Background: Pharmacist participation in multidisciplinary rounds (MDRs) has been proposed as a high leverage strategy to improve medication safety and patient outcomes in hospitals. Objective: To systematically review the effectiveness of pharmacist participation in MDRs on medication safety and clinical outcomes among inpatients. Methods: We searched MEDLINE/PubMed, Embase and CINAHL (1999–October 2025) for randomized or observational comparative studies in adult inpatients where a pharmacist joined MDRs/ward rounds and outcomes included medication errors, preventable adverse drug events (pADEs), drug-related problems (DRPs), appropriateness, mortality, readmission, length of stay (LOS) or costs. Two reviewers independently screened, extracted data, and appraised risk of bias. Narrative synthesis was performed. Results: Twelve original studies (1 randomized, 11 quasi experimental/observational) met inclusion. Pharmacist participation during rounds reduced prescribing errors and pADEs, improved medication appropriateness and the acceptance of recommendations, and frequently identified DRPs at the point of prescribing. Effects on LOS and readmissions were mixed; mortality benefits were most apparent in intensive care settings where pharmacists were embedded in daily rounds. Conclusions: When pharmacists are integrated into MDRs, medication safety and prescribing quality improve, with probable downstream clinical benefits in high-risk settings. Hospitals should prioritize round-based clinical pharmacy services and evaluate implementation context, team processes, and scope of practice to maximize patient impact.