Perioperative Medicine for Older Patients; Induction Pack for POPS (Proactive Care For

Perioperative medicine for older patients; induction pack for POPS (Proactive care for Older People undergoing Surgery)

FY1&2 Programme

Contents

[1] Introduction

[2] Description of clinical job including clinical responsibilities

[3] Education and training

[4] Clinical and educational supervision

[5] Audit

[6] Leave

[7] Online resources for clinical support

[8] Appendix with useful links Introduction

Welcome to Guy’s and St Thomas’ and to the Proactive care of Older People undergoing Surgery (POPS) team. We know that starting a first job or rotating to a new job can be daunting. During this job you will be clinically and educationally well supported with lots of opportunities to learn and develop skills and experience in perioperative medicine and generic skills essential for your ongoing careers. This induction pack explains what you can expect clinically and educationally and what your roles and responsibilities are. Please contact us about any queries either before the job starts or during the placement.

The primary aim of the Foundation Programme is to develop competencies, appropriate attitudes and clinical skills of junior doctors reflecting good medical practice as defined by the General Medical Council (http://www.gmc-uk.org/guidance/good_medical_practice/GMC_GMP.pdf).

During this placement you will have the opportunity to gain experience in the medical management of patients undergoing surgery. As you will be aware, treating older adults is uniquely challenging in terms of managing multiple co-morbidities as well as having an understanding of rehabilitation and discharge planning. You will be working in conjunction with surgical teams, a model which enables the most comprehensive treatment of older surgical patients. Much of what you will learn during this attachment is directly linked to the Foundation Programme Curriculum. Description of the clinical job

This job is divided into a) ward based in-patient care b) out-patient and community care c) on-call commitment

THIS IS NOT THE SAME FOR THE GI JOB – we will discuss this with GI FY2 at induction in more detail

1) Ward based care The day is 8am to 4pm. Clinical responsibilities You will attend the daily surgical ward round. Related to this ward round your responsibility will be to a) present the patient, highlighting relevant medical, rehabilitation or discharge planning issues b) ensure documentation of each ward round consultation (together with the surgical team) c) ensure jobs from the ward round are divided appropriately between team members and completed that day Your additional responsibility will be to a) document the background history, assess cognition using MoCA, ensure collateral history where required, obtain relevant previous investigations (eg old echos) b) ensure all health issues are uploaded on EPR for coding purposes c) review the drug chart and identify areas for rationalisation and optimisation (discuss this on ward round with your POPS consultant/CNS ) d) provide proactive review of blood results (eg initial investigation of anaemia and CKD) e) ensure dementia screening question, VTE risk are documented on EPR f) daily review of lines, catheters, bowel charts with discussion on POPS ward round g) ensure proactive communication with patient (update on progress and plan) and with carers/relatives where appropriate (this will necessitate a proactive phone call to relatives/carers with consent from patient) h) ensure health issues, medical developments and geriatric issues are summarised in the EDL i) present patients and document discussions from ward based POPS MDMS including discharge planning j) handover care to the on call/weekend teams

Your ward based consultant will discuss these roles and responsibilities in further detail with you.

2) Clinic/community The day is 9am to 5pm, unless advised otherwise. Clinical responsibilities You will receive a detailed timetable according to the surgical subspecialty where you will be working. a) POPS Clinic  On your first day in POPS clinic you will sit in with a senior to review one patient  You will then see patients independently followed by discussion with the consultant in clinic  You will be expected to assess and manage the patient according to CGA principles (which you will be taught).  Discuss every patient you see with a senior (consultant/CNS) while they are still in clinic

A note on clinic letters (See appendix for some helpful resources) A teaching session early in the attachment will cover what you need to know about writing letters. Writing clinical letters is a valuable skill which you will use throughout your career. Letters form an important part of the POPS service. They are our primary means of communication with other specialties and contain important patient information. It is therefore imperative that high standards are adhered to when writing a letter. A few general points:

