This document outlines the participation of clinical pharmacists in ward rounds, which are daily assessments of inpatients by healthcare professionals. Key objectives include understanding patient status, providing drug therapy information, optimizing management, and detecting drug interactions. It also details the types of ward rounds, preparation needed for effective involvement, and the importance of communication and follow-up in the pharmacy practice.

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
1. Pre-ward rounds.
2. Registrar/resident rounds.
3. Professor/chief rounds.
4. 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:
 Allergies or hypersensitivities
 The reason for admission
 Provisional or final diagnosis
 Past medical history
 Medications on admission
 Relevant social history
 laboratory data
 Other relevant investigations and reports
 Medication 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.
 Pre-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.
 Pharmacist 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:
i. Active - Personal visits to influence prescribing
ii. Passive - Drug information services
iii. Reactive - Monitoring prescriptions

17. The errors identified by the pharmacist included:
o Incomplete orders
o Wrong dose
o Wrong frequency
o Inappropriate choice
o Duplicate therapy.
The main drug-related queries that may arise during ward rounds
relate to:
 Dose and frequency
 choice of medication
 Adverse effects

18.  Drug interactions
 Formulation
 Duration of therapy
 Actions and uses/pharmacology
 Drug availability/supply
 Identification of patient’s medications on admission
 legal and administrative issues
 Miscellaneous, 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:
1. Responding to enquiries
2. Communicating information - changes in drug therapy
3. Completing documentation-ADRs identified during the
round may need to be documented on an alert sheet.
4. Altering the patient’s care plan
5. Discussions with patients - the reasons for alteration in
therapy, drug administration or self monitoring techniques
and caution regarding likely adverse effects

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

22. HAVE A GOOD DAY!