Pediatric Ward Orientation

Welcome to MacPeds!

CTU STRUCTURE

You will be assigned to either CTU Team 1 or CTU Team 2

CTU teams usually consist of a Staff, SPR +/- General Peds

Fellow, NP, JPR/Off Service Residents, and Clerks

Patients are primarily located on 3C +/- ER

Sometimes patients from Team 1 & 2 can be on 3Y if no beds are

available on 3C

CTU Team 3 consists of our Chronic Complex Care Team

and 4C (Newborn nursery)

CTU 5 consists of a Staff + NP that see a few ward patients

and run the afternoon PRAC clinic.

A DAY IN THE LIFE

7:15 or 7:35 Morning Handover

(Print a list before attending except on your first day)

8:00 Morning Teaching

9-10:20 Patient Care

10:30- 12:30 Walk around Bedside Rounds

Afternoon – Note writing, Consults, Teaching and Update List

16:40 or17:00 Evening Handover

CTU TEACHING

MORNING TEACHING (8-9AM)

Monday – General Pediatrics Rounds

Tuesday – Resident Teaching or Research Roundtable

Wednesday – SPR led Teaching or Heart to Heart Rounds

(1x/month)

Thursday – Grand Rounds

Friday – Morning Report or Mortality and Morbidity Rounds

(1x/month)

AFTERNOON TEACHING

Monday Afternoon (1:30-2:15)

Clerk Bedside Teaching with Teaching Resident or Chief

Newborn Exam (Please review ppt)

Wednesday Afternoons (1:15-2:00)

Staff/Fellow Led Teaching

Thursday Afternoons: (1:15-2:00)

Subspecialty Teaching

Exception: Starting in Dec, the ID session will take place on Mon instead of Wed (refer to calendar)

*Check out the binders in the 3C conference room with lots of resources and articles separated by subspecialty

YOU WILL RECEIVE THE TEACHING SCHEDULE

FROM KIM

Also located in the 3C conference room or online on

the MacPeds website

*Please check the room location before each session!

CLERK BEDSIDE TEACHING

Takes place every Monday afternoon from 1:30-2:15 pm with the

teaching or chief resident. You only need to attend 1 session.

The session will be focused on the Newborn Exam

Please review the PPT presentation and handout that is uploaded

to your medportal prior to the session

PROTECTED TIME

• Please let your attending and senior resident know at the start of your

rotation when you have protected teaching time. Please write these times

beside your name at the top of the handover list.

• Attendance at all teaching sessions is mandatory! If you are attending to a

sick child, please notify the staff or senior resident that you have protected

teaching time so they are able to take over their care.

• Update the list and touch base with your team before leaving for

your half days.

TEACHING RESIDENT

Most blocks will have an assigned teaching resident

You can check the CTU Teaching Schedule located in the 3C

conference room to find out who is assigned

Check the top of the handover list to find the teaching

resident’s contact information

Feel free to contact them for any teaching!

Consider using them to complete MacDOTs(ie. observing your

physical exam during morning patient rounds, observing a history

during a consult etc.)

Contact them for informal teaching sessions during any downtime

CTU HANDOVER

MORNING HANDOVER

• AM handover starts promptly at 7:15 or 7:35am

• AM handover on weekends AND holidays start at 8:30

• Team on take that day has the later AM & PM handover times

• Ensure you print a list and bring it to handover

• The on call residents/clerks will briefly review new

admissions and any overnight issues

Team 1 admits on ODD days, Team 2 admits on EVEN

days

EVENING HANDOVER

• PM handover occurs at 16:40 or 17:00

• Day team is in charge for printing 2 updated

patient lists for the night time team

• IPASS…IPASS…IPASS…IPASS format for handover!

PM HANDOVER – I-PASS

• On your first day of CTU, the

senior will model IPASS by

handing over your patients for

you.

