Surgical induction slides
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General Surgery FY1/FY2 NNUH Departmental Induction • On call duties. • The List • Ward cover • Follow-up and EDLs • Weekends • IT • Nights • The Rota & Leave Content • Handover Schedule • Study Leave • Clerking • Useful Numbers • Documentation and Paperwork • EGS/Speciality inductionDay on-calls 07:30 – 19:30 • Meet in the Alan Birt office at 7:30 • There is usually 2 foundation doctors, 1 registrar (and possibly 1 CT) on the day shift for EAUS. • Once you have arrived you can immediately start clerking. • The patients from the nightshift should be handed over to the EGS team so you usually do not have On to get involved. -alls CLERKING (details to follow) • Both foundation doctors will be clerking during the day. • Clerking include general surgery, Urology, Vascular, and Thoracic patients. • The registrar will be in theatre and will be reviewing patients between cases. • If there is no CT on your day shift one of the foundation doctors may be asked to assist in theatre. • At 17:30 one of the foundation doctors will take over the 0244 ward cover bleep until 19:30. Lists • You are expected to have the list ready for handover at 19:30 • Please print 3 lists ready for handover to the night team.Ward cover: 17:30 – 7:30 (#0244) After 17.30 the day surgical teams leave and all surgical patients are cared for by the on-call team. • (with the exception of plastics/ENT/T+O/max fax/dermatology) On -alls One FY on SDEC takes the 0244 bleep from EGS and becomes ward cover. • The day teams may contact you to hand over jobs such as chasing blood results/CXRs. • They will also inform you of any of their patients who are sick and may need attention overnight.Ward cover: 17:30 – 7:30 (#0244) • You will receives jobs from the hospital at night team. • cannulas/bloods that need taking.scoring, medications that need prescribing or • You will need access to the hospital at night online system. This is usually your regular On IT log in. -alls • Go to NNUH home page → Web systems → Hospital at Night. All jobs allocated to you have completed the tasks. For any urgent jobs they may call you. update it when you • Any patients you are concerned about or feel unable to deal with you can escalate to your CT (#0082) to ask for their help/advice. If you are unable to get them you can call your registrar (#0080/6717 Dect.). • Bare in mind that your registrar is a general surgery trainee – any patients from urology/vascular/thoracics should be discussed with the CT and then may warrant a phone call to the relevant speciality registrar.Weekends ward-cover 07:30 – 17:30 • 2 foundation doctors and 1 CT doing weekend ward cover. • One foundation doctor will attend the vascular ward round at 7:30 on Denton and then complete the jobs + carry the #0244 bleep. They will need to delegate sensibly to their colleague as they will receive the majority of the Weekends bleeps. • The other foundation doctor will attend the thoracics ward round at 07:30 on Docking and then the urology ward round at 08:30 on Edgefield and complete their jobs. • The CT completes their own ward round of all the upper GI and colorectal patients, usually with a SNP. • If you are worried or unsure about any of the patients, you can ask the urology/vascular/thoracics registrars or you can contact the core trainee who will be happy to help/give advice. • At 17:30 you are to handover any outstanding jobs/sick patients to the SDEC team as well as the #0244 bleep.Nights •20:00 - 08:00 •Ensure you have access to hospital at night system •You will work in a group of 4 – oncall SpR, oncall CT, FY1/2 (x2) •One FY Dr will clerk new patients on EAUS/AEC and carry 1400 bleep. nderking is on symphony/in a booklet. Ensure you inform each respective specialty for a review/advice if needed. The 2 FY Dr will carry 0244 bleep and look afteright all the surgical wards. •It’s a good idea to switch wards/clerking roles between you each night if you wish. Remember to stay well hydrated and bring snacks. •Ensure all new patients have their regular meds prescribed + TEDS/LMWH unless contraindicated. Keep patients NBM if they require emergency surgery. •Ensure the list with all new admissionsfor general surgery is ready for printing by 07:15 ready for handover in the Alan Birt room. List can be found in S Drive – Surgical Division – General Surgery – zzzzz take Handovers •Remember you are a team and if one of you is free, you should offer the other a hand with their jobs and share the hospital at night jobs between youHandovers TIME WHO WHERE KEY TASKS • Review updated, printed lists Night FY/CT/SpR • Handover any outstanding ward reviews 07:30 to Alan Birt • Outstanding tasks/ Awaited important results Handover Day EGS FY/SpR/CONS • Patients "To Be Aware" of. Day surgical teams & • Ward Pts who require review 17:30 EGS to on-call ward AEC Office • Outstanding tasks/ Awaited important results cover • Patients "To Be Aware" of. Day FYs/CT/SpR • Review updated, printed lists 19:30 to AEC Office • Handover any outstanding ward reviews Night FYs/CT/SpR • Outstanding tasks/ Awaited important results • Patients "To Be Aware" of.Typical approach to clerking • Talk to the patient - AND put cannula in and take blood (inc Coag if warfainised, inc G&S if “unwell” ) • Keep NBM • Prescribe fluids (Hartmann’s or Blood for resus or replacement) • Prescribe analgesia including PRN opiates with a multi-modal antiemetics • Prescribe LMWH – (prescribe and withhold if active bleeding) Night • Prescribe TEDS (not if vascular-ischaemic-leg) • Prescribe regular medications (prescribe and withhold anticoagulants / antiplatelets) • Request ECG if >50 or unwell • Put details on the EXCEL list in the AEC office • Handover plan to nursing staff • Talk to your CT or SpR about the patientDocumentation and Symphony Symphony access is crucial. Do your training asap. Documentation and Paperwork Make sure documentation is adequate and clear, its a large department and patients may be seen by many different team members during their stay and throughout follow-up. Minor/Day presentations require equally adequate documentation and this can become problematic during follow-up or when complications arise. Don’t forget: PMHx, DHx and SHx Consultant/Senior Review Examination findings Discussions with seniors and specialties Clear plans VTE IS CRUCIAL - Please don’t forget anti-embolism stockings as well as LMWH. (NO STOCKINGS FOR PATIENTS WITH VASCULAR DISEASE)The List • Foundat : S:\Division 2 - Surgical\General Surgery\ZZZZ TAKE HANDOVERS • It is crucial that this is kept up to date throughoutthe day • A new list needs to begin generatedeach morning and saved to the correct dateto avoid overriding the previous days list The List • Clearly indicate outstanding jobs including outstandingimaging • Patientswho are seen and dischargedhome need to enteredunder the HOME tab • If a patientis to returnto AEC for imaging or review – please notethis under the TCI tab • Unwell wardpatientsrequiringsenior review will be notedunder the Ward referrals tabs • PLEASE make sure you updatepatientlocationsbeforeprinting the list • Lists should be ready and printedat 07:15 and 19:30 for the day and night handoversrespectivelyFollow-upand EDLs •concise. If not completed they will be highlighted to the seniors.scharge segment which is done though Symphony- keep these brief and Follow • EDLs are necessary for coding and hospital funding so a failure to complete them will trigger notification emails sent to seniors and consequently to you. - p and EDLs • Ensure appropriate follow-up is arranged for patients on discharge – this may be further imaging, AEC review or OPD follow-up. • Patients can be offered 48 hr emergency access to the AEC • SDEC have booking slots for USS – these can be booked with time slots communicated to patients. These still need to be requested on ICE – please include information that the patient has been offered an SDEC slot. • OPD follow-up is arranged by emailing the appropriate secretary.Important IT access and logins Please ensure you have full working access to the following: 1. Symphony – for clerking patients in AEC 2. EPMA - for