Induction Pack

2016

2

CONTENTS Page

1. Department overview 3

• Contact details • Secretaries • Anaesthetic seminar room • Tea / Coffee / Milk

2. Staff members 5 3. Multi-disciplinary team 7 4. Training & Assessments 8

• Assessments • Appraisals • Logbook • Audit / Research • Mandatory courses

5. “Housekeeping” 10

• Rota’s • Leave • Bleeps • Doctors Mess

6. Subspeciality area’s 13

• ICU • Obstetric anaesthesia • Pain medicine • POAC / CPEX • EMRTS / Prehospital care

7. Departmental policies 15

3

DEPARTMENT OVERVIEW Welcome to the Anaesthetic Department at Wrexham Maelor Hospital! Contact details :

Department of Anaesthesia, Critical Care and Pain medicine, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Croesnewydd Road, Wrexham, LL13 7TD.

Tel : (Switchboard) 01978 291100

(Dept) 01978 725955 or 725956

Fax : 01978 725932

We are a large, busy district general hospital covering most of the surgical specialities including vascular and we are the regional upper GI surgery centre. We have one of the busiest ITU’s in North Wales, with 12 level 2&3 beds and the only one currently recognised for Intermediate and Higher level training and we have 2 FICM trainees completing their step 1.

We are an award winning teaching department and regularly have

medical students, paramedics and sixth form students rotating through on attachments. There is a structured departmental teaching program designed to cover a lot of the primary syllabus as well as fortnightly North Wales teaching which covers the final syllabus. Every October we run the successful North Wales primary viva/OSCE course just before the autumn sitting of the primary exam.

There is a state of the art simulation suite on site and simulation

facilities on ITU as well which we use frequently to cover the management of core anaesthetic emergencies as wells as teaching crew resource skills to the senior trainees. Trainees are encouraged to take part in Sim training both as participants and session facilitators, gaining invaluable experience on how to set up and manage a teaching session.

The department and the hospital is very friendly, supportive and

welcoming as attested to by our positive trainee feedback. You will have no problem in settling in and we hope you enjoy your time with us.

4

Secretaries :

If you need any help or have any questions please do not hesitate to contact one of the secretaries and they will be happy to help you. The department has two secretaries:

Miss Emma J Hughes ext 5955 (Critical Care Consultants & Dr Agnew)

Mrs Jo-Ann Barlow ext 5956 (Obstetric/General Consultants & Dr Sandow)

The Anaesthetic Department is located on the first floor, near the main

entrance (entrance A). Proceed past the café and shops, turn right at the end of the corridor and up the first set of stairs on you left. Turn left at the top of the stairs and the department is located on the left (opposite SAU & Glyndwr Wards) labelled Theatre A and Anaesthetics.

The secretaries are located in the first office on the left as you enter. The office hours are :

Monday – Thursday 08:30 – 17:00 Friday 08:30 – 16:30

Anaesthetic Seminar Room :

This is located opposite the secretary’s office, which has a security-coded lock on door (code will be provided to you when you start). This room is the social hub of the department where you can rest between cases or when on call and is also used for departmental meetings, audit meetings and for teaching.

There are 4 computers with internet access and printing capabilities there for your use and the hospital has good WiFi coverage in most areas which is free to use.

All members of staff will have a post tray located in the seminar room. Post gets delivered daily around 10.30 – 11.00am and will be distributed into your post trays. Tea / coffee / milk :

The seminar room has a small kitchen with a microwave, fridge and tea and coffee making facilities. The secretaries organise a fund for this (£5.00 for 3 months) so you can always get a drink but please wash your mug up afterwards.

