paediatric sho survival guide james and carol...paediatric input (e.g. those on antibiotics for...
Post on 17-Apr-2020
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Contents:
Timetables ……………………………………………………………………………………………… 2Consultants ……………………………………………………………………………………………… 4Duties:
i. WillowWard ………………………………………………………………….. 5ii. PAU ………………………………………………………………….. 6iii. SBCU/Walnut ………………………………………………………………….. 7
iv. Postnatalwards ………………………………………………………………….. 8v. On-call ………………………………………………………………….. 10vi. Nights ………………………………………………………………….. 10vii. Weekends ………………………………………………………………….. 11
Letterwritingforreferrals
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TimetableWillowWard SpR:nobleepSHO:nobleepTime Activity Location Notes0900-0930 Morninghandover Doctorsoffice,WillowWard Consultantled0930-1300 Wardround
WardjobsClerkingnewarrivals
WillowWard
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1630 Wardjobs
ClerkingnewarrivalsWillowWard
1630-1700 Afternoonhandover Doctorsoffice,WillowWard Consultantled1700-2100 EveningSHOx2(bleep319and176)coverwardandPAU/admissions2100-2130 Eveninghandover Doctorsoffice,WillowWard RegistrarledPaediatricAssessmentUnit(PAU) SpR:316SHO:319(CRASH)Time Activity Location Notes0900-0930 Morninghandover Doctorsoffice,WillowWard Consultantled0930-1300 ClerkinginPAU
CompletePAUjobsinhandoverfolder
PAU
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1630 ClerkinginPAU PAU 1630-1700 Afternoonhandover Doctorsoffice,WillowWard Consultantled1700-2100 EveningSHOx2(bleep319and176)coverwardandPAU/admissions2100-2130 Eveninghandover Doctorsoffice,WillowWard RegistrarledWalnutWard/SpecialCareBabyUnit(SCBU) SpR:533SHO:nobleepTime Activity Location Notes0900-0930 Morninghandover Staffroom,WalnutWard Consultantled0930-1300 Wardround
WardjobsClerkingnewarrivals
WalnutWard EnsuredailyandweeklytasksarecompletedKeepBadgerNetupdated
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1700 Wardjobs
ClerkingnewarrivalsWalnutWard
PostnatalWards(PNW) SpR:533SHO:176(CRASH)Time Activity Location Notes0900-0930 Morninghandover Doctorsoffice,WillowWard Consultantled0930-1300 DailyreviewofVTCbabies
BabychecksDeliverybleepcalls
CedarWard,AspenWard,BirthCentre,DeliverySuite
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1630 Babychecks
DeliverybleepcallsCedarWard,AspenWard,BirthCentre,DeliverySuite
1630-1700 Afternoonhandover Doctorsoffice,WillowWard Consultantled1700-2100 EveningSHOx2(bleep319and176)coverwardandPAU/admissions2100-2130 Eveninghandover Doctorsoffice,WillowWard Registrarled
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Nightshift NeonatalSpR:533PaediatricSpR:316SHO:176&319(CRASH)
Time Activity Location Notes2100-2130 Eveninghandover Doctorsoffice,WillowWard Registrarled2130-0800 Attendanceatcrashcalls
CompleteclerkingsinPAUEDreferralsWardreviews/jobs
PostnatalwardscoveredbyneonatalSpRunlessworkdemandsrequireflexibility
0800-0900 Wardround WillowWard Consultantled0900-0930 Morninghandover Doctorsoffice,WillowWard Consultantled
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Consultants:Consultant Secretary Contactnumber InterestsDrSelwynD’Costa(SDC) Anne-Marie
Pateman8219 Respiratory
DrAlokGupta JulieHudson 8752 ClinicalDirectorDiabetes
DrAliBokhari Anne-MariePateman 8219 EducationalDirectorCardiology
DrAbdulHasib RachelPithman 8229 Neonatalspecialist.Collegelead
DrBharathGowda ValerieStrathmore 8230 NeonatesDrGauthamKulkarni ValerieStrathmore 8230 Epilepsy
AllergyDrKishaneeKiriella SharonVickers 4674 DiabetesDrKumar JulieHudson 8752 SickleCellDrKhan AlisonKinnaird 8228 Gastro
Childprotectionlead.
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WillowwardTimetable:WillowWard SpR:nobleepSHO:nobleepTime Activity Location Notes0900-0930 Morninghandover Doctorsoffice,WillowWard Consultantled0930-1300 Wardround
WardjobsClerkingnewarrivals
WillowWard
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1630 Wardjobs
ClerkingnewarrivalsWillowWard
1630-1700 Afternoonhandover Doctorsoffice,WillowWard Consultantled1700-2100 EveningSHOx2(bleep319and176)coverwardandPAU/admissions
Seeon-callsectionbelow2100-2130 Eveninghandover Doctorsoffice,WillowWard RegistrarledDuties:
- FinishwardroundwithConsultantandRegistrar(usuallystartedwithnightteam).- Ongoingmanagementofwardpatients/wardjobs.- Wardreviews(e.g.weaningfromnebulisers/inhalers,monitoringoforalintake).- Clerkingindirectwardadmissions.- ReviewnewadmissionsfromPAU.- CompleteEDN(electronicdischargenotifications)priortodischarge.