e-prescribing 3. PACS - to review radiology imaging and reports IT 4. ICE - to view lab reports and request lab tests, radiology, referrals and for Discharge letters 5. Emergency theatres - to book acute cases (contact karolina.boddy@nnuh.nhs.uk Next: 2326) 6. Orsos web view - to view upcoming elective theatre lists 7. Orsos peri-op - to view op and write notes 8. S Drive - Access to daily list The Rota / Leave • Annual leave must be organised with your base team’s rota coordinator. • AL cannot unfortunately, be arranged during your on-call/EGS shifts - if you wish to take time off duringe Rota / Leave these you will need to swap with colleagues and inform both the on-call and base team’s rota coordinator. • There are minimum requirements for staff in each of the sub-specialities and therefore not all leave in NWD can automatically be accommodated. • If you are unwell and unable to undertake your shift please let people know as soon as possible. Please inform the on-call rota coordinator AND your base team’s rota coordinator. • If you're off for significant sick leave you mustinform your parent team rota coordinator, Miss Sreedharan and victoria.worman@nnuh.nhs.uk. You will need a "return to work assessment".Study Leave • Study leave/taster weeks must be also organised with your base team’s rota The Rota / Leave coordinator. • Once approved with the coordinator, please ensure you complete the NANIME form available on https://nanime.nnuh.nhs.uk/trainee-support/study-leave/ • Your form will need to be signed off by you ES and then submitted to NANIME • Once your ES has approved the SL – kindly reconfirm this with the rota coordiantorUseful Numbers EAUS: 2424 General surgery SpR: 0080 bleep /6717 DECT phone Core surgical trainee: 0082 bleep Useful Numbers Ward cover: 0244 Urology SpR: bleep via switch board, mobile via switch at night Vascular SpR: 0884 bleep, mobile via switch at night Thoracics SpR: 0904, mobile via switch at night Duty radiology: 6966 To bleep: Dial 156 followed by the bleep number followed by number you’d like them to contactEGS: -7:30 – 17:30 Emergency General Surgery • The EGS team is responsible for looking after all post-take AND Emergency General Surgery inpatients. • Handover at 07:30 in the Alan Birt. • The night team puts all the outstanding jobs from their shift in a separate column on the take, it is your responsibility to do all of these jobs. • Plans might be changed during the handover/ ward round at the discretion of the Consultant on-call.EGS: -7:30 – 17:30 Emergency General Surgery • Everyday there is a “Gold case” for the day - the first operation on the emergency theatre list – please make sure everything is prepared for this patient to go to theatre i.e. G+S, consent form, ECG, booking. • Following handover, you will do the post-take ward round with the Consultant on-call and will see all the patients on the list. To be efficient, take turns writing in the notes whilst the other person prepares the next set, it is wise to do the jobs as you go along e.g. book scans.EGS: -7:30 – 17:30 Emergency General Surgery • After you have finished the post-take ward round, go to the EGS Consultant’s office where a patient list will be printed for you. • The Consultant’s to do the ward round for all the Emergency General Surgery inpatients are Mr Evans, Mr Valero, Mr Moss or Mr Aikoye. • The EGS list can be long and finishes mid-afternoon. • Normally there are 3 juniors and an SN. Ideally one junior holds 0244 and books scans, EDL’s and TTO’s as they go along to save time.EGS: -7:30 – 17:30 Emergency General Surgery • Be sure to discuss any scans as soon as possible with the duty radiologist on 6966 DECT phone or Ring 2100 otherwise they will not happen even if they have been booked. • From 7:30 to 17:30 you are responsible for the Emergency General Surgery inpatients and the post-take patients only. If you receive a bleep for any other surgical specialty, you should check which Consultant they are under and advise them to contact their respective firm. • At 17:30 you have to go to the SDEC office for handover. You will have