STANDARD OPERATING POLICY GYNAE ONCOLOGY INPATIENT CARE DEPARTMENT OF GYNAE ONCOLOGICAL SURGERY ABMU HEALTHBOARD
Content 1. Standard operating policy for gynaecological oncology patients a. Team members b. Rotas c. Day to day proceedings i. Ward rounds ii. Daytime cover iii. Pre assessment clinics iv. Admission of patients Morriston hospital 1. Theatre list v. Admission of patients Singleton hospital vi. Friday handover d. Out of hours cover i. Morriston hospital ii. Singleton hospital iii. Flow chart for ward cover (Morriston) iv. Flow chart for ward cover (Singleton) 2. Appendix 1. Example Gynaecological Oncology weekly team timetable/rota 2. Example of Gynae oncology operating list 3. Example of Gynae oncology in patient list 4. Contact numbers 5. Gynaecological Oncology Team rota email distribution list 6. HDU/ITU bed booking form 7. Severe sepsis screening tool 8. Contact details department of gynaecological oncology
1. Standard operating policy for surgical care of gynaecological oncology patients INTRODUCTION: The South West Wales Gynae Oncology Centre provides secondary and tertiary care for women with gynaecological cancers as part of the South Wales Cancer Network. Referrals are received from cancer units based in Hywel Dda and ABMU health boards respectively. Tertiary referrals are also received from further afield for patients requiring treatment under the care of the pelvic oncology MDT. The Department of Gynae Oncology provides surgical treatment for these patients and is based at Singleton Hospital as part of the Directorate of Women s and Child Health. Surgical activity takes place on two sites Singleton and Morriston. There are two sessions based in Singleton on a Wednesday afternoon and Thursday morning respectively. Elective surgical cover at Singleton is limited and there is no HDU support. Therefore suitable cases for Singleton are patients deemed to be of low anaesthetic risk and those that are unlikely to require multi disciplinary surgical input. There are five operating sessions based at Morriston: three on Tuesday and two on Thursday. All high risk surgical patients are operated on at Morriston. Decisions regarding place of surgery are usually made following the MDT meeting on a Wednesday at 12.30pm in the gynae oncology administration office. As the surgical service is a split site model, there are challenges to providing adequate cover for patients and key to the success of this service is adequate communication, prompt intervention and effective team working. The initial part of this document outlines the standard day to day working of the department with regard to the surgical pathway and should make clear the roles and responsibilities of each member of the team. a. Team members The GO team consists of three consultants (with one recently appointed and due to start in mid 2016), one Associate specialist, one senior specialty registrar/research fellow (SpR), one academic F1, one SHO (covered in accordance with general O&G rota), two Gynae oncology nurse specialists and three secretaries. Please see the appendices for details of members of the team. b. Rotas There are two rotas in circulation, one for Morriston and one for Singleton. Morriston: The responsible clinical team alongside all relevant contact details will be displayed on the weekly rota, which is distributed via email by the Medical Staffing Manager for Women and Child Health (Sarah Watchman), and will be displayed on the notice boards of wards V, G and H as well as theatres (See appendix for Morriston distribution list). Singleton: This is the General Gynaecology on call rota. This rota is on display on ward 20, theatres and labour ward notice boards respectively.
c. Day to day proceedings i. Ward rounds In Morriston hospital, all ward rounds start at 8am, except for Mondays when they commence at 8:30am. On Wednesday mornings, a consultant review takes place at 7am, followed by ward round by the day team at 8am. At the Singleton site, all ward rounds start at 8:30am. The ward rounds will be either consultant led or supervised by the senior registrar/ Associate specialist. Clear plans for patients care will be made during rounds, clearly documented in the patient s file and discussed with the nurses in charge to ensure safety and continuity of care, as well as adherence to the team s action plans. Notes taken during the rounds are to include NEWS score, patient observations, input/output charts and all other relevant information. In case other teams need to be involved, the team will contact relevant parties without delay (i.e. pain team, stoma nurses, surgical/medical colleagues, radiology). It is the responsibility of the gynae oncology team to chase up all investigations and ensure that management plans are effectively implemented. The responsible consultant should be updated on the status of the patients following the ward rounds. Ward rounds on the weekend (for both sites) should be conducted by a senior member of the on call gynaecology team on both Saturday and Sunday. This would include a senior registrar (ST6 or above) or the consultant on call. Morriston: ii. Daytime cover If a gynae oncology patient becomes unstable on the ward during the hours of 8am 5pm then the gynae oncology team are responsible to provide initial assessment and support (see flowchart). If immediate support is not available then contact the surgical on call team or critical care outreach as appropriate. The consultant responsible for the patient should be made aware of any concerns raised and updated accordingly. Singleton: During daytime working hours, contact the on call Gynae oncology F1 or if unavailable the on call Gynaecology SHO/SpR or consultant, escalating depending on staff availability and urgency of the clinical situation (see flowchart). If immediate support is not available then contact the surgical oncall team or critical care outreach as appropriate. The consultant responsible for the patient should be made aware of any concerns raised and updated accordingly. Inpatient list: An inpatient list covering both sites is updated on a daily basis (Monday to Friday) and distributed to all members of the gynae oncology team as well as the rota coordinator (Sarah Watchman). The responsibility for updating this list lies with the gynae oncology team covering the wards. This list includes clinical details on patients admitted on both Singleton and Morriston sites and outlines a summary of any clinical concerns or actions to be taken on the day (see appendix).
