Ward Round Participation- Mastering Knowledge and Understanding
Anantha Naik Nagappa and Uday Venkat Mateti
Manipal College of Pharmaceutical Sciences, Manipal University, Manipal-576104
What are ward rounds?
Ward rounds are the routine clinical rounds where the healthcare providers visit the patients in the ward to assess the progress of the health condition of the inpatients. It is also utilized as bed side teaching for interns the clinical skills in a teaching hospital. The doctor led ward rounds comprises of the unit of medicine or any other specialty where in professor, associate professors, assistant professors, senior residents, postgraduates and interns along with pharmacists and nurses observe the patient's condition and assess to decide further therapeutics for the patients.
What are the goals of the ward round participation?
The goal of the ward round is to closely monitor the patient's condition and take immediate intervention to improve the patient condition and avoid death. The doctors are visiting all the patients admitted in their unit in an order beginning from intensive care unit. The patients who are improving are usually visited at the end of the ward round session. Here also there is documented case reports to remind the case history of the patients who quickly updates and is able to change the strategies of treatments.
What are the objectives of the ward round participation?
There are several objectives from ward rounds which is very important activity of hospital based clinical practice. The ward team comprises of doctors, nurses and pharmacists who work in a team with a common objective to ensure safe, effective, economic and patient friendly treatment with knowledge inputs of each professional practice.
What is the role of pharmacist in ward round participation?
The pharmacist being an expert in the matters of drug should be available for the ward round team to decide upon the matters of dosage regimens, formulary interpretations, ADR monitoring, Drug-drug interactions, Drug-food interactions and drug and poison information services. The availability of pharmaceutical services definitely enhances accuracy of treatment, patient safety and efficacy.
What are the communication skills required for the pharmacists in ward round participation?
The pharmacists in ward round should be ready to interact with doctors and nurses who seek the opinion in the matters of drug related issues. The pharmacists should keep himself abashed latest developments in the field of pharmaceutical care and be confident to help the team to take correct decisions. There should not be any lack city or disinterest expressed during ward rounds just for the reason that the patients are closely watching the professionals working on them. The availability of information in public domain can be of great help for the pharmacists to explain and convince the fellow healthcare professionals.
What are the duties of the pharmacists in ward rounds?
The pharmacist in ward round should take to 2 times 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 any possible risk to the patients due to drug administered he will alert the team and prevents the further causality that would have occurred due to non-viability of clinical pharmacy services. In the 2nd round the pharmacist targets the patients prior to discharge and advice the patients regarding discharged medication practice in the rounds. He also motivates to knowledge diet and exercise required for disease management for a patient to be discharged
Specify the importance of ward round participation?
The withdrawal of pharmacists from the ward rounds will be a great loss for the clinical team and the patients. The medication errors, incorrect dosage can bring down the therapeutic outcomes in a negative perspectives. It is well established that the expectations from the patients does not stop at the clinical cure but for a cost effective economic expenses with improved quality of life. The gaps in the knowledge of healthcare practice in disease management can be fulfilled by a qualified pharmacist in a hospital.
What are the practical tips for the pharmacists in ward rounds participation?
The pharmacists during ward rounds should exhibits highest level of professionalism while communicating and answering specific knowledge based enquiries of fellow healthcare professionals. He should be able to assess the urgency of the information, opinion and act quickly without wasting any time. In case the query is to not so urgent he may request the DIC. He should always give an accurate information timely and be known for reliability for quality information and opinion.
How equity in healthcare delivery can be achieved by multi-healthcare ward round participation?
It is usually projected that doctors are all in all as per the finalization of therapeutic decisions but changed times are demanding accountability for the decision takers by doctors. The professional decisions of subject to the consumer right who are demanding a rational evidence medicine to be given them. As a result the equity among health care professionals is a mandatory requirement to achieve the consumer expectations. Hence the style of treatment changed from physician centric to patient centric.
How the ward rounds are going to help the patients?
The patients are looking forward to learn from healthcare professionals regarding what is the status of their health and when they are likely to be discharged from the hospital. They always want to speak to somebody their health and other issues bothering them. They would be happy to meet any healthcare professionals who comes and listens to them. Further the medication review, ADR monitoring and issues of drug-drug interactions and drug food interactions are attended in the course of ward rounds by the pharmacist.
What are the advantage of ward round participation?
The ward round participation brings the current issues and problems faced by healthcare professionals and the patients. It is a planned meeting where a healthcare team share their expertise and decide upon the best possible decision. It is a platform where in the roles and responsibilities of each healthcare professionals are put to practice in the interest of the patients.