to hand over any outstanding jobs and the 0244 bleep to the AEC day team.Colorectal FY1/FY2 NNUH Departmental Induction Mohamed Rabie The Team & our Department FY1 in Colorectal Ward round Content Ward jobs Follow ups Colorectal Rota Useful Numbers The T eam & Our Department • Consultants The Team & • Mr Hernon, Mr Wharton, Mr Shaikh, Mr El-Hadi, Mr Stearns, Mr Kapur, Mr Dastur, Mr Mishra • Registrars Our Department • Mohamed Rabie, Christina, Elle, Rami, Mohamed Ali, • Core Trainees • Kaso, Syed, Arturs. • Specialist Nurse Practitioners • Amanda, Jess, Sam and Michael • Most patients are on Dilham and Denton FY1 in Colorectal • 7.30am meet in Dilham doctor's office (just before you walk onto Dilham it is on the right) • Collect a list which will have been printed out by the SNPs FY1 in Colorectal • We tend to split into two teams • Registrar ward round at 7.30am • Followed by completing your jobs in the afternoon • Catch up in the afternoon with the registrars, where you can run through any issues/questions • Consultant offices are on the corridor between EAUS and Gissing • Meetings on Mondays 8am and Fridays 8am in the Alan BirtWard round • Registrar ward round at 7.30am, where you check the patient's observations, write in the notes and keep track of the jobs for each patient Ward round • Consultants often do miniature ward rounds at various times during the day for their patients • Patients are on Dilham, Denton and any outliers (Docking, Cley, EAUS, Earsham, Edgefield, ITU/HDU etc) • Bring the bloods stickers with you on the ward round to stick in the notesWard jobs • Prescribing medications • Booking scans • CT scans are pretty much always CTAP with contract • Book and vet your scans as early as possible to ensure they are done the same dayWard jobs • EDLs/TTOs • Cannulas/bloods/ABGs • Reviewing bloods and actioning anything that is needed – and writing the bloods on stickers for the next day to be used on the ward round • Booking bloods for the next day (and if it is a Friday, ensure they are booked for Saturday/Sunday/Monday) • Most colorectal patients require daily bloods, unless they are MFFD or palliative • If a patient is on TPN ensure you have booked TPN bloods (you can search for this profile on ICE) • Discussing patients with other teams over the phone for advice • Referring to other teams for input e.g. pain team/nutrition team/dietetics teamFollow ups! • All patients who have had an operation for cancer will need to complete 28 days of prophylactic Dalteparin in total – ensure you include this in the TTO/EDL Follow ups • The follow up the patient requires is often stated on the ward round or you can check with the registrars • Clinic follow up with the consultant they are under if required • Sometimes patients require OP flexi sig/colonoscopyRota • Rota coordinator: Mohamed.rabie@nnuh.nhs.uk • Minimum 2 colorectal FY1s/FY2s for functional staffing levels, since the job can be very busy especially when the colorectal consultants have Rota been on call over the weekendThoracics FY1/FY2 NNUH Departmental Induction XXX The Team & our Department FY1 in Thoracics Ward round Content Ward jobs Follow ups Thoracics Rota Useful NumbersThe T eam & Our Department The Team & Find us in the Hethel ward corridor! Consultants: Mr Van Tornout, Mr Bartosik, Mr Kouritas, Mr Kadlec Registrars: Haisam, Rika, Rushmi, Niran (bleep 0904, ALSO ask to join their WhatsApp Group) Our Department SHO: Dhiraj FY1/2: There are usually 2 FY doctors on Thoracics, but they are never on at the same time! Specialist nurses: Di Menzes, Zoe Lyons Secretary: Caroline Patients are dotted throughout: Denton (post op clean ward), Docking (dirty ward), Gissing (high risk post ops), ICU (complicated post-ops/ severe trauma)FY1 in Thoracics 7.30: Meet the registrar on-call in the thoracic registrar office (off Hethel ward). Print off an up-to-date list off the S drive. You will need a consultant to give you access to this list. Bleep 0904 for the reg if they aren't in the office. Thoracic F1s carry the bleep 1025 – FY1 in which is left in the reg office at the end of each