iii. Pre assessments clinics Currently, pre assessment for Morriston patients is carried out on Wednesday afternoons in the gynae oncology pre assessment clinic. This is based in Singleton gynae outpatients and a separate policy exists with regard to the conduct of this clinic. Briefly, patients undergo medical clerking, are seen by the anaesthetist and relevant investigations will be carried out (i.e. ECG, echo). Any particular requirements on admission (including HDU) or peri operatively are documented, including issues related to discharge planning. The pre assessment process is therefore vital to optimising patient care during the peri operative period and allowing safe discharge in a timely fashion. Pre assessment for Singleton patients are carried out on the day of admission as these patients are usually considered to be low risk. However anaesthetic reviews are obtained if necessary prior to admission. A pre assessment service for all gynae oncology patients (Singleton and Morriston) is currently being developed. Booking an HDU/ITU bed: In case a patient requires a postoperative HDU/ITU bed electively, this will be booked at the time of pre assessment. A HDU/ITU booking form (example see appendix) has to be filled in and put into the booking folder at the ITU reception. The case needs to be discussed with the ITU consultant (38609) to confirm the booking. iv. Admission of patients Morriston Hospital Patients are usually admitted on Mondays for the Tuesday operating list and on Wednesdays for the Thursday operating list. On the day of admission, the gynae oncology team on site is required to liaise directly with the bed manager (contacts see appendix) at lunchtime about patients to be admitted and their respective wards. If necessary, the bed manager contacts the responsible consultant directly if there is an issue with availability of beds. Please note that on the day of admission, patients may be admitted to various wards, including, but not restricted to, wards V, G and H. Post operatively however, patients will be admitted to wards V, G and H only. In case of elective HDU/ITU admission, the gynae oncology team needs to ensure that this has been booked (see booking an HDU/ITU bed above). Some cases are admitted on the day of surgery, including day cases. Most day cases will be admitted to the Theatre admissions unit (TAU). These patients are usually discharged from TAU on the same day although occasionally patients will be admitted to a ward subsequently for overnight stay if necessary. On admission, patients require medical clerking to ensure guidance issued in the pre assessment clinic is carried out. The prescription charts should be checked and completed. It is particularly important to ensure that patients receive prophylactic anticoagulation on the day of admission. Blood investigations should be carried out as indicated. It is imperative that a second group and save sample is performed on admission (the first should have been done the week prior to admission). If the first sample was not performed, then 2 samples must be taken at least 30 minutes apart. This should ensure that electronic issue is available for the patient on the day of surgery. If a patient is
known to have antibodies from her initial sample or clinical history, this should be discussed directly with the blood bank at Morriston as soon as possible. 1. Theatre list Once received, the operation list is normally put on the office notice board of ward V and in addition on wards G and H if any patients are admitted there. Once the operating list is received by the ward and the gynae oncology team, it is the responsibility of the Gynae oncology SHO to obtain a printed copy of the list and take it to main theatre reception, where it should be placed into the future theatres folder. Once done, the SHO should confirm this by replying to the distribution list for theatres. On the morning of the operating lists, the following tasks must be carried out: Check electronic issue for blood is available and inform the anaesthetist Check that prophylactic anticoagulant was given the night before Check which wards the patients were actually admitted to and inform main theatre reception and the gynae oncology theatre (theatre 6) so that the operation list can be amended accordingly. v. Admission of patients Singleton Hospital On Tuesdays and Wednesdays patients are commonly admitted to Ward 20 for Wednesdays afternoon and Thursdays operating list. This list is filled with a variety of Gynae oncological cases ranging from day cases to major abdominal surgery. The postoperative recovery of these patients does not usually require HDU/ITU admission however it still requires great attention to detail in their care. The bed manager is usually responsible to assign vacant beds to these women. The operation list is distributed the day prior to surgery (see distribution list). Postoperative care is commonly provided on ward 20 with nursing staff well trained in looking after such patients. vi. Friday/weekend handover The daily handover sheet should be updated by the Morriston team first and sent over to the Singleton F1 (or SHO covering the gynae ward), so that the Singleton patients can also be updated and distributed by 4pm. This is to allow the rota co ordinator (Sarah Watchman) to email a copy of the handover sheet to the on call team for the weekend. A formal handover is to take place on the phone between the Morriston Gynae oncology registrar and the Singleton gynaecology registrar on Friday afternoons. At 5pm, the weekend handover sheet is printed out and formally handed over to the on call team by the SHO/F1 or daytime gynaecology registrar. A copy of the handover sheet should be placed on both ward 20 and the labour ward handover room.