 You may find it helpful to take a look at some previous POPS clinic letters to give you an idea of structure  Use the POPS clinic template when dictating your letter  Be clear in your dictation  Letters should be dictated on the day of clinic not after  Use the listed standard texts where appropriate  Mark all POPS letters as ‘Urgent’ so they are flagged up to the secretaries  All cancer 2 week wait patient letters should be marked as ‘Cancer 2WW’. These patients will have TCI dates in the next 2 weeks so it is important that they are typed, checked and committed to EPR as a matter of priority  Once you receive the typed letter, you will need to edit the letter and attach any results and forward to the consultant  The consultant will return to you with any necessary changes for your education. You will then need to send to the secretaries for committing on EPR  You will present the cases at the Wednesday POPS team MDM in the OPAU seminar room (Guys site) (this is a forum to discuss, learn and peer review in a supportive environment).  Do not wait until after the Wednesday MDM to send letters to the consultant. Make a start and send what you have so far, it can very easily be amended if need be before being committed to EPR  The letter should be authorised within 5 working days  Check all bloods the next day - do not wait for clinic letters to be returned from secretaries before checking bloods You may be involved in data entering for outpatients.

Handing over clinic patients Handover is an inevitable part of any medical job. In particular you will need to handover any outstanding jobs for clinic patients. Please ensure you hand over to the person coming in your place. Email is usually best, with the consultant copied in. b) Surgical clinics You should start morning clinic at 9am and afternoon clinics at 2pm unless told otherwise. On arrival report to the lead consultant and sit in for one consult. You will then be expected to clerk and present patients to the consultant (or nominated individual) and dictate. You will need to ask the consultant how they would like the editing and committing of their letters to take place. This will vary according to the specialty and setting. c) CPOAC You should start morning clinic at 9am and afternoon clinics at 2pm unless told otherwise. On arrival report to the lead CPOAC nurse and sit in for one consult. You will then be expected to clerk, document using the proforma and present patients to the nurse responsible for the clinic. Ask nurse in charge for information sheets on first morning telling you which investigations each surgical speciality requires Also check with them which information sheets need to be given to which patients d) Theatre You should discuss attendance in theatre with the consultant named on your timetable. This should be done by email at least 48 hours prior to the session. If the consultant does not reply then you must discuss with your clinical supervisor. e) Community The details will vary according to the subspecialty you are doing. Make sure you have looked at the timetable and clarified any queries with your clinical supervisor. Your responsibilities within this part of the job are similar to those in the ward block and you are not supernumerary or a clinical observer.

3) On call service This is subject to change and will be discussed in detail at induction. Any issues relating to on calls should be discussed with medical education (Catherine Cameron) or with the specialty involved (surgery or medicine). These are not POPS on calls per se. Issues regarding on calls for POPS Fy1s contact Josephine Enang Issues regarding on calls for POPS fy2s contact Josephine Enang for Guy’s Nights and Ruth McDermott or Dominic Thamby for STH weekend

Working patterns We adhere to EWTD in the POPS service. We do not expect you to regularly stay beyond the timetabled working hours. We expect you to take natural breaks as appropriate during the working day. If this is not happening it is your responsibility to raise this immediately with your clinical and/or educational supervisor and to document this discussion. This is very important so that we can support you in having a fulfilling attachment with the POPS team.

Additional information regards Community block

Minnie Kidd House

Some of you will have the opportunity to visit this GSTT administered nursing home, one of the very few NHS run care homes in England and Wales. Minnie Kidd House accommodates 28 residents with complex nursing and medical needs allocated to NHS continuing care funding.

Address:

51c Hazelbourne Road Clapham South SW12 9NU

Structure of session:

Minnie Kidd House is located near to Clapham South Tube station on the Northern Line. Please arrive on Tuesday at 13:30 as POPS commitments allow and meet with Dr Jim Fleet (unless otherwise advised). You are timetabled to finish at 17:00.