• **Please review the IPASS

presentation that has been

loaded to your medportal

prior to your first day on

float/CTU

GUIDE TO PRESENTING NEW CONSULTS

• Practice with your overnight resident before handing over

your first evening consult in morning handover

• Spend 2-3 minutes on each new patient and discuss

• Name, age, main presenting complaint

• Brief HPI focusing on pertinent positives/negatives

• Brief summary of objective findings (physical exam,

investigations)

• Admitting diagnosis and plan

HANDOVER LIST - SAMPLE

On each handover list there should be a template at the

bottom. Feel free to copy and paste the cells, and fill in

the information pertinent to your admitted patient.

FLOAT SHIFTS

FLOAT SHIFTS

• Arrive to handover at 4:30pm to introduce yourself to the

team (You do not need to print team lists)

• If you have to leave at 11pm (Monday, Thursday, Sunday

nights) then you are to arrive at noon to start seeing

consults

• Page 1645 (SPR pager) to let them know you have

arrived and to arrange a meeting spot

• If there are no afternoon consults, make sure you join

any teaching sessions happening that afternoon with the

CTU teams.

• You will meet up with the night time team at 4:30pm at

handover

FLOAT SHIFTS

• Your primary responsibility is to see consults

• No CTU team pager

• The SPR will see the consult briefly to ensure they are stable before you start the consult

• All consults need a written and dictated note

• While waiting to review, write your note, and start an admission order set

• Make sure you add the patient to the appropriate CTU team handover list

ADMISSION ORDERS

• Please use the Pediatric Admission Order Set

when admitting patients

• Look for the “order set” icon on your citrix,

and search under the pediatric tab on the left

• Be aware or ask your fellow residents if there are

specific order sets that you should be using ie.

bronchiolitis, asthma, DKA, UTI etc.

WHO CAN I CALL FOR HELP?

• Senior Resident (or any other resident on the team)

• The SPR is available for any questions or to be

support if you are concerned about a patient

• NEVER feel worried to get a more senior

member of the team if you are feeling

uncomfortable about a patient

• REMEMBER – there is always either a SPR

or staff carrying pager 1645

PACE

• Paediatric Assessment of Critical Events– Call paging or page 75030

• Team includes: – PICU resident and fellow

– PICU nurses

– RT

– PICU staff

• Activation criteria available on PACE cards

• ANYONE who is concerned about a patient based on these criteria can call PACE

CTU ROUNDSBEDSIDE WALK AROUND ROUNDS

BEDSIDE WALK AROUND ROUNDS

Efficiency is KEY!

How can you help?

Make sure the charts are on the cart by 10:20AM

If you are not presenting a patient, someone should have the chart

and write down orders/fill scripts/DI req’s etc as the plan is being

decided for the patient

Each chart has a binder with extra forms (ie. order sheets, DI reqs

etc). Please fill them if you notice they are running low.

CTU MULTI-D BEDSIDE ROUNDING

Multi-D rounds introduced July 31 2017

Goal is to collaboratively develop and communicate a plan of action for each patient

Standardized Rounds to take place from 10:30AM – 12:30PM

Multidisciplinary rounds will occur at the bedside with patient and family present

Your role:

• ID: Brief patient summary (age, gender, reason for admission, relevant PMHx)

• Prioritized Problem List

• Assessment and Plan

• Summarize pertinent physical exam findings and investigations

• List Active Issues (include DDx as appropriate) and propose management plan for each

• **If you are not presenting – help by writing orders and requisitions

CTU ROUNDING

CTU ROUNDING

CTU ROUNDING

ROUNDING IN ACTION

Video Link: https://www.youtube.com/watch?v=5FQE0c7BsL0&feature=youtu.be

DOCUMENTATION

DOCUMENTATION

• Every patient requires a daily progress note

• Exact details (ie labs and vital signs) are part of the electronic

chart. It is important to capture these by documenting trends

and providing interpretations.

• The most important part of your note is the

impression and plan:

• Make sure you detail the rationale for pursuing one

treatment versus another or reasons for changes in mgmt.

• Include working diagnosis or differential diagnosis.

