Medical Orientation Manual. Tully Hospital

Transcription

1 20 bed inpatient capability (9 currently funded) Medical Orientation Manual 1 Tully Hospital FIRE & SAFETY ON LINE INSERVICE TO BE UNDERTAKEN ON YOUR FIRST DAY. Clinical services capability Level no theatre low risk maternity (midwife driven) Emergency Department 1 bed resuscitation bay, 2 triage bays, 4 offices, 3 with patient beds. ED 24/7. RN will triage and complete assessment. Transfer to Cairns or Innisfail by QAS or RSQ retrieval dependent on patient condition and clinical services capability. TEMSU available for local HHS medical support Nursing escort dependant on patient condition. PHO to liaise with SMO prior to discussing/organising any transfer to other facilities. Tully Hospital has Medicare 19(2) exemption and is able to bill all outpatient/ed medical services through Medicare. This includes pathology and X-ray as well as medical services. A Medicare Provider number for billing should have been organised prior to placement. If this is not the situation then you must liaise with your Agency/Liaison and Hospital Admin as a matter of urgency please. Medicare item numbers are to be completed by the attending MO at the time of consultation. Ward rounds must be conducted daily commencing at approximately 0830 following handover. Ward telehealth is available via a CHHHS Physician on Monday and Thursday. Patients who require this service are to be identified the day prior and their information is to be ed as per P&P. All medical staff in conjunction with nursing staff are responsible for identifying patients requiring this review. Daily review of all inpatients takes place on the ward at medical handover commencing at 0800hrs. It is desirable that all medical staff attend unless detained in the Emergency Department. This review is also attended by nursing staff. Discharge summaries are to be completed for all patients within 24 hours of discharge. Ward and night shift PHOs are responsible for these. GP follow up is encouraged for patients with an identified private GP, or the hospital GP Clinic (the hospital GP clinic is also a provider of GP services.) Appointments can be arranged. The Night shift PHO also undertakes medication chart checks and pathology results checks during their shift and is to attend nursing handover at 2230hrs and 0645hrs. Please do not require patients who have a designated community GP to return to the hospital clinic for follow up. Please ensure documentation is fully completed in a timely manner for all patients (inpatients, GP Clinic and Emergency Department presentations). Telehealth Appointments for various Telehealth services via Videoconferencing in the Education Room (Wd10) are also provided at the hospital. These include Renal, Oncology, Cardiac, Genetic services, Pain Clinic etc, and are clinically supported via Townsville, Cairns and Brisbane services. The Ward PHO or 6 th Year Medical Student provide patient support for these appointments. Appointment details/requirements are to be found in the Ward Diary and Telehealth Appointment Folder at the Nrs Station. Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 1

2 Pharmacy no pharmacist on site routine medications kept on site range of IV antibiotics and all emergency drugs. If you have any queries, please liaise with CN in ED. Anti-Microbial Stewardship videoconference (see P&P) is facilitated via Atherton Pharmacy each 1100hrs in the Education Room (Ward 10). Medication charts for all patients on antibiotics both oral and IV are to be ed to Atherton Pharmacy the Monday prior to this videoconference. This is the night shift PHO s responsibility. Please ensure the clinical indication for each antibiotic is written in the patient s medication chart at time of prescribing. Medical staff rostered to the ward are to attend the AMS videoconference. There are two community pharmacies in Tully and one in Mission Beach. The Community Pharmacies are open weekdays and Saturday. All Outpatient presentations and ED presentations are to receive outside prescriptions in accordance with PBS regulations. Starter packs for analgesics etc. and full courses of oral antibiotics are available for supply afterhours (if outside of Community Pharmacy hours). Therapeutic Guidelines are available on line via QHEPS: Alternatively the Therapeutic Guidelines are available via CHHHS home page and typing in therapeutic guidelines in the search box. Xray Licensed operators rostered weekdays and where possible on weekends. On call for emergency only. Restricted to Chest, abdomen, pelvis and extremities. Urgent spinal and facial x-rays are to be transferred to IDH/CBH. Reports are usually available within a few hours of submission on PACS (Merlin Web). There is a visiting radiographer service every Tuesday (x-ray only) and Wednesday (x-ray and ultrasound). There is also a bedside ultrasound machine. 2 CT Scan available at Innisfail Hospital and privately at Rural Medical Imaging in Innisfail. form) are available for private services. Inpatients can only be referred to public service. RMI (private request MRI available in Cairns at Cairns Hospital and privately. For private referrals the patient is responsible for any out of pocket expenses if MBS criteria are not met. Please ensure private referral forms are used for private referrals. Ultrasound available on site weekly. Echocardiograms available in Innisfail. Private service (Rural Medical Imaging) available at Tully Medical Centre. Referral to private service on private request form. Inpatients to be referred to public service. Pathology twice daily courier service to Innisfail weekdays results available on AUSCARE later that day. An ISTAT machine (POC testing) available for urgent bloods including Troponin,INR, Biochemistry, Lactate and blood gases. Pathology forms for all outpatient services must be signed by patient to ensure hospital not billed for these services. Allied Health Occupational Therapist, Social Worker, Physiotherapist on site part time. Speech Therapist, Dietician visiting service weekly. Equipment Patients requiring walking frames or any type of equipment for discharge, please refer to NUM in ward who will organise this. Please do not give out equipment of any type to inpatients or outpatients. Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 2