Clinical Role:

 Assess new transfers to the nursing home and present to consultant

 Assess medical complaints of care home residents highlighted by nursing staff

o Independently

o On ward round with Dr Fleet

 Document assessments in medical notes

 Prescribe on paper drug chart and help rewrite when needed

 Assist with referrals and investigation ordering

 Assist in carer/relative discussions and advanced care planning meetings

Learning opportunities:  Manage multiple co-existing/interacting long term (and advanced) conditions

 Diagnose and manage acute illness in patient with advanced long term conditions and frailty in care home /community setting

 Practice palliative care of patients with chronic terminal disease (including neurodegenerative illness) and acute life limiting illnesses in care home/community setting

 Manage common geriatric syndromes in a care home e.g. falls, delirium and incontinence

 Undertake advanced care planning

 Understand the application of NHS “fast-track” and ”Continuing Healthcare” funding

 Experience ethical and legal frameworks for community and care home medicine

Amputee Rehabilitation Unit

12 bedded specialist rehabilitation unit run by GSTT in Lambeth for adults who have undergone major amputation. Orthopaedic FY1s and Vascular FY2s will be part of the medical team supporting this unit in the community / clinic part of their timetable.

Address:

Amputee Rehabilitation Unit Lambeth Community Care Centre Monkton Street London SE11 4TX

0203 049 6912

Nearest tubes:

Elephant and Castle or Lambeth North – both about 10minute walk

Timetabled medical input to ARU:

Monday 11am – 2pm FY2

2pm Consultant Ward Round (Dr Thomson)

Wednesday 12.30 – 2pm FY

2pm MDM with team and Consultant

Friday 8am – 9am FY

9am – 12noon Ward round OOPE SpR & FY Clinical role:

 Assess / clerk new patients when admitted and present to consultant  Assess patients medically if asked to by MDT members or highlighted by nursing staff both independently or with Consultant / SpR support  Document in medical notes (particularly at MDM)  Prescribe on paper drugs charts and help rewrite or sign drug charts when needed  Assist with referrals and ordering / organising investigations  Complete EDLs  Assist with collateral history gathering, gaining information from referring hospitals and arranging on-going follow up  Discussing with relatives & supporting team with complex discharge planning  Complete handover email for senior team and current medics following each visit to the unit.  Receive phone calls from the unit / nursing staff – give advice over the phone if possible or escalate to the covering consultant. EDLs:

If from STH then these should be an addition to the previous ward visit giving a summary of the medical issues in rehabilitation. Do not create a new episode as still part of GSTT. Check primary diagnosis and co-morbidities correct.

If transfer from outside GSTT then need to ensure primary diagnosis and co-morbidities are clearly listed with detail of reason for amputation from previous hospital, to ensure coded correctly.

Learning opportunities:

 Manage complex patients of all ages with multi-morbidity, particularly PVD, COPD, Diabetes, IHD, cognitive impairment, cerebrovascular disease.  Assess, diagnose and manage acute exacerbations of long term conditions including decision making about transfer to the acute sector.  Advance care planning for times when medical staff are not on site, ensuring adequate handover.  Liaison with specialist teams to ensure optimum long term management

 Experience being part of a specialist MDT – learn about amputee rehabilitation techniques from therapists.  Get experience / exposure of alternative therapies e.g. acupuncture.  Manage common geriatric syndromes – falls, delirium, dementia, incontinence  Useful contacts:

Jodie Georgiou, Clinical Lead, 0203 049 7752, [email protected]

Paul Dunne, Ward Manager, 0203 049 6915, [email protected]

Education and training

Learning priorities The key learning priorities for all doctors in this firm are to develop skills in the following, as relevant to the clinical setting (i.e. acutely unwell patients, in hospital patients, out-patients and community);  History and examination

