1. 1. Ward Round Participation SOURABH KOSEY ASSOCIATE PROFESSOR DEPT.

OF
PHARMACY PRACTICE ISF COLLEGE OF PHARMACY WEBSITE: -
WWW.ISFCP.ORG EMAIL: SOURABHKOSEY@GMAIL.COM ISF College of Pharmacy,
Moga Ghal Kalan,nGT Road, Moga- 142001, Punjab, INDIA Internal Quality Assurance
Cell - (IQAC)
2. 2. Definition A Ward round is a visit made by a medical practitioner, alone or with a team
of health care professionals and medical students to hospital in-patients at their bedside
to review and follow-up the progress in their health. 2
3. 3. 3Introduction  Usually at least one ward round is conducted everyday to review the
progress of each patient outcome.  Pharmacist’s participating in medical ward rounds
promotes health care  Participation of the Pharmacists in ward rounds in various
practice settings helps to provide rational drug use.
4. 4. 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 patient care through the provision of drug information and
promotion of rational use of drugs. 4
5. 5. Goals and objectives 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 5
6. 6. 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 co-morbidities, medication compliance or
alternative medicine use that might be relevant to their 6
7. 7.  Detect , manage and prevent, Adverse drug reaction drug interactions.  Participate
in the in-patients discharge planning 7
8. 8. Ward rounds participation also provides many learning opportunities for pharmacists. It
allows pharmacists to see first hand how drugs are used and prescribed to see the
effects of these drugs on patients 8
9. 9. Classification of ward rounds Classification based on purpose of the round and
composition of the healthcare team  Pre-rounds  Registrar / resident rounds 
Professor / chief rounds  Teaching rounds 9
10. 10. Pre-rounds Usually by interns or medical postgraduates 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. 10
11. 11. 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. 11
12. 12. Professor / chief rounds In teaching hospitals, the chief 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. 12
13. 13. Teaching rounds In teaching hospitals, academic medical staff conducts bedside
clinical teaching rounds for residents, medical PG students, interns ,medical UG students
and PharmD 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 13
14. 14. Pre-ward round preparation Pharmacists need to prepare well before participating in
ward rounds. Accurate and up-to-date information on the patients’ health status, disease
management and past medical history is essential for effective participation in clinical
decision making 14
15. 15. Pre-ward round preparation  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 diseases related issues that may arise during a ward round 15
16. 16. Pre-ward round preparation  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. 16
17. 17. Practical tips for ward round participations  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, ensures that all prescriptions are in accordance with the hospital formulary. 17
18. 18.  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 18
19. 19. Interventions during ward round  A Pharmacy intervention is defined as, any action
by pharmacists that directly results in a change in patients management of therapy. 
Intervention by pharmacist to assist prescribing can take several forms. 19
20. 20. Interventions can be: Active [use of guidelines, particularly backed up by personal
visits in influence prescribing] Passive [drug Information services] Reactive [monitoring
prescriptions] 20
21. 21. Intervention during ward round 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 21
22. 22. 7. Actions and uses / pharmacology 8. Drug availability / supply 9. Identification of
patient’s medications on admission 10. Legal and administrative issues 11.
Miscellaneous such as storage conditions 22
23. 23. Communication during Ward rounds  Clinical Pharmacist should work closely with
other health care staffs to meet the health care needs.  Effective communication skills
and clinical knowledge are pre-requisites for effective participations in ward rounds. 
Good inter-personal relationships are a key of success. 23
24. 24.  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. 24
25. 25.  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. 25
26. 26. Ward round follow-up Completing documentation:  Recommended actions 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 26
27. 27. 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- motivating techniques and cautious regarding likely adverse
effects) 27