3 State-wide Clinical Pathways 3 Queensland Health has developed the following statewide clinical pathways which are utilised within the Cairns and Hinterland Hospital and Health Service. The pathways available on the Clinical Access and Redesign Unit are: Cardiac Pathways Clinical Guidance for the Dying Patient Head Injury Pathways Maternity Pathways Meningococcal Disease Clinical Pathway Orthopaedic Pathway Renal Pathway Surgical Pathways Smoking Cessation Pathway TIA / Stroke Pathway The Clinical Access and Redesign Unit website link: Referral Hospitals Innisfail Maternity Unit with on call OT and Anaesthetics High Dependency Unit with telemetry available Staff Physician CT Scan and Ultrasound Mental Health & ATODS Monthly specialist clinics including Paediatric- Endoscopy- Surgery -Geriatric /memory clinic- Gynaecology Haematology -cardiology/gen Medicine Cairns all services - patients for review or admission organised through ED and with accepting treatment team. On line inter hospital transfer referral form to be completed prior to transfer. Patient will not be accepted until form is completed. Please see CHHHS policy in full Tully Hospital Medical Orientation Information Folder. Copies of the Manual are to be found in the Ward at the Nurses Station and in ED. Emergency Department or Med Reg On call CBH speed dial for all other departments 2729 Transfers to Tully Hospital from other Hospitals or GPs NB: All transfers must be discussed with the DONM and/or NUM before accepting a patient to ensure bed availability and patient suitability for Tully Services If you are contacted by a Medical officer from Cairns the patient may be accepted medically, however this cannot be finalised until DONM/NUM has been contacted regarding bed availability and suitability of the patient for Tully, this includes but is not limited to wandering dementia, violent or aggressive patients, high Allied Health needs, Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 3

4 occupational therapy, speech pathology. All patients waiting placement must have ACAT completed and Nursing home applications completed prior to transfer. Work Hours Hospital duties Shifts vary, please see roster, all shifts include an unpaid meal break of 1 hour and on call as rostered. When on rostered shift you are required to remain in the facility except for your meal break. On Call senior staff are required to remain within 10 minutes of the hospital. The Ward rostered Medical officer attends to the inpatient workload including: Ward rounds and reviews of all inpatient Medication chart review and rewrite Pathology result review and follow up Emergency department attendances Outpatient appointments 4 Nursing staff will triage and assess patients. All patients requiring admission must be attended by MO. As a general rule, all patients presenting after hours will be reviewed by the SMO/PHO on shift. Rostering requests are to be discussed with the Medical Superintendent. Tully Hospital also provides an outreach service to Jumbun Indigenous Community. The MO rostered to this Clinic is identified on the medical roster and also checks the hospital ED prior to travelling to Jumbun and on return unless clinic runs late. Nursing and Admin support is provided via Community Health staff and is outreached from Tully Community Health staff. Medical Officer Fatigue management: Locum medical staff are required to complete a minimum 8 hour shift exclusive of the 1 hour meal break in accordance with your contract. Any MO who is experiencing fatigue which he believes will impact on his clinical judgement must advise the Medical Superintendent so suitable relief arrangements can be made. QH medical staff are entitled to a 10 hr fatigue break if they have worked more than 2 hours overtime between rostered shifts and not had a continuous 10 hr break from clinical duties whilst on call (as per Medical Officer s Certified Agreement 2014). Please liaise with nursing staff/medical superintendent if you are fatigued and what time you will be returning to work so clinics etc can be covered. The Nurse Unit Manager is available to discuss any ward or emergency issues. Please write your name and number at the Nurses Station in the Ward so staff are aware of your contact details. The medical roster is available to nursing staff in the ward so they will be aware of who is on call. Roster: The Medical Superintendent is responsible for the medical roster. Any roster requests are to be discussed with the Medical Superintendent. The on call is shared amongst the Senior Medical Officers including weekends. PHOs are not rostered on call. PHOs your first day commences at 0800hrs and your last day will conclude at 1700 or as rostered unless otherwise negotiated. Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 4