5

STAFF MEMBERS

NAME

AREA

SPECIAL INTERESTS

OFFICE

BLEEP

Dr A. Campbell

ITU / Gen

ICM College Tutor Trauma Lead FICE / CUSIC mentor

5321

5142

Dr D. Counsell

ITU / Gen

Acute pain Lead Upper GI surgery Longterm ventilation

5139

5778

Dr K. Elfituri ITU / Gen Upper GI surgery Lead Educational supervisor

5321

5729

Dr C. Littler

ITU / Gen

Clinical director Paediatric Lead Imaging Lead Vascular anaesthesia Lead WICS secretary

5346

5129

Dr G. Mayers

ITU / Gen

EMRTS Anaphylaxis Lead Trauma, transfer and retrieval

5720

Dr H Reddy

ITU / Gen

College Tutor AIT Lead RRAILs Lead Upper GI & Vascular anaesthesia Point of care ECHO

5321

5721

Dr S. Sandow ITU / Gen ITU Lead CPEX and Preop assessment

5346 5723

Dr D. Southern

ITU / Gen

Point of care ECHO FICE mentor Audit and research Ethics Lead

5156

5123

Dr S. Abraham Obs / Gen Educational supervisor (F1) Appraiser

5347 5194

Dr C. Dowling Obs / Gen CEPOD Joint school facilitator

5028 5713

Dr R. Jones Obs / Gen 5139 5722 Dr J. Kenningham Obs / Gen AAGBI Linkman

Rota co-ordinator 5347 5731

Dr V. Madhavan

Obs / Gen

Airway Lead NAP 6 Lead (periop anaphylaxis) Educational supervisor Appraiser

5346

5113

Dr J. Young Obs / Gen Obstetric anaesthesia Lead 5346 5165

6

NAME

AREA

SPECIAL INTERESTS

OFFICE

BLEEP

Dr T. Haag Pain / Gen Regional anaesthesia Chronic pain

5139 5198

Dr S. Underhill Pain / Gen Musculoskeletal MDT Lead Chronic pain

5028 5120

Dr N. Agnew

General

Preop Assessment Lead Blood Transfusion Lead Clinical Governance Lead CPEX

5156

5114

Dr S. Coghlan General Welsh BMA representative Day Case Surgery Lead

5346 5725

Dr W. Edmondson

General

College Examiner Nutritional Support Lead Vascular & Paediatric anaesthesia

5347

5727

Dr J. Points

General

Chair of Division Educational supervisor T & O Lead

5732

ON CALL

ITU 5701

GENERAL 5703

OBSTETRICS 5877

7

MULTI-DISCIPLINARY TEAM

GRADE

NAME

BLEEP

SPECIALISTS

Dr Vinit Vedpathak 5718 Dr Hans Meulman 5728 Dr Ben Sasi 5726 Dr Fiona Nelhans 5117 Dr Miki Erdi-Krausz 5174 Dr Ahmed Youssef 5712 Dr Hannah Mbako 5116 Dr Tarek Elmagarbi 5172 Dr Nishantha 5195 Dr Piri Naragala 5192 Dr Ahmed Dagez 5191 Dr Kanda Bharathi 5177

TRAINEES

Dr Tom Bird 5118 Dr Archie Awsare Dr Ben O’Donovan 5820 Dr Anna Williams 5175 Dr Tammy Towers 5173 Dr David George 5730 Dr Trish Dunkley 5171 Dr Gillian Bennett 5137 Dr Chloe Edmonds 5821 Dr A Waite 5197 Dr L Bair Kadar 5724 Dr Nowfal 5189

8

PAIN TEAM

Lead CNS Lucy Jones Bleep 5871 Clinical Nurse Specialist Ruth Jones Bleep 5872

Andy Roden

NUTRITION TEAM

Clinical Nurse Specialist Paula Edwards Bleep 5434 Mandy Kerr

Senior Dietician Jane Power Bleep 5503

ACUTE INTERVENTION TEAM

Advanced Nurse Practitioners

Bleep 5090

PREOP ASSESSMENT TEAM

Secretary Claire Porter Ext 7216

Fax 7767 Nurses Tony Bailey Ext 7217

Jeanette Harris Ext 6095 Heather Hale Ext 6094 Fiona Harris Ext 6056 Carie Attree Ext 6059 Trish Carroll Ext 6093 Steph Galvin Ceris Roberts

