Paediatric SHO SURVIVAL GUIDE james and carol...paediatric input (e.g. those on antibiotics for...

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Darent Valley Hospital SURVIVALGUIDE Paediatric SHO survival guide

Transcript of Paediatric SHO SURVIVAL GUIDE james and carol...paediatric input (e.g. those on antibiotics for...

Page 1: Paediatric SHO SURVIVAL GUIDE james and carol...paediatric input (e.g. those on antibiotics for suspected sepsis, jaundice, hypoglycaemia o These babies require daily reviews with

DarentValleyHospital

SURVIVALGUIDE

PaediatricSHOsurvivalguide

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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.


Neonatal jaundice briefing (paper2) | Neonatal jaundice ...

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Paediatric liver conditions Present with combinations of the following symptoms and signs Jaundice Encephalopathy (altered consciousness or behaviour)

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Neonatal Jaundice Carrie Phillipi, MD, PhD. Newborn with Jaundice.

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Bilirubin and Jaundice - columbia.edu · Bilirubin and Jaundice ... Jaundice Defect in Conjugation Unconjugated bilirubin ... Microsoft PowerPoint - 041806gi-BrennerJaundiceColor.ppt

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