FABELLA Super Fab Guide

7/25/2019 FABELLA Super Fab Guide

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CLERKs ENDORSEMENT:

Everyday Responsibility:

- Do progress notes on your residents patients (old and new)

- Do not be late. Do your progress notes ahead of your resident.

-

Inform your resident (via sms if he/she is not yet at the hospital) of any

abnormal vital sign noted.

WARD DUTY (pre 1)

- Do progress notes of all your residents patients (CS or NSD) during your

24 hours duty. Do progress notes on MHR or Ward 2 patients first

before going to the CS/NSD ward.

- Be sure to finish all your progress notes (all wards) by 7 am.

- At exactly 8 am gather all of your patients NSD deliveries (ward 4 only)

at the IE room. New patients only. Call them at the mic in front (besides

nurses table) Mga nanay lahat po ng tatawagin, pumunta na po sa likod

para ma-examine at mapauwi ng doctor ninyo. Magdala ng tissue at yun

mga gamut na nireseta sa inyo. Then mention their bed numbers followedby their names.

- After 10 minutes of announcing and they are not yet at the IE room, go to

their beds and tell them to go the IE room NOW. Babies should be left at

the bed.

- If they are already at the back give them their charts (make sure all your

progress notes are inserted in the first page. This is where the resident

writes their IE) and let them fall in line at the IE room.

-

Patients who underwent BTL and given IUD need not be examine. Give

them their charts and let them fall in line at the back of their resident.

- After IE, make sure your patient doesnt go back to their bed. Make sure

that after IE, they go straight to their resident for them to bedischarged. After they are discharged, thats the time they can go back

to their beds.

- Old patients need not to be examine again. Just get their chart and give

it to your resident.

-

Make sure all of your patients were discharged during this time. If your

patient underwent BTL or is at the FP room during mass discharge, inform

your resident so they will note it down that they have to come back for

this patients.

-

1 clerk should post at the MHR ward and 1 clerk at the ICU by 8 am.

He/she can endorse his/her patients for discharge to another clerk.

Clerks who are assigned at the MHR or ICU should monitor all patients Q1

including FHT. Refer any abnormal VS to your resident ASAP. Do not

leave the MHR or ICU without a clerk on post. (HINDI PWEDENG

MAWALAN NG CLERK ANG MHR AT ICU FROM 8 AM TO 4 PM

DURING YOUR WARD DUTY POST).

- Mass discharge is usually finished by 10-11 am. After the residents

discharge their patients, you should all post at the MHR unless you were

ask to do some errands.

-

All clerks will post at the MHR after the mass discharge to do the ward

endorsement (MHR and ICU patients only). You will make your own

endorsement form. Everybody should be familiar with the cases because

you can all be asked during endorsement. ALL should help in the Q1

monitoring of each patient. Report any abnormal VS ASAP.

- Follow up all lab results of MHR and ICU patient.

-

During ward post, you will be asked to extract on some patients at theward. Make sure to take note of the patients name and follow up the

result.

- All works should be done by 4 PM. You should endorse at the ward

resident by 4 PM or 12 PM on weekends.

WARD endorsement form:

BED no, name, date of admission, age -!refer to the pink sheet.

Chief complaint (CC), IE --!refer to the triage form of the admitting chart.

Service consultant (SVC) and Resident in charge (RIC) !refer to doctors

orders. (first few entries)Subjective: subjective complaint of the patient pertinent to the case.

All cases: Good fetal movement (GFM), uterine contractions (UC),

watery/bloody vaginal discharge

PES/PEM/CH/CH with SPE: headache, dizziness, blurring of vision

(BOV), difficulty of breathing (DOB), chest pain, epigastric pain

PROM/PPROM/Oligohydramnios/LNAF: watery vaginal discharge,

fever

UTI: dysuria, fever


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Previa: vaginal bleeding/spotting, uterine contractions

Objective: latest VS including FH and FHT. Do not copy the fundic height at

the chart.

Diagnosis: Last doctors rounds or pink sheet. Make sure to update the AOG

of the patient, write down if the condition is controlled or resolved (e.g PES-

controlled, previa not in hemorrhage, pre-term labor resolved, etc)

Labs: latest labs, including latest ultrasound or BPS

Meds: last doctors order. If patient is on dexamethasone, mgso4 or

antibiotics make sure to mention how many dose were given already or on what

day of antibiotics. If dexamethasone or mgso4 is completed take of the date

and time the last dose was given.

Plans: last doctors order

NOTE: scan the chart. Make sure to carry out ordered labs or follow up

results. If the result is not yet available before endorsement, note it on your

endorsement that lab request done, for follow up of result.

WARD ENDORSEMENT:

Leader: Good afternoon dra! Respectfully endorsing po, _____ patients at the

MHR ward, _____ patients at the ICU. For our breakdown of cases, we have

____ case of _____, _____ case of _____, etc

CLERK 1: Good afternoon po dra! Respectfully endorsing po MHR/ICU patient

___(bed no)___. ____(name)____, ___(age)____, admitted po last _____,

on her ___ hospital day, under the service of dr. ________, resident incharge ______. Patient came in with the chief complaint of ____, last IE po,

_______. During our stay at the ward, patient has _________, with the

following vital signs of ________. Working diagnosis po, ____________.