day. 7.30-9.30: We have usually between 6-15 patients. The reg leads the ward round in the Thoracics morning, but the consultants will also do a round through the day to see their own patients 9.30-5.30: Coffee and jobs: Do the ward round jobs, and any extra jobs as they crop up through the day. This is a good specialty to work on your portfolio, do an audit, or see any surgery – if you're interested in surgeryWard round Approaching each patient: Our typical patients: Check their clerking hx if they are new to you. Elective: Elective patients are clerked over the phone by the Wedge/lobectomy/pneumectomy patients specialist nurse pre-op for query or biopsy proven lung cancer Ward round Emergency patients are usually seen by the registrar Thymoma overnight prior to the WR Chest wall reconstructions Assessment Referrals from Respiratory: - NEWS score Elective complicated loculated pleural effusions - Chest drain (you need to get to grips with the Complicated/ recurrent pneumothorax – various chest drains – Topaz, underwater and flutter – pleurectomy/ pleurodesis) ask any of the registrars to help you with this – as it is learn what the drainage/ air leak and suction means) Emergency: - Pain management! Look at their pain catheters and Trauma - rib fractures +/- pneumothorax +/- their PCA usage. Thoracic surgery is particularly painfulpost op and it is typical for them to have a haemothorax +/- pulmonary contusions pain catheter and a PCA -Hx/ exam/ planWard jobs • Request and chase CXR TIPS! • EDL/ TTOs CXRs • Medication reviews Post-op patients need a same day CXR after the Ward jobs • Help specialty nurses with chest drain removal operation – the operating registrar will request and review this usually. • Dressing changes • Bloods/ ABG for unwell patients Day 1 post-op - patients will need another CXR • Discussing with other specialties and routine bloods • Review bloods 1-2pm and book them for the next A CXR is required 4-6 hours after a chest drain has day been removed to check that the lung is up. • Updating the patient list on S drive – to make sure the on-call registrar has all of the up-to-date information from the time you leave. Follow ups! • Follow ups are usually 4-6 weeks with the If there has been a complicated discharge i.e discharging consultant - Patients with complicated wounds/ dressings • Cancer patients are usually discharged with 28 - Patients discharged with a flutter bag Follow ups days of Dalteparin FROM the day of their operation unless specifically contraindicated • If the patient has had a chest drain, then they Then they can be reviewed in the Docking specialty nurse led clinic on Thursday afternoons may need their suture removed at their GP by the practice nurse 8 days after D/C. Always for assessment +/- CXR. This needs to be booked in with Zoe/ Di – find them in the thoracic check this on the WR if the patient may go corridor! home before doing the EDL.Rota • Rota coordinator: haisam.saad@nnuh.nhs.uk Rota + Useful numbers Useful numbers • F1/F2: 1025 • On call reg: 0904 • Inpatient X-ray: 2105 • Duty radiologist: 2100/6966 • Reg office: 2167UGI FY1/FY2 NNUH Departmental Induction Nehal Yemula The Team & our Department FY1 in UGI Ward round Content Ward jobs Follow ups Upper GI Rota Useful Numbers The T eam & Our Department • 5 Consultants, 3 Registrars, 2 Core Trainees The Team & • Mr Cheong, Mr Lewis, Mr Wemyss-Holden, Mr Kumar, Miss Sreedharan • James Laycock, Christos Athanasiou, Scott Whiting (Fellow) • Ioannis Rantos and Teri Toi Our Department • 2 FY1 and 2 FY2 (normally one junior always on whilst an SNP may also be available) • Secretaries • Karen Turner, Rachel Hughes • Base Ward • Docking • Friday 2pm Upper GI Meeting FY1 in UGI • The conditions we seem commonly in Upper GI are: • Oesophagectomies, Gastrectomy, Pancreatitis and Cholecystitis/CBD Obstruction. We diverticulitis, colon cancer etcatients and this can include lower GI pathology e.g. • gastrectomy. These patients go to ITU and HDU after their operations and get FY1 in UGI stepped down to the wards quite quickly. Normally, the consultants keep a