Dietician Claire Dobson Ext 6057 Pharmacists Sarah Blood Ext 5512 Rocco Hadland

ORTHOPAEDIC PREOP ASSESSMENT TEAM

Secretary Angeline Roberts Ext 7216 Nurses Ann Shone

Shirley Acton Angela Evans

Ext 5224 Ext 7817 Ext 5588

9

TRAINING & ASSESSMENTS Points of contact :

Dr H. Reddy RCoA College Tutor Dr A. Campbell ICM College Tutor Dr V. Madhavan Educational Supervisor (CT / ST) Dr J. Points Educational Supervisor (CT / ST / LTFT) Dr S. Abraham Educational Supervisor (FY) Dr K. Elfituri Educational Supervisor (SAS)

ALL Consultants are available for informal advice and pastoral

support so please feel free to approach any of us if you have any concerns you wish to discuss. This trust operates a zero tolerance policy against bullying and this is outlined further in the “Dignity at Work” policy which is available on the intranet. Please ask for help as we can support you better if you do.

You will be asked to sign a learning agreement, specific to your stage of training, at the beginning of your rotation with us. This sets out your obligations to attend training events and complete assessments, and stipulates what training opportunities are available to you.

Mon Tues Wed Thurs Fri

AM 08:30 – 09:00 Journal Club

09:30 – 12:30 Dept teaching

PM 17:30 ITU teaching Trainees are asked to volunteer to present a journal of their choice. The

chosen journal should be less than 12 months old and to pick one that affected your practice. Other than that anything is suitable. If you would like us to give you some ideas, please let us know.

The department and North Wales teaching programs are aimed at helping trainees prep for the fellowship exam. Closer to the exam dates, extra tutorials or exam practice is available for those who wish it. The North Wales teaching program venue rotates between the 3 North Wales Hospitals.

Please make every effort to attend these teaching sessions as they have been arranged for your benefit. You will be rota’d time to attend them and attendance is mandatory unless post on call or after discussion with the secretary’s or with the College Tutors.

10

Assessments :

As part of competency based training you are required to get several workplace assessments signed off. Full details are available in the CCT document on the RCoA web site. Please inform Dr Kenningham in advance of the modules which you need to complete and every effort will be made to allocate you preferentially, although not exclusively, to these clinical areas wherever possible.

Please stay on top of your paperwork and assessments.

• It is YOUR responsibility to get them done in a timely fashion. • DO NOT leave them till just before your ARCP as they may

not get completed by your trainer and you may fail your ARCP as a result.

• Every trainee needs an educational supervisors report AND a College Tutors report before each ARCP.

Appraisals :

All trainees need to be registered on the e portfolio and all workplace based assessments and units of training sign offs completed electronically. Please update your details on the portfolio reflecting your change in hospital and change of supervisor.

Your first appraisal will be arranged with your educational supervisor within 2 weeks of starting in Wrexham. Please bring your completed Record of Induction to this initial meeting. Thereafter, it is the responsibility of each trainee to arrange subsequent appraisals, at least 3 - 6 monthly.

You will need to undergo a 360o appraisal in the form of a multi-source feedback after about six months in the post. If you are doing an ITU module, you need a separate MSF for ITU and please send a form to all of the ITU consultants. It takes time to collate the responses so please allow sufficient time to get an adequate response. Logbook :

All trainees are required to keep a logbook. It is recommended that you use an electronic version. The RCoA provides a free electronic logbook downloadable from www.logbook.org.uk. Which works on Mac’s and PC’s. Portfolio summaries should be printed off for review at each appraisal.

11

Audits / Research :

The GMC and RCoA both require you to show evidence of active involvement in regular audit or quality improvement projects. Topics are available in the “green audit recipe bible”, available in the department library or online on the RCoA website. Please get involved by asking those Consultants with a special interest in your topic to help get you started. Remember to register all audit projects with the audit department and we will make every effort to get your audits presented or published at regional and national level. Mandatory training :

You are required to complete the following e-learning packages on : 1. Blood transfusion (www.learnbloodtransfusion.org.uk) 2. Equality & Diversity training available on www.doctors.net.uk 3. Tracheostomy management (ELfH) 4. PCA & epidural pump training (arrange via secretaries)

They are free and can be completed out of hours or at home if you wish. Books : The department has a large number of textbooks that are kept in a bookcase in the Anaesthetic seminar room and a locked bookcase in the secretaries’ office. The books in the locked bookcase may be taken out on loan, but the books located in the seminar room must not be removed from the department!