Tips:
- EDNsforsimplepresentations(e.g.viralinducedwheeze,gastroenteritis)canbeconcise;youwillsaveyourselfalotoftime!
- TrytocompleteEDNsearlyinthedaytofacilitatedischarge,especiallythosewithTTOs–ideallytheseshouldbewithpharmacyby11am.
- Updatethelistaheadoftheafternoonhandoverat16:30.- ReferralsshouldbemadeusingPatientCentre(seebelow).
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PaediatricAssessmentUnit(PAU)Timetable:PaediatricAssessmentUnit(PAU) SpR:316SHO:319(CRASH)Time Activity Location Notes0900-0930 Morninghandover Doctorsoffice,WillowWard Consultantled0930-1300 ClerkinginPAU
CompletePAUjobsinhandoverfolder
PAU
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1630 ClerkinginPAU PAU 1630-1700 Afternoonhandover Doctorsoffice,WillowWard Consultantled1700-2100 EveningSHOx2(bleep319and176)coverwardandPAU/admissions
Seeon-callsectionbelow2100-2130 Eveninghandover Doctorsoffice,WillowWard RegistrarledDuties:
- AttendcrashcallswithPAUregistrar.- TakereferralsfromED(referralsmayalsocomefromGPs,communitymidwivesandhealthvisitors,
buttheseoutsidereferralsusuallygothroughtheregistrar).- AssesspatientsonPAU,orinEDasrequired.- CompleteoutstandingjobsonhandoverlistandinPAUjobslist(incoordinationwithCarol
Hartley).Tips:
- AllchildrenundertheageoftwelvemonthsattendingEDareautomaticallyreferredtothepaediatricteam,exceptthosewithinjuries.
- Notallreferralshavetobeautomaticallyaccepted.Ifyouareunsurecheckwiththeon-callregistrar.
- WhenachildrequiresadmissiontothewardlettheWillowregistrarandSHOknow,informtheNurseinChargeandaddthechildtothehandoverlist.
- CheckthePAUjobsfolderonadailybasisandcompletetheformaspartofthepatient’smedicalrecord.
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WalnutWard/SpecialCareBabyUnit(SCBU)Timetable:WalnutWard/SpecialCareBabyUnit(SCBU) SpR:533SHO:nobleepTime Activity Location Notes0900-0930 Morninghandover Staffroom,WalnutWard Consultantled0930-1300 Wardround
WardjobsClerkingnewarrivals
WalnutWard EnsuredailyandweeklytasksarecompletedKeepBadgerNetupdated
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1700 Wardjobs
ClerkingnewarrivalsWalnutWard
Duties:
- Wardroundonunit.- Completewardjobs.- UpdateBadgerNetpaperwork(onadmissiontounit,dailyupdateanddischarge).
Tips:
- Seniorled,soyoushouldnotberequiredtomakebigmanagementdecisions.- Ensureallbabieswhoarewellenoughhaveacompletednewbornbabycheckwithin72hours.- Therearevariancestothewardrounddependingonthedayoftheweek:
o Monday:o Tuesday:o Wednesday:o Thursday:o Friday:
- Thereareseveralscreeninginvestigationsthatyoushouldreviewforeverypatient(includingcranialUSandROPscreening)onaweeklybasistoensuretheyarerequestedasperscheduleorhavebeensignedoffasrequiringnofurtheraction/surveillance.
- Outofhourscoverisprovidedbyneonatalregistrarsothereisverylittleneedtoattendunlessworkloadrequiressomeassistance.
