Responsibilities of On Call Registrar (Obstetrics & Gynaecology) Originator: Labour Ward Forum Date Approved: 18 th January 2012 Approved by: Quality & Safety Group (W&CH) Date for Review: December 2015
Singleton Hospital On calls Shifts start at 0830hrs and 2030hrs and last for 12 hours. The Obstetric registrar and the Gynaecology registrar are responsible for caring of patients on the CDS, antenatal and postnatal wards and Gynaecology ward. Women on the Birth Centre will be the on call team s responsibility in case of emergency. The team on call is required to do a ward round at the beginning of each shift. This should include all patients under consultant led care on delivery suite including the high and low dependency areas. The women on the antenatal ward are usually reviewed by their own team during daytime. Those women not been reviewed or follow-ups after investigations ordered during daytime are the responsibility of the on call team. It is good practice to document all reviews and discussions involving patient care. Handovers The morning handovers at 0830hrs are multidisciplinary and are led by the Labour Ward Consultant involving the O&G on call team, anaesthetic team and midwifery shift coordinator. Both the incoming and outgoing teams are involved and the hand over takes place in the office behind the CDS reception. All patients on delivery suite are handed over along with any on-going concerns regarding women on the wards. Women booked on the CEPOD list should be handed over. Details of the hand over are documented by the obstetric SHO in the handover sheet. Names and details of both obstetric and gynae patients discussed are documented along with the names of the attending personnel. It is the responsibility of the on call Registrar to ensure that the handover sheet is filled and filed. The night handovers are at 2030hrs and involve the same process without the on call consultant. Additional handovers with discussion of patients occurs at 1700hrs when there is a changeover of on call consultants. Telephone handover with the on call consultant(s) is at 2200hrs and is done by the senior registrar on call.this is usually done after the night ward rounds and allows discussion of any on-going concerns. Details of plans made should be documented in the patient s notes. Contacting the on call consultant The consultant on call for labour ward carries a bleep (5510) during the daytime. During out of hours they can be contacted via the switchboard or directly from delivery suite reception. Triage and Antenatal day assessment units These are Midwifery led with obstetric input when required. Responsibilities of On Call Registrar Page 2
Early pregnancy assessment unit This is led by Nurse Specialist with input from on call team. Women suspicious of having an ectopic pregnancy are admitted to gynaecology ward and should be reviewed by the on call gynae registrar. Appropriate management plans should be made after liaising with the on call consultant. Ward 16 The PAS service is based on ward 16 and is run by Specialist Nurse with input from ISH Consultant. Retained products and incomplete abortion with excessive bleeding in women having MTOP should be dealt as gynae emergency and managed by the on call gynae team. Women can be transferred to ward 20 should they require overnight stay. CEPOD list Gynaecology emergencies are booked on the CEPOD list and the consultant on call should be informed. Anaesthetic cover for these lists is by a consultant anaesthetist after 2100hrs.It is again good practice to avoid operating after 2200hrs unless the patient is hemodynamically compromised. In-utero transfers Accepting in-utero transfers is usually done by the consultant on call. If the registrar on call is involved this can be done after appropriately liaising with Midwifery co-ordinator, oncall consultant and SCBU. When women need to be transferred out it is the on call registrars responsibility to identify and liaise with the receiving unit including their SCBU. The consultant on call should also be informed to facilitate consultant to consultant transfer. The All Wales transfer document should be filled in all cases including those within the same trust. Princess of Wales Hospital Generally the on call registrars are responsible for the immediate supervision of all deliveries on labour ward and for all Gynae emergencies. They have to work as team members with the midwives and ensure good liaison with the midwifery coordinator and with the members of their own medical team. Handover Handover takes place at 09.00 and at 21.00hrs every day in the labour ward. In the morning, it is attended by the incoming Consultant, outgoing and incoming registrars, SHO s covering wards 11, 12 and the lead Midwife as well as the anaesthetic team. Responsibilities of On Call Registrar Page 3
