Ward Round Participation

                
    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.

It is also utilized as bedside teaching skills in a teaching hospital.

Usually, at least one ward round is conducted every day to review the
progress of each patient outcome.
Pharmacists participating in medical ward rounds promote health care.

Goals and Objectives

                   A clinical pharmacist is an important member of the healthcare
team and should attend wards and clinical meetings whenever possible.

The goals of clinical pharmacists participation in ward rounds are to:

To closely monitor the patient's condition and take an immediate intervention
to improve the patient's condition and avoid death.
To gain an improved understanding of patients' clinical status and progress,
currently planned investigations, and therapeutic goals.
To get relevant information on drugs consumed, their effectiveness, and
adverse effects.
Optimize therapeutic management by influencing drug therapy selection,
drug administration, monitoring, and follow-up, investigate unusual drug
orders or doses.
Additional Information about the patient comorbidities, medication
compliance, or alternative medicine use that might be relevant to their
management.
Detect, manage, and prevent adverse drug reactions and drug interactions.

The doctors are visiting all the patients admitted in their unit in an
order beginning from the intensive care unit.
Also, there is a documented case report to remind the case history of
the patients who quickly update and can change the strategies of treatment.
The ward team comprises doctors, nurses, and a pharmacist who work
with a common objective to ensure safe, effective, economic, and patient-
friendly treatment with the knowledge inputs of each professional practice.

Participants in the inpatient discharge planning.

Ward rounds participation also provides many learning opportunities for
pharmacists. It allows the pharmacist to see how drugs are used and
prescribed and see the effects of these drugs on patients.
Ward round participation strengthens the inter-professional ships among
various HCP leading to better healthcare research. 

Classification  
Ward round participation is conducted at secondary and tertiary hospitals.
Classification is based on the purpose of the round and composition of the
healthcare team.
It is as follows:
             Pre-ward rounds.
             Registrar/resident rounds.
             Professor/chief rounds.
             Teaching ward rounds.

Pre-Ward Rounds
Visit the patient ward by the postgraduate students of medical college
and (or) Interns to perform the daily review of patients health status is called
pre-rounds/pre-ward rounds.
Such type of ward rounds are a part of the training of the students.
A clinical pharmacist can accompany the HCP during such ward rounds
but will have limited learning opportunities since during such visits, fewer
decisions of disease management are made.
    
Registrar / Resident Rounds
The visit to the patient ward, daily at a fixed time (usually in the
morning) by registrars and the resident doctors of the 
hospital individually or as a team conducts ward rounds.
Further, such type of ward rounds in the intensive units may be
conducted multiple times a day depending on the seriousness of the patient's
disease.
       Such kind of ward sounds can be very useful for the clinical
pharmacists since they are extensive and involve the teaching of clinical
aspects to PG students.

Professor / 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.
     More challenging for clinical pharmacists 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, 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.

Preward 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 are essential for effective
participation in clinical decision making.
A review of the medication chart and the case record should be completed
before the ward round.
Preward round preparation gives an overview of the drug and diseases
related issues that may arise during ward rounds.
Identify and prioritize drug-related problems.
Prepare re-medical action for the identified drug-related problems.
Maintenance of individual patient profiles that summarize information
relevant to the patient's drug therapy.
Interventions
A pharmacy intervention is defined as any action by pharmacists that directly
results in a change in a patient's management of therapy.
Intervention by pharmacists to assist prescribing can take several forms.

Interventions can be,

Active: Use of guidelines particularly backed up by personal visits in
influencing prescribing. 
Passive: Drug information service. Reactive: monitoring descriptions.

The major drug-related queries that may arise during ward rounds are
related to:
      Dose and frequency,
      Choice of medication,
      Adverse effects,
      Drug interactions,
      Formulation,
      Duration of therapy,
      Action send use/pharmacology,
      Drug availability/supply,
      Indication of patient medication on admission,
      Legal and administrative issues,
      Miscellaneous such as storage conditions.
Role of Pharmacist
The pharmacist being an expert in matters of the drugs should be available
for the word round team to decide upon the matters of dosage regimen,
formulary interpretation, ADR monitoring, drug-drug interactions, drug-food
interactions, and drug and poison information services.
The availability of pharmaceutical services enhances the accuracy of
treatment, patient safety, and efficacy.

Duties of the Pharmacist

The pharmacist in the ward round should take 2 times i.e. one with the
doctors and another one with himself alone.

In the first ward round, he follows the treatment given and checks the
formulary for the dose prescribed.
Further, he may also critically think of any possible risk to the patients due to
the drug administered he will alert the team and prevent the further causality
that would have occurred due to the non-viability of clinical pharmacy
services.

In the 2nd round, the pharmacist targets the patients before discharge and
advises the patients regarding discharged medication practice in the rounds.

He also motivates the knowledge of diet and exercise required for disease
management for a patient to be discharged.