Leaders in health-system pharmacy are challenged to maintain the highest quality pharmacy service at the lowest cost. Clinical pathways are evidence-based road maps that assist in reducing variations in clinical practice. Integration of clinical pathways within the electronic health record further helps to facilitate evidence-based practice. This article reviews the evolution of the clinical pathways, describes their clinical and economic impact, and identifies ways pharmacy directors can successfully implement these pathways into their institutions. Pharmacy directors can utilize their skills in this area or task clinical pharmacists to serve as members of the clinical pathway development team to further enhance patient-centered pharmacy services.

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ultrasound findings done in ED by the emergency resident, conventional ultrasound findings, disposition and outcomes. Based on these findings the patients were classified into mild and severe groups, early onset and late onset groups, primary and secondary DF groups.Results: During our study period, 482 patients presenting with features suggestive of dengue were evaluated and treated in the ED. According to the inclusion criteria, 140 patients (29.04%) were eligible for the study. Most of the patients presented within the febrile phase of dengue fever between 1 and 7 days (83.6%) when compared to convolascent phase (16.4%). Male sex (61.4 %) were most commonly involved. The majority of patients had gallbladder wall thickening (86.4%), Ascitis (68.6%) and pleural effusion (45.7%) identified on ultrasounds during their febrile episode. Gallbladder wall thickening (>5mm) with or without polyserositis indicates a high risk for developing DHF or DSS. Most of the ultrasound findings were present in severe DF, early-onset DF and primary group of DF with significant p-value <0.05. The majority of patients (60.71%) were admitted to the intensive care; 4% died during the hospital course.Conclusions: Our study showed that the point-of-care ultrasound of chest and abdomen can be used an initial supportive investigation modality in suspected dengue fever to detect early signs and severity of disease. In clinical practice it is difficult to predict which dengue patient will develop severe complications. Transient plasma leakage into serosal cavities, which may progress to life-threatening hypovolemic shock, is a hallmark of severe dengue. But ultrasound will help in preventing cases from progressing to hemorrhagic fever or dengue shock syndrome as laboratory markers indicating plasma leakage, such as hematocrit are rarely of clinical benefit. More research is needed for evaluation of the exact day of dengue infection at which the plasma leakage were detected initially.