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that's just going live. However, Um, welcome to our third mind. The big webinar and I have 41 Survival Guide, 10 parts Siris. Today's talk breaks down, walk around and documentation, and it's going to be delivered by my colleague Doctor Hamza defender, who is an f y one, soon to be halfway two in the West Midlands. Just a reminder that this weapon I will be recorded under load. It's a metal on the mind of the beauty channel. Who's amendment to ask questions in the chop. We'll make sure to ask them at the end. Um, I would also be available in the chapped to answer any questions throughout the webinar. Remember, you can also sign for free weekly webinars opposed to link in the chart. We're all supposed to link for the feedback forming the chap at the end of the webinar, for which you'll get a certificate for your portfolio. Um, without further ado or 100 times, right, thank you Need uh, okay, let's get started. So it's talk will be on ward runs and documentation. So welcome to today's talk on ward runs and documentation. This will be an important part of your role as an F Y one, if not the most important part, GMC states, you must keep clear, accurate and ledge a bill records for the majority of you. Your hospitals was still use paper notes, and thus this took talk will focus more on paper notes and hand written documentation, however, that, uh, some of you will also use Elektronik notes. This talk will also be relevant because the principles are the same. Unfortunately, medical school does not teach you how to document in patients notes. And that's that's something we both have learned was on the job. Hence we fought. This talk would be really important for you guys. So today's topic will cover good documentation, how to write in senior lead war grounds, how to do a solar walk around job jobs. This and finally, a summary idea. So why is it important to document well patient notes or legal documents if there is to be an investigation into a patient step or the quality of care they've received in hospital? The responsible body were used. Their hand written notes a k your documentation patients and notes also control continue to of care and and allow the clinician responsible of this patient's care to get a good understanding of what has happened over the last few days. As you might appreciate, doctors keep changing over and over again, tense, the patient notes off. The only continue to of care that we have other than hand over, for instance, the only way you can figure out what has happened over the last few days, especially if you've been awful on the bank. Holiday is for the patients notes. Good documentation also helps guide the patients care and the care delivered by other members of the health care professional team. For example, if your patient is due to go to surgery tomorrow and they'll to be kept in near by mouth writing, know by mouth as from midnight on, the patients who notes will let the nursing stuff in the X years know that this patient should not receive any food or drink as from midnight. Good documentation will also help you and your colleagues, right this john summaries instead of looking through pages of notes. If someone has documented well, you have the most up to date information readily available at hand. Lastly, for good documentation, you can readily update patients and family members off the current progress. This is particularly important because you might not be familiar with this patient's care enhanced. This documentation will allow you to become familiar with what has happened over the last few days. Okay, let's move on to the components of a good documentation. So here are the key components of good documentation. It should always include a date and time and include a patient, identifiable details. For those of you who use paper notes, the war clock will usually print some stickers with patient, identifiable labels, which you can stay at the top of each continuation sheets. And for those of you using electronic notes, this is automatically done so you don't need to worry about this part. Uh, you also have to write the name and the role of the assessing person at the top and usually write this in bold letters. So then you write in the plan and the examination, and then when you finish, you write your name, you sign it off with your GMC registration number and his signature again. For those of you using electronic notes, this will automatically be done. But for those of you using paper notes, you can use your fancy stamps, which will be provided by your hospital, so patient notes should be logical, and it should also be in black ink. It's preferable to use both open. Remember to be courteous in your documentation. This is because most doctors was have read your documentation before having read you, and just they would have form an opinion of you based on your documentation. So here are two examples of documentation. Again, these are made up scenarios, so you have the patient identifiable details on top, the patient's name and the hospital number, the date and time the assessing person. So this is myself. If it is yourself, you can write the initial of your first name, followed by your surname and your title So f Y one and what you were doing at that time so you might have been on call, and, uh, it's good to write it in bold as well. So then here you can document it should be legible in black ink and then always include a plan for the nursing stuff and other members of the healthcare team so that they're familiar with what's happening as Well, I've also included my stamp, which has my name, my GMC registration number and his signature as well. So this is one instance where I've documented about an n g tube location to start a patient feeding so you can see if anything goes wrong. They can go back to this documentation and see who it was who documented that on the right. You have another example off the documentation I've written for patient inside of fall. And they were on a do. Uh, so I've written the reports of the scan as well, which I've been osteo Chase and