ward Round Participation.pptx

Clinical Pharmacy

1. WARD ROUND P AR T I C I P A T I O N

2. DEFINITION A ward round is a visit made by a medical practitioner, alone or with a team of health professionals and medical students, to hospital inpatients at their bedside to review and follow up the progress in their health . ROLE OF CLINICAL PHARMACIST Clinical pharmacist may participate in ward rounds along with medical staff and monitor the treatment of patients. Pharmacist can identify drug effect modifications due to interactions with several foods, alcohol, smoking, environment chemicals as well as due to pregnancy. Pharmacist may suggest an alternate therapy if applicable and can compile and process data using computers and make it available to the medical staff. Pharmacist can also participate in drug utilization review and patient care audit which assures the quality of drug use in ambulatory patient and to control drug costs.

3. GOALS AND OBJECTIVES OF CLINICAL PHARMACISTS ON WARD ROUNDS Gain 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. Optimize therapeutic management by influencing drug therapy selection, implementation, monitoring and follow- up Investigate unusual drug orders or doses. Assimilate additional information about the patient such as co-morbidities, medication compliance or complementary and alternative medicine use that might be relevant to their management. Detect adverse drug reactions and drug interactions. Participate in patient discharge planning.

4. CLASSIFICATION Ward rounds may be classified according to the purpose of the round and composition of the participating healthcare team. The common types of ward rounds are Pre-rounds Registrar/Resident rounds Professor/Unit chief rounds Teaching rounds

5. PRE-ROUNDS During the rounds, th e inte r ns o r medical PG students in teaching hospitals perform a daily review of patients in their unit and ward. This is largely a learning opportunity and very few management decisions are made during these rounds. Trainee clinical pharmacist also join these rounds. The clinical pharmacist can complete the patient medication and clinical review at this time.

6. REGISTRAR/RESIDENT ROUNDS In teaching hospitals, the registrar/ residents/ individually or as a team conduct ward rounds, at least once a day at fixed time, usually in the morning. 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 of experience to join.

7. PROFESSOR/ UNIT CHIEF ROUNDS The chief of a unit or ward, or the professor in a speciality conducts rounds together with their registrars/residents, post graduate and interns for all patients under their care, on a daily basis or on a few days of each week. These rounds may be more challenging for clinical pharmacists in terms of their clinical knowledge.

8. TEACHING ROUNDS In teaching hospitals, academic medical staff conduct bedside clinical teaching rounds for residents, medical postgraduate students, interns and medical undergraduate students. Though these rounds provide an opportunity for pharmacists to improve their clinical knowledge, they are not the best rounds for making interventions or recommendations.

9. PRE-WARD ROUND PREPARATION 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. A review of the medication chart and case record should be completed prior to the ward round. Issues that arise during pre-ward round participation need to be clarified by referring appropriate information

10. PRE-WARD ROUND PREPARATION In case of newly admitted patients, a detailed medication history need to be collected from the patients or their care givers. Any new information gained during medication history interview should be brought to the attention of the appropriate healthcare professionals and used to update existing patient profiles.

11. PRACTICAL TIPS FOR WARD ROUND PARTICIPATION Pharmacists should complete their pre- ward round preparation well ahead of commencement of the round. In hospitals with a formulary or drug list, the pharmacist should ensure that all prescriptions are in accordance with the hospital formulary. While identifying potential problems such as drug interactions, adverse reactions and medication errors; pharmacist should be prepared to

12. 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. Opportunities for intervention arise during various activities like: 🢝 Me d icat i o n history interview 🢝 Medicatio n char t review 🢝 Thera p euti c dru g monitoring 🢝 Dru g information 🢝 War d roun d p a rt i cipation. Intervention by pharmacist to assist prescribing can be 🢝 Active 🢝 Passive 🢝 Reactive

13. INTERVENTIONS DURING WARD ROUNDS The main drug – related queries that may arise during ward rounds relate to: 🢝 Dos e a n d freq u e n cy 🢝 C h oic e o f me d i c ation 🢝 Adv e rs e effects 🢝 Dr u g i n tera c tions 🢝 Form u lation 🢝 D u ratio n o f ther a py 🢝 Actions a n d u ses/p h ar m a c ology 🢝 Dr u g a v ail a bilit y /s u pply 🢝 Id en ti f i c atio n o f patie n t’ s me d i c ation s o n ad m ission 🢝 L ega l a n d ad m i n istra t iv e issu e s 🢝 M isc e lla n eo u s, su c h a s s t orag e co n ditions

14. INTERVENTIONS DURING WARD ROUNDS Recommendations or interventions made during ward rounds need to be prioritized according to their clinical significance and likely patient benefits. Interventions are more likely to be successful when pharmacist recommend solutions / alternatives for the drug therapy problems identified.

15. COMMUNICATION DURING WARD ROUNDS Effective comminication skills and clinical k n o w led g e are prerequisites for effective participation. Pharmacists need to take an active role in patient care by conveying their views on patient management to other healthcare professionals. Good inter-professional relationships are key for success. English is the official language of communication among healthcare professionals during ward rounds. Knowledge of regional language is an added quality as most of the time the clinician talk to the patients in their regional language. Pharmacists should be cautious while discussing drug-related issues on the ward round in the presence of patients or their care givers. Interventions should be made in a diplomatic way, which shows respect for the physician’s clinical experience and should not challenge a medical practitioner’s integrity.

16. WARD ROUND FOLLOW- UP Clinical pharmacists often encounter issues during a ward round that require follow-up Pharmacist should prioritize these issues according to their urgency and relevance.

17. ISSUES THAT REQUIRE FOLLOW-UP Responding to enquiries Communicating information Completing documentation Altering the patient’s care plan Discussion with patients