Ward Round Participation

Ward Round Participation



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


                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


       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



       Drug availability


       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:


       Registrar / resident rounds

       Professor / chief rounds

       Teaching 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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