5 Allocation is made during your normal shift day for a 1 hour meal break. This is to be taken unless required to attend to an emergency. This hour is part of your normal shift day e.g hrs includes the hour unpaid meal break. Timesheets will reflect this e.g meal break 1 hr. For QH staff Queensland Health timesheets or MED AVAC are to be completed and will be signed off by the Medical Superintendent. All medical staff are required to remain in the hospital whilst on shift. Medical staff on call outside of their shift must remain within 10 minutes (close call) of the hospital. TIME Sheets and Invoices All time sheets must be verified and authorised by the Medical Superintendent. QH MEDAVAC form or QH locum time sheet is to be completed for any additional recall and/or overtime duties that involve direct patient care along with the UR numbers of patients seen. Please ensure these are supplied weekly on Monday mornings for signing. Computer access Please see admin on your first day to be given access to: Novell, AUSCARE, The Viewer (CIMHA access is via The Viewer), EDS and Outlook. QHEPS Intranet is available on all computers Telephone Dial 0 to access an outside line some phones do not have full access most regularly called numbers have programmed speed dials Hospital phone books are located near phones. Vehicle use If you are provided with a Qld Health Fleet vehicle for use after hours, the car remains part of the Hospital fleet during work hours and must be available for use for Hospital requirements. All QH fleet cars are supplied with fuel cards. When refuelling the odometer reading is required by the console operator. Please keep cars at least half full as there is no after hours fuel available. Before filling the car check that it is not diesel. Please report any faults/damage to the car to ADMIN and if you are involved in an accident there is a Fleet car assistance number in the glove box. In each vehicle is a log sheet which must be completed for each journey this is a QH requirement. Please deliver completed log sheets to Admin staff after each use. Unless utilising a Cairns fleet vehicle, all fuel dockets must be cleared from the car and also given to Admin. The cars must be maintained in a clean condition by the user of the car. Parking is available at the back of the Nrs Qtrs for private vehicles (hire cars etc). The area on the hospital side of the Nrs Qtrs is for Qld Health Fleet Vehicles as indicated. Thank you in your assistance with this. 5 Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 5

6 Accommodation: 6 For any staff utilising on site or facility provided accommodation, please report any maintenance issues to DONM/Facility Manager or Operational Services Supervisor. Accommodation is limited so you may be required to share. Where accommodation is shared access to the rooms is only available to the designated person. Access to the accommodation for maintenance may be required during your stay. Whilst every effort will be made to accommodate times that ensure you are not disturbed during downtime, this is not always possible and should this instance arise, your cooperation is requested. PHOs due to overlap of staffing you will be required to utilise an en suite room at the commencement or completion of your contract. The Operational Services Supervisor or Director of Nursing & Midwifery/Facility Manager will advise should this be necessary. Every effort is made to minimise accommodation changes. ON Call When on call you must remain contactable at all times and within 10 minutes of the Hospital and in the hospital when on rostered shift. Nursing staff/pho will call you when you are required. SMOs please inform the RN/PHO when you will be attending if not required to attend urgently for an ED presentation. Pathology results All QH Pathology results are available on line and are signed off electronically by a medical officer. If follow up is required, please print out and note on pathology result and chart will be retrieved and made available. It is your responsibility to check all pathology tests you have ordered and recall as required. Please notify Administration staff as to any recalls required and they will contact the patient. Please do not ring patients yourself as this lead to confusion re appointments etc. GP Clinic (aka Outpatient s Clinic) All medical staff will be required to attend to Outpatient/GP appointments whilst at Tully Hospital. To be able to bill through Medicare you will require a provider number for Tully Hospital. The Hub Med Super executive support officer will assist with the forms required. This should be arranged well before you arrive at Tully so you are able to refer patients/request private pathology and bill at the clinic from your first day. Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 6

