Rounding the Right Way: Creating a Consistent Foundation for Acute Care Pharmacy Practice

Kayla Kotch and Brian Simpkins 

Clinical pharmacists bring significant medication expertise to the patient-care team, but competing priorities and differences in daily workflow can make it difficult to apply that expertise consistently. A December 2025 survey of acute care pharmacists reinforced that concern: respondents described traditional interdisciplinary team rounds as a limited use of pharmacy time, documentation as burdensome or duplicative, and some operational activities as work that could be completed by other members of the pharmacy team. “Rounding the Right Way” is an Enterprise Pharmacy initiative designed to transform pharmacist workflow in support of high reliability by standardizing rounding practices, reducing variation, and prioritizing high-value clinical activities. The work is part of a broader effort to optimize pharmacist workflow, advance safety, efficiency, and reliability, and equip pharmacists with the clear expectations, optimized workflows, and tools needed to consistently deliver high-impact patient care. 

The initiative reframes rounding as a proactive, patient-centered process that is not limited to joining a physician-led team at the bedside. A pharmacist can independently round by completing a structured medication assessment, meeting with the patient, introducing pharmacy services, addressing medication questions, and intervening when therapy can be made safer or more effective. Every rounding encounter is intended to incorporate four core elements: proactive medication optimization, medication safety surveillance, discharge readiness assessment, and patient-centered transitions of care. This shared framework helps clarify the pharmacist’s responsibilities across the patient’s hospitalization while providing a consistent foundation for practice across acute care teams. 

To support systemwide implementation, the team developed a rounding tool in Epic rather than adopting an existing template. An Enterprise Pharmacy champion partnered with Epic Informaticians to translate the workgroup’s vision into a working design, with iterative feedback from frontline pharmacists and coordinators. The tool will serve as a one-stop resource for comprehensive, efficient patient workup, with an embedded checklist that reinforces non-negotiable rounding activities and reduces variation in practice. Structured documentation will allow pharmacist interventions to be measured, tracked through dashboards, and benchmarked across sites. As it goes live across the system, the rounding tool is expected to support greater consistency, efficiency, and focus on high-value clinical decision-making. 

The customizable sidebar workspace brings together the pharmacist handoff, daily and admission or discharge checklists, prior-to-admission and current medications, clinical alerts, consults, laboratory and vital-sign trends, and transitions-of-care information. A consistent review-of-systems structure organizes relevant data across clinical domains, while embedded links open tools for diabetes management, anticoagulation, and antimicrobial stewardship alongside the patient review. Pharmacists can address certain alerts without leaving the workspace, reducing the need to move repeatedly among different parts of the chart. 

Turning a broad responsibility into an actionable process 

The “Rounding the Right Way” framework translates the broad concept of medication optimization into a practical checklist. Daily activities include reviewing age-appropriate medication use, antimicrobial stewardship opportunities, glycemic control, guideline-directed therapy, medication route optimization and each medication’s indication, effectiveness, safety and adherence considerations. The checklist also includes pharmacokinetic review, dose adjustment and evaluation of venous thromboembolism prophylaxis and anticoagulation therapy.  

 Admission and discharge considerations are integrated into the same process. Pharmacists are prompted to assess barriers to discharge, medication education needs, medication history and reconciliation, patient experience, readmission risk and enrollment in Meds to Beds. Discharge medication reconciliation review and potential referral to transitions-of-care medication therapy disease management services are also included. This structure places discharge preparation and continuity of care alongside daily clinical review rather than treating them as separate, last-minute activities.  

 A pharmacist process map supports the checklist by showing how these responsibilities can be incorporated throughout a successful day in acute care practice. The tool itself was refined through repeated review by a workgroup of frontline pharmacists and coordinators. Superusers then completed quality assurance to identify missing information, confirm that data appeared in the appropriate sections, and provide final feedback before systemwide rollout. 

Making room for pharmacists to practice at their highest level 

Standardizing expectations is only part of the work. The broader workflow strategy recognizes that pharmacists need adequate time and support to perform these activities. Related initiatives include documentation simplification, technician decentralization, and replacing portions of traditional interdisciplinary rounding with a focused two-minute touch base between the pharmacist and charge nurse before and after interdisciplinary team rounds. Before rounds, the pharmacist can surface pharmacy-related discharge barriers identified in Epic; afterward, the charge nurse can relay any new medication needs raised by the team. This approach is intended to free approximately one hour for rounding, patient experience, and other value-added activities. 

The decentralized technician model is designed to use pharmacy technicians as pharmacist extenders for defined responsibilities. Examples in the project materials include medication histories, patient education support, patient experience activities, triaging missing medications and medication-room inspections. Documentation simplification further supports the workflow by distinguishing among checklist widgets used to confirm task completion, iVents used when the pharmacist intervenes and navigators used to document consult services. 

These interconnected efforts share a common goal: reducing responsibilities that do not require a pharmacist’s expertise so pharmacists can focus more consistently on clinical judgment, medication safety and direct patient-care needs. 

Connecting daily work to strategic priorities 

The framework also connects pharmacist activities with broader priorities. Project materials link patient education and communication activities with patient experience; glucose management and antibiotic timing with efforts to decrease surgical-site infections; and Meds to Beds enrollment and readmission-risk review with efforts to reduce readmissions. Enhancing patient safety is identified as an additional strategic priority. 

Moving acute care pharmacy forward 

“Rounding the Right Way” provides a practical vision for acute care pharmacy practice: establish clear expectations, equip pharmacists with usable tools, and redesign supporting workflows so clinical expertise can be directed toward the patients who need it most. By standardizing rounding practices and creating a shared process for medication optimization, safety surveillance, discharge preparation, and transitions of care, the initiative is intended to reduce variation while advancing safer, more efficient, and more reliable high-impact patient care across Enterprise Pharmacy’s acute care services. Just as importantly, it supports a cultural shift in which pharmacists round as individual clinicians with a defined pharmacy-based assessment, whether or not they participate in a traditional interdisciplinary bedside team. Over time, the structured activity data can also help the team understand where pharmacists are intervening, compare practice across sites, and continue refining the model.