Explain how the ward round participation is an educational methodology?
The actual live demonstration of therapeutics is possible, when only the team of healthcare professionals make and observations and explain the case to the interns and students. The students and interns who are participating in ward rounds gets an opportunity and experience to observe and develop the skills of professional practice. For example in a multi-disciplinary ward rounds the pharmacy interns gets an opportunity to observe and understand the skills of prescription analysis which will be referred by physicians to make a note and give feedback. Further the independent ward rounds by a pharmacist will give an opportunity for the pharmacy interns to develop the skills in the area of patient counseling and discharge medication counseling of the patients.
What is the role of preceptors in ward round participation?
The preceptors are the watchdog of professional practice by medical, nursing and pharmacy interns. Preceptors are resource of skills and knowledge who are readily available for interns to answer the doubts and solve the confusion of professional matters arising in the mind of interns while going through ward rounds. Preceptors are usually have the background of doctors, nurses and pharmacists. Here we have understand that the preceptor can be approached by any of the interns to get resolved of the questions. Hence there should be a multidisciplinary of pool of preceptors in the hospital to help and facilities the ward round education.
Is there a necessity for pharmacist to go for independent ward rounds?
The common ward round in a multidisciplinary healthcare team lead by doctors is having the objective of consultation of and multidisciplinary participation in the therapeutic course for example doctor wants to clarify regarding the drug-drug interaction issue he can make request for pharmacist to get the information and resolve. However when pharmacist goes for an independent ward round he interact with the patient and learns the patient experience and grievances due to drugs and suggest interventions to healthcare team hoe to resolve that particular issue.
What is the role of doctors as preceptors for clinical pharmacy interns?
In regular practice doctors are to work under lot of stress and tight time schedule in fact they have to make quick decisions which are not irrational and does not harm the patient safety. They need a good team of pharmacist and nurses who are ready to respond quickly to the need of the minute. Such a team can only be built by continuous practice and rapport. As a professional responsibility and development of experts in pharmacy and nursing. There is a need for doctors to train the pharmacy and nursing interns.
How the ward round participation should be documented by pharmacy interns?
The pharmacy interns are going to practice pharmacy as clinical pharmacist after their training. The ward round documentation should focus on the prescription analysis and the economic issues along with quality of life issues. There is no need to over emphasis the clinical outcomes as these will be documented by regular case record and thoroughly reviewed by nurses and doctors.
Highlight the contribution of pharmacy practice services during Ward round participation
The pharmacist shall be available for the ward round team who are asking for an updated information about drugs and its effects. They have to refer the updated version of formulary Micromedex and other latest information relevant to the intention of query. They should able to summarize the information and delivery it to the healthcare team in a timely simple precise manner so that the health care team can take an indigent decision.
How the ward round participation can improve collaborative care practice?
The ward rounds is a social experiment where the doctors, nurses and pharmacist meet face to face and move along the ward beds during course of ward round journey. They observe and consult each other in the matter of their own professional expertise. Here the need for collaborative care gets intensified and practically happens. The confidence and mutual respect among team members strengthens due to appreciation of importance of contribution in the team.
How the ward round participation can improve medication related problems?
The medication related problems are not usually picked up by doctors or nurses as their professional domains and expertise are beyond the professional practice of nursing and doctors. The not so important medication related problems are usually ignored as the focus of the therapeutic team is on clinical outcomes. For example a patient treated with Streptomycin need to be monitored for signs and symptoms of ototoxicity and nephrotoxicity both these symptoms are likely to be ignored and patient may end up with hearing impairment and damaged kidney. There is a need to monitor the blood concentration of Streptomycin as it never crosses the minimum toxic doses. The pharmacist can be a helping hand in preventing the ADR of Streptomycin by therapeutic drug monitoring of the blood levels never crossing the limits of toxicity.
1. The Society of Hospital Pharmacists of Australia committee of specialty practice in clinical pharmacy. SHPA guidelines for the practice of selected clinical pharmacy activities. Aust J Hosp Pharm. 1990; 20: 248-9.
2. Leon Shargel, Alen H. Mutnick, Peggy C. Yarborough, Comprehensive pharmacy review: Pharmaceutical care and disease state management. 7th ed, Lippincott; 465-73.
3. Mateti UV, Rajesh V, Laddha A, Sharma S, Anantha NN. Activities of Pharm D students in Indian Hospital. Pharma Rev. 2011;7:133-4.
4. Micheal D, Antun D, Margaret C, Sylvia C, Galbraith K, Matthews H. SHPA Standards of Practice for Clinical Pharmacy. J Pharm Pract Res. 2005;35:122-46.