I've written a clear plan. So start on the Duac again and continue new robs ovations. So this is how you guys should aim to document. So now we're going to go on a vaccine. Your lead wardrobes. Yeah. So for senior lead war grounds, have a patient list prepared Seniors will rely on f y wants to direct them as to which patient they need to see. That's easy if you're on a specialized ward such as cardiology, because all your patients will need to be seen anyway. But if you're on other specialties, you might have patients all over the place, all across the hospitals, on different words, and you also have outlines, so it's important important to know who your patients are and where they are. The last thing you want is for you to having Ms patients doing wardrobing and that being called to see them near the end of your ship. So having a good patient list will ensure that you know where to go. Know the name and roll of your seniors, and so that you can also document this. Oh, Watts writing and have the observation. The observations of each patient's ready so most trust were used and used to school. So then you can readily have this available through the computer or through the paper news to chart and in patients on scoring know for what their scoring have blood tests also available and the trend of these blood tests so blood tests in isolation mean nothing. But if you have a trend to compare with, it can give you a better picture of what's happening. You can also include relevant medications such as antibiotics, but only if it's relevant. For example, if a patient's on the free out of a five day course of antibiotics that would be relevant so you can write this down, and you can also document the results of any scans and procedures. So all of this that we've mentioned so far, you can have this ready before going to see the patient by their bedside, as you can see it before going to see the patient by the bedside. You already have a lot of information about this patient, and you can start to form a picture about them. When you go to see the patient by the bedside, you can document, like any concerns, the patient house or how they're feeling. Usually the patients well, I will write patient, comfortable dressed. And then, if there are no concerns, right, no can no concerns. I'm present. You can also document the results of relevant investigation findings up. Sorry, elephant examination findings. And because this is a senior lead ward round your seniors will usually direct you as what to write for. Examine, For example, if the examining the heart, they'll tell you to write the results of the exportation toe heart sounds, a member heard a moment not hurt or chest clear. And last year, at the end of your documentation, it's really important to include the plan. So have a plan listed, including the jobs that need to be done and the current management that needs to be followed. If you're not sure about the plan again, also seen your members before moving on to the next patient. So this is again an example of another water on entry. Again, this is a made up scenario. So on the top, right, you can see the patient's name and the hospital number on the left. You can see the date and the time, so this is the time is usually the time at which you see the page and know the time at which you prepared the notes on the left. I also have the observations of the new school and for what the patient is scoring. So the oxygen SATs and they're on two liters nasal spect, their heart rate, BP, temperature and their weight. The weight is only relevant in certain situations, such as cardiology, where you have patients overloaded so usually the weight is important because we do daily weights to monitor the progress off the offloading. So then it's important to have these observations at hand. And if my senior does ask me, what is the patient scoring for? I can remember and say their scoring for 93% oxygen saturations on two liters of nasal spect on the right. I usually write the blood test and the dated which these Bloods were done. So I've written the HB and only the relevant blood test. So white cell count. As you can see it's raised neutrophil is raised a swell, and so is CRP. Usually one trick I do. I put a little star next to it. If it's abnormal, the computer system will tell you if it's abnormal. But that's just for documentation purposes. I put a little star so I can remember as well, and you can see a swell I've written next to it. So the first set of results are Britain or the blood tests that were done on the fifth and on the right or the previous readings for the same parameter, so you can see the trend. The white cell count is actually going down and over it in a little arrow. Neutrophil count is going down, COPD is going down and he GFO is going up if things are normal and they're not relevant, are usually just abbreviated to normal. Leftie is a bone profile or normal. Using these, you can also include information about relevant culture, so such a sputum culture or urine culture. For this patient, for instance, Joe blobs, you can see urine culture was positive for equal eye on the second of June, and it was sensitive to trimethoprim on the top. I usually write the patient's name and include a little symbol for male or female. Have a background of this patient as well. So they're post medical history, but only relevant boss medical history. So Joe Blocks has a history of heart failure, Type two diabetes and osteoarthritis, and I also include a little bit about the presenting complaint. So Joe Blocks came in with two week history of worsening shortness of breath and ankle swelling. Below that, I put a little triangle, the Little Triangle Sinus for the diagnosis of this patient. So the diagnosis is CCF congestive cardiac failure. They also had a UTI, as you can see from the urine, M. C. N s during this admission, and they've also had an A k I. But this has resolved now, so it's not reflected on the Jeff are. I've written a little note about the patient's offloading on 40 mg of IV furosemide beauty. So that's where I've said only include medications if it's relevant and