- BadgerNet:o GetaccessfromseniorsistersonSCBU.o Fulladmissiondetailsshouldbeuploadedontosystemattimeofadmissionandprintedout,
signedandaddedtopapernotes.o Dailyupdatesofsignificantclinicalevents,includinginfectionrisk,NECetc.o Ensurefullupdateofadmissioneventsfordischarge(trytoplanaheadandupdatetheseifa
dischargeisdue)andprint5copiesforthenursestodischarge.- Notifythenamedconsultantandsecretaryofallfollow-upsandinvestigationsarrangedonSCBU
forapatient- ReferralsshouldbemadeusingPatientCentre(seebelow)
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Postnatalwards(PNW):Cedar,Aspen&BirthCentreTimetable:PostnatalWards(PNW) SpR:533SHO:176(CRASH)Time Activity Location Notes0900-0930 Morninghandover Doctorsoffice,WillowWard Consultantled0930-1300 DailyreviewofVTCbabies
BabychecksDeliverybleepcalls
CedarWard,AspenWard,BirthCentre,DeliverySuite
1300-1400 Teaching Asperteachingschedule Mostweekdays1400-1630 Babychecks
DeliverybleepcallsCedarWard,AspenWard,BirthCentre,DeliverySuite
1630-1700 Afternoonhandover Doctorsoffice,WillowWard Consultantled1700-2100 EveningSHOx2(bleep319and176)coverwardandPAU/admissions
Seeon-callsectionbelow2100-2130 Eveninghandover Doctorsoffice,WillowWard RegistrarledDuties:
- Attendneonatalcrashcallsasmemberoftheneonatalcrashteam- Attenddeliveriesthatrequirepaediatricpresence- Newbornbabychecks(asrecordedinfoldersonCedarandAspen)- Postnatalwardreviewsforvirtualtransitionalcare(VTC)babiesandthoserequiringongoing
paediatricinput(e.g.thoseonantibioticsforsuspectedsepsis,jaundice,hypoglycaemiao Thesebabiesrequiredailyreviewswithprogressdocumentedinthenoteso Oncedischargedfromthepaediatricteamthesebabiesrequiredischargedocumentation:
§ ForVTCbabiesthisisaBadgerNetsummary§ Forotherchildren(i.e.thoseunderreviewbutnotonVTCsuchascommunity
referrals,thosewithcongenitalproblemsrequiringfurtherinputetc.)aNeonatalEDNisrequired(1xcopytoparents,1xcopytoGP–ifyouareunsureifthiswillbesentelectronicallyrequestapapercopytobepostedtotheGP,1xcopyinbaby’snotes)
- Takecommunityreferralsforbabiesunder10daysofage(e.g.weightloss,jaundice)Tips:
- Asktheneonatalregistrartoattenddeliverieswithyouuntilyoufeelcomfortableattendingalone(10-20atleast)
- Babychecksshouldbecompletedwithin72hoursofbirth,butnotebefore6hoursofage.Ifyoufindsomethingyouareunsureaboutoneitherbabycheckorreview,ASK,nomatterhowsillyitmayseem.Babychecksarenotroutinelyperformedafter17:00.Theycanbere-arrangedforthenextdayorarrangedinthecommunity.But,bekind,andhelpwherepossible
- Referto‘CommonNeonatalProblems’Handbookonhowtomanagecommonlyencounteredissues.Acopywillbesenttoyouatinduction,butthisisavailableonAdagio.LearntheearlyneonatalsepsisguidelinesindicationsforstartingIVantibiotics
- ThereisnopostnatalSHOcoveroutofhoursasbothSHOsarecoveringpaediatricreferrals/admissions.Newwardreferralsandmanagementofbabiesonpostnatalwardshouldbedirectedtotheneonatalregistrar,butyoumaybeaskedtobeflexibleifPAUisquietoriftheneonatalregistrariswithanunwellbaby.
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Generalinformation:Someofthemidwivesareabletoperformbabychecks(seebelowforlistofindicationsformidwifebabychecks).Themidwivesareonarotatocompletemidwifebabychecksduringnormalworkinghours(Monday-Friday0900-1700).Ifyouareaskedtohelpoutwithmidwifeledbabychecksduringtheweekorweekendduetolackofavailabilitythenpleasehelpoutasotherdutiesallow.Babiessuitableforexaminationbymidwivesshouldfulfilthefollowingcriteria:
- AnybabybornfollowingspontaneousvertexdeliveryorelectiveLSCSwhereapaediatricianwasnotrequiredforimmediateresuscitation.
- Anybabyafter36weeksgestation.- Themidwifemayexamineababybornat35weeksgestationatthediscretionofthepaediatrician
(i.e.thewellsmallbabyonthepostnatalward).- Ventouseofforcepsdeliverywithnoapparentbirthinjuriesorresuscitationneeds.- Noobviouscongenitalabnormalities.- Apgars9oraboveat5minutes.- Meconiumstainedliquorwherethebabydidnotneedresuscitation,SBCUadmissionandwhereall
observationshavebeencompletedwithnodeviationfromnormal.- ProlongedSRMwherethebabyisasymptomatic(dischargeafter12hours).- Insulindependentorgestationaldiabeteswherethebabydidnotneedresuscitation,SCBU
admissionandisasymptomatic.- Breech,wherebabydidnotneedresuscitation,SCBUadmissionandisasymptomatic.- BabieswithinitiallowBMs,thathavehadtwoconsecutiveBMs>2.6mmolandarefeedingwell.- BabiesofGroupBStrepmothersinapreviouspregnancywhoareasymptomaticaftercompletion
ofobservationswhohavenootherriskfactorsforsepsis.- Mildbirthtraumaifthebabyiswellandasymptomatic.
