Ward Round Participation
Content
Importance of ward rounds
• Different types of ward rounds
• Significance of ward rounds
Objective
After completion of this lecture, student will be able to:
• Describe the importance of ward rounds
• Explain different ward rounds
• Describe the significance of ward rounds
Definition
A ward round is a visit made by a medical practitioner, but
usually a physician with a team of health professionals and
sometimes with medical, pharmacy students etc., to hospital in-
patients at their bedside to review and follow-up the progress in
their health.
Introduction
• Usually at least one ward round is conducted every day to
review the progress of each patient outcome
• Pharmacist’s participation in medical ward rounds in the
United States and United Kingdom dates back to the 1970s
• Participation of pharmacists in ward rounds in various practice
settings helps to promote rational drug use
• Decreases adverse drug events, improve patient care, and
reduce length of hospital stay and health care cost
• Enables pharmacist to contribute prospectively to
patient care through the provision of drug information and
promotion of rational use of drugs.
Goals
• The goals of clinical pharmacist’s participation in ward
rounds are to
• Gain an improved understanding of patient’s clinical
status and progress, current planned investigations
and therapeutic goals
Provide relevant information on various aspects of drug therapy
such as
• Pharmacology
• Pharmacokinetics
• Drug availability
• Costs
• Drug interaction
• Adverse drug reactions
Optimize therapeutic Regimen and management by
influencing
• Drug therapy selection
• Drug administration
• Monitoring and follow-up
• Investigate unusual drug orders or doses
• Assimilate additional information about the patient co-
morbidities, medication compliance or alternative
medicine use that might be relevant to their management
• Detect, manage and prevent adverse drug reaction and drug
interactions
• Participate in the in-patients discharge planning
Classification of ward rounds
Classified based on purpose of the round and composition of the
healthcare team:
• Pre-rounds
• Registrar / resident rounds
• Professor / chief rounds
• Teaching rounds
Pre-rounds
• Usually by interns, medical postgraduate students and
clinical pharmacy students in teaching hospital
• Only few management decisions are made during these
rounds
• Trainee clinical pharmacist may join the interns or PGs in
their pre-rounds and complete the patient medication and
clinical review at this time
Registrar/resident rounds
• In teaching hospitals, the registrars and the residents
individually or as a team conduct ward rounds
• At least once a day at a fixed time usually in the morning
• Useful rounds for clinical pharmacist of all levels of experience
to join
Professor / chief rounds
• In teaching hospitals, the chief of a unit or the professor in
a specialty conducts rounds together with other healthcare
professionals
• Conducted for all patients under their care on a daily basis
• More challenging for clinical pharmacist in terms of their
clinical knowledge
Teaching rounds
• In teaching hospitals, academic medical staff conducts
bedside clinical teaching rounds for residents, medical PG
students, interns and medical UG students. It is usually
extensive rounds and is conducted only a few times a week
• It provides an opportunity for clinical pharmacist to improve
their clinical knowledge.
•
Pre-ward round preparation
• Pharmacists need to prepare well before participating in ward
rounds
• Accurate and up-to-date information on the patient’s
-health status
-disease management and -past medical history
• Essential for effective participation in clinical decision making
• Review of the medication chart and the case record should
be completed prior to the ward round
• Pre-ward round preparation gives an overview of the drug
and disease related issues that may arise during a ward
round
• Identify and prioritize the drug related problems
• Prepare remedial action for the identified drug related
problems
• Maintenance of individual patient profiles, which summarize
information relevant to the patient’s drug therapy
Practical tips for ward round participation
• Complete the pre-ward round preparation well ahead of
the commencement of the round
• Prioritize the ward round (in case of more) to those rounds in
which you can contribute more
• In hospitals with a formulary, ensure that all prescriptions are
in accordance with the hospital formulary
• Carry appropriate references while working in the ward [BNF,
CIMS, Drug review] Hospital Formulary.
• If potential DRPs identified, prepare to suggest alternatives to
resort the problem
• If many DRPs are identified, prioritize them and discuss the
most important DRPs
• Avoid entering into discussions concerning diagnosis
Intervention during ward round
• A pharmacy intervention is defined as, any action by
pharmacist that directly results in a change in
patient’s management or therapy
• Intervention by pharmacist to assist prescribing can take
several forms.
• Active - [use of guidelines, particularly backed up by personal
visits to influence prescribing]
• Passive - [drug information services]
• Reactive - [monitoring prescriptions and seeking
amendment of those that are unclear, inadequate or
inappropriate]
• The major drug related queries that may arise during ward
rounds relate to:
1. Dose and frequency
2. 2. Choice of medication
3. Adverse effects
4. Drug interactions
5. Formulation
6. Duration of therapy
• Actions and uses/pharmacology
• Drug availability/supply
• Identification of patient’s medications on admission
• Legal and administrative issues
• Miscellaneous such as storage conditions
Communication during ward rounds
• Clinical pharmacist must work closely with other health
care professionals to meet the health care needs
• Effective communication skills and clinical knowledge
are pre-requisites for effective participation in ward
rounds
• Good inter-professional relationships are a key of success
• Try to resolve differences in opinion in a direct manner but
in a way that conveys respect for others
• Learning of regional language helps the pharmacist to
follow the conversation between the clinicians and the
patients
• It also helps you to interact effectively with the patients
• Be cautious while discussing drug-related issues on the ward
round in the presence of patients
• Avoid bluffing or guessing, but rather undertake to
retrieve the relevant information and then communicate the
same to the prescriber.
• Not to challenge a medical practitioner’s integrity
Ward round follow-up
Clinical pharmacist often encounters issues during a ward round
that require some follow-up. It includes:
• Responding to enquiries
• Communicating information
• Completing documentation
• Making necessary alterations
• Discussion with the patients
Responding to enquiries
• All unanswered queries, raised during ward rounds
should be recorded and followed up at the earliest
convenience.
• Responses may be given over the telephone, by e-mail, in
print or in person, as appropriate.
Communicating information: In some instances, the clinical
pharmacist may need to communicate changes in drug
therapy made during ward rounds to relevant health care
professional
Completing documentation:
Recommendations or interventions made by the pharmacist
during a ward round may need to be documented
appropriately.
Making necessary alterations:
The pharmacist may need to make alterations to the
patient’s care plan to meet the requirements resulting from
changes in patient management.
Discussion with the patients:
• If appropriate the pharmacist should discuss drug therapy
issues with the patients.
• Example: The reason for alteration in therapy, drug
administration or self-monitoring techniques and cautions
regarding likely adverse effects.