“HOUSEKEEPING”

Rotas : Weekly Rota’s

Weekly rotas are published 4 weeks in advance and are arranged by our secretaries and Dr J. Kenningham. As far as possible you will be allocated to lists appropriate to your training modules and, wherever possible, trainees will be attached to a Consultant to maximise teaching and training. Please let us know of any requests you may have as soon as possible so we can try and facilitate them. The more notice you give us, the more likely we will be able to arrange it!

The Rota’s are emailed to you and posted on the notice board in the

seminar room.

12

On call Rota’s

Leave should be booked 6 weeks in advance. A memo will be circulated before each 8 week on call rota is produced. Please put your requests in before this deadline. The rota is currently a full shift system and is fully compliant with the New Deal and European Working Time Directive (2009). Emergency on call work and the on call team :

Remember when you are on call you are part of a TEAM. Always keep in touch with the other on call anaesthetists. Although you will have a predominant area of responsibility, if things get busy, you may be asked to help out in other areas.

The on call rooms are conveniently sited, behind Theatre B, for all resident trainees.

All bleeps must be handed personally to the next person coming on call, this usually takes place in the anaesthetic seminar room. It is essential that a detailed handover of any current or outstanding patients takes place. Half an hour is included in your shift for this purpose. Please handover in an appropriate area (i.e. not the theatre reception area) Leave : Annual Leave

• Leave should be booked 6 weeks in advance. • You are entitled to 28 days annual leave per year. This should be

booked through the secretary’s, the forms are in the seminar room. • No more than 4 trainees may be away at the same time. • Please do not take more than 3 weeks at once. • Please do not take your leave at the end of your contract. • If you work a bank holiday you are entitled to a ‘time in lieu’ day off.

These lieu days must be taken as soon as possible and we will try and accommodate your requests if the Rota permits.

• Leave taken during your ITU module must be agreed with Dr A. Campbell (ICM College Tutor).

• It is permitted to carry over a maximum of 5 days annual leave from one leave year to the next ONLY when agreed to by the Clinical Director.

*** Please don’t make holiday arrangements till you know your leave has been authorised – you maybe disappointed! ***

13

Study Leave

• You are entitled to 30 days study leave each year (including up to 5 days for private study).

• Study leave requests should be made 6 weeks in advance. • Examination, ARCP and leave for job interviews needs to be entered

into the diary as soon as possible.

Sick Leave

If you are ill, please let the Anaesthetic Office know by 08.30 and if possible give an approximation of how long you expect to be off. Out of hours, the relevant on call team should be notified. A doctors certificate is required if you are absent for 7 days or more. Paternity/Maternity Leave

Details are available from Jane Smallman in Personnel Extn: 5374. Bleeps :

Trainees will be allocated a personal bleep by the secretaries on arrival to the department. This should be signed for and returned to them when completing your post. If you have any difficult operating your bleep please do not hesitate to contact one of the secretaries who will be happy to help.

Batteries can be obtained from Switch Board (ground floor, under the anaesthetic department).

DIAL 81 and follow the verbal instructions:

ENTER 4 digit BLEEP NUMBER

then…

ENTER YOUR 4 digit EXTENSION NUMBER

HANGUP once your bleep request has been acknowledged

14

Doctors Mess :

The Mess is located on the first floor, not far from the anaesthetic office. It is a comfortable place to relax when you are on call. The mess is open 24/7 and hot food is served from 08.30 – 10:00 for breakfast and 12.30 - 13.30 for lunch. There is a vending machine with microwaveable meals, which are accessible out of hours. There are also tea and coffee making facilities, bread and condiments and a selection of cereals and biscuits.

