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
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!