Latest laboratory po revealed _________. For the patients medications dra,

_________. Plan po _______. Thank you po.

OPD post (pre 2)

- Be at the hospital early. Do progress notes on all your residents patients.

Report any abnormal VS (via SMS), ASAP!

-

Be sure to finish all your progress notes by 7 am.-

Be at the OPD by 8 AM.

- At the OPD you are going to interview patients, carry out request for

admitted patients. Expect a lot of patients to be interviewed, so do your

interviews fast!

- Some patients had their first consult at the ER so ask them if they

already have a hospital card. If there is none, give them a new card and

proceed with your interview. Just fill up the OPD chart. For new patients,

make sure to give them laboratory request for: CBC, Urinalysis, 75 g

OGTT, HbsAg, RPR/VDRL, ultrasound.

- Ask first if they have any existing medical condition. Hypertension, DM,

goiter, heart problem, seizure disorder, asthma, etc! if they have anexisting medical condition inform the team leader, ASAP.

-

If there is no existing medical condition, proceed with your interview.

- Any abnormal sign or symptom (vaginal spotting, labor pains, watery

discharge, etc) refer ASAP!

-

Ask if the patient has laboratory results with her. Make sure to copy the

result at the chart (doctors orders)


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- For multigravids, make sure to write the OB history of the patient.

Gravidity, parity, year of delivery, etc

-

After your interview, give them their chart with the lab request then tell

the patient to proceed to dental.

-

If a patient is hypertensive one patient will be asked to stay inside the

room and monitor the patient every 15 minutes. Refer if the BP is >/=

150/100.

- If a patient is for admission, one clerk will be asked to assist in the

admission. Make sure to carry out the laboratory request (CBC, urinalysis,

blood chem., etc), fill up the triage form.

- Together with the resident, you will be asked to bring the patient to the

ER. At the ER, do your baseline vital sign. Wait for the resident to finish

her endorsement at the labor room. Wait for the patient to be brought

up to the labor room, then you can go back to your post.

- After OPD, go home and REST! Prepare yourself for duty the following

day!

DUTY POST: (be at the LR/DR 7:45 AM)

Runner:

- Be at the LR/DR by 7:45 AM and endorse with the last runner from the

last duty group. Make sure to take note of results to be followed up.

- As a runner you will be asked to follow up labs/blood, bring specimen at

the laboratory, do the errands outside the OR complex.

- Make sure you have your tackle box/bag wherein you can place your

specimens to be submitted.

-

Make sure to replenish all tubes. The runner makes sure that the LR

tackle box never runs out of supply. (tubes, syringe, specimen bottle, etc)

-

Write down names of patient with specimen submitted at the utilization

sheet so you can replace your tubes.

- Make sure to write down all the name, lab procedure requested at the

logbook, so you can follow up all the results.

- Before submitting the specimen make sure the lab request form is

completely filled up including middle name.

- U can tape the specimen at the middle of the request form.

- To the clerk who will be collecting the specimen, make sure to label the

tube or the specimen bottle. FULL NAME and FILE #. Ask mommy her

name first

- If STAT is indicated at the lab request, that means you have to follow up

the result or blood ASAP! (Paganahin ang pa-cute at pa-awa powers by

this time!) follow up the result after 30-45 minutes (hindi aabot ng one

hour dapat!).

- If asked to submit the request for blood, submit the request with the

extracted blood at the blood bank. Asked the staff on duty how long will

the processing take before you can get the blood. Take note of the time

and follow up ASAP! (Again, paganahin ang pa-cute and pa-awa powers,

especially if the patient is TOXIC!)

-

Always check the team leaders white board for lab results to be followed

up.

- If its already time for you to change your post, endorse with the

incoming runner. If the incoming runner is still assisting, wait for him to

finish his work then report at your post!

- If the runner is not doing anything, you should help at LR. Monitor

patients, or you can extract the blood or collect the specimen and submitit afterwards.

- Runners can also be called by the ER resident to extract blood so make

sure if you are called at the ER, prepare at least 6 tubes (2 for each top)

and syringe (5 and 10 cc)

NOTE: all labs requested should be carried out ASAP.

Logbook:

Gabriela Silang --- CBC, Urinalysis, Blood chem, PRBC

"

extracted" submitted at the laboratory

" Results given

LABOR ROOM/OPERATING ROOM:


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- When a patient comes in at the labor room, check her ID tag and carry

out the lab request.

-

Make sure that each patient has a partograph or monitoring sheet

bedside. Also make sure if any labs are done or should be requested

-

Monitor vital signs q1 including FHT. Report any abnormal VS to a resident

asap! For hypertensive patients, monitoring is q15 (esp. BP and fht). Refer

if BP is >/= 150/100. If pt is (+) PROM, monitor temp, refer if febrile

- For NSD patients, fill up the partograph ONLY, unless patient is also

hypertensive. For CS patients, fill up the monitoring sheet ONLY!

