bvh on call & amu · - amu from 17.00 - collect 981 bleep from amu f1 - on teaching days,...
TRANSCRIPT
BVH on call & AMU
Venu Kollipara
Objectives
- Explain the on call shifts at BVH
- Numbers on call
- Registrar, Junior & F1 both day & night
- What roles are required at each
- Explain how AMU works
- Explain the clerking booklet
Numbers on call
• Week days
- Registrar 997 (9.00 – 22.00)
- Ward cover
- 2 juniors (F2, CMTs, ACCS, GPSTs)
- Home teams 9.00 – 17.00 (with one junior responding to arrest calls)
- Ward cover 17.00 – 22.00
- Hospital at night team – bleep 600
- 1 advanced nurse practitioner from 4pm – bleep 600
- Acute response team hold 600 during the day
• Weekend wards - day time
- Registrar 997 (9.00 to 22.00)
- Junior *2 (9.00 – 22.00)- see intranet on call rota for division of wards - Wards
- Crash
- F1 (9.00-17.00)
- Hospital @ night team - 2 ANP
- Operated via nerve centre on blackberries
- Additional juniors on bank holidays
AMU
•Weekdays
- 3-4 AMU consultants on PTWR
- AMU team
- 2 F1s, 1 F2, 1 ACCS, 2 GPSTs,
- 2 registrars
- Registrar 997 based on unit
- 2 Juniors (Do Monday-Thursday on call)
- 731 (9.00 – 22.00)
- call taker & clerking
- 732 (10.00 – 22.00)
- clerking
- F1 (17.00- 22.00)
AMU
•Weekends
- 3-4 consultants post take on AMU & Wards
- Registrar 997 – Wards & Resus (AMU if busy)
- AMU registrar
- Covered by 2 shifts
- early 9.00- 17.00
- Late 16.00 – 24.00
- Juniors
- 731 9.00 – 22.00
- 732 10.00 – 22.00
- F1 present on unit 9.00 – 22.00
Nights 21.30 – 9.30
- Registrar 997 - AMU & Wards
- (Occasional additional locum registrar on weekends & busy weeks but very intermittent)
- 2 juniors - Based on AMU
- 731 – call taker & clerking
- 732 – clerking & crash team
- F1 & 2 ANP - Wards & crash team
In summary:
• Week days:
• Wards: Registrar, 2 Juniors on Wards 17.00 – 22.00
• AMU: AMU team (Registrar, 2 F1s, F2, 2 GPSTs, occasionally ACCS), 2 on call juniors, F1 Amu 17.00 – 22.00
• Weekends:
• Wards: Registrar, 2 juniors, F1 9.00 – 17.00, 2 ANPs
• AMU: Registrar, 2 juniors, F1
• Nights
• Registrar (occasional 2nd on AMU), 2 juniors, F1, 2 ANPs
Handover
- All handover occurs on AMU
- Morning handover
- 9.00 at AMU electronic board at AMU hub.
- Evening handover
- AMU relatives room or if in use, AMU staff room
- 21.30
- + 12.30 AMU board rounds.
FY1
- Baton bleep 981
•Weekdays
- Complete 9.00 – 17.00 on ward with home team
- AMU from 17.00 - collect 981 bleep from AMU F1
- On teaching days, on-call F1 is on AMU all day and does not attend teaching
- Complete jobs handed over & report to sister in charge for any further jobs
- Clerk patients & discuss with senior
- Attend handover at 21.30
FY1 weekends
- AMU
- Attend handover at 9.00
- Accompany consultant on ward
- Complete ward round jobs
- Complete TTOs
- Clerk patients & discuss with senior
- Attend handover at 21.30
• Weekend wards
- 9.00 – 17.00
- First on call for jobs on: - Stroke
- 23 & 24 – Respiratory Wards
- 18 – Endocrine Ward
- 19 – Short Stay ward
- Jobs via nerve center
- Bleep Junior at 17.00 with outstanding jobs & to inform about sick patients
• Nights
- Cover medical wards with 2 nurse practitioners from hospital @ night team
- Jobs listed on nerve center via the blackberry
- Try to pop into the hospital @ night office prior to nights to ensure you can get on the system and someone can show you how it works
- Any concerns or questions, discuss with the registrar
- Clerk any patients on Hematology & Stroke who are admitted directly to the ward
- Discuss these with the registrar
- Attend Crash calls & medical emergencies
- Attend handover 21.30 & 9.00
Junior on call
•Crash
- Week days - works with home team 9.00 – 17.00
- On crash team all day
- At 17.00 will cover:
- 23 / 24 - Respiratory
- 25 / 26 - Care of the Elderly
- C – General medicine & oncology
- Haematology (Ward E)
- Weekends – entire day on wards (occasionally need to attend WR on AMU)
- Clerk direct admissions to Haematology ward
- Escalation to Registrar if any concerns
- Attends handover at 9.00 am (weekends only) & 21.30
• Wards
- Week days - works with home team 9.00 – 17.00
- At 17.00 will cover:
- 2 – General Medicine/Care of the Elderly
- 11 / 18 – Endocrine
- 12 - Gastro
- 19 (SSW)
- Stroke (33/34)
- 6 & Cardiac Day Case – occasionally used as escalation wards
- Outlying wards
- Weekends – entire day on wards (occasionally need to attend WR on AMU)
- Clerk direct admissions to Stroke ward
- Escalation to Registrar if any concerns
- Attends handover at 9.00 am (weekends only) & 21.30
Ward cover
- The wards are also covered by the hospital at night team
- Usually one ANP on late and 2 on nights but some changes recently in order to cover Clifton rehab hospital out of hours.