d. Out of hours cover (see flowcharts below) i. Morriston Hospital Out of hours, first call cover is provided by on call surgical F1. When a patient is reviewed by the surgical F1, if there are any concerns he/she should contact the on call gynae team at Singleton to discuss management. If the on call general gynaecology consultant is required, but is unavailable, then contact the surgical on call consultant or the responsible gynae oncology consultant. Please note that the general gynaecology consultant may need to be contacted via the Singleton Switchboard. ii. Singleton Hospital Out of hours cover is provided by the on call O&G team. For contact details of the on call doctors responsible for the care of gynae oncology patients refer to the most up to date rota.
iii. Morriston flowchart for ward cover During day time hours Out of Hours Gynae oncology F1 / SHO Gynae oncology SpR (bleep numbers see rota) Gynae oncology Consultant (Contact via switchboard or see rota) On call Surgical FY1 On call Gynaecology SpR (Singleton) (bleep numbers see rota) On call Gynaecology Consultant (Contact via switchboard) If unavailable contact: On call Surgical SpR On call Surgical consultant Gynae oncology Consultant (Contact via switchboard) If unavailable contact: On call Surgical SpR On call Surgical consultant
iv. Singleton flowchart for ward cover During day time hours Out of Hours Gynae oncology F1 / SHO On call Gynaecology SpR (bleep numbers see rota) Gynae oncology Consultant (contact via switchboard) On call Gynaecology SHO On call Gynaecology SpR (bleep numbers see rota) On call Gynaecology Consultant (contact via switchboard) If unavailable contact: On call Surgical SpR On call Surgical consultant Gynae oncology Consultant If unavailable contact: On call Gynaecology consultant (contact via switchboard) If unavailable contact: On call Surgical SpR On call Surgical consultant
Appendix *A copy of this policy is available on the Clinical Online Information Network (COIN), handed over to new junior staff during handover and is emailed to senior nursing staff for further distribution in both sites. 1. Example Gynaecological Oncology weekly team timetable/rota Registrar Monday 4.4.2016 Morning 09:00to 13:00 Dr Florian Drews Afternoon 13:00 to 18: 0 0 Dr Florian Drews Morriston Gynae Oncology Service Weekly Cover Week Commencing 4th April 2016 Tuesday 5.4. 2016 Morning 08:30 to 13:00 Dr Abdulrahlm Azgougo & Dr Florian Drews Afternoon 13:00 to 17:00 Dr Abdulrahlm Azgougo &Dr Florian Drews Afternoon 13:00 to 17:00 Wednesday 6.4.2016 Morning 09:00 to 13:00 Dr Florian Drews Morning 08:30 to 13:00 Afternoon 13:00 to 18: 0 0 Telephone Advice Only Dr Florian Drews Afternoon 13:00 to 17:00 Thursday 7.4.2016 Morning Afternoon 08:30 to 13:00 13:00 to 17:00 Dr Abdulrahlm Azgougo & Morning Afternoon 08:30 to 13:00 13:00 to 17:00 Friday 8.4.2016 Morning 08:30 to 13:00 Morning 08:30 to 13:00 Afternoon 13:00 to 17:00 Afternoon 13:00 to 17:00 SHO/F1 Dr Sophie Pearson Bleep: 5448 Dr Shelley Jenkin Bleep: 5534 Dr Sophie Pearson Bleep: 5448 Dr Sophie Pearson Bleep: 5448 Dr Shelley Jenkin Bleep: 5534 Dr Shelley Jenkin Bleep: 5534 Dr Sophie Pearson Bleep: 5448 Dr Sophie Pearson Bleep: 5448 Please note: The clinici ans named on the above rota should be available on site. If the clinicians are not available on site they will be available for telephone advice as stated on the rota. Consultant Monday 4.4.2016 Evening 17:00 to 20:30 Night 20:30 to 08:30 Locum / On Call Surgical Team Satur day 9.4.2016 Out of Hours Morriston Gynae Oncology Service Weekly Cover Week Commencing 4th April 2016 Tuesday Wednesday Thursday 5.4. 