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

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

2. Medical Ward Round
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 progress in their health.
At least one ward round is conducted everyday to review the progress of
each inpatient. However more than one is not uncommon.

3. Ward Round
Various countries has shown pharmacist participation in ward round helps
patient as well as other health care professionals.
 Addition of pharmacist participation in ward rounds helps ensure safe,
effective and economic use of drugs which ultimately results in decreased
adverse drug events, improved patient care, reduced length of hospital stay
and reduced health care cost.

4. Goals/objectives of Clinical Pharmacist on Ward Round
 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 ADRs
 Optimise therapeutic management by influencing drug therapy selection,
implementation, monitoring and follow-up.

5. Goals/objectives of Clinical Pharmacist on Ward Round
 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

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

7.  Referral centres for 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, Karin Nyfort Hansen, Milap C Nahata. A textbook of
clinical pharmacy practice Essential concepts and skills. Universities
Press. 2nd edition.