BVH on call & AMU. Venu Kollipara

Transcription

1 BVH on call & AMU Venu Kollipara

2 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

3 Numbers on call Week days - Registrar 997 ( ) - Ward cover - 2 juniors (F2, CMTs, ACCS, GPSTs) - Home teams (with one junior responding to arrest calls) - Ward cover Hospital at night team bleep advanced nurse practitioner from 4pm bleep Acute response team hold 600 during the day

4 Weekend wards - day time - Registrar 997 (9.00 to 22.00) - Junior *2 ( )- see intranet on call rota for division of wards - Wards - Crash - F1 ( ) - night team - 2 ANP - Operated via nerve centre on blackberries - Additional juniors on bank holidays

5 AMU Weekdays 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) ( ) - call taker & clerking ( ) - clerking - F1 ( )

6 AMU Weekends consultants post take on AMU & Wards - Registrar 997 Wards & Resus (AMU if busy) - AMU registrar - Covered by 2 shifts - early Late Juniors F1 present on unit

7 Nights Registrar AMU & Wards - (Occasional additional locum registrar on weekends & busy weeks but very intermittent) - 2 juniors - Based on AMU call taker & clerking clerking & crash team - F1 & 2 ANP - Wards & crash team

8 In summary: Week days: Wards: Registrar, 2 Juniors on Wards AMU: AMU team (Registrar, 2 F1s, F2, 2 GPSTs, occasionally ACCS), 2 on call juniors, F1 Amu Weekends: Wards: Registrar, 2 juniors, F , 2 ANPs AMU: Registrar, 2 juniors, F1 Nights Registrar (occasional 2 nd on AMU), 2 juniors, F1, 2 ANPs

9 Handover - All handover occurs on AMU - Morning handover at AMU electronic board at AMU hub. - Evening handover - AMU relatives room or if in use, AMU staff room AMU board rounds.

10 FY1 - Baton bleep 981 Weekdays - Complete on ward with home team - AMU from 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

11 FY1 weekends - AMU - Attend handover at Accompany consultant on ward - Complete ward round jobs - Complete TTOs - Clerk patients & discuss with senior - Attend handover at 21.30

12 Weekend wards 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 with outstanding jobs & to inform about sick patients

13 Nights - Cover medical wards with 2 nurse practitioners from night team - Jobs listed on nerve center via the blackberry - Try to pop into the 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 & 9.00

14 Junior on call Crash - Week days - works with home team On crash team all day - At 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

15 Wards - Week days - works with home team At will cover: - 2 General Medicine/Care of the Elderly - 11 / 18 Endocrine 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

16 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 night team to explain the system & how to use the blackberries

17 Amu on call Attend handover at Take 731 bleep & 732 until 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

18 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

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20 Utilise PCAU - Primary Care Assessment Unit open mon-fri Mon Friday 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!

21 Ambulatory care Combined assessment and treatment unit. Medical and surgical. Same day service. Short stay unit: less than 48 hrs stay.

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25 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 and 9.00 if post nights

26 Registrar on call - Baton bleep 997 ( ) - 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

27 AMU - 36 bed ward - Currently 3 consultants - Clinical Lead Dr Kollipara - Take patients average

28 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

29 Admission document Call taker documents name, DoB & hospital number if available C Call taker documents brief history Call taker documents their name, date & time call taken and where call from History Essential that you document NAME, GMC, GRADE, BLEEP (NOT ON CALL NO) DATE & TIME

30 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

31 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

32 Examination findings

33 Dementia screen monitored daily

34 Investigation results space for baseline bloods

35 Diagnosis, plan, and sign date & GMC number again

36 VTE assessment prophylactic agent in BVH is 5000units dalteparin

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38 Pathways Pathways in place for: - Sepsis - Community acquired pneumonia - COPD - Stroke - Acute Kidney Injury - Abdominal pain - (Neck of femur pathway)

39 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!

40 Trainee representatives August 2015 August 2016 Muna Parajuli CT2 Currently based on Care of the Elderly Wards 25 & 26 Until Early September 2015 Aoife Lillis ST3 Based on Respiratory - Any questions please ask!

41 Questions?