- This means the evening shift is not always covered
- Nights and weekend jobs are completed via nerve centre
- These are accessed via a blackberry which you will carry with you
- Jobs are then allocated to different doctors/ANPs
- Please call in early on your first shift and ask the hospital @ night team to explain the system & how to use the blackberries
Amu on call
• 731
- 9.00- 22.00
- Attend handover at 9.00
- Take 731 bleep & 732 until 10.00
- Take all referrals from A&E
- Take GP referrals out of hours and when no ANP cover
- Add patient to electronic system
- Attend handover at 21.30
Referral tips
- Medicine accepts:
- Chronic pancreatitis but not first presentation
- See abdo pain proforma, surgeons generally need to at least see patient unless very clear cut medical problem
- Chest pain
- For repeat trop’s & NSTEMIs
- STEMIs go straight to cardiology
- Cardiology also take
- Chest pain if they are under active cardiology follow up, if the chest pain sounds cardiac & is on going, sometimes! If these are present ask them to discuss with cardiology first, if unsure ask consultant or registrar on call
- If GP phones, chest pains need to be reviewed in A&E first!
- Stroke goes to A&E (if GP referral) & from there directly to stroke ward – don’t come to AMU
- Try to ask about cultures, abx, fluids , CXR - these should be done in A&E prior to transfer
- Give the nurse in charge warning if patient is likely to need a side room- input on tracking system
•Utilise PCAU
- Primary Care Assessment Unit open mon-fri 9.00 – 17.00 - Mon – Friday 9.00 – 18.00 NP takes GP calls
- If she is off, 731 will take calls
- GPs usually able to inform you if they think their patient is appropriate for PCAU
- Essentially any patient who could possibly be discharged on the same day
- Obs need to be stable
- Need to be mobile
- Can arrange transfusions on there electively
- Acceptance criteria beside electronic board in AMU
- If not sure, ring down & ask!
Ambulatory care
• Combined assessment and treatment unit.
• Medical and surgical.
• Same day service.
• Short stay unit: less than 48 hrs stay.
• 732
- 10.00 – 22.00
- Clerking patients
- Holds 731 when they are on break or doing a procedure
- On the crash team at night
- Responsible for taking the grab bag from AMU to arrests, please see ANP at start of shift for direction regarding this
- Attends handover at 21.30 and 9.00 if post nights
Registrar on call
- Baton bleep 997 (9.00 - 22.00)
- Lead Crash calls
- In charge of take
- Awareness of number of patients to be clerked, escalate if necessary
- Clerk unwell patients in A&E resus if contacted directly by A&E team
- Senior reviews
- Unwell patients & patients prior to transfer from AMU to wards
- Thrombolysis for Stroke & PE
- Review patients referred by other specialities
- Helps with clerking, especially at night
AMU
- 36 bed ward
- Currently 3 consultants
- Clinical Lead – Dr Kollipara
- Take 35 – 50 patients average
Clerking
- Patients to be seen
- Identified in order of arrival by time on the AMU tracker system
- Patients who are unstable will be triaged as yellow or red, red being more unstable
- Patients clerked in the order of red, yellow, green then time
- When clerking
- Click on the patient, put your name to show that you are going to clerk that patient
- When finished, enter your diagnosis & click clerking completed so they can be highlighted for senior review
Admission document
• C Call taker documents their
name, date & time call taken
and where call from
Call taker documents
name, DoB & hospital
number if available
Call taker
documents brief
history History
Essential that you document
NAME, GMC, GRADE,
BLEEP (NOT ON CALL
NO) DATE & TIME
PMH & Drug History are essential
- Notes can take time to come to ward
especially at night
- Use Vision Portal
- Vital information – all letters to GPs,
discharge summaries & MIG – GP
record of PMH & Medication list
Patients who are confused: try to
always ring nursing homes or
relatives to get an idea of their
baseline
Smoking & alcohol
recording is often audited,
if you can complete these,
please do
Examination findings
Dementia screen monitored
daily
Investigation results
space for baseline bloods
Diagnosis, plan, and sign
date & GMC number
again
VTE assessment –
prophylactic agent in BVH
is 5000units dalteparin
Pathways
• Pathways in place for:
- Sepsis
- Community acquired pneumonia
- COPD
- Stroke
- Acute Kidney Injury
- Abdominal pain
- (Neck of femur pathway)
Teaching
- Lunchtime - Departmental teaching
- Respiratory: Xray meeting Monday, teaching Tuesday, MDT
friday
- Gastro: Teaching Tues & Wed, Xray thurs, MDT Friday
- CoE: Teaching Thursday
- Endo: Teaching Tuesday
- Most provide lunch!
Trainee representatives
• August 2015 – August 2016
• Muna Parajuli CT2
• Email: [email protected]
•Currently based on Care of the Elderly Wards 25 & 26
•Until Early September 2015
•Aoife Lillis ST3
•Email: [email protected]
•Based on Respiratory
- Any questions please ask!
• Questions?