Alfred I Dupont Hospital for Children

PICU Resident Rotation Alfred I DuPont Hospital for Children Nemours Foundation

Resident Resources

Introduction to PICU Rotation

Residents given PICU Core Curriculum (see separate attached file) Outlines expectations of residents and general educational plans

Residents given folder with additional information PICU Procedure and Primary Patient Logs.

PICU Resident Systems Based Learning Project Quality Improvement Case Analysis form.

InfoLink information.

Copy of combined resident and critical care attending progress note form. This form is used to prepare for patient care rounds and for presenting patients’ clinical course on rounds.

Request to discuss TPN details on patient care rounds

Daily Goals sheet

Mechanical Ventilation Weaning Guidelines

PICU Order Entry Flow Sheet for writing orders during busy PICU times

Process for Patient Transfer Out of PICU

Alfred I DuPont Hospital for Children Transfer of responsibility for Patient Care and Medication Reconciliation Memo

Visiting residents receive Beeper, Proxy Card, Parking Passes, Meal Cards. (Pediatric and Medicine-Pediatric residents already have these resources). Visiting medical students receive Proxy Card and Parking Pass.

Exposure to a pediatric medical-surgical PICU population

Participation in multidisciplinary-team care of critically ill children and adolescents

U/ECullen/Word/Educatio/Resident/Reports/PICU Resident Resources061209 1 Clinical supervision by board-certified pediatric critical care medicine physicians 24 hours a day

Exposure to pediatric critical care fellows

PICU Resident Rotation Web Site* http://www.nemours.org/healthpro/education/de/residency/picu.html

Overview Faculty Curriculum Orientation Outcomes Outcomes Measurement Resources Content Administrative Issues General information Patient responsibilities Transfer Out of PICU Algorithm Solid Organ Transplant Handbook Lectures and Presentations (in-house power-point presentations) Pediatric Toxicology Critical Care Respiratory Diabetic Ketoacidosis Post-op Liver transplantation Multiple Organ Dysfunction Narcotic Withdrawal and Methadone taper Nutrition in Critical Care Pediatric Shock Respiratory Failure Septic Shock and MOF in Newborns and Children Sold Organ Transplantation, Pharmocologist’s View SIRS and ARDS in the PICU Traumatic Brain Injury Evidence Based Clinical Practice Definition and Skills Asking a Focused Clinical Question Literature Search Strategies Summary Criteria Reports 2001-2002 through 2007-2008 Contact Information Links PCCM web site PICU Rotation Time Line

U/ECullen/Word/Educatio/Resident/Reports/PICU Resident Resources061209 2 Pediatric Critical Care Goals for PICU Resident Rotation Code Blue Roles Presenting Difficult PICU Cases on Rounds Daily Note Difficult Airway Cart Pre-Rotation Questionnaire PICU Post Test

*Internet site is reviewed and updated yearly in June/July

Interactive case-based bedside teaching

Supervised participation in critical care procedures: intubation, central venous line placement, arterial line placement, chest tube placement

Radiology reviews patient XRAYs in PICU (Monday-Friday)

PICU Mock Code (Fridays, 1400) (availability depends on PICU acuity)

Evidence Based Journal Club (monthly) Presented by Pediatric Critical Care Medicine Attendings and Fellows and PICU Nurses

Monthly lecture by Pediatric Critical Care Fellows

Internet access to Society of Critical Care Medicine power-point presentations for residents participating in a PICU resident Rotation http://www.learnicu.org/Clinical_Practice/Fundamentals/PICU/Pages/Course_Presentatio ns.aspx

Airway Mechanical Ventilation HFOV Respiratory Failure ARDS Blood gas Analysis Shock States Shock and Sepsis Cardiogenic Shock DIC Vasoactive Drugs Arrythmias Fluid and Electrolyte Emergencies Sedation/Analgesia and Neuromuscular Blockade Enteral and Parenteral Butrition Hyponatremia

U/ECullen/Word/Educatio/Resident/Reports/PICU Resident Resources061209 3 Head Injury Coma Guidelines for Medical Management Traumatic Brain Injury Spinal Cord Injury Renal Failure Hepatic Failure Asthma Status Epilepticus Thromboembolic Dosorders DKA Toxicology Strokes in Children Oncologic Emergencies Sickle Cell, critical care Pharmokinetics / Pharmodynamics Endocrine Emergencies Extracorporeal Life Support Renal Replacement Therapy Post-Op Cardiac Management Single Ventricle Physiology Pulmonary Artery Catheterization Stabilization and Transport Pediatric Disaster and terrorism Preparedness Medical errors-The PICU Perspective Ethics in PICU Pediatric Office Emergencies

Textbooks available in PICU

Pediatric Critical Care Third Edition Fuhrman/Zimmerman

Pediatric Critical Care Medicine Slonim / Pollock

Pediatric Intensive Care, Third Edition Mark C. Rogers

The Difficult Pediatric Airway Anesthesiology Clinics of North America Jalil Riazi, MD, Editor 1999

