JMO Rolling Term Handover (ROVER) Form

ROVER South West Healthcare HMO Rolling Term Handover (ROVER) Form

This form is designed as a resource written by and for HMOs about the specific, practical, day-to- day responsibilities involved in a particular rotation. It is a rolling document that may be modified or updated as different HMOs rotate through the term. The ROVER forms are to be kept in electronic form and paper form with Dr. Brendan Condon. Please update if required throughout the term and email to Dr. Brendan Condon in week 8 of the term: [email protected]

There are 5 sections to this form. It is not mandatory to fill in all of the sections – they are intended only as a guide.

Term Name: Paediatrics Term Supervisor(s): Fiedler, Olinsky, Pallas, Thies

Registrar: Dr. Kathleen McGrath Other Important Staff: Sue Marsh (NUM)

1. Roles and Responsibilities Eg. Start times, daily routine, average patient load, how ward rounds are run, entries in notes, general expectations, role of the registrar *Only see those patients under the bed cards of Paediatricians *There is a consultant Paediatrician on for the entire week. Change over is on a Monday. The Paeds Reg is on call 8:00-17:00 on Monday, Wednesday and Fridays and overnight on Tuesday and Thursdays. The consultant Paediatrician is on call for the entire weekend from 17:00 Friday.

8:00-9:00 – see all patients on Paeds Ward – assess their progress, chase results and formulate a management plan. Paeds Reg will see all babies in the Special Care Nursery (SCN). If finish early, can go into SCN to help Paeds Reg. Any new patients can be seen by Medical Students to present on Ward Round. 9:00-10:30 – consultants come for Ward Round. Round on Paeds Ward first. Students present new patients. Add to their histories and update on progress. Then round and see each patient. Then move to SCN and round through all babies. 10:30-13:00 – complete jobs from ward rounds. 13:00-16:00/17:00: Once you’ve completed all jobs from ward round, there are things to attend in the afternoons. *Team/Family Meetings *MRI with sedation *Attend Deliveries/C-sections with Reg for Resus *Baby checks – must be done prior to a feed as much as possible *Paperwork – transfer letters, discharge summaries, baby check paperwork (green book and brown paper), asthma action plans, online infectious disease reporting, elective admissions, etc. Once all jobs are completed, and if there is nothing to attend in afternoons and no paperwork to complete, then head down to A&E. Pick up Paeds patients, and if there is no Paeds patients see adults. You may also be called by A&E if an expected arrival presents and is to be worked up for admission. 16:00 – 17:00 (Thursdays): journal club at paeds rooms Once a month/fortnight, there’s a case presentation after lunch by paeds reg/consultant.

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Paeds Ward – Deb (Ward Clerk) will hold any discharged patients files in the ‘expected admissions’ drawer on the Paeds ward. Once you complete and print a discharge summaries, place them in the file and return to the ‘expected admissions’ drawer. Deb then sends a copy to the Paeds Rooms and GP directly from the ward so they get it ASAP. If Deb is absent, you can drop off the discharge summaries at the paeds rooms.

Paeds ward round notes – similar to adults

Format for paeds discharge summary *PHx –Birth Hx, Growth & Development Hx, immunizations, diet *SHx - ?smokers around child *Issues * Discharge meds & allergies *Follow-up

SCN – Julia (Ward Clerk on Maternity) will leave discharge histories in SCN until they are completed. Once completed place GP copy in the file, and place in tub under desk behind Julia. If there’s outpatient follow up, keep a copy of the discharge summary and drop it off at the paeds rooms. (Julia does not fax your summaries to the paeds rooms.)

SCN ward round notes–Day of life, gestational age (GA), corrected Age (CA), Birth Weight (BW), Current Weight (CW), obs, temps, passing urine (PU), bowels open (BO), TCB head/chest/under nappy, current feeds; Issues; Plan

Format for SCN discharge summary *Maternal Hx – Gravida/Para; GBS status; Blood Group; Labour; Serology; Ultrasound *Birth Hx – Gestation; Delivery type – vaginal, instrumental delivery, elective/emergency LUSCS; presentation; APGARs & any resuscitation; Birth Weight, Length, Head Circumference *Issues – include baby check findings; vaccination; newborn screening test; discharge weight; feeding regime. *Follow-up – appointments; hip ultrasound for breech; domiciliary midwife visit (dom).

2. Resources E.g. Useful protocols, go-to people, roles of allied health, where to find information for patients etc. *Neonatal Handbook *RCH Clinical Guidelines *Therapeutic Guidelines *Australian Medicines Handbook *Pharmacopoeia *Frank Shann Drug Doses *Protocols from PROMPT

3. Referrals E.g. How to get an allied health referral or send someone to a rehab facility Referrals to the Paediatric team, especially newborns on maternity, are made by verbal request from the midwives or O&G resident, usually on the morning ward round. There are no written referrals to the Paediatric team. Referrals to allied health (physio, dietician, asthma education, CASS, etc.) are usually made by the nursing staff over prompt.

