Night Float Supervisor Rotation Guide
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1 Night Flat Supervisr Rtatin Guide Cntact Infrmatin Rtatin C-Directrs: Rtatin Liaisn: Becky Ivancie Anna Lin Rishi Mediratta Intrductin Welcme t Night Flat Supervisr! This inpatient rtatin will give yu expsure t general and subspecialty pediatrics. Yu will be respnsible fr acutely and chrnically ill patients wh are admitted t the wards at Lucile Packard Children s Hspital Stanfrd. This patient ppulatin ffers high cmplexity as well as high acuity management which will prepare yu fr yur future career as a pediatrician. Schedule Rtatin Schedule Sup 1 Sup 2 Mnday Tuesday Wednesday Thursday Friday Saturday Sunday 5P- 12n 5P- 12n Int 1* Int 2 Mnday Tuesday Wednesday Thursday Friday Saturday Sunday 5P-7A 5P-7A 5P-7A 5P-7A 5P-7A Crsscver Crsscver 5P-7A 5P-7A 5P-7A 5P-7A 5P-7A Crsscver Crsscver * Nte: The 1 st week f the Intern rtatin is the 2 nd week f the Supervisr rtatin.
2 Nightly Schedule 5P-6P Signut 10P-10:30P Safety Runds 11P-11:30P Teaching Sessin 6A-7A Intern Signut 7A-8A Signut 8A-12nn* Admissins/Discharges/Runds * If all wrk is dne prir t nn, yu may leave as early as 10 AM. Rtatin Specifics Orientatin The night flat supervising resident shuld review the welcme and 5 Minute Orientatin Guide prir t the start f the rtatin. As the night flat supervisr, this is yur pprtunity fr autnmy, including yur rle as a supervisr which will include teaching. Yu may set persnal gals fr yur rtatin and review them with the hspitalist n call. It is als imprtant t rient yur interns and guide gal setting fr them. The night flat supervising resident shuld hld a brief sessin n the first night f the intern rtatin t discuss hw night flat will be run and the expectatins fr hw t handle, as well as wh t call fr, wrsening patient cnditins, admissins, discharges, and interactins with medical students, fellws, and attendings. Night Flat Team Cmpsitin The night flat team cnsists f a supervising resident and 2 interns. The interns cver Blue-Yellw and Red-Green services. Depending n the time f year, there may be a sub-intern rtating, as well. Signut The night flat team arrives at 5 PM fr signut frm the day team. Team supervisrs will sign ut t yu. Interns will signut separately. Signut shuld be in the IPASS frmat. As time prgresses, the night flat team will knw the services better, and it shuld be relatively quick and cncise fcusing n new admissins and new develpments fr existing patients. Each mrning (Mnday thrugh Friday) supervisrs frm each day team will meet with the night flat supervisr at 7 AM t sign ut new patients and imprtant vernight events. Interns will signut t each ther separately at 6 AM. It may be helpful t run the patient lists after signut with yur interns t ensure a shared mental picture.
