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 in-patients at their bedside to
review and follow-up the progress in their
health
 Introduction
Usually at least one ward round is conducted
everyday 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
 Introduction
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 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 various aspects of

drug therapy such as pharmacology,
pharmacokinetics, drug availability, costs, drug
interaction and adverse drug reactions
 Goals and objectives
Optimize therapeutic 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
 Goals and objectives
Detect, manage and prevent adverse drug
reaction and drug interactions

Participate in the in-patients discharge

planning
Ward rounds participation also provides
many learning opportunities for
pharmacists. It allows pharmacist to see
first hand how drugs are used and
prescribed and to see the effects of these
drugs on patients
 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
 Classification of ward rounds
Pre-rounds
Usually by interns or medical postgraduate 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
 Classification of ward rounds
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
 Classification of ward rounds
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
 Classification of ward rounds
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 patients’
health status, disease management and past
medical history is essential for effective
participation in clinical decision making
 Pre-ward round preparation
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
 Pre-ward round preparation
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
Practical tips for ward round participation

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

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. It can be:
Intervention during ward round
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]
Intervention during ward round
The major drug related queries that may arise during ward
rounds relate to:

Dose and frequency

Choice of medication
Adverse effects
Drug interactions
Formulation
Duration of therapy
Intervention during ward round

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
Communication during ward rounds
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
Communication during ward rounds
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:
 Ward round follow-up
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
 Ward round follow-up
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 (eg. The reason for alteration in therapy, drug
administration or self-monitoring techniques and cautions
regarding likely adverse effects)
Thank you