2016 6.4.2016 7.4.2016 Night Evening Night Evening 20:30 to 08:30 17:00 to 20:30 20:30 to 08:30 17:00 to 20:30 Evening 17:00 to 20:30 Lutchman Singh/ On Call Surgical Team Sunday 10.4.2016 08:30 to 20:30 20:30 to 08:30 08:30 to 20:30 20:30 to 08:30 Consultant Mo selhi / Moselhi / On Call Surgical Team On Call Surgical Team Majoko / On Call Surgical Team Night 20:30 to 08:30 Kevelighan / On Call Surgical Team Friday 8.4.2016 Evening 17:00 to 20:30 Night 20:30 to 08:30 Moselhi / On Call Surgical Team Contact Details Information Dr Florian Drews (Registrar) Bleep: 5316 Dr Abdulrahlm Azgougo (Associate Specialist) Mobile Number: 07884 268014 Dr Sebastian Smolarek (Pelvic Oncology Fellow) Via Switchboard Chris Davies (Specialist Nurse) Bleep: 5977 Paula Robinson (Specialist Nurse) Bleep: 5968 Gynae Oncology Secretaries: Ext: 7773/7774 Mr Kerryn Lutchman Singh (Consultant): Mobile Number: 07791 091584
2. Example for operating list 3. Example of gynae oncology in patient list
4. Contact numbers: a. Blood bank (Singleton) 5075; (Morriston) 3054 b. Bed manager (Carol Bale) bleep 3124 c. Switchboard (Morriston) 100; (Singleton) 5000 d. Gynae oncology registrar bleep 5316 e. Oncology registrar bleep 5516 f. MDT coordinator (Kim Davies) p:6767 g. Ward 20 Singleton Hospital 5721 / 5789 h. Ward V (Morriston) 3743 i. Acute pain team bleep 3997 j. Palliative care (Kate Rosser) 01792702222 k. Cardiology for ECG 4100 l. Lung function tests 3364 m. Stoma nurses 3673 or bleep 3957 n. Dietetics 3239 o. Physiotherapy 3124 p. Main theatre Morriston 3489 q. ITU reception Morriston 3447 r. Main theatre Singleton 5438
5. Gynaecological Oncology Team rota email distribution list a. Abdulrahim Azgougo (Associate Specialist) Abdulra him.azgougo@wales.nhs.uk b. Christine Davies (CNS) Christine.Davies9@wales.nhs.uk c. Florian Drews (SpR) florian.drews@wales.nhs.uk d. Sarra Wilcox (Ward V) Sarra.Wilcox@wales.nhs.uk e. Sian Lia (Ward V) Sian.Lia2@wales.nhs.uk f. Anna Sloan (Receptionist Ward V) Anna.Sloan@wales.nhs.uk g. Jules Hefford (Ward G) Jules.Hefford@wales.nhs.uk h. Julie Davies (Ward H) Julie.Davies23@wales.nhs.uk i. Kalyan Dhar (Consultant) Kalyan.Dhar@wales.nhs.uk j. Kerryn Lutchman Singh (Consultant) Kerryn.Lutchman Singh@wales.nhs.uk k. Lorna Hood (Ward H) Lorna.Hood@wales.nhs.uk l. Marcia Blyth (Secretary) Marcia.Blyth@wales.nhs.uk m. Melanie Davies (Ward G) Melanie.Davies3@wales.nhs.uk n. Nadine Jones (Ward G) Nadine.Jones3@wales.nhs.uk o. Nicola Shepherd (Colorectal dept.) Nicola.Shepherd@wales.nhs.uk p. Nicola Sheppard (Ward V) Nicola.Sheppard2@wales.nhs.uk q. Patti Chappell Smith (Secretary) Patti.Chappell Smith@wales.nhs.uk r. Robert Collins (Theatre manager Singleton) Robert.Collins@wales.nhs.uk s. Sara Rosser (Theatre manager Morriston) Sara.Rosser@wales.nhs.uk t. Shelley Jenkin (FY1) Shelley.Jenkin@wales.nhs.uk u. Susan James (ITU secretary ) Susan.James@wales.nhs.uk v. Switchboard Morriston abm.switchboardmorriston@wale s.nhs.uk w. Tessa Johns (Secretary) Tessa.Johns@wales.nhs.uk x. Tina Smyth (Lead nurse surgical specialities) Tina.Smyth@wales.nhs.uk
6. HDU/ITU bed booking form T he P POSSUM Score needs to be calculated (http://riskprediction.org.uk/pp index.php) before this form can be discussed with the ITU consultant.
7. Severe sepsis screening tool
8. Contact details department of Gynaecological Oncology Singleton Hospital Department of Gynaecological Oncology West Ward Block, Level 3 Ward 17 Singleton Hospital Direct Line (01792) 200373 Ext 7773