmacy services only upon request, with adequate notice, and only when mission requirements allow as permitted by the supervisor.
• Perform and maintain data collection in accordance with DoD, USAF, and other specified agency guidelines. Conducts and/or participates in program evaluation as directed.
• Participate in interdisciplinary team meetings, designated facility meetings, and care coordination meetings.
• Treat all staff members and patients with dignity, respect, and in a professional manner always. Internal and external customer complaints are monitored.