DAY-TO-DAY LIFE AS A SURGICAL JUNIOR A JUNIOR-TO-JUNIOR REAL WORLD HANDOVER BETWEEN PLACEMENTS!
Felicity Knights (FY1, just finished HPB)
WHAT I WILL COVER What baffled me & what I wish they had told me when I started! ‘Common mistakes’ by specialty Best practice r.e. clerking Best practice r.e. handover (N.B. new system in place) Your rota & duties (sometimes confusing!)
CLERKING Minimum Key Details - Demographics - Proposed (elective/urgent) procedure under which consultant - Last clinic (review if any specific pre-op instructions) - Review anaesthetist’s notes – any pre-op instructions? - Find protocol for operation if possible Five steps: 1) History (Med hx, changes since pre-op) & Exam (On yellow booklet) 2) IV access & bloods (incl G&S +/- X-match) 3) VTE & Tinz & Dementia 4) Reg meds (See paper included r.e. which to exclude, SCRIPT module) 5) Handover to day team
ON CALL SHIFTS ‘Long Day’ 2 – 9pm - Support other FY1s (e.g. bloods/cannulae they are struggling with) - Support your team if necessary - Clerkings which will not otherwise be done by 5 ‘Nights’ 08.30pm – 08.00am - Clerkings which have not been completed in the evening - Routine meds & IVT / TPN / Insulin (if H@N not a prescriber) - Venflons & bloods - Seeing sick (and not so sick!) patients (call SHO / Reg)
‘Weekends’ 08.00am – 08.30pm - The dreaded shift! - Be prepared! Be organised! - Recommend signing as much as possible in advance - Organise your lists in advance e.g. side per ward - FY1 does HPB & Colorectal WR, SHO does Vascular WR - Establish essential bloods on the round - Establish priority jobs on the round - Phone your SHO in case they are free if you get overwhelmed
HANDOVERS Appropriate: - Clerkings which you have not got to. If you know they have ‘special’ needs then hand these over too! - Failed venflons - Post bloods-round jobs (although order scans yourself) - ITU reviews/ putting out bloods if required Inappropriate: - Day bloods unless there is a problem (ask for help AT 2 not 5pm!) - Venflons you have not tried / Day 5 venflons -
BEWARE Tinzaparin – MUST be done on admission Anticoagulants pre and post-op Neuroendocrine tumour / leak:
octreotide (400 micrograms in 40mls at 5ml/hr) Lines – sepsis, thrombosis Consistently dropping Na+
SPECIAL ‘HPB’ THINGS Ordering lines – type which type of line you want into the free text box on ‘Central Line placement’ on e-record
Ordering ERCP/ EUS / Necrosectomy / NJ etc are all
ordered on an OGD paper form. Check if the reg wants a stent (this must be stated clearly as requires a longer ERCP slot not an EUS slot)
SPECIAL ‘VASCULAR’ THINGS Suspend clopidogrel prior to ANY procedure except angioplasty. Otherwise
switch to aspirin.
Angio – ‘Angiogram’ or ‘Angioplasty’ ?Clarify APTR – measurement of heparin infusion. Take samples as per protocol in
blue bottle. Increase /decrease infusion as per protocol chart in patient notes.
BP – Almost always a fixed range post-op. Check Post-op notes and phone
reg if it is outside of this and no clear plan.
QUESTIONS?