Ward Round Participation
Objective
After completion of this lecture, student will be able to:
• Describe the importance of ward rounds
• Explain different ward rounds
• Describe the significance of ward rounds
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
Ward Round Participation
• Usually at least one ward round is conducted every day 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
• 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
• 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
• Adverse drug reactions
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
• Detect, manage and prevent adverse drug reaction and drug interactions
• Participate in the in-patients discharge planning
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
Pre-rounds
• Usually by interns or medical postgraduate students in teaching hospital
• Only a few management decisions are made during these rounds
• Trainee clinical pharmacists may join the interns or PGs in their pre-rounds and complete the patient medication and clinical review at this time
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 pharmacists of all levels of experience to join
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 daily
• More challenging for clinical pharmacist in terms of their clinical knowledge
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 patient’s
-health status
-disease management and
-past medical history
• Essential for effective participation in clinical decision-making
• Review of the medication chart and the case record should be completed before the ward round
• Pre-ward round preparation gives an overview of the drug and disease-related issues that may arise during a ward round
• 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
• 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, prioritized 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
• 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]
• The major drug-related queries that may arise during ward rounds relate to:
1. Dose and frequency
2. Choice of medication
3. Adverse effects
4. Drug interactions
5. Formulation
6. 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
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
• 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
• 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:
• Responding to enquiries
• Communicating information
• Completing documentation
• Making necessary alterations
• Discussion with the patients
Responding to enquiries
• All unanswered queries, raised during ward rounds should be recorded and followed up at your 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
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
• Example: The reason for alteration in therapy, drug administration or self-monitoring techniques and cautions regarding likely adverse effects
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