In the Mess there is a dedicated computer room with five computers, a TV room (with SKY), and a meeting room, which can be booked via the medical institute. To access these facilities please complete a Mess application form – it costs a nominal fee of £10 per month which is collected directly from your salary.

SUBSPECIALITY AREA’S Intensive Care Unit :

Trainees usually complete a 3 or 6 month dedicated attachment to

critical care. Daily ward rounds are held every morning in both HDU and ITU at 08.30 and at 17:00. It is the on call trainee’s responsibility to update the handover sheet at the end of each shift and to inform the parent teams of any discharges that occurred during their shift.

Dr A. Campbell is the ICM College Tutor, please liase with him to maximise your training opportunities during your attachment. We have educational evenings every Wednesday evening for an hour covering M&M, hot topics and journal club. Details can be found on our ITU department website : nwcriticalcare.com.

Most of the ITU consultants are ECHO competent so please tap into this and try and learn some ECHO basics whilst you are with us. Obstetric anaesthesia :

Trainees with less than 12 months anaesthetic experience are not allocated to obstetrics. Trainees are put onto the obstetric on call rota only after successfully completing their initial obstetric anaesthesia competencies. Dr Judith Young is the Lead Obstetric anaesthetist and she will be able to help you if you have any concerns. Daily Labour ward “board rounds” are done every morning with the obstetric team and the oncall team. It is the busiest Obstetric unit in North Wales and we regularly deal with complex cases. For those trainees who are interested in pursuing a career in this area, we have thrice weekly antenatal clinics at which we assess and risk manage these complex patients.

15

Pain Medicine : There are 4 clinics per week. Dr Haag has clinics on Monday afternoons and some Wednesday afternoons. Dr Underhill has a clinic every Thursday afternoon and some Tuesday mornings The pain nurses do daily ward rounds and hold regular training days to familiarise you with analgesia pumps. You will need to book a place on this MAP Study day and this can be arranged with the Anaesthetic secretaries. The anaesthetist on call for obstetrics covers the out of hour’s pain service. The pain secretary is Sarah Doughty-Davies on ext 5857.

Preoperative Assessment & CPEX :

The Preop Assessment Clinic (POAC) is located in the main outpatient area. A dedicated team of nurses assess the vast majority of adult patients there supervised by Dr Agnew (Clinical Lead), Dr Sandow and Dr Meulman. The Consultants and sometimes the nurses may discuss with you impending challenging cases to forewarn you of any potential problems that may arise with your list.

On the day of surgery, patients present to the Arrivals unit, which is located opposite the entrance to theatre A. The POAC documentation is within the notes and summarises the patients history, test results and vital signs. The notes are arranged according to the surgeons name and the patients locations are on the whiteboard opposite the ward clerks desk. Dr Agnew and Dr Sandow run the cardiopulmonary exercise testing service and for those interested trainees it may be possible to arrange an attachment with them. If you are interested, please discuss training options with them. Emergency Medical Retrieval and Transfer Service (EMRTS) :

The EMRTS is a new, exciting development in Wales and has only been up and running for a couple of years now. They are a team of highly skilled acute medical physicians who coordinate and carry out emergency transfers by road and air, currently during office hours.

If there are any trainees who wish to go on an observership day or are

interested in a career in Prehospital Care, please speak to Dr G. Mayers who is one of the Deputy Clinical Directors for EMRTS in North Wales.

16

DEPARTMENTAL POLICIES 1. Theatre Lists • Theatre lists are available from the reception area in each theatre

complex from 16:30, the day before. • Morning lists start at 08:30, afternoon lists start at 13:30 • Daycase lists are available from Pasteur ward on the day of surgery.

2. Cancelling patients

• NEVER cancel a case without discussing it first with the responsible Consultant Anaesthetist.

3. Equipment

• Check all equipment before use – this is YOUR responsibility even if it has been prepared and checked by the anaesthetic support staff.