 Appropriate investigation

 Diagnosis and developing skills in clinical decision making

 Formulation of initial management plans and contacting seniors appropriately

 Safe prescribing practice

 Use of evidence in the best interests of the patient

 Develop effective verbal and written communication skills with staff, patients and relatives

to include presentation of cases in clinical settings and conference presentation

 Effective time management and organisational skills including prioritisation

 Awareness of ethics and law as part of clinical practice

 Supervision and teaching of junior colleagues and undergraduates

 Adherence to infection control policies

 Team working

 Safe and effective handover of patients

By the end of this rotation you should have gained some understanding of the following areas of perioperative medicine:

 Assessment and optimisation of medical comorbidities and geriatric syndromes in surgical

patients

 Assessment and management of common postoperative complications such as sepsis,

acute kidney injury cardiac arrhythmias, delirium and functional decline

 The perioperative pathway of care including a patient centred approach and the relationships between community and secondary care (and specialty teams within secondary care)

 An understanding of the national priorities in perioperative care

 The importance and practicalities of clinical governance (local and national audit, QIP, research)

Educational opportunities During your time on the firm you will be expected to attend the following formal educational sessions;

[a] mandatory FY1/2 teaching.

F1 teaching is every Tuesday from 12-1pm (South Wing lecture theatre and videolinked to Sherman) F2 – you will need to attend 1 half day training session every month on a themed topic. There will usually be 4 half days (Thursdays 1pm-5pm)

[b] POPS teaching – Friday 1-2pm at alternate sites (see timetable below).

[c] surgical subspecialty teaching – this varies according to subspecialty and is not mandatory. We will update you at induction

[d] older persons unit teaching – 4.00-5.00pm – academic room, 9th floor, north wing, St Thomas’ (this is not mandatory but offers a useful educational experience)

[e] older persons assessment unit multidisciplinary teaching Thursdays 1-2pm (venue as above, this is not mandatory but offers a useful educational experience)

[f] Grand round Wednesday 1-2 East wing lecture theatre at St Thomas’, Sherman lecture theatre Guy’s site Timetable for Friday POPS teaching

This aims to cover important aspects of perioperative care and is mandatory for all POPS juniors. A register will be taken for every session, please inform your colleagues through whatsapp group in advance if you are unable to attend because of leave or on call. Allow enough time for travel if you are at the opposite site.

Please familiarise yourself with this timetable. You will gain much more from teaching if you do some pre-reading and participate during sessions.

Date Topic Presenter Venue

7.4.17 Perioperative medicine for Jude Partridge Seminar room, Older older people – the national Persons Assessment Unit, picture Ground floor, Bermondsey wing. Guy’s

14.4.17 Good Friday ------

21.4.17 CGA, Documentation and Jason Cross SpRs Mitchener Seminar room, letter writing and liaising with and consultant TBC Mitchener ward, 12th Floor, other specialties North Wing. STH Seminar room, Older Persons Assessment Unit, Ground floor, Bermondsey wing. Guy’s

28.4.17 Quality improvement Jude Seminar room, Older methods (audit) and clinical Partridge/Jugdeep Persons Assessment Unit, governance Dhesi Ground floor, Bermondsey wing. Guy’s Nominal group technique Aminata Mohammed

Andy Rogerson

5.5.17 Anaesthesia for the older Wint Mon Seminar room, Older patients Persons Assessment Unit, Ground floor, Bermondsey wing. Guy’s

12.5.17 Perioperative cognitive Philip Braude Mitchener Seminar room, disorders Mitchener ward, 12th Floor, North Wing. STH

19.5.17 Quality improvement SpRs and JD Seminar room, Older methods (audit) and clinical Persons Assessment Unit, governance progress Ground floor, Bermondsey wing. Guy’s

26.5.17 Anaemia in the perioperative Krishanthi Mitchener Seminar room, setting Sathanandan Mitchener ward, 12th Floor, North Wing. STH

2.6.17 Frailty in surgical patients Philip Braude Seminar room, Older Persons Assessment Unit, Ground floor, Bermondsey wing. Guy’s