Principles and Practice of Mechanical Ventilation 2nd Edition

U/ECullen/Word/Educatio/Resident/Reports/PICU Resident Resources061209 4 Tobin

Management of Pediatric Trauma Buntain

Illustrated Textbook of Pediatric Emergency and Critical Care Procedures Dieckmann, Fiser, Selbst

Textbook of Pediatric Emergency Medicine Ludwig Fleisher

The Pharmacologic Approach to Critically Ill Patients Chernow, Third Edition

Principles and Practice of Intensive Care Monitoring Tobin

Supportive Care of Children with Cancer Current Therapy and Guidelines from the Children's Cancer Group 2nd Edition, 1997 Edited by Arthur R. Ablin M

Proxy Card access to medical library, ground floor Alfred I DuPont Hospital for Children

Internet access to InfoLink, an integrated resource that combines clinical applications, medical search engines, specific PICU educational material and evidence based medical textbooks and learning modules. Each resident receives material that will guide them through the InfoLink available resources. Below is a partial list of resources on InfoLink.

EPIC Radiology I-Site Lexicomp Micromedex Escription Epocrates Medical Calculator

Up To Date Dynamed STA!Ref Practice Guidelines ACPJ Cochrane Library MD Consult OVID CINAHL

U/ECullen/Word/Educatio/Resident/Reports/PICU Resident Resources061209 5 PubMed Google Scholar Gene Tests OMIM Nemours eJournals Dermatology textbook Pediatric Critical Care Medicine Literature Interesting Cases Evidence Based Journal Club Web connections for critical care

PICU Rotation (link) SCCM power-point lectures (link) Critical Care Projects Infant Botulism Treatment and Prevention Program Mechanical Ventilation Weaning Protocol PICU Evidence Based Guideline Conferences. Internet access to our previous reviews: Steroids and Septic Shock. Use of Saline in Suctioning Artifical Airways. Severe Traumatic Brain Injury in Children: Management and Monitoring. Review of Evidence for Daily Interruption of Continuous Sedation in Mechanically Ventilated Children. Mucous Plugs in Kid’s Airways, What’s the Evidence for Treatment. Insulin Infusion Protocols in the PICU. Oral Decontamination to Prevent Ventilator Associated Pneumonia. Induced Hypothermia (NeuroProtectant). CVP and Intravascular Volume. Is There Evidence for the Use of N-acetylcysteine as a Protectant Agent Against Contrast Induced Nephropathy? Ventilator Associated Pneumonia. PICU Nursing web site PICU Case of the Week (under construction) PICU Article Collection Pertinent articles that we can enter and maintain. Mainly sepsis, ARDS, TBI.

Users’ Guide to The Medical Literature Learning Modules (Evidence Literacy) Calculators used in evidence based medicine Searching medical engines

U/ECullen/Word/Educatio/Resident/Reports/PICU Resident Resources061209 6 Personal Evidence Project – Developing a Critically Appraised Topic Rational Clinical Exam

Individual Workspace URL Search

ACGME Resident Duty Hours followed

Each pediatric critical care physician completes an on-line specific program evaluation for each resident at the completion of their PICU rotation. Evaluations are based on the ACGME six competencies :Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems Based Practice.

U/ECullen/Word/Educatio/Resident/Reports/PICU Resident Resources061209 7 Requests of Residents

Prior to beginning the PICU rotation, complete 8 hours of internet based instructions regarding EPIC electronic medical record.

Review Resident PICU Core Curriculum

Complete on-line Pre-Rotation Questionnaire at the beginning of their rotation

Maintain a PICU Procedure Log and List of Primary Patients responsible for (age and diagnoses) and hand it in at the end of their PICU rotation

During patient care rounds, ask focused clinical questions about patient clinical problems, find medical literature that addresses these questions, using evidence based medicine techniques evaluate the validity, results and patient applicability of the information and bring information back to the PICU team.

Participate in Quality Improvement Case Analysis that identifies a PICU system problem.

At the end of their PICU rotation, complete on-line SCCM national test for residents who have completed a PICU rotation

Return Beeper and Proxy Card.

Complete their respective residency program’s on-line evaluation of the PICU rotation

Monitoring of PICU Resident Rotation

If completed, Pre-Rotation Questionnaires, SCCM post-test scores, critical care procedures done and critical care patient logs entered into our Access Data Base. (Partial data from1992 to present). We also have partial data of residents’ evaluations of the PICU rotation that was collected before individual programs developed their individual on-line forms.

Since 1992, we sent a survey to physicians now in practice who participated in our PICU rotation as residents. Survey requested information about their need to use pediatric critical care knowledge and skills in their practice settings. If survey returned, data entered into our Access data Base.

Presently, we request from their respective program directors a yearly summary of their residents’ evaluations of the PICU rotation

Reports of our PICU Rotation overview and plans 2001-2008 are available on our PICU Resident Rotation Web Site, under Reports. http://www.nemours.org/healthpro/education/de/residency/picu.html

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