Exploration of barriers and enablers of pharmacists’ participation in the multidisciplinary ward round

According to the new professional vision for hospital pharmacy, pharmacists will be essential members of the multidisciplinary team who are present on ward rounds and clinics providing expert advice, actively prescribing and influencing prescribing decisions.

Multiple studies have discussed the positive significance of clinical pharmacists’ contribution to integrated care during ward rounds but in many healthcare settings pharmacists’ participation in ward rounds is not yet routine practice^​1–3​. Previous studies have predominantly examined barriers and facilitators from the perspectives of medical teams; evidence capturing pharmacists’ own views remains limited^​4,5​. 

The service evaluation

In response, a service evaluation was initiated that aimed to explore the barriers and enablers, perceptions, confidence, and challenges of pharmacists in relation to ward round participation in a hospital setting. Pharmacists employed across two NHS trusts (n=96) were invited to complete an anonymous 21-item online survey exploring perceptions and experiences of ward round participation. The overall response rate was 52% (n=50), representing pharmacists from a range of clinical backgrounds.

Results

Most respondents (82%) had previously attended ward rounds, although participation was infrequent: 32% sometimes (a few times a month), 32% rarely (once every few months), 24% never, and only 12% indicated they participate a few times per week. Ward round participation was dependant on the pharmacists’ level of experience. All wished to participate more often and the overall perception of pharmacist ward round participation was positive with 92% reporting sufficient confidence in their knowledge and skills, also citing increased job satisfaction and professional development benefits. The majority, 58% (n=29) of pharmacists were independent prescribers, while 14% (n=7) were studying for independent prescribing (IP) qualification at the time of the survey, and others had not enrolled on the course yet. Of those with IP annotation, 55% (n=16) confirmed that they used their IP skills to prescribe independently (e.g. without consulting with the medical team) during ward rounds, while 72% (n=21) stated that they used their IP skills to action the ward round plan (e.g. consultant led or shared decision). 

The majority of pharmacists (94%) strongly agreed or agreed that they contributed to improved patient care by providing clinical reviews, optimising medications, advising on treatment regimens, blood interpretation and resolving prescribing errors by attending a ward round. Most pharmacists (82%) strongly agreed or agreed that ward round participation helps with patient education and counselling.

Responses to questions about social influences on ward round participation were mixed. Nearly half of the pharmacists (44%) neither agreed nor disagreed that their line manager or clinical team lead expects their ward round attendance, while 34% agreed/strongly agreed and 22% disagreed/strongly disagreed. Most of the pharmacists felt supported and respected by other healthcare professionals and felt that their recommendations were valued by the medical team. There was a mixed view on consultant-led ward rounds/hierarchy as a barrier. A proportion of pharmacists (30%) found consultant-led ward rounds/hierarchy as a barrier to participating in the ward round, while 40% disagreed, and around 30% did not have an opinion.

Environmental factors were the major barrier to pharmacist ward round participation. The main challenge indicated by most pharmacists (84%) was excessive workload owing to other work commitments/responsibilities, including dispensary shifts, homecare prescriptions, medical day unit cover, teaching sessions and supervision of undergraduate students or trainee pharmacists. Additionally, 70% of pharmacists stated that there was a lack of awareness from other healthcare professionals regarding their clinical role during ward rounds. The workforce was identified as another major barrier, as 68% stated that there were not enough pharmacists to attend ward rounds and 76% believed there was a lack of non-pharmacist staff to support pharmacists on the wards (e.g. medicines management technicians). 

Discussion and conclusion

Pharmacists’ ward round participation remains limited, largely owing to workload, staffing pressures and lack of professional recognition, despite strong confidence and motivation to contribute. Key facilitators included supportive teamwork, adequate staffing, medical team relationships, motivation, clear expectations, visible leadership and prescribing authority. These findings provide direction for interventions to reduce barriers and strengthen enablers. Further work will build on these results through qualitative interviews to explore experiences in greater depth and co-design strategies. A limitation is that the study was conducted in only two organisations, which may restrict generalisability.

Elena Kryzanovskyte, clinical pharmacist, NHS Humber Health Partnership

Kristina Medlinskiene, principle pharmacist – education and training, NHS Humber Health Partnership