9.6.17 Nominal group technique Aminata Mitchener Seminar room, Mohammed Lizzie Mitchener ward, 12th Floor, Biswell North Wing. STH

Andy Rogerson

16.6.17 Critical appraisal Andrea Joughin Seminar room, Older Persons Assessment Unit, Ground floor, Bermondsey wing. Guy’s

23.6.17 Applying the MCA in the Ffion Pritchard and Mitchener Seminar room, perioperative setting AJ Brien Mitchener ward, 12th Floor, North Wing. STH

30.6.17 Fluid management in the Wint Mon and Seminar room, Older perioperative setting Andrea Joughin Persons Assessment Unit, Ground floor, Bermondsey wing. Guy’s

7.7.17 Presentation skills Jugdeep Dhesi Mitchener Seminar room, Mitchener ward, 12th Floor, North Wing. STH

14.7.17 Audit presentations FY1/2 Seminar room, Older Persons Assessment Unit, SpRs and Ground floor, Bermondsey consultant TBC wing. Guy’s

21.7.17 Audit presentations FY1/2 Mitchener Seminar room, Mitchener ward, 12th Floor, SpRs and North Wing. STH consultant TBC 28.7.17 Nominal group technique and Andrew Rogerson Seminar room, Older firm feedback Persons Assessment Unit, Jude Partridge Ground floor, Bermondsey wing. Guy’s

Eportfolio and Assessment

It is your responsibility to arrange the initial and end of firm appraisal meetings with your Clinical Supervisor. Please make contact with your supervisor in good time for these. You may need to contact the foundation school to ensure your assigned clinical supervisor appears on your eportfolio.

Remember appraisal is a two-way process. Before you attend this meeting it is worth having a think about what specific learning goals you might have for the rotation or if there is anything in particular you want to achieve during your time here. Where possible your supervisor will suggest ways to facilitate these.

You will have been provided with information about the number of SLEs you are expected to complete. There should be ample opportunity to undertake SLEs during this firm. It is strongly recommended that you spread these out over the firm. You should inform your assessor you wish to undertake an SLE in advance rather than have them complete it retrospectively. Assessments can be completed by SpRs and CNSs as well as consultants. DO NOT ask for multiple assessments to be completed at the end of the placement. This is not good for your learning and discouraged by the Foundation School.

This is the current recommended minimum of SLEs per placement (*based on a four month attachment).

SLE Recommended minimum number per placement* Direct observation of doctor/patient interaction: Mini-CEX 3 or more DOPS Optional to supplement mini-CEX Case-based discussion (CBD) 2 or more Developing the clinical teacher 1 or more

Supervision structure

Speciality Name of junior doctor Clinical supervisor (for duration of POPS firm) Urology Sarah Adil Yas Dr Dhesi Stephanie Greenwald Dr Dhesi Sittiga Hassan-reshat Dr Dhesi Rishil Patel Dr Dhesi Vascular Leticia Harding Dr Partridge Adam Marcus Dr Partridge Orthopaedics Lottie Ashford Dr Dockery Philip Thirkell Dr Dockery Ziyad Elgaid Dr Thomson Xin nee Ho Dr Thomson GI Eva Stengaard Dr Braude

You will be clinically supervised by the relevant surgeon, physician and/or senior nurse when you are seeing patients in these settings. If you have any clinical concerns you should always contact the allocated clinical supervisor listed above without delay (all contact numbers are attached as well as being available through switchboard)

If you have concerns about your working hours and workload, colleagues, seniors or access to education and training, contact your clinical or educational supervisor immediately or if you feel this is not appropriate then discuss with the clinical lead (Dr Dhesi).