on a day free out of this, a seven day course of tremendous bring for the UTI below. I've written the results of the scans so his chest X ray chest X ray was clear and the results of this echo because this is relevant, as he has called, Yeah, failure so severely reduced left ventricular ejection fraction and left left ventricular ejection fraction less than 40% with no valvular pathology. So all of these kids have been prepared before actually going to see the patient. As you can appreciate, you already have a clear picture of the patient and what's going on before you even gone to the bedside. So that's why good documentation is good below. I've written about the examination, so that's when we do go by the bedside. The patient is comfortable addressed with no new concerns. The senior communication has listened to the chest and the chest was clear. There is some mild evidence of pitting edema is after I've done a little drawing. So usually for your examination, there's some drawings and symbols you can learn for the chest. You can draw to Lums, and then they cleared. You can cross that out. If they are crackles, you can just draw a little Cross is at the long basis for heart sounds is usually recorded is one plus two plus 00 means There's no murmurs, but if there are any moment's, you can write one plus two plus systolic or diastolic murmur heard abdomen soft and nontender. I've drawn a little hex ago nothing Yeah, little Hexagon and then crossed it out. So that means the abdomen is soft and nontender Zar know relevant findings there and then for the carbs. I've drawn like two little legs again. An important part of the documentation is the plan in the plant average and continue offloading daily weights. So that's for the nursing staff to be aware that we should measure this patient's weights every day and blood every other day. So this is relevant for myself and for my other colleagues, because I might not be in work over the next two days of my colleagues and always go back to my documentation and know whenever when we want to bloods taken for this patient. I've also written continuing antibiotics for UTI. So my colleagues know that we should not stop the antibiotics presently. And I've written a plan in anticipation. If this patient does have further temperature spikes, would do blood cultures and speak to microbiology regarding the antibiotics below. I've also written a job for myself just to remind myself so to chase this patient's notes from another hospital from a previous admission and discharge planning. So this charge planning is for good nursing notes. For the nursing staff to know the nursing staff would usually go for your documentation to know what needs to be done for this patient. That's why it's really important for your documentation to be ledge a ball and to have a clear plan for them. And then, lastly, I've included my stamp with my name and GNC registration number, and I've signed for it as well. It's really important to have your jobs written in the plan. I mean, you won't go, you will go around with the jobs of this is well, but the main source the primary source where you should write your jobs should be in the plan. You can always come back and update your jobs. This but we'll talk about jobs lists a bit later on. So here are common abbreviations that could be used. I've taken this from the mind, the bleep a judge. They have an article on war rounds and documentation, so I recommend you guys having a quick look about this as well. So if we're writing days, if it's into less than a week, we write one out. We want right it out of seven. If we're writing in terms of weeks, it's out of 52 because they're 52 weeks in a year and in month it's out of 12. Because of 12 months in the year, some common abbreviations are hard edge off for heart rate, are off a respiratory rate, an F f D. Medically fit for discharge, PT and OT physical therapy and occupational therapy talked trial without catheter. So that's when you try. When a patient's being catheterized, you remove the catheter and you see if they can pass urine without that catheter. F. U is follow up. Follow up in clinic A P O. C. Is package of care. Package of care is usually when we send patients home with like care is and everything that so these are common. Our previous Asians again, don't be too overwhelmed that there's so many are privations. You will get used to this as you start on the job, but you can familiarize yourself with some of these abbreviations using this presentation or the mindedly article available on the website. So so lower wardrobes. It's important to prepare wealth of solar warren. So by good preparation, I mean prepped innards well, having the observation and the blood test at hand, knowing about the patients back around that age and they're presenting complaint, you can also update patients about the blood test. So any scan results, uh, you might know appreciate, but a lot of patients are not actually not aware off their management plan was in hospital because a lot of doctors actually go around forgetting to update patients off what's happening. So patients really appreciate that when during solar ward runs, this could be a good opportunity to update patients about what's happening again. If if there is like breaking bad news. This is probably left to senior members, but little things that just improvement in inflammatory markers or gas X ray Showing X finding You can update patients about this when during solar war grounds. Uh, it's important to familiarize yourself with the previous plan that was written in the previous water on gun by a senior member of Stuff and the current management plan. So usually your consultants or register will only let you do solar war grounds if they think the patient will continue on the same management plan, which they've directed of the last few days. So that's why it's really important to go through that law centuries but that having been said when doing the solar war drowned, it's important to be for us to do a quick, systemic examination. Check if the symptoms are off. The patients are improving if they're