- Carry out the lab request on each patient ASAP. Do not ask a

primigravid/multigravid patient who is already on the active phase of

labor to urinate on the bed pan. Just collect your specimen via straight

catheter. Always ask if labs are needed. If theyre from MHR or for CS

usually they have labs

- Always check the team leaders white board for lab request to be carried

out.

- If a patient is for OR, an OR clerk will be asked to accompany the patient

to the OR. Once the patient is transferred at the OR table, do a baseline

VS including FHT then do your clinical history form. Monitor the VS q15BP and Q5 FHTuntil the patient is inducted. Record your VS at the

monitoring sheet. NEVER LEAVE THE PATIENT ALONE at the OR!

- After the OR, wait for the patient to be transferred to the RR. At the

RR, do a baseline VS, report it to the nurse at the RR then go back to

your post.

- If a patient underwent BTL and the fallopian is not for histopath, put the

tubes in a specimen bottle, label it and have the patient receive them at

the ward during your from duty post. Dont forget to let them sign at the

chart, indicating that they have received their tubes and it will not be for

histopath. (Natanggap ko na ang aking mga tubo at hindi ko na ito ipapa

examine)- If a patient delivered at the LR, one clerk should borrow a primi set.

- By 630 am (from duty), LR clerks should make sure that all patients who

are still at the LR should have a progress note. Make sure each patient

had their last IPM at least 2 hours before 8 am, all blood request carried

out and all partograph/monitoring sheets should be properly filled up

prior to endorsement.

- If you are not sure of your FHT, do not hesitate to ask a resident for

help.

DELIVERY ROOM:

- Each clerk should always have at least 2-3 primi set and 2 straight

catheter ready.

- Primiset contains:

o

Mayo curve-1o Mayo straight

o Tissue

o

Kelly clamp-2

o Straight clamp-3

o Needle holder

o 2 socks

o 2 cloths

(Numbers assigned are priority instruments. Please familiarize)

- You are going to deliver all primi patients. Multigravid patients can be

assisted by students from other schools if they are around. If there are

no students available, all cases will be handled by the resident/clerk at

the DR.

-

Prioritize Multi and Fully. If youre delivering the placenta while there is

an unattended mother whos already giving birth at the adjacent table,

attend to that table with new set of gloves. Priority is getting the baby

out

- For every delivery prepare your primi set, straight catheter, gloves and

cord clamp

- For primi patients aside from the primi set, make sure to prepare

lidocaine, syringe and suture.

-

During deliveryWhat to do in order:o

1. Drape (make sure lidocaine is prepared): 2 socks and 1 cloth at

the abdomen

o 2. Clean the area using the betadine soaked cottons.

o

The stroke for cleaning is shown below. For every stroke (blue

arrows)at the perineal area, u use a new cotton per stroke. For

the 3 stokes(green arrows)at the legs, just use 1 cotton per leg.


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-

- If you are not assisting in a delivery, monitor the FHT of all the

undelivered patients at the DR. Monitoring of FHT at the DR is every 5

minutes.

- Make sure that once the patient is transferred at the DR table, take note

of the time, and FHT, or you can ask a co-clerk to do it for you while you

prepare your things and the patient.

-

Coach all mothers at the DR. encourage them while they are on labor.

-

At the DR, always be alert! Be extra cautious especially if your patient isa multigravid.

- Once the baby and the placenta is delivered, teach the mother to do

uterine massage.

-

After delivery, clean your primi set, return it at the instrument room and

replace it with a new one.

-

If a patient at the DR is already for CS, continue monitoring the patient

until she is brought at the OR.

- REMEMBER: MONITOR THE FETAL HEART TONE IF THE BABY IS

STILL UNDELIVERED.

FROM DUTY:

-

Take note of your residents deliveries (CS and NSD) during your 24 hour

duty. You can get the list from the Delivery logbook at the DR.

-

Always make sure that all patients to be endorsed to the incoming duty

has a complete lab result and all labs requested were carried out.

- Once you have endorsed with the incoming clerks, you can ask permission

from your resident if you can do your progress notes already.

- Finish your progress notes, follow up any lab result your residents asked

you then go home and rest!

Always work as a TEAM! Do what is ask of you. Do not fight! If you are not

sure of anything, do not hesitate to ask

Sample ID tag of patients:

CIL cephalic in labor

CNIL cepahalic not in labor

FBIL frank breech in labor

CIPTL cephalic in pre-term labor

IUFD intra-uterine fetal demise

PES pre eclampsia severe

PEM pre eclampsia mild

CH chronic hypertension

CH with SPE chronic hypertension with superimposed pre-eclampsia

"#$ %&'()*+& ,)+&-.

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%1/< " =>


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REMEMBER:

-

Greet all residents/consultants if you see them in the hallway

- During your duty post it will be easier for you if you have an extra tube

and syringe with you always. (violet/red top).


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FABELLA Super Fab Guide

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