7 Orientation to Hospital and Practice 7 On your first day you will receive orientation from During this time you will be required to complete a short induction check list undertake your Fire Safety (compulsory), sign the Signature Log sheet and be given a tour of the facility. If you have any questions you will have an opportunity to ask them during your orientation. Outpatient/ED Staff Monday to Friday 1 Clinical Nurse (RN) hrs this person is also able to cover x-ray services 1 RN staffing numbers permitting Admin staff 4-5 weekdays, 1 weekend After hours ED is covered from ward nursing compliment Medical officers are rostered as available usually at least 2 daily. PHOs are rostered on night shift each night and as per roster for other shifts. Saturday/Sunday as per roster. Operating hours hrs Monday to Friday (reception and nursing commence at 0800) First patient bookings dependant on medical staffing It is important that all Medical officers work in partnership to promote safe quality care for the patients, any workload issues should be brought to the attention of the DONM/Facility Manager or Medical Superintendent for discussion at your earliest convenience. There are 4 consultation rooms set up with computer and equipment for general appointments. There is a 5 th room which is utilised for other clinics. The Xray department is located in the general Outpatients/ED area. Pathology Service: Pathology is collected by the RNs on shift and is packed and sent by courier each weekday. Weekend pathology is only available via istat. Results are downloaded twice daily. Appointments: All appointments are bulk billed to Medicare, except for Worker s Compensation cases and ineligible patients. 15 minutely appointments with emergency fit in to next available medical officer. Bookings are essential to ensure the GP Clinic runs efficiently and on time. Pathology, x-ray and histology results require appointments please advise patient to book before they leave Elective excisions/procedures to be booked for the weekday afternoons only Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 7

8 Pathology, dressings, immunisations and child health assessments, all other health assessments to be booked in with Nursing Staff Longer appointments available by request Medicals are not bulk billed unless driving medical for age or medical condition. Reception can advise of the cost. Non eligible patients must pay for treatment emergency presentations always receive treatment. Costs for ineligible patients depends on triage score for ED presentations. Administration Officers will liaise with ineligible patients re charges. For Emergency Department presentations this is calculated by Triage level. Please do not enter into discussions with Ineligible patients re costs. Patient must produce Medicare card and photo identification if in doubt 8 Medical records: Tully Hospital has a written integrated Medical Record for all collocated services except for Community Mental Health. Clinical information for CMH patients is available on CIMHA (access via The Viewer). All records remain the property of QH. Requests for information must be authorised by the Patient Information Officer from Innisfail. Please discuss any requests for information with the Medical Superintendent or DONM/Facility Manager before release. Other Medical Service: QAS is available for transfer to Cairns and Innisfail. Nursing/Admin staff will assist with request QAS daily Patient Transport bus, this must be booked MAMU (ATSI Medical service) Medical Officer visiting from Innisfail, times vary. Nursing and Health workers other days. QH Visiting service from Innisfail Physician outreach clinic weekly (Wednesday) FROGS (FNQ Regional Obstetric & Gynae Service) approximately every 6 weeks includes colposcopies. Dietician weekly Speech pathology referral based ATODS referral based Phone Numbers Dial 0 for external line or last 3 digits for internal numbers Hospital (main switch) Emergency Room 127 General Outpatient/ED 129 DONM/Facility Manager 124 Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 8

9 NUM Ward 163 or 160 Med Super 128 Complaints /problems Please see the Medical Superintendent or the DONM/Facility Manager if you have any problems during your time at Tully. Tully Hospital is very grateful for any feedback positive or negative. If you should receive a complaint/compliment from a person accessing the service patient visitor or relative please inform the receptionist /nurse who will notify the DON. Clinical incidents are reported on RISKMAN please notify the DONM/NUM to report any incident that has the potential/caused harm to a patient. Staff related Incidents are also reported via RISKMAN. PLEASE NOTE: FURTHER ORIENTATION/CHHHS INFORMATION IS TO BE FOUND IN THE FULL ORIENTATION INFORMATION FOLDER. COPIES OF THIS MANUAL ARE TO BE FOUND AT THE NURSE S STATION IN THE WARD AND IN THE ED AREA NEAR THE PHONE IN ROOM 16. Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 9

10 Any suggestions/feedback 10 Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 10

11 11 Orientation Check list DAY 1 Introduction to staff Tully Hospital DONM & NUM Please sign when orientation completed Medical team Meet with Admin to set up access for Novell Outlook Auscare (Auslab) Electronic discharge EDS The Viewer Tour of Hospital Outpatients/ED X ray - and QH computer access PACs Pharmacy Fire evacuation points and fire equipment location Alarms duress, building Security cameras Staff toilets Wards and AH entry Accommodation Medical Practice Reception Waiting room Consult rooms QH computers Treatment /Procedure room & emergency trolley Equipment Referral procedure, script pads and consult room equipment Roster Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 11

12 12 Wards Patient rooms Nurse station path results, chart location, communication book Phone system and location of phone books Emergency trolley Patient handover Treatment room medications Conference room Staff toilets Emergency Department Location of room and equipment within room Airway equipment IV pumps and lines Location of emergency drugs REDIT enter on system as clinician Istat Oxylog X ray requests process for afterhours call Accommodation keys Breakages and repairs Brochure Complaints & Compliments register PRIME how to access Incident reports Orientation 2015: Reviewed Dec 2015: August 2016: Oct 2016: August 2017: March 2018: June 2018 Page 12