opening their bowels, if they're mobilizing, and if there are any concerns, discuss with your seniors, so having no fresh hold to escalate your ring, solar ward runs. The support is always available in your hospitals in your trust, and it's better to escalate rather than no so you can discuss with your seniors, and it doesn't necessarily mean you have to escalate for every patient. You can just have a brief, have a brief conversation and run your plans past your seniors just to see if they agree with your plan. But if there are any, like red flag symptoms, uh, you you have to escalate to your seniors. So now we go onto the jobs of this. So the job's list is an important part. Is an important piece of document for each one doctor. You can use this as your patients listen well, so this is an example of a form out of a job. Cities you. Each will have your own style of doing it and your personal way of writing down your jobs list. But he has an example you can follow. So in the first column, you have the patient's location that day and the bed number so you can use this. Is the patient's list a swell to direct your seniors or to know where your patients are? You have the patient's name, and you have that diagnosis is, well, you have any on ongoing issues? Are you so you're familiar with what's being done for this patient and then on the right. You're right. Any jobs that need to be done for this patient again, I must emphasize that it's more important to write the jobs in the patient's plan first and then write it in your jobs. This after. As you might appreciate, war drugs, they're done really quickly, so you can always come back to you to the plan in the documentation and update your jobs list. The reason I say that is because your jobs this contains patient, identifiable information, so you will usually throw the jobs list. Or you should for the jobs this away at the end of each shift. So if you're not in on the on the following day, the only way you you colleagues taking over this patient's care would know whether job is done or not is by checking patient's planets or documentation, because they won't have your jobs list. So after the war ground, you can regroup with your colleagues and to go through the jobs This you can update your jobs list and so you can go back to the notes as well to make sure you have enough today, jobs this and then divide and conquer. You won't be alone. You have other colleagues. So rain storm and and see which colleagues will do with jobs and communication is really important, because you throughout the day you'll know what jobs have been done, and this will save you. Having done the jobs twice. So below is a little image of what most junior doctors have done in the past. I mean, you can choose to use this or not, but it is, uh, most people have found it useful. Usually, you draw a little square next to your job. And if it's empty and means the job is still outstanding, if you have a line across that, it means the job has been requested, such as a scan, a radio large course gun. But it hasn't happened yet, and if you have shaped box, it means the job is half done. For example, you've taken large for this patient, but you're still awaiting results from the from the labs. So the job is not completely done because you still have to chase the blood results. And if the box is completely filled in, that means the job is completed so to summarize. We've talked about the importance of good documentation, how to document. We've talked about war drawn entries for both senior lead and solar ward runs, and the importance of the jobs is if you if you have, like this talk, feel free to tune in for other talks off the F Y one survival guide. So we'll have a range of talks covering the contract, Uh, and managing deteriorating patients as well. We'll have a speakers from different backgrounds, including medical registrars or countenance. A swell there will speak about the relevant topics said. This might be quite useful for you, So this is the end of my presentation. It's being quite brief because I appreciate that most of it will be food questions you guys might have, which will aunt's at the end. Uh, so this is Ah, a barcode. If you scanned this, this'll provide your feedback forms, which you can use for your port, for you can come to our genomic or teaching hours. So we're happy to answer any questions you guys might so put the questions in the chapter Memorable would just answer them. Thank you very much for that comes up. Um, your documentation is certainly a lot better than mine. No guys. Before we started to any questions, I'll just let you guys know about actually prepare for my one course. So these are identical in person. Cause is based on liver poor London and Sheffield. The simulation, based with five years of experience free lunch and dinner, is provided an extra sponsor. The next step. Last year, confidence for Effort one rose from 19.6% to 74% on there. The next step to you in a panel with extra junior doctors survives because teaching is the small groups. It's quite in demand. We're almost so so for more details on designing go to mind oblique dot com slash FBI Well, course now, God, you can put any questions you want in the chart. Um, we'll start string them. Yeah, opposed to link for the feet. But for any questions arise any tips for people who have really terrible handwriting? Ah, I don't know. I guess it depends if you're going to somewhere where they have Elektronik notes than you don't really need to worry about that because you'll be typing. Uh, but if no, I guess just just take your time. War drives will feel quite Russia, even some of us who have really nice and writing our handwriting will will not be the best because Walgreens applied rush to take your time. You can always come back after the war ground to write it again. But as long as you have something there to remind you, uh, you can come back after the war grand to write it. They call the time and write it. Allegedly. Do you have anything else to add about this? Neal, I have nothing you come without. Quite honestly, um, a question from Sharon Jones. How do you know who is the senior? You're doing a walk around for, uh, so they'll usually come at the start. And though it introduce themselves to you and you will be working with the team. So you'll be with this team for four months, so you'll become quite familiar with them. But on the first day, they will. You'll usually introduced himself to you. They'll come find you. Ah, I want to say through their badge. But most seniors don't actually wear their budge, but they'll comment what? They'll come and find you so I wouldn't worry too much about it. And then over the next few days, you just get to know who they are. Just a question from Craig's start, which I'll answer. So Craig's asked any chance of enough for one course happening in Scotland or just England? So we're not actually organizing the course is through. Mind the sleep. From what I understand, because of the capacity of the junior doctor panel they've only been able to arrange in London. Live Report and Sheffield. So at the moment, nothing for Scotland. I can raise this with them, though. On Well, if there's any updates, we'll update them on the face with page for you guys. Okay? For a question from Carletta, Huh? Um so, Holmes, any tips for new graduated students in a force can cook up? Maybe. I think I think all in means, but you're not quite sure. Collar. Can you just expand on that? I'm more walkable. Answer that in a second. Um, times A question from Daniel Knee is so a legitimate framework of making water around roads. So I'm I'm not personally familiar with this so framework, but as long as you have a good way of documenting. It should be all right. Yeah. So I'm not think. I've heard of soap in medical school. I think he is a legitimate framework from making water. And that's the main thing is up. You're writing clear legend ball like arms Or said you've looked at the observations, the bloods, the training of the bloods. You've written down the problems list. You assess the patient. So how are they doing today? You examined the patient on you? Put a clear plan, so I think so. It does include that everyone has their different methods. Um, so if you like, so go ahead and yourself. So Breo has asked, is documentation and walk around similar for weekends. Any tips were prepping notes or requests for the weekend. So yeah, documentation and ward run will be the same for weekends will be the same for weekends. For night shift as well. Obviously, there won't be any war drugs during the night, but like you always be called on the words to document, so they will always be the same and get in the habit of having a good documentation. Um, good documentation. Have it. Good. Good way of documenting, and then it would just become second heartbeat for you. Any tips for prepping notes or requests for the weekend? So it would be the same? Yeah, just a question. Without a PPO. Can you apprised these features to surgical border arms? Are how are surgical or grounds? Different medical water Ounce? Yeah, absolutely. So the reason why I didn't divide it into a medical and surgical ward runs is because the same principles apply again. You won't. But you have the dates that time, your observations, your blood tests. So it's exactly the same. The only thing during surgical ward grounds there's surgical ward grounds are quite quick. So you might, um, it quite a lot of the information. So, for instance, for observations like in the example I gave her here, if the patient was using a to the surgical ward rhyme, I would only write what their scoring for. Um, I wouldn't really have time for the background, uh, because this wouldn't really be relevant. So in surgical ward runs its a bit less less documentation, but also always include the relevant findings. Relevant information. Yeah. So the example I gave you and medical Warren documentations are gold standard, but then in surgical walk around because they go quite quick. Um, they don't include all of it. And again, your examination for surgical ward rounds it will be different. So the things you're looking for in the patient will be different. If you're on a colorectal ward, for instance, you want to know whether the patient has opened their bowels. That storm are working or they're mobilizing was on a medical water. And if you're on the cardiology, would you want to know whether the chest pain has resolved or if they have congestive cardiac failure? Whether, uh, PTO edema wise result? Yeah, so always adopted according to this specialty you're working on. But you will, you is just second nature. You will pick it up As you start on the joke comes a question from Michael. Can we break by news to patients? If they're scars, we're updating the patients with us suspicious or, for example, a trauma. Was it usually don't bussiness eso. I'd usually leave that to a senior. Would you agree? Me know? Yeah, exactly. I think any serious bad news, you know, expected to deal with that as an f. I want your senior would break the bad news to the family and the patients. It may differ in an emergency situation. So, for example, I remember during my am your rotation. Um, a CT scan showed a patient had a brain tumor and I had to contact neurosurgery urgently. It wasn't in my center, so I have to inform the patients off the news. An updated Well, what? Where the progress was in that were contacting neurosurgery with urgent referral. So there are exceptions, but 90 95% of the time, you won't be breaking serious about news to patients. Um, Carly just come back and it's current fide, he says he's a waiting distribution for internship. So I think I know you mean So you've graduated, but you're waiting a while before you get a job or before you start working. Um, yes. So how did you have any tips for someone who's graduated, but they're not going to start working straight away? I mean, in terms of documentation, I'd say, uh, just you can familiar. Familiarize yourself with the radiations that there's not much in terms of documentation, because it will be the same and you'll pick it up as you start. But in terms of medical knowledge, uh, I would say, Just keep in touch with things you've learned that medical school, The Oxford Handbook, which knee I'll mention in this previous talk about preparing for F Y one is quite good. It's quite concise about concise things. You need to know what's on the job. So it's more keeping up to date about clinical practice. In terms of documentation, the principals will stay the same, and once you learn it will stay with you for life. Any advise us any advice on time management on solar ward runs and how to prioritize jobs on the job? Says uh, So in terms of time management off on solar ward runs when you do, start off your it's quite natural to take all your time, so you'll be very low, very thorough and precise. But then I gained more experience. Ah, you like you'll be quicker. But also it's important to know before doing the solar walk around. So your senior colleagues will tell you I want you to see he's X number of patients today says it's important to plan out how long you want, so how long you want to be spending. So usually a general rule of thumb is trying to finish award round by around 12 so you can go for lunch and then come back for the jobs. So let's say it's nine o'clock and you're starting on a medical war ground. So you have three hours and your senior has said C six patients in that time, So then you can leave yourself around often. Our patient. I generally leave sometime at the end because some patients, some things, might come up unexpectedly. Uh, but yeah, just just plan your time. Well, allocate like a fixed number of time for patients. Uh, yeah, in terms of prioritizing jobs, this, uh so I would prioritize jobs for patients who are critically on well, so things that can actually make a difference within the next few hours if you ought to do them well. Instance of dating a family member off someone who's bean in hospital for a week and is waiting package of gannets completely fine is not as urgent as ordering a chest X ray for someone who might be having a little respiratory tract infection. So in general, try to order. Do blood tests and scans for your critically on, well, patients. And if it's going to do if it's going to change your management plan, I don't know if there's anything else you want to add to this. Neal. No, I agree. Absolutely with you. I think you learn as an f I want which jobs important on which can wait. So things like updating family members discharge summaries, he's come wait until a bit later in the day. Things like ordering scans are quite important. If you've got patient who's potentially having a bleed and HPV dropping and you told her some pop around cells, that's gonna be number one on your Protonix. Okay, so it just depends. Is a patient on Well, what needs to be done? Um, is the patient's stable. Camping's went for later in the day on most of your patients. Generally, if the days are going to buy, water is stable. Um, so it's a lot easier to prioritize, but in certain situations you've gotta be sharp on the Born and prioritize the unwell patients and focus on that. Even if it takes someone will, patients will take 2 to 3 hours out of your day sometimes, but it has to be done. Um, question comes up, um, from my letter, but related to the talk. But as F y ones do you were smart outfits or do we have hospital scrubs? Northern Ireland if I was usually where they were in schools. So again, this will depend on your hospital and you trust for our hospital and our trust work currently wearing scrubs. Uh, so this is the policy according to infection control. But I know another trust people that wearing small outfit so it will depend on you trust what the policy is. Yeah, I think most trust have adopted a hospital scrubs policy because of cove it and because off infection controls most of time you were wearing scrubs unless you're a senior registrar or a consultant. But some hospital policies may differ. It's just about finding out what the policy is when you join. And again, it's important to remember to be below the elbow. But I'm sure you guys know this already through your experience in the hospital or no, uh, to your door has asked as an f y y, can you take any decision about treatment on your own. Yeah. So absolutely. As an f Y one, uh, you will be doing You will have a lot of independence. Uh, so and this will come also during on cautious or night shifts because the consultants won't be around. You'll have maybe one or two register if you're lucky and two of free, essentially covering the whole hospital. So a lot of the things, Uh, a lot of the time it will be your decision about treatment plan, but that having been said, don't feel you're on your own, support is always available. You can always run it past your registrars, your house offices. Um, but with time, like like me and er, like we're approaching the end of our FBI one. Yeah, you gained confidence, and there are things you will be able to manage independently. Uh, yeah, but then I have to start. I appreciate it can be quite stressful and quite difficult, but running positive. Carney's, but absolutely like you will be making decisions about patients care. And some of them can be life changing decisions. I really love Absolutely. You can make decisions typically if you work in. If you're condition generals, stools a little bit more freedom on responsibility that if you're working in a territory center, but normally, just follow the advice of your seniors during the war drowned and you won't need to do many of the things for the patient, not day during your own course ships. So you will need to make decisions for patients for me to assess patients fund. It's your decision on whether to ask you if you think it's appropriate. Um hum. So just a question from ti Dora is the jobs list only for your use doesn't require your name and stamp on it. Yes, and the jobs list is only for your use. I mean, your colleagues and use it is Well, I'm sure your colleagues will have their own jobs list on there. It doesn't require your name will just stamp on it. Actually, it's best not to have your name and stamp on it. Um, really important not to forward to leave the hospital always right in the confidential waste bin because it has patient identifiable details on it. Keep your jobs is updated. Um, yeah, yeah, Just start to that. The top list is only for your use. Very rarely some departments and some teams will have a shared jobs list. Okay, I'm incontinent, wants in medical school and never encountered it again. Um, so just a very simple Parliament department. But 99% of the time, it's for your own use. You don't need to put your name and stop on it. You can put your name on it if you say if you get lost and you want someone to give it to you. But, um, you probably won't be doing on a day to day basis. Yeah, Any more questions goes, no more questions. Okay, Um, sometimes of Michael is asked, was an extension to to do it was question you passed jobs along with their notes to your colleagues at the end of your shift? Or do you have to finish them all before going home? So in terms of notes, notes will stay in the patient's folder. Uh, but in terms of jobs, you should aim to finish all your jobs by the end of your ship. But then, when it's time to go home at five, there will always be like one of your colleagues who's on call. But just bear in mind. Your colleague on call is not just covering your ward. You can you Usually your colleague on call will be covering several words, if not the whole hospital. So I would all on the hand over pressing jobs which haven't been done, uh, which are really important. So I, for instance, I wouldn't really hand over a job that wouldn't change my management plan, such as Abdominal Family Member. For someone who's all right, this can be done tomorrow. So most of the time aimed to finish your jobs If you don't manage to, you can, uh the non important jobs can always be done tomorrow. But if there are some really important jobs, absolutely. You need to hand it over to your colleagues on the on call or night shift. For instance, if the results of blood tests or radiological scans which can be life changing, you do need to hand it over so that can usually be done by bleeping their own Call F one. Don't court said show to hand over the jobs. Yeah, yeah, I agree with, um, you only really 100 of a job certainly have been able to do in the day you should have done all your energy jobs if something has taken you buy store. When you've been within one more patient for three hours, I'm sure your call it will be fine if you explain this and explain why you need to turn over some jobs to them. I don't feel like you can't handle over jobs. That's what the on call doctor is for. But the uncle doctor is only amongst a couple of other doctors covering the whole hospital, so be calling to them. If it's not something that needs to be done overnight, you can wait till tomorrow. So only pressing things that have to be up have to occur over night. Um, should be 100 over comes up, um, Door has another question. Do you have clear guidelines for emergency situations? So if you want effort on call well, you make decisions based on your knowledge or based on the trust protocols. That's part of the F one program. You'll be required to do that 80 or less course. The 80 or less course will prepare you for a lot of the emergency situations, but if you have not done your HDLs course or there are things know, including the less course. Uh, yet, uh, you always there's an up you can use the advance life support up which runs you from comin emergency situations. Um, in terms of your own knowledge or trust protocol most of the time, that the same if it wouldn't really change much in terms off medications you were to give. But if, uh, you had a choice, I would go according to trust protocol. Although you might appreciate that bringing up the trust protocol on the Internet might be time consuming. You might not know where it is, but if you know where it is and it's available at hand, I would absolutely go to the go according to trust protocol. Uh, there is no use your own knowledge and again run it positive seniors like, if you have a patient is critically on. Well, you think they're having like, a novel axis or sepsis. I would start the management and I would inform the register all they could. Also, they could also update you on the management plan. Yeah, which they're more experience with their more experience with the trust protocols. Well, anything else I need help. Um, not uh, most trust will have protocols for emergencies. So, um, doesn't you know, for example, if a patient's hemorrhaging there's a major hemorrhage particle? But she fallen. If a patient's got hyperkalemic, there's a hyper clean the approach court you follow. If you're unsure. Always, you know, if it's an emergency situation you're unsure. Always escalate to see musically, it's better to be safe than sorry. Um, that's the advice that give for incoming after I want your seniors are there to support you. They know, you know, as an F 41. You really been working a few weeks to a few months or whatever. Um, so there's no stupid questions escalate if necessary. But there are normally new guidelines for emergency situations, which you can access by the trust Internet. You call your senior for hypertension, for example, to your door has us. Yeah, absolutely. I mean, if you just started work, are you just started F one and you wouldn't really be familiar with a lot of these presenting complaint. I mean, medical school does preparers for some of this stuff, but lot of the things of things you will pick up, which you haven't been prepared for eso. Yeah, I'd run it past your senior aren't. For instance, I remember calling, uh, my S h o for patient with hypertension at the start. But now I'm really confident in managing hypertension so your confidence will grow. But if ever you feel you don't have the confidence I will I would escalate. No question is a city question. Even if it's just being like I've initial initiated this management plan and then running it positive. Would you agree, or do you want me to do anything differently? It shows you still thinking about how to manage it. But you just want to be a safe doctor. So, yeah, I would escalate, if not sure, I remember. Guys, um, you know they're seeing doesn't necessarily have to come and see the patient. You can call them over the phone by a bleep and just discuss it with them more. Most the time. They're absolutely happy to discuss, um, this whole situation with you. So don't fret about about just a particular thing with hypertension, though a member systolic BP over 1 80 or diastolic over 1 20 is a hypertensive emergency. So if they're above those primitives, I I would consider all the necessary investigations and just run it past the senior was enough. One Another question from Christopher. Oh, hi, Chris. I think I went to university with you. Um, so after you complete a job on fill in the box and your personal list, would you then go back to the, um, inpatient notes on document if it had been completed in there as well that this would depend on the nature of the job. For instance, if it's a really important scan, can I keep coming back to cardiovert you? Because I did a cardiology job. But if it patients do to go for, uh, it's stand like a Tavis can, which would help them for an operation. So the's stands are really hard to organize. Uh, and they will. They will need to be discussed with the radiologist. I would go back, and I I I would write Scan has been requested, but if it's things like printing blood forms for the phlebotomist to do the next day, I wouldn't really bother. But if you think it's important, I would go back and write it. It won't take long. It would just be like you go on your plan B like this has been requested or something like that. It would save your colleagues having to do the job again twice if they're in the next day and you're not there because there's no one to update them. The want to let them know this drug has been done. Yeah, so just write it up. Um, updating that part Bloods. You don't necessarily have to do it. You can post Baltic next year on there on the job. This if you feel like you want to let someone know. Um, man, it's always chasing those results. So if you don't blow tests and potassium come back is 5.7 or something, something borderline. Document it in the notes and say we're going to do about it. Um, And again, if you've requested a CT head for a patient of suspected bleed, um, you don't need to document that. Your question is you would you say the quest CT head? But you don't need to say, Come back and say that you've done it. You moved Your documentation will be evidence of you doing it on. Then you need to document the results. So CT had showed no acute hemorrhage on put the daytime. Um, your name signature? Stamp it on Assad. Abdelhamid side has said, what about 90/60 is an emergency. So, working in a hospital, you see lots of patients with this BP 90/60. It depends as the BP, BP being chronically low and anything if it's 90 or above 90 systolic, we're not. We're really worried if it's dropped down slightly to, like 84 and the patients in a symptomatic usually treated with the fluid bolus or something, and see if it improves initially at the start of starting at why one? If you're not really confident, I would run it past you said you you wouldn't really need a Reg, uh, like input. But if pressure is actually like plummeting, going to like I'd say sixties fifties, then, yeah, you definitely You need to contact your register all because they might need I know Tropic support or anything like that. But 90/60 by itself is not an emergency, because even higher blood pressure's as needed. House said systolic. Above 180 is the hypertension emergency, but a lot of the time working in hospitals. We've seen patients scoring for BP. 150 160 systolic. And that wouldn't really worry you. I mean as much as, like something above 180 systolic or below 90 systolic. You just add to that absolutely agree with hamsters said it depends on the context of the occupation. What the for the other observations are like, what clinical examination shows, How well do they look from the end of the bed? Do they look and well, are they sitting up talking, shopping with their family? You know, all these things been pointing towards that, you know, a diagnosis of what's going on. Okay, um, one thing that when you see a little pressure, think septa truck. Okay, always rule out sepsis. Think about your sepsis stick. Protocol remembers f y ones. This is something that you would expect it to know. I'm in some of the basics, but a lot of the time you know a BP of 90/60 by itself. It's not an emergency. You can run it past a senior. If you're unsure, you can give a fluid bolus. So 500 miles and 15 minutes if the heart failure and give a little bit smaller of a balance of 250 miles just to make sure they don't go become overloaded. But yet examine the patient. Look at the blood. Look at the rest of the obs. Um on. See where? See where your clinical examination takes. You okay on cells under that said they would be battling a low BP. You're also complaining of dry coughing, chest pain. I think what he's coming out is so in. Is the patient hemodynamically unstable? So, just in isolation of BP of 90/60? Yeah, that wouldn't really worry you, but if it's 90/60 and then they're having tachycardia me, I guess what you mean by the dry cough side is maybe they might even be having hemoptysis is chest pain or the tachycardia that would make you think. Are they having a P? Are they hemodynamically unstable? Yeah. Then I would escalate. Um, even if if it's low BP tachycardia having a temperature could be sepsis. Well, as a z, how said again I would make the register available. Even the register on know, even though at medical school we are trained to manage sepsis. It's good to know your medical register a little about it to be aware of. It just posted the feedback form again in the truck. Guys, if anyone has any questions, please let us know. Otherwise, we go had home and, uh, enjoy the evening. Any questions, guys? Think this talk will also be recorded. Wanted me. Now it will be available on there. Yeah. So this talk will be available on metal via touch it content. Also, go to the monitor. You gyptian Okay, if you need to come back to and have a look. Um, yeah. So don't worