2.b ward round participation

A Ward round is a visit made by a medical practitioner, alone or with a team of health care professionals and medical students to hospital in-patients at their bedside to review and follow-up the progress in their health.
Usually at least one ward round is conducted everyday to review the progress of each patient outcome. Pharmacist’s participating in medical ward rounds promotes health care , Participation of the Pharmacists in ward rounds in various practice settings helps to provide rational drug use. Decreases adverse drug events, improve patient care, and reduce length of hospital stay and health care cost

1. WARD ROUND PARTICIPATION Presented by Dr. S P SRINIVAS NAYAK Assistant Professor Sultan – ul-Uloom college of Pharmacy

2. DEFINITION and introduction A Ward round is a visit made by a medical practitioner , alone or with a team of health care professionals and medical students to hospital in-patients at their bedside to review and follow-up the progress in their health . Usually at least one ward round is conducted everyday to review the progress of each patient outcome. Pharmacist’s participating in medical ward rounds promotes health care , Participation of the Pharmacists in ward rounds in various practice settings helps to provide rational drug use . Decreases adverse drug events, improve patient care, and reduce length of hospital stay and health care cost

3. GOALS AND OBJECTIVES 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  drug therapy, pharmacokinetics, cost of drug, ADRs, drug interactions. Optimize therapeutic management by influencing drug therapy selection, drug administration, monitoring and follow-up, Investigate unusual drug orders or doses. 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 drug interactions. And Participate in the in-patients discharge planning 

4. CLASSIFICATION OF WARD ROUNDS Classification based on purpose of the round and composition of the healthcare team PRE-ROUNDS REGISTRAR / RESIDENT ROUNDS PROFESSOR / CHIEF ROUNDS TEACHING ROUNDS

5. PRE-ROUNDS Usually by interns or medical postgraduates 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

6. 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.

7. PROFESSOR / CHIEF ROUNDS In teaching hospitals, the chief 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. 

8. Teaching rounds In teaching hospitals, academic medical staff conducts bedside clinical teaching rounds for residents, medical PG students, interns, medical UG students and PharmD 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  

9. PRE-WARD ROUND PREPARATION Pharmacists need to prepare well before participating in ward rounds. Accurate and up-to-date information on the patients’ health status, disease management and past medical history is 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 diseases related issues that may arise during a ward round

10.  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.

11. PRACTICAL TIPS FOR WARD ROUND PARTICIPATIONS 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, ensures that all prescriptions are in accordance with the hospital formulary. Carry appropriate references while working in the ward [BNF , CIMS ,Drug review ] 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

12. INTERVENTIONS DURING WARD ROUNDs A Pharmacy intervention is defined as, any action by pharmacists that directly results in a change in patients management of therapy . Intervention by pharmacist to assist prescribing can take several forms . Interventions can be : Active [use of guidelines, particularly backed up by personal visits in influence prescribing] Passive [drug Information services] Reactive [monitoring prescriptions]

13. INTERVENTION DURING WARD ROUND THE MAJOR DRUG RELATED QUERIES THAT MAY ARISE DURING WARD ROUNDS RELATE TO: 1 . Dose and frequency 2 . Choice of medication 3 . Adverse effects 4 . Drug interactions 5 . Formulation 6 . Duration of therapy 7 . Actions and uses / pharmacology 8 . Drug availability / supply 9 . Identification of patient’s medications on admission 10 . Legal and administrative issues 11 . Miscellaneous such as storage conditions

14. Communication during Ward rounds Clinical Pharmacist should work closely with other health care staffs to meet the health care needs. Effective communication skills and clinical knowledge are pre-requisites for effective participations in ward rounds. Good inter-personal 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 .

15. 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.

16. Ward round follow-up Responding to quiries missed in ward rounds, changing any therapy plans Completing documentation: Recommended actions 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- motivating techniques and cautious regarding likely adverse effects)

17. Reference A text book of clinical pharmacy practice By G Parthasaradhi , page no. 211 to 225 Assignment: Solve the three cases given at the end. Page 221 – 225 Roll no. 1 to 10 case No. 1 Roll no. 11 70 20 case No. 2 Roll no. 21 to 30 case 3