4. Common Conditions E.g. conditions commonly encountered on this term and routine management i.e. general management measures, length of stay, etc. Paeds - Resp: apnoeas, bronchiolitis, viral-induced wheeze, asthma, croup, pneumonia/LRTI - ENT: otitis media, tonsillitis - Endo: type 1 diabetes - Neuro: seizures - Gastro: food challenge, gastroenteritis, mesenteric adenitis vs appendicitis, somatization, non-specific abdo pain - UTIs - Mental health: eating disorders, depression - Unsettled behaviour in infants

Neonates - RDS, presumed sepsis - Jaundice - Hypoglycemia, establishing feeding - IUGR, SGA - Temperature regulation - Prematurity

5. Medications E.g. Commonly used medications (analgesia, anticoagulants, aperients, etc) and doses All medication, oxygen and fluids are calculated by weight. If you are unsure, even about a dose of paracetamol, check your dose with Pharmacopoeia, a nurse or the registrar.

6. Miscellaneous Tips

E.g. Particular consultant preferences, ward quirks, and hints for getting things done Don’t be afraid to ask the nurses, registrar or consultants any question, no matter how trivial! They are more than happy to help, and it may save a mistake with detrimental outcomes.

1. Outpatient ultrasound - There's a special referral form for outpatient ultrasound (Christian does them). It's located in the bottom most drawer at the SCN computer desk. - You will need the registrar's signature and provider number for this form. - The hip ultrasounds for breech babies are done at 6 weeks corrected age i.e. not at 6 weeks of life

2. Inpatient ultrasound - request completed on normal radiology forms

3. Obs charts - there are specific obs chart categorised according to age for paeds - ONLY registrars can modify MET criteria

4. Drug charts - there are specific paeds drug charts so don't use adult ones for paeds patients unless they are teenagers

5. Pathology results - beware that neonates pathology results often don't appear on Trak. You'd have to ring the lab and get them to fax it to maternity ward. It's very frustrating and I've made a phone complaint to medical records (Miles). If it it keeps happening, might be worth writing a proper complaint letter.

6. Baby check paperwork - green book: this is the child health record that mums take home with. See tab 'birth details' in the book. Has to be completed before discharge. - brown paper: called 'neonate physical examination'. Copy your findings from the green book onto this paper. This brown paper is a copy for the history.Occasionally, paeds reg would write SCN admission onto this brown paper and therefore complete the initial examination. In this situation, you don't have to fill in the brown paper.

You only do baby checks on babies that are under the nursery's bed card (babies could be in either nursery or in maternity ward). You do not do the baby checks on babies that paeds CONSULT on; the O & G resident does them.

7. Neonate physical examination - babies who stay in the nursery for a while still needs regular examination. This should happen twice a week. This examination is different from a baby check in that it's brief e.g. cardio/resp/abdo as opposed to a head to toe check

- if a baby is in the maternity ward, the baby's history and obs chart could be: 1) in the nursery OR 2) at mum's bed side (in maternity ward) OR 3) in the designated baby shelf next to all the mum's histories at maternity ward reception office

8. Communication - I leave my mobile number with paeds ward and SCN because I don't have a pager. It's much easier for staff to contact you. - I tend to text the paeds reg or consultant for any non-urgent stuff.

9. Computers Paeds - there are 4 computers: Deb's computer, computer with headphones, computer with video camera

of 5 ROVER South West Healthcare HMO Rolling Term Handover (ROVER) Form monitoring and laptop in treatment room - treatment room laptop: has Trak but no inteleviewer, has internet, prints (laptop login password: Paediatric@8) - computer with headphones: has Trak but don't use Trak on it because it's SUPER slow. Has internet, prints - computer with video camera: has Trak, no inteleviewer. Has internet but needs password. Doesn't print. (internet password: Paediatric@8) - Deb's computer: has Trak but no inteleviewer. Has internet, prints. Has nursing handover list,

SCN - only 1 computer: has Trak but no inteleviewer. Has internet, prints. Has nursing handover.

I print 2 copies of paeds and nursery nursing handover respectively in the morning. (one for reg and one for myself)

10. Notifiable disease reporting - remember to ask patient's parents about the school/day care/kinder they go to including sibling's school and if parents work in a school. The schools' details will have to be provided in the online reporting form for notifiable diseases

11. MRI with sedation - if sedation needed, chloral hydrate is used 20min before MRI - remember to bring a 'bag and mask' with you from paeds ward before going downstairs to the MRI control room - when at MRI, monitor obs on screen next to radiographer and observe child through glass window - parents should be in MRI control room to pacify and monitor child. Therefore, parents also need to fill in MRI safety questionnaire. - if child needs resus, take child out of control room into waiting bay area first. Otherwise the whole MET team will go into the MRI control room 12. Intelliviewer - The computer with the headphones has Intelliviewer – program for viewing medical imaging