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On-call(1700-2130)/LongdayDuties:
- PrimarilybasedinPAU/Willow.- TwoSHOsoncalleveryweekdayevening(alongsideoneregistrarcoveringWillowandPAU):
o Onecarriesdeliverybleep(176),othercarriespaediatricbleep(319).- Anyreviewsrequestedbythepostnatalwardsshouldbeattendedbytheneonatalregistrarunless
PAUisexceptionallyquiet.
Nights(2100-0930)Timetable:Nightshift NeonatalSpR:533
PaediatricSpR:316SHO:176&319(CRASH)
Time Activity Location Notes2100-2130 Eveninghandover Doctorsoffice,WillowWard Registrarled2130-0800 Attendanceatcrashcalls
CompleteclerkingsinPAUEDreferralsWardreviews/jobs
PostnatalwardscoveredbyneonatalSpRunlessworkdemandsrequireflexibility
0800-0900 Wardround WillowWard Consultantled0900-0930 Morninghandover Doctorsoffice,WillowWard ConsultantledDuties:
- PrimarilybasedinWilloworseeingadmissionsinED,andattendingdeliveriesovernight.- Anyreviewsrequestedbythepostnatalwardsshouldbeattendedbytheneonatalregistrarunless
thenightisexceptionallyquiet.- Therearemanylocumregistrarswhocovertherota.Manyarelongtermregularlocumsandare
verygood,butifthereareanyconcernspleasediscussthemwiththeon-callconsultantthefollowingmorning.Ifthereareurgentissuesovernightthatarenotbeingaddressedbythelocumregistrar,thencontacttheotheron-callregistrarforadvice.Ifthereareseriousissuesthatcannotbedealtwiththefollowingmorning,thenyouareabletocontacttheon-callconsultantviaswitchboard.
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WeekendsTimetable:WeekendsTime Activity Location Notes0900-0930 Morninghandover:
ForWillow/PAU/SCBUDoctorsoffice,WillowWard Consultantled
0930-1500 ForlongdaySHO(319):- Wardround- Wardjobs- Clerkingnewarrivals
ForpostnatalSHO(176):- Postnatalwardreviews- Babychecks
1500 HandoverofbleeptolongdaySHO1500-2100 Wardjobs
ClerkingnewarrivalsAttendingdeliveries
Willowward,PAU,ED,PNW,deliverysuite
Ifbusyaskneonatalregistrartokindlyhelpwithdeliveriesasavailabilityallows
2100-2130 Eveninghandover Doctorsoffice,WillowWard RegistrarledDuties:
- PostnatalSHO(0900-1500,carriesdeliverybleep(176):o Completespostnatalwardreviewsasabove.o Completesnewbornbabychecksasaboveforbabiesgoinghomethatday.o NotrequirestoattendSCBUwardround.o HandsovertowardSHOat1500.
- LongdaySHO(0900-2130,carriespaediatricbleep(319)anddeliverybleepfrom1500:o CompleteswardroundandongoingmanagementonWillowwardasperabove.o AssessesPAUpatientsasabove.o Takesoverdeliverybleepat1500.
Generaltips
- Trytodevelopgoodworkingrelationshipswiththenursingandmidwiferystaff.Theyareafountainofknowledge,especiallyfornewSHOs.
- Askthepalyspecialiststohelpwithbloodsandotherprocedures(alongsidethepatient’snurse)astheyarefantasticfordistractionandsupport.
- SomenursesareabletocannulateonSCBUandonWillow,butstilltaketheopportunitytolearn.- Youarenevercompletelyaloneinpaediatrics,theregistrarsareavailableandapproachable,so
makeuseofthemifneeded.- IFYOUAREUNSURE,ASK!
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LettersReferralsfromallareasshouldbemadeusingtheappropriatetemplatefoundonPatientCentre,withacopysavedforfuturereference.
- InPatientCentre,selectthepatientyouwouldliketocreatealetterfor.- IntherighthandsidebarselectClinicalDocuments,andclickthe
PatientDocumentsoption(thePatientDocumentViewercanbeusedtoseeolderlettersforthispatient).
- Clickthroughtheoptionstoselecttheappropriateadmissionepisode.
- Findtheappropriatetemplate.ForthemajorityofreferrallettersyoucanfindtherelevantconsultantheadedletterintheSECRETARYtab:
- OnceyouhavecompletedyourletterinthewordapplicationopenedfromPatientCentre,closeWordandthensavetheletter,afterchangingthenameoftheletterinthePatientCentresavebox.Thiscanthenbeprintedandsenteitherviaemailorbypost.
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