• If you are not familiar with the anaesthetic machine or ventilator, please ask for guidance. It is your responsibility to ensure you understand the equipment you are using including syringe drivers and infusion pumps.

4. Assistants

• Do not start or continue any theatre lists without trained assistants. • Anaesthetic assistants will usually attend cardiac arrest calls and

trauma calls. If you want their help urgently, please bleep the theatre coordinator on bleep 5717.

5. Clinical Supervision

• Trainees will usually be attached to a list with a more senior anaesthetist to maximise your learning opportunities. You should have at least 3 supervised lists a week, if you would like more then please discuss this with Dr Kenningham and Dr Reddy.

• Before completion of the initial competency assessment, trainees must be fully supervised for all cases.

• During unsupervised lists, it is essential that you ask for help when required and arrange for direct supervision of more complex patients. This is always available from the General Consultant on call 24 hours a day or from the HDU Consultant (see weekly rota).

6. Monitoring standards

• Adhere to the AAGBI minimum monitoring standards for ALL patients irrespective of anaesthetic technique or surgical procedure.

17

7. Consent and Patient Identification

• The responsible medical practitioner has a duty to inform the patient of risks and to obtain consent.

• No anaesthetic should be administered until the WHO and safety brief has been done.

8. Written Records

• Always fill in a full and legible anaesthetic record. • Records should also be kept for patients who are anaesthetised outside

theatres e.g. A&E, CCU, and CT Scan etc. • Notes should be made in the patients records, if you are asked to give

an anaesthetic opinion. • If an unexpected patient assessment or intervention is necessary (e.g.

patient deterioration in the recovery area), please make a record where appropriate – anaesthetic chart or patients notes.

• When certain drugs are given in theatre there may be implications for the timing of subsequent postop doses e.g. antibiotics, analgesics. Please document these drugs on the prescription chart as well as the anaesthetic record.

• ALWAYS document date, time, name, grade and GMC number. 9. Controlled drugs

• The controlled drugs register should always be signed by the anaesthetist before the end of the list.

• Ampoules must not be shared between patients and wastage must also be recorded.

10. Recovery room

• All anaesthetists should hand over every patient individually to a member of the recovery room staff.

• It is a good practice to see all patients before they are discharged from recovery. Patients remain the responsibility of the anaesthetist whilst in the recovery room.

• Do not leave the hospital before checking that the recovery nurse is happy with your patient’s condition. If a prompt exit is needed, please ask an anaesthetic colleague to assume responsibility for the patient until they are fit for discharge.

11. ICU / HDU beds

18

• For elective cases, beds are often booked by the surgical team. If you identify a need for postop critical care that the surgeons have not, please discuss this with the surgeons and intensivists.

• It is very important to check that booked ICU/HDU beds are still available BEFORE starting an elective case.

12. Adverse events

• Any problems resulting in potential or actual harm to a patient must be reported to a Consultant and a critical incident form should be completed. These are available in every anaesthetic room and can be returned to the collection boxes in each recovery area.

• Under hospital policy the reporting of adverse events is mandatory, it is not intended to be punitive to the individuals involved. It provides a valuable educational opportunity for other members of the department and should be presented and discussed at the bimonthly audit/clinical governance meetings.

13. Cancelled lists

• If your list is cancelled or finishes very early please notify the anaesthetic office.

• Between 09:00 and 17:00 hours all trainees should keep the department notified or their whereabouts and carry their bleep.

14. Patient transfers

• The anaesthetic team is often requested to assist with patient transfers. This may be the intra or inter hospital transfers.

• DO NOT undertake a transfer unless you are certified to dos and are familiar with our equipment.

• ALWAYS take a trained assistant with you.

15. Daycase Unit and Remote Locations

• Please ensure that a Consultant is immediately available to help and that you have a trained assistant with you at all times.

• If going to MRI for the first time. Please ensure you go with a senior anaesthetist who can show you the layout.

16. Children

• As a general guide, children under the age of 5 usually require a Consultant present in theatre and children under 10 should always be discussed with a Consultant.

• If in any doubt ALWAYS ask!