Audit opportunities and responsibilities

You will be expected to complete an audit during your time on the firm. This is a compulsory part of the job and has several potential benefits for you. These include;

 Experience of completing an audit (essential for CV and job applications)  Opportunity to publish an abstract / letter  Opportunity to contribute to data entry and analysis contributing to publication  Opportunity to present audit findings at departmental meeting (useful for presentation skills and CV purposes)  Opportunity to progress to a quality improvement project

At the induction meeting your audit project will be allocated in pairs (after discussion with your colleagues and supervisors). You will be fully supported in the design, execution and completion of the project. It is your responsibility to;

 register the audit on the trust system  complete the audit within your time on the firm  write it up in an appropriate form (i.e. for inclusion in the trust annual report / for an abstract / for team clinical governance purposes) dependent on the audit

Presentations

There are two sessions for presenting your audits near the end of the placement. This is a learning opportunity and is not marked. Please ensure you complete your project in good time. 15 minutes are allocated to each audit, split roughly equally between presentation and discussion. Bear this in mind when preparing your presentation. You may use this opportunity to request the facilitator to complete a Developing the Clinical Teacher assessment. Ensure you request this in advance.

Annual leave We really would like all our trainees to enjoy a two week block of annual leave. You will see leave friendly weeks marked on the attached rota. The benefit of you taking these weeks is that there is no on call to swap and no need to arrange cover for your duties as there is cover already built into the timetables. Choosing to take leave at other times will involve each individual arranging all this themselves with their colleagues and require the clinical supervisor and myself to approve. The benefits of the approach we have taken are many – both for you and the clinical service. The main benefit for you is that this is one chance of getting 2 weeks in a row. The benefit for the service is that there is continuity of care for our patients.

Sick leave You should contact Jason Cross and your clinical supervisor if you are off sick (020 7188 2092) so that clinical duties can be covered and a record of sick leave can be kept. Please also let your team know. If you are off for 2 weeks we will contact the foundation school your educational supervisor as per the regulations. If you are off for more than 20 days this may affect your training. This is so that we can support you through period of ill health and involve the Occupational Health department appropriately.

Study leave This is subject to discretion and includes all mandatory teaching and courses. There will be a number of courses that you will need to attend during the attachment. These course and dates will be offered by the Foundation School/PGME dept but do need to be discussed with your clinical and educational supervisor.

FY1s do not have separate study leave entitlement.

FY2s have 2 days study leave entitlement over the 4 month period.

Because of the number of options you have to do your various study days/afternoons, co-ordinating everything requires some planning. We obviously need to make sure that you all have your training while all clinical areas are covered sufficiently.

1. Wards- there should be a minimum of one doctor on the ward at any time. You should be consulting with your team when trying to arrange SL to ensure the ward is covered properly. There will be situations where there is no F2 on the ward because of mandatory training (esp vascular)- you need to ensure your SpR/consultant knows abut this.

2. Clinic/ community- you should contact the individual clinic lead if you are away because of SL. For POPS clinics please contact clinic consultant and Chino about potential SL days as this can require clinic number adjustment. You should be requesting SL at least 6 weeks in advance (as is normal policy) however we understand that this may not always be possible.

3. SL dates should be sent to Jason Cross by email

4. When taking days for leave/training etc, update the leave spreadsheet on the shared drive once confirmed with supervisor

Offices The POPS team works at both sites. Our bases are the Older Person’s Unit (OPU), Ground floor, Bermondsey Wing at Guy’s hospital and Mitchener Unit, 12th floor North Wing at St Thomas’s hospital.

Codes for doors:

OPU- 3152

Mitchener Unit- 1524

POPS CLINICAL TEAM CONTACT NUMBERS

Dr Jugdeep Dhesi STH Ext: 88617

Consultant Physician Guys Ext: 82084 Clinical Lead Mobile: 07525451329 Based Cross-Site [email protected]

Dr Philip Braude STH Ext: 88617

Consultant Physician Guys Ext: 82084

Based Cross-Site Mobile: 07941962120

[email protected]

Dr Clare Thomson Mobile: 07811280661

Consultant Physician (locum) STH Ext: 88617

Based Cross-site Guys Ext: 82084

[email protected]

