Inpatient Interventions
Date:
Patient's Initials:
Unit/clinic:
Intervention: ADR reported Allergy/disease state contraindication Aleternative Route Recommendation Antibiotic Regimen Change Drug Informatoin Formulary conversion Drug Interaction/Incompatibility Medication history Patient counselling Code particpation Pharmacokinetic consult Renally excreted drug recommendation Therapeutic consult - adjust dose or regimen Therapeutic consult - Nutrition support Therapeutic consult - TPN/PPN electrolyte adjust
Drug:
Explanation:
Intervention Outcome: Accepted Information only Not accepted
Other information:
Student Initials:
Pharmacist's Initials:
Dollars saved? yes no