• Important to include a disposition plan

DOCUMENTATION

• On Fridays, each patient should have a more

detailed note outlining the treatment plan for

the weekend, especially if the patient is a

predicted discharge

• Please try to have planned weekend discharges

organized (prescriptions written, appointments

arranged, CCAC arranged etc.)

• You are responsible for the discharge dictation if

the patient has been admitted for longer than 48hrs

CTU SCUT SHEET – AVAILABLE ON THE MAC PEDS

WEBSITE

DICTATIONS

• Every Consult and Discharge requires a dictation within

24-48hrs

• Exception – PICU transfers do not need a dictated

consult note

• When dictating, ensure you indicate the admitting staff and

please SPELL their name

• The Pediatric Survival Guide contains templates for

common discharge diagnoses – Please use them when

applicable

• Make sure you write down the dictation number on your

consult note, or on the discharge face sheet

DISCHARGES

• Ask a resident to help you with your first discharge

• “Face sheet” must be filled out for every patient at the time

of discharge

• Charts for discharged patients will remain on the wards for

48-72 hours (located behind the 3C business clerk)

• Please put the dictation job ID on the face sheet once the

dictation is completed

• If you are transferring to another hospital, please ask for the

‘transfer document’ and ensure it is completely filled out

before transfer.

HANDOVER LISTS &

MEDITECH ACCESS

CTU TEAM HANDOVER LISTS

Team lists are located on the Citrix handover site

Please update the lists everyday and include any overnight / weekend instructions

Don’t wait to the last minute to update a list as there can only be one checked out list at a time

Be sure to check your lists back in so that others can edit them

Remember: The patient lists contain confidential information! Do not leave printed copies in the handover rooms or on wards! Dispose in confidential waste bins at the end of the day!

HOW TO ADD SERVICE HANDOVER FOR ACCESS

TO THE CTU TEAM LISTS

APPSCRIBER- SEARCH FOR ‘SERVICE HANDOVER’

Click on the + button to activate

OPEN THE CLINICAL FOLDER

You may need to refresh or log out of Meditech for the

service handover app to appear in your clinical folder

OPEN SERVICE HANDOVER

CHOOSE YOUR TEAM LIST

“CHECK OUT” TO EDIT

**SAVE AND CHECK IN BEFORE YOU EXIT **

PRESS “OK”

MEDITECH ACCESS

SELECT “LIVE APPLICATIONS”

REMEMBER HAH!!

ENTER YOUR USERNAME AND PASSWORD

CHOOSE PATIENT CARE INQUIRY

MORE THAN ONE WAY TO FIND YOUR PATIENT

• Search by Name,

Number

• Search by Location

– scroll down to

MI-3C

RECENT INVESTIGATIONS

VITAL SIGNS – PATIENT FLOWSHEET

Use Patient Flowsheet for Vital

Signs & Ins/Outs

PATIENT FLOWSHEET

• Hit ‘F12’

• *If it asks you for a facility – type

in ‘M’

FLOWSHEET

CALCULATING URINE OUTPUT

We always report urine output as CC/KG/HR

Therefore divide the total urine output (be aware of diapers

mixed with stool) by the weight and the number of hours

Before calculating a urine output, make sure the flowsheet

has been accurately documented and is up to date

VITAL SIGNS – PAIN MGT

VITAL SIGNS – GRAPH MODE

INTAKE AND OUTPUT

CUMULATIVE INS AND OUTS

HELPFUL PEDIATRIC

RESOURCES

HELPFUL RESOURCES

GREEN PEDIATRIC HANDBOOK

MAC PEDS CTU WEBSITE – ARTICLES, CASE BASED

LEARNING

CANADIAN PEDIATRIC SOCIETY STATEMENTS – TOPIC

SPECIFIC

AAP “PEDIATRICS IN REVIEW” ARTICLES – TOPIC

SPECIFIC

Mac Peds WEBSITE

http://www.macpeds.com/general_pediatrics.html