The outgoing team is expected to be familiar with all patients present in the labour ward and Gynae emergencies and be able to provide a synopsis of them. They are also expected to be aware of any special cases on the ante and postnatal wards and on the Gynaecology ward. There is a handover form which needs to be filled in and stored in the handover file (only names of people present at handover to be written). Night Handover The handover at 2100hrs is between the outgoing and incoming registrars, Advanced midwife practitioner, the lead midwife and the anaesthetic registrar as appropriate. The registrar on duty at night is expected to review the women on labour ward and any cases of concern on wards. Any issues should be discussed with the on call consultant and a clear plan of management documented in the notes. Antenatal ward round The antenatal ward rounds are done by the oncall Consultant, registrar and the SHO covering ward 12. At weekends and Bank holidays the registrar needs to do a round. Registrars should also debrief women who had Caesarean Section and complete the Caesarean Section Debriefing Letter. Gynaecology ward round During the week the SHO covering ward 11 sees all the Gynae patients and any concerns should be discussed with the on call registrar or Consultant. The Gynae patients should ideally be reviewed by the respective consultant team unless the registrar is away or on different site. The on call registrar should only have to deal with the emergency workload (and with their own patients). Early Pregnancy assessment Unit / Antenatal Day Assessment Unit The service is nurse led. Patients needing review are to be seen by the on call team. CEPOD list Any patients on the CEPOD list are taken to theatre by the on call team. They need to be informed of any patients that are added to this list by anyone else. Contacting the consultant on call in case of problems Registrars are expected to liaise with the consultant on call. Caesarean Sections, difficult instrumental deliveries, multips possibly requiring syntocinon, obstetric cases needing to go to theatre should be discussed. Furthermore, any serious obstetric complications either antenatally or postnatally need to be brought to the attention of the consultant (eclampsia, severe preeclampsia, HELLP, severe APH or PPH etc ). Responsibilities of On Call Registrar Page 4
In Gynaecology the consultant needs to be informed of suspected ectopic pregnancies and any other serious Gynae emergencies. The consultant should be aware of any Gynae cases booked for theatre. All consultant telephone details are available from the labour ward board, as well as from switchboard. Labour ward and Gynaecology protocols All registrars must familiarise themselves with the protocol book on the labour ward and in the Gynaecology ward. All protocols are available on WISDOM. Resuscitation equipment The defibrillator on labour ward is kept by the central desk area. Training is available from the Resuscitation department. OSATS All middle grade doctors need to be assessed by the consultant regarding their technical skills. OSAT forms are used for this and can be printed off from the computer in the labour ward office. Please organise these assessments in conjunction with the consultant on duty. General Health Board information Protocols/Guidelines Departmental and trust guidelines are available on the Delivery Suite / Labour Ward and are also available on WISDOM which is accessed via ABM UHB Intranet site. For further information regarding accessing policies on-line, please contact The Library in Singleton Hospital. Incident reporting All members of staff are expected to complete and incident forms whenever the need arises. Trigger lists are available via WISDOM and from the Delivery Suite / Labour Ward which give guidance on the kind of incidents that need to be reported. Incidents are completed on line via the Health Board Intranet site using the On Line Incident Reporting Link. Once submitted, an incident report reference number will be provided. If and incident is relating to a patient, this reference number should be noted in the patients note. Responsibilities of On Call Registrar Page 5
Directorate of Women & Child Health Checklist for Clinical Guidelines being Submitted for Approval by Quality & Safety Group Title of Guideline: Responsibilities of On Call Registrar Name(s) of Author: L W Forum Chair of Group or Committee supporting submission: Madhuchada Dey, Dawn Apsee Issue / Version No: Next Review / Guideline Expiry: January 2015 Details of persons included in consultation process: LW Fourm, All Consultant Obstetricians and Senior Midwifery staff across the Health Board. This policy is an amalgamation of the 2 separate policies that are already in place on each site. Name of Pharmacist (mandatory if drugs involved): Please list any policies/guidelines this document will supercede: None Keywords linked to document: On Call, Registrar, responsibilities Date approved by Directorate Quality & Safety Group: File Name: Used to locate where file is stores on hard drive * To be completed by Author and submitted with document for ratification to Clinical Governance Facilitator Responsibilities of On Call Registrar Page 6