Dr Jude Partridge STH Ext: 88617

Consultant Physician Guys Ext: 82084

Based Cross-site Mobile: 07739722293

[email protected]

Jason Cross Bleep 2740

Advanced Nurse Practitioner STH Ext: 88617

Based STH Guys: 82092

Guys Mondays and Wednesdays Mobile: 07932725387 [email protected]

Ffion Pritchard STH Ext: 88617

CNS Specialist Nurse Guys Ext:87129

Based Mainly STH Gynae Bat Phone: 07583842944

Wednesday Guys Mobile: 07732869572

[email protected]

OOPE (1) Krishna Sathanandan STH Ext: 88617

POPS Team Guys Ext: 87129

Mobile: 07791072292

OOPE (2) Andy Rogerson STH Ext: 88617

Mobile: 07779433418

OOPE (3) Andrea Joughin STH Ext: 88617

Mobile:07769182901

Chino Achor Guys Ext: 82092

Administrator [email protected]

Based Guys

Ramata Carew Guys Ext: 82519

Medical Secretary - OPAU [email protected]

Based Guys

Joan Jessop Guys Ext: 82520

Medical Secretary - OPAU [email protected]

Based Guys

OT-Occupational Therapist Guys 82092

Natalie Lee

Lizzie Biswell STH Ext: 89916 Research Nurse

Based STH Mobile: 07407690016

[email protected]

Aminata Mohammed STH Ext: 89916

Research Nurse [email protected]

Based at STH

Jim Fleet Mobile: 07779255257

Consultant Physician (locum) [email protected]

Based Cross-site POPS team online guide and advice

The POPS team has its own dedicated intranet page with links to the more common GSTT guidelines, assessment Proforma, policy and national information. www.popsteam.co.uk will direct you to our page. Click on ‘Resources’ at the bottom left of the page.

Commonly referred to guidance, most available on the POPS website, but can search via GSTT intranet.

 Peri-operative management of diabetes mellitus medicines  Perioperative bridging of warfarin in adult patients undergoing elective surgery  Perioperative Bridging of New Oral Anticoagulants in Adult Patients Undergoing Elective Surgery  Protocol for patients with Cardiac Implantable Electronic Devices (CIEDs) undergoing Surgery  The Prevention, Recognition and Management of Delirium in Adult In-Patients  Acute Kidney Injury: Initial Management Bundle  Management of uncomplicated hypertension in adults  Management of atrial fibrillation in the adult acute care setting  Think Glucose guidelines

This list is not exhaustive. Many common post operative complaints have an easy to follow pathway / bundle. Please refer to these when formulating a management plan but always feel free to contact a member of the team for further advice if needed.

Useful phone apps (for iPhone users)

 BleepPod – fantastic phone / bleep directory for GSTT. Register with GSTT email.  Patient Safety Manual – GSTT produced treatment and protocol guidance (basic but good)  Infections – GSTT produced Infection and treatment guidelines  NICE BNF – requires login  PPOSSUM -http://www.riskprediction.org.uk/index-pp.php (or just google ppossum) and then the details regards blood loss etc are in the link below

APPENDIX

POPS letter dictation: POPS clinic checklist:

Quick guide to draft a POPS POPS CLINIC dictating POPS Letter (2).doc Letter.doc CHECKLIST FOR FY1s.docx

Listed standard texts for clinic letters: Information for POSSUM scoring:

listed standard texts Information for vs 2 14.11.14.doc POSSUM scoring.doc

Dictating Using Bighand Guidance: POPS glossary:

HOW TO DICTATE POPS glossary.doc ON BIGHAND.docx

Orthopaedic consultant preferences for stopping antiplatelets before surgery:

Aspirin - Consultant preferences.doc

Common perioperative protocols

WARFARIN INR.pdf Diabetes in adults - Antiplatelets before the use of HbA1c.pdf Urology Surgery.doc