GLIMPSES FROM FORUM - Pharmacists Involved in Doctors' Ward Rounds 1978

This article was published in the November 1978 issue of FORUM. It was written  by Cyndy McKeown, senior pharmacist at a provincial hospital in Durban.

 

PHARMACISTS INVOLVED IN DOCTORS' WARD ROUNDS

 

Pharmacists and trainee pharmacists at this provincial hospital are in the fortunate           position of having received an invitation to accompany doctors on their ward rounds.  As a result, we are included in neurosurgery, cardio-thoracic and plastic surgery ward consultations.

 

Twice a week, we attend the neurosurgery rounds, which involves, on the one occasion, a complete assessment of alI the cases in both the ward and the intensive care unit attached to the neurosurgery ward, while on the second occasion we are involved in a teaching round. These ward round s are conducted by a consultant neurosurgeon, and are attended by other   consultants, registrars and an anaesthetist.  Those of  us attending these ward rounds feel that we have  earnt a great deal, as we are not only involved and included in the discussions around each bedside and have learnt to recognise various diagnostic neurological features and symptoms, but a tremendous bond of respect has sprung up between the neurosurgeons  and ourselves. The surgeons and registrars are now far more approachable and don't hesitate to raise any  query which they think we might be able to solve.

 

We have become so much part of the medical team on these neurosurgery rounds that we have been taken to see various operations, following discussion on the ward round, and when emergencies arise with a patient having a C.T. brain scan, we are automatically included in the team which rushes  to the scan area to assess the patient. Plans for the future involve the inclusion of one pharmacist on one of the surgical teams for a   month at a time.   During this period, the pharmacist will be instructed on taking case sheets of patients on admission and will be consulted on medication for the patient.

 Our inclusion once a week in the cardio-thoracic ward round has resulted in us gaining a far greater understanding of and ability to interpret X-Ray films. It is amazing how clear terms such as "open  drainage"     and "closed drainage" of empyemas become, once you have actually seen them being carried out. We have even been able to hear through a stethoscope the 11whooshing' of blood through a gash in the septum of the heart, caused by a knife thrust. At the same time, we have been consulted on drugs for anaerobic and fungal infections, as well   as the treatment of tuberculosis.

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The plastic surgery ward rounds, which take place twice a week, have proved especially interesting and stimulating, as we have not only gained an insight into the drugs used in this specialised field of surgery but have been  able to apply our knowledge of antiseptics and disinfectants to control sepsis in the ward. The cases in this ward include leg ulcers, malignant ulcers involving ·both bone and skin grafts, bust reductions and increases, cl eft lip and palate and burn cases. Thus, a very broad knowledge of all aspects of wound treatment and dressings is gained by alI who have participated in these ward rounds.

Being involved in these ward rounds has meant that we have had to brush up on or knowledge of pharmacology, but at the same time we are able to benefit from the practical experience of seeing a patient respond to therapy or conversely experience a drug reaction – there is nothing like actually seeing the skin rash caused by phenytoin in an epileptic child, for that particular side effect to remain in your mind. It is amazing how readily we have been accepted into these ward rounds by all the doctors involved. Although this is only scratching the surface at the moment, I feel that this is a positive step towards achieving some degree of clinical pharmacy in our hospital and something on which we can build for the future.

           Cyndy McKeown

           November 1978