ward round participation.pptx

Clinical Pharmacy plays various roles in a Hospital. Ward Round Participation is one of the primary services provided by Clinical Pharmacy.

1. WARD ROUND PARTICIPATION AMEENA KADAR K A FIRST SEM M PHARM PHARMACY PRACTICE SANJO COLLEGE OF PHARMACEUTICAL STUDIES

2. CLINICAL PHARMACY SERVICES

3. MEDICAL WARD ROUNDS Ward rounds are the routine clinical rounds where the healthcare professionals (a doctor with or without a nurse, pharmacist, or any paramedical staff like technician or physiotherapist) visit the patients in the ward to assess the progress of the health condition of the inpatients. At least one ward round is conducted every day to review the progress of each inpatient, although more than one is not uncommon . It is also utilized as bedside teaching skills in a teaching hospital.

4. Goals and Objectives of Clinical Pharmacists on Ward Rounds Gain an improved understanding of the patient’s clinical status and progress, current planned investigations and therapeutic goals. Provide relevant information on various aspects of the patient’s drug therapy, such as pharmacology, pharmacokinetics, drug availability, cost, drug interactions and adverse reactions Optimize therapeutic management by influencing drug therapy selection, implementation, monitoring and follow-up Investigate unusual drug orders or doses

5. Assimilate additional information about the patient such as comorbidities, medication compliance or complementary and alternative medicine (for example herbal remedies) use that might be relevant to their management Detect adverse drug reactions and drug interactions Participate in patient discharge planning.

6. WARD ROUND CLASSIFICATION   Pre-ward rounds. Registrar/resident rounds. Professor/chief rounds. Teaching ward rounds.

7. PRE-ROUNDS During these rounds, the interns or medical post-graduate students in teaching hospitals perform a daily review of patients in their unit or ward. This is largely a learning opportunity to familiarize themselves with the cases, especially new admissions or transfers, and very few management decisions are made during these rounds. Trainee clinical pharmacists may join the interns or postgraduates in their pre-rounds and complete the patient medication and clinical review at this time.

8. REGISTRAR/RESIDENT ROUNDS In teaching hospitals, the registrars and residents, individually or as a team conduct ward rounds, at least once a day at a fixed time, usually in the morning. In the intensive care unit (ICU), rounds may be conducted several times a day. These rounds are extensive and may also involve clinical teaching to medical postgraduate students and interns. These are useful rounds for clinical pharmacists of all levels too.

9. PROFESSOR/UNIT CHIEF ROUNDS A ward round participation involving PG students, registrars, residents, and experienced doctors together is known as professor/chief rounds. It may be conducted daily, weekly, or monthly. These types of ward rounds become extensive and specialized for discussing complex and complicated problems. It may be difficult for clinical pharmacists to join these consultant rounds due to timing.

10. TEACHING ROUNDS In teaching hospitals, academic medical staff conducts bedside clinical teaching rounds for residents, medical PG students, interns, medical UG students, and Pharm D students. It is usually extensive rounds and is conducted only a few times a week. A clinical pharmacist can join during such rounds but will have limited exposure since this kind of ward rounds do not involve any kind of decision making and interventions.

11. PRE-WARD ROUND PREPARATION Pharmacists need to prepare adequately before participating in ward rounds . Accurate and up to date information on the patient’s health status, disease management and past medical history is essential for effective participation in clinical decision making. To achieve this a review of the medication chart and case record should be completed prior to the ward round. Pre-ward round participation gives an overview of the drug and disease related issues that may arise during a ward round.

12. Many clinical pharmacists maintain individual patient profiles which summarize information relevant to the patient’s drug therapy. This includes: A llergies or hypersensitivities T he reason for admission Provisional or final diagnosis Past medical history Medications on admission Relevant social history laboratory data Other relevant investigations and reports M edication compliance

13. Patient Profile Form

14. For all newly admitted patients, it is appropriate to collect a detailed medication history from the patient or their carers, which needs to be cross-checked with information collected by other healthcare professionals. Any relevant new information obtained during the medication history interview which may change patient management (for example, history of allergy to a medicine) should be brought to the attention of the appropriate healthcare professionals and used to update existing patient profiles. P re-ward round preparation allows the pharmacist to be well informed and organized about the patient.

15. Practical tips for ward round participation Pharmacists should complete their pre-ward round preparation well ahead of commencement of the round. P harmacist should ensure that all prescriptions are in accordance with the hospital formulary. Clinical pharmacists may wish to carry appropriate references while working in wards, Eg. BNF, up-to-date clinical guidelines, Drug Information Books., etc. When identifying potential problems such as drug interactions, adverse reactions and medication errors, pharmacists should be prepared to suggest alternatives to resolve the problem.

16. Pharmacists should avoid the temptation to enter discussions concerning diagnosis. The one exception to this is where a patient’s symptoms or signs are possibly drug-related. Interventions during ward rounds A pharmacist intervention is defined as any action by a pharmacist that directly results in a change in patient management or therapy . Types: Active - Personal visits to influence prescribing Passive - Drug information services Reactive - Monitoring prescriptions

17. The errors identified by the pharmacist included: I ncomplete orders W rong dose Wrong frequency Inappropriate choice D uplicate therapy. The main drug-related queries that may arise during ward rounds relate to: Dose and frequency choice of medication A dverse effects

18. D rug interactions F ormulation D uration of therapy A ctions and uses/pharmacology D rug availability/supply I dentification of patient’s medications on admission legal and administrative issues M iscellaneous, such as storage conditions

19. Communication during ward rounds Effective communication skills and clinical knowledge are pre- requisites for effective participation ward rounds. Good interpersonal relationships are a key of success. 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 . Interventions or recommendations made by the pharmacist should be made in a diplomatic way, which shows respect for the physician’s clinical acumen and experience, and should not challenge a medical practitioner’s integrity.

20. WARD ROUND FOLLOW-UP Clinical pharmacists often encounter issues during a ward round that require some follow-up. Some of the outstanding issues that may arise during a ward round include : Responding to enquiries Communicating information - changes in drug therapy Completing documentation- ADRs identified during the round may need to be documented on an alert sheet. Altering the patient’s care plan Discussions with patients - the reasons for alteration in therapy, drug administration or self monitoring techniques and caution regarding likely adverse effects

21. REFERENCES A Textbook of Clinical Pharmacy, Essential concepts and Skills by G Parthasarathy , Karin Nyfort -Hansen, Milap C Nahata . 2 nd Edition. Pg No:211- 221. https:// www.14impressions.in/2020/12/goals-classification-interventions-and.html#point0

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