Assesses prescribers medication orders with respect to the overall patient therapy to evaluate: known allergies; rational therapy/contraindications; reasonable dose and route of administration; reasonable directions for use; duplication of therapy; drug to drug interactions; drug/food interactions; drug disease interactions; adverse drug reactions; proper utilization, including over-utilization or under-utilization, and use clinical laboratory or clinical monitoring methods to monitor and evaluate drug effectiveness, side effects, toxicity, or adverse effects, and appropriateness to continue use of the drug in its current regimen. Consults with Nursing, Medical Staff and patients regarding medications, orders, drug and pharmaceutical details, patient reactions, errors and complaints and/or the patients' caregivers.