close eye on these patients, but you are the first contact and its important inform your senior early that these patients are unwell. They may need to go back to theatre for a relook. • Ensure that patients with pancreatitis have enough fluids or they develop SIRS! • Always listen to your consultants and if you have any difficulties then please ask them. Especially Mr. Cheong, he is very particular about his patients and even the smallest detail let him know. For all Mr Cheong’s MIO’s ensure they have regular medications to start and stop. Any issues message him!He will tell you which • Be prepared to act as a physiotherapist and help mobilise the patients.Ward round • Meet in Docking Doctors office at 7:30am where a list will be printed and ready for you by an SNP • Go on the ward round and write down any jobs just like any rotation, the ward rounds are quick so you must be efficient. You will also go to HDU or ITU to see any patients there. VisitingDoctorHDU (hdu2020) or VisitingDoctorITU (itu2020) • Coffee Break • The most common Upper GI jobs include booking OGDs, ERCPs, MRCPs, requesting PICC lines via vascular access, CTAP with contrast, barium swallows, nutrition reviews for TPN and booking patients onto emergency Ward round for the elective surgical patientsots of jobs via whatsapp too and you will have to prescribe regular medications • they have TPN bloods booked (there is a specific search in ICE for this).d LFTs. If patients are on TPN ensure • on a sticky label ready for the next day.lood tests, correct any abnormalities and write the blood results down • The registrar will meet you in the late afternoon and go over jobs • If you have time, try and go to theatre and observe some procedures. They are very complex and skilled operations. • Consultants like to check on the patients at random times, especially Mr Cheong so be ready when he rings you. • You may also need to refer patients to the Upper GI MDT or HPB MDT. Email Helen Lucas or Sonia Baker.Rota • Rota coordinator: Teri.Toi@nnuh.nhs.uk • Please discuss AL requests with them first and ensure there is always one FY doctor on the wards. Rota • On-Calls and EGS day’s must be swapped if you require to take AL on those set dates.Urology FY1/FY2 NNUH Departmental Induction Sumbal Bhatti • The Team & our Department • FY1 in Urology • Ward round Content • Ward jobs UROLOGY • 0007 • Follow ups • Rota • Useful Numbers The T eam & Our Department • Welcome to the department! The Team & • We are a busy unit with a very high turnover of patients. During your 4 months here you will see a wide variety of presentations, ranging from complex cancer cases.with haematuria or urosepsis, routine operations, and Our Department • The team is made up of consultants, registrars, associate specialists, clinical physician associates, the physiology team, the lithotripsy team, lots of nurses, secretaries, theatre staff, continence nurses, oncology nurses, ward nurses and nursing students, OT/PT… etc. • Everyone is really nice and always approachable • Usually you will be based on Edgefield ward (the doctors office is also here) FY1 in Urology • You will spend your time split between Urology and General surgery on-call. Days on the rota labelled NWD will be spent on Urology, and days/nights are spent on the surgical admission unit (EAUS/AEC) clerking surgical patients. • Hours are 07:30 to 17:30 on a normal working day. Most of the time, this is FY1 in Urology ample time to complete your jobs. You will commonly see patients with haematuria, urosepsis, renal colic, retention, nephrostomy blockages and of course difficult catheterisations. • The SpRs will be able to teach you a wide range of skills and techniques we use to manage these conditions • You should not stay late to complete routine tasks, these should be handed over to the evening team (0244) with a clear plan for the patient. • On occasion you may need to stay late to look after sick people if called just before you shift ends or to complete urgent tasks that can’t wait (exception report if this is a regular occurrence).Ward round • We have 2 ward