Ward round participation

Definition of the ward round
Clinical Pharmacist in ward round
Ward round in Indian Scenario
Types of Ward round

1. WARD ROUND PARTICIPATION
Dr. RameshBhandari
Asst. Professor
Department of Pharmacy Practice
KLE College of Pharmacy, Belagavi

2. Medical Ward Round
Awardroundisavisitmadebyamedicalpractitioner,aloneorwithateam
ofhealthprofessionalsandmedicalstudentstohospitalinpatientsattheir
bedsidetoreviewandfollow-upprogressintheirhealth.
Atleastonewardroundisconductedeverydaytoreviewtheprogressof
eachinpatient.Howevermorethanoneisnotuncommon.

3. Ward Round
Variouscountrieshasshownpharmacistparticipationinwardroundhelps
patientaswellasotherhealthcareprofessionals.
Additionofpharmacistparticipationinwardroundshelpsensuresafe,
effectiveandeconomicuseofdrugswhichultimatelyresultsindecreased
adversedrugevents,improvedpatientcare,reducedlengthofhospitalstay
andreducedhealthcarecost.

4. Goals/objectives of Clinical Pharmacist on Ward Round
Gainanimprovedunderstandingofthepatient’sclinicalstatusand
progress,currentplannedinvestigationsandtherapeuticgoals.
Providerelevantinformationonvariousaspectsofthepatient’sdrug
therapy,suchaspharmacology,pharmacokinetics,drugavailability,cost,
druginteractionsandADRs
Optimisetherapeuticmanagementbyinfluencingdrugtherapyselection,
implementation,monitoringandfollow-up.

5. Goals/objectives of Clinical Pharmacist on Ward Round
Investigateunusualdrugordersordoses
Assimilateadditionalinformationaboutthepatientsuchasco-morbidities,
medicationcomplianceorcomplementaryandalternativemedicineusethat
mightberelevanttotheirmanagement.
Detectadversedrugreactionsanddruginteractions
Participateinpatientdischargeplanning

6. Ward Rounds: Indian Scenario
Primary care clinic
Primary care hospital
Secondary care hospital
Tertiary care hospital

7. Referral centresfor complex
medical or surgical cases.
Each specialty has multiple
units where individual units
are headed by a senior
specialist.
Senior practitioners of
these units with academic
responsibilities at an
affiliated medical college
are involved in clinical
teaching at bedside.
Tertiary care hospital
Have general surgical and
medical teams for patients
admitted with various surgical
problems.
One specialist in general
medicines who treat the most
of the common medical illness
Can refer to higher centre.
Secondary Care hospital
Primary care hospital also
called as nursing home
Take responsibility of early
management of patients and
treating those with minor
ailments.
General physicians are
responsible for the
management of these
patients.
Refer to the higher center for
complication cases.
Primary Care Center

8. CLASSFICATION OF WARD ROUND
1.Pre-rounds
2.Registrar/resident rounds
3.Professor/unit chief rounds
4.Teaching rounds

9. 1. Pre-rounds
Interns or post graduates students perform a daily review of
patients in their unit or ward.
Learning opportunity to familiarise themselves with the cases
Trainee clinical pharmacists may join the intern or
postgraduates in their pre rounds and complete the patient
medication and clinical review.

10. 2. Registrar/resident rounds
Registrar or resident individually or in a team conduct ward
rounds at least once a day at a fixed time.
These rounds are extensive and may also involve clinical
teaching to medical postgraduate students and interns.
Useful rounds for clinical pharmacists of all level of
experience to join.

11. 3. Professor/unit chief rounds
Unit/ward chief conducts the round together with their registrar,
residents, postgraduate students and interns for all the patient
under their care.
These rounds are extensive and address more complex issues
regarding diagnosis and management.
These rounds may be more challenging for clinical pharmacists in
terms of their clinical knowledge.

12. 4. Teaching rounds
In teaching hospitals, academic medical staff conduct bedside
clinical teaching rounds for residents, medical postgraduate
students, interns and medical undergraduate students.
Conducted few times a week
These round provides opportunity for pharmacist to improve
their clinical knowledge.

13. Pre-ward round preparation
Prepare adequately before participating in ward rounds.
Accurate and up-to-date information on the patient’s health
status, disease management and medical and medication history
is essential for active participation in clinical decision making.
Review of the medication chart and case record should be
completed prior to the ward round.

14. Pre-ward round preparation
Clinical pharmacist may maintain individual patient profiles
for summarizing information relevant to the patient’s drug
therapy.
If any issues may arise that need to be clarified by referring
appropriate information resources.

15. Intervention during ward round
A pharmacist intervention is defined as any action by a
pharmacist that directly results in a change in patient
management or therapy.
Opportunities for intervention may arise during various
clinical pharmacy activities including medication history
interview, medication chart review, therapeutic drug
monitoring, provision of drug information.

16. Intervention during ward round
Intervention done by pharmacist can be active or passive or
reactive.
Decision are made regarding inpatient management during
ward rounds and clinical pharmacists participating on ward
rounds may influence these decisions.

17. Ward round follow-up
Clinical pharmacist often may encounter issues during ward
round which may require follow-up.
Pharmacist should prioritise these issues according to their
urgency and relevance.
Eg; Responding to enquiries, communicating information,
completing documentation, altering the patient care plan etc.

18. REFERENCE
G.Parthasarathi,KarinNyfortHansen,MilapCNahata.Atextbookof
clinicalpharmacypracticeEssentialconceptsandskills.Universities
Press.2
nd
edition.