3 Pagers and Phnes The night flat supervisr has a Valte phne prvided. Yu will need t lg in at the beginning f yur shift. Chse Sup as yur rle. Yu will als need t chse the Night Flat Team as anther rle. D nt frward yur pager t the Valte phne. The night flat supervisr is respnsible fr carrying the cde pager. The team pagers shuld be frwarded t the respective night flat intern [Blue 19405, Yellw 12074, Red 19626, and Green 19627] pagers r cell phne. Safety Runds Yu are expected t attend and ideally lead - Safety Runds with the hspitalist, nursing supervisr and patient placement representative. Runds generally start at 10 PM n PCU 380 PCU 350 PCU 360 PCU 374 PICU. If yu have patients hused in the Shrt Stay Unit, PCU 160, r alternative care areas, please cntinue runds nt these units as well. Safety Runds Review clinical cncerns with charge nurse n each unit, especially any sick patients Any new PICU transfers? Any patient deteriratin [i.e. escalating O2 needs]? Review PEWS scres Any ther safety cncerns? Review any discharges fr the next day, especially early mrning discharges Fr clr team patients, discuss any ptential needs fr the teams t address medicatin recnciliatin r paperwrk, etc Review Missin Zer fr the mnth PICU Safety Runds with Charge Nurse and PICU Fellw/Attending Discuss any acute care patients that are cncerning Discuss pending transfers t flr r pssible transfers t the PICU at the PICU bard. This is led by the PICU fellw. THIS DISCUSSION DOES NOT TAKE THE PLACE OF FACE-TO-FACE BEDSIDE HANDOFF OF ANY PATIENT WHO TRANSFERS OVERNIGHT; teams shuld fllw nrmal prcedures fr this warm handff Team Cverage Blue, Yellw, Red and Green Team The night flat supervisr is respnsible fr verseeing all clr medical teams [Blue, Yellw, Red, and Green]. Admissins shuld be staffed with the n call fellw/attending f each team. Interns are expected t see new admits in the
4 Stanfrd ED. Supervisrs are encuraged t d this, as well, but it is nt mandated. PAMF patients wh are admitted t Blue Team after 5 PM shuld be discussed with the vernight LPCH Hspitalist. Purple Team The Night Flat Team is respnsible fr new admissins and transfers frm the intensive care unit frm 6p-7a. The Night Flat Supervisr will determine which intern will manage the new admissins/transfers. Cardilgy fellw r Purple Team resident will sign ut all incming patients t the night flat supervisr. Cardilgy fellw is respnsible fr all existing Purple Team patients. The Night Flat team will manage the new patients fr the first night f admissin r transfer t flr The Blue/Yellw, Red/Green Intern r Night Flat Supervisr will place an MD t RN rder stating that pages regarding the patient s care will g t the Intern and/r Night Flat Supervisr until 7 AM the fllwing mrning The Night Flat Supervisr will call the vernight cardilgy fellw in the mrning t sign ut any vernight events. The cardilgy fellw will then sign ut the patient t the Purple Team resident. Teaching The night flat supervisr is encuraged t engage in infrmal, n-the-fly teaching ver the curse f the night. This may include review f new admissins, the differentials and treatment plans as well as medical decisin-making n existing patients vernight with yur interns. In additin, the night flat supervisr is respnsible fr leading teaching sessins at night. The night flat curriculum material is available at the fllwing website: 1 fr Interns / 2 fr Senirs: Mnday Fever Tuesday Triage n the Wards Wednesday Respiratry Distress Thursday Cmmunicating with Patients and Families in the Nighttime Rle Sunday Seizures 2 fr Interns / 1 fr Senirs: Mnday Depressed Mental Status Tuesday Handffs Wednesday Shck Thursday Autnmus Decisin-Making Sunday Pain Management
5 3 fr Interns: Mnday - Objectives and Orientatin Scavenger Hunt Tuesday - Cde Cart Scavenger Hunt Wednesday - Chest X-Ray 101 +/- 102 Thursday - Chest X-Ray 102 +/- 103 Sunday - Hands-On Respiratry Equipment 4 fr Interns: Mnday - Objectives and Self-Reflectin (refer t previus bjectives wrksheet) Tuesday - Cmmunicatin with Staff Wednesday - EKG 101 Thursday - EKG 102 Sunday - Medical Equipment: G-Tubes and Trachs Night Flat Resurces Althugh resurces are mre limited at night, please remember that there are sme available. Cnsider the fllwing resurces: Night time hspitalist PICU fellw CVICU attending Pediatric Anesthesia fellw OB Anesthesia attending and fellw Administrative Nursing Supervisr Evaluatins Please fill ut yur evaluatins in Medhub f the rtatin, yur night flat interns and the attendings with whm yu wrk. Yur night flat interns and attendings are expected t d the same fr yu. Please let us knw f any questins, cncerns r feedback. We hpe yu have a great experience!
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