round teams → Emergency team (acute inpatient admissions + post take) and Elective team (all post – op elective patients) • Emergency ward round → Consultant led with at least 1 FY (bleep 1297), 1 UNP and ROW (SpR of the week) • Elective ward round →SpR led with 1 FY (bleep 0007) Ward round • responsible for seeing those patients.ating consultant and their assigned SpRs who are • Most patients will be on dilham or denton ward. • The SpRs for each team will see the patients in the morning before their clinics/theatre. You will need to liaise with them for the jobs and try to see as many with them as possible. • days there will also be a Urology Specialist nurse to support.times. On most • At the start of the week you should know who will cover what team (it is usually pre-assigned on the rota) • In the morning at 7.30am you will need to prepare the ward list for each wardround. You will need to get access to the patient handover system for this to see where all patients are.Ward jobs • Jobs mainly include EDLs and TTOs, chasing bloods, ordering investigations (usually ultrasounds or CTs), and often arranging interventions such as nephrostomies. (All via ICE and phone-calls) • X-rays just happen unless you want it urgently then you need to call inpatient X-ray (A&E Ward jobs out of hours – 2105/2068). • CT and ultrasound needs to be discussed with duty radiology - 6966. • Nephrostomies need to be discussed with IRU (need a clotting done beforehand, INR<1.5) – 2690 • On a Friday, you will need to request bloods for each patient for Saturday/Sunday/Monday as appropriate and ensure that each patient had a plan for the weekend. • Each afternoon you should check ‘Orsos Web View’ (via web systems tab on intranet home page) for operations that are happening that day. Patients who will be staying can then be added to the ward list and have bloods requested for the next morning if required.0007 • One junior will need to carry bleep 0007 / alertive. You will be the on-call FY doctor for Urology between 07:30 and 17:30. There is an on-call registrar who will take all new referrals from A&E, GPs, JPUH/QEH and other specialties ( you must not accept any referrals). • You should do the elective ward round and then go to EAUS to clerk in new Urology admissions and to establish what they need from you that day.o communicate with the registrar on call early in the day 0007 • All patients that you see on SDEC will need senior review. • The registrar keeps track of the patients he/she sees and will write a handover the following day which will be emailed out to the team. • Clerking is done on Symphony so ensure you have a login for this before you start! • outstanding patients.patients are clerked by the General Surgery FY team. Handover to them anyFollow ups! • MDT: give form to MDT booking office (corridor on the left as you leave Edgefield ward then 1st door on the right) • Flexicystoscopy/HOLEP/TURBT: form goes to the booking office (corridor on the right as you leave Edgefield ward then 2nd door on the right) • UTOV/Urodynamics clinic: give in to incontinence nurse office (down the corridor on the left as you leave Edgefield ward) • Any patient with stones, MUST be added to stone MDT (clinical form on ice). A plan should be made on discharge regarding change/removal. Follow ups • Patients discharged with nephrostomies and stents will need a long term plan. Nephrostomy exchanges need booking on ICE prior to discharge for 3/12. Stents need changes in 6/12 – if stent is out in clinic (string) or removal in endoscopy (no string). W/L for URS • Patients discharged with catheters will need a plan. If they failed TWOC then arrange either TWOC in community or clinic (usually 1-2 weeks). If it is long term then thy need a date for change (usually 12 weeks). • All patients who have had major cancer surgery will need LMWH for 28 days (e.g.cystectomy,prostatectomy, nephrectomy, lymph node dissection) • Any prostatectomy patients will need LMWH for 28days +PSA form to be printed. They need to have a PSA done 1 week before their OPA in week 7 post-op. • UROWD is run by ROW for difficult catheter changes, SPC changes and wound checks. Email the secretary of the patient’s consultant to arrange.Rota • Rota coordinator: derrick.Tsang@nnuh.nhs.uk • block for general surgery. If you need to take leave here then you will need to arrange swaps between yourselves. All annual leave must be taken during normal working days and should go through the urology rota coordinator. • 6 weeks is notice is required and it is your responsibility to book all your leave beforeta the rotation ends or you may lose it! • There must be two FY doctors allocated to the ward at all times. This therefore may limit where you can/can’t take leave. For this reason, it’s important to urge you to get your leave requests in early. • It may be possible for you to take study leave for exams or important courses, or even take a taster week in another specialty, this needs to be approved by Mr Ho (clinical supervisor), educational supervisor and nanime.Useful numbers • On-call Consultant – Dect. 1387 • On-call SpR – 1734 Useful numbers • On-call FY – bleep 0007 • Emergency FY– bleep 1297 • Urology NP – Dect. 3101 • Edgefield Drs office - 2733 • Duty Radiology – Dect. 6966 • IRU – Dect. 2690Vascular FY1/FY2 NNUH Departmental Induction Osamuyimen Omoragbon The Team & our Department FY1 in Vascular Ward round Content Ward jobs Follow ups Vascular Rota Useful NumbersThe T eam & Our Department • 7 consultants The Team & ✓Mr Armon / Mr Al-Jundi / Mr Bennett / Miss Meyers / Mr Morrow / Mr Brightwell / Mr Delbridge • 5 registrars ✓Mo Chowdhury / Ish Aziz / Roshan Bootun / Kersten Morgan-Bates / Ayman Hamdy Our Department • 2 CTs ✓Shreya Kulkarni / Harry Smeeden • 1 VSN ✓Judith Ompok • Most patients are on Denton & Docking • Few outliers + HDU/ITUFY1 in Vascular • 7:30am Dr's office on corridor to Denton ward • Update the list - Patient handover / on-call reg handover (email) / orso web view • Prep patients notes • Reg ward round ~ 8:30 FY1 in Vascular • Consultant ward round times on poster in Dr's office – can vary • Grand round Fridays (on-call consultant swaps with next on-call consultant) • Midday board round with reg to f/u a.m jobs • 5pm board round with reg to f/u p.m jobs / update list Teaching • Wednesday at 8:00am – Dr's office on corridor to Denton Patients • AAA repair / TEVAR / amputations (AKA/BKA) / wound washout & debridement / fem-pop by-pass / carotid endarterectomyWard round Review; • Antibiotics • Anticoagulation • Post-op wounds & drains Ward round • CTaorta / CTangio / angioplasty reports (document in patients notes) / X-rays / vein map • Bone / tissue cultures • Blood cultures Advice; • Email Mr Armon to get access to S:Drive vascular list • Call IRU @ 8:30am for patient's a/w angioplasty • Read post-op notes and action the plan • All vascular patients need to be on a statin & antiplatelet / sometimes DAPT - unless contraindicatedWard jobs • Request – vet – schedule imaging • D/W micro or other specialist teams • Review bloods p.m & prep stickers for next day Ward jobs • Book bloods for next day • Chase IRU for angioplasty availability (INR must <1.5) • Chase results of any bodily specimens • EDL & TTOs • Join the reg to clerk new patients in surgical AECFollow ups! • 6/52 O/P f/u with their consultant - unless advised otherwise • Some may need f/u scan on same day as clinic appointment - consultant will letllow ups you know, otherwise just ask Rota • Rota coordinator: ishtiaq.aziz@nnuh.nhs.uk • There should always be 2 juniors on the ward Rota + Useful numbers Useful numbers • Juniors bleep - 0208 • Reg bleep - 0884 • IRU - 2690 • Amputee specialist nurse - 7971 • PICC line - 2088 Breast Surgery • No formally assigned FY1/FY2 • May require some support if they have admissions/inpatients BREAST SURGERY • FYs are always welcomed to theatre/clinics • review.nfective presentations to AEC usually require Abx and booking into breast clinic for • If patients are unwell: discuss with the on-call reg. • Acute presentations of post-op complications out of hours should be discussed with the on-call gen surg reg and the patient's operating consultant