Ward Round Participation

Ward Round
Participation

Content

       Importance
of ward rounds

       Different
types of  ward rounds

       Significance
of ward rounds

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

Introduction

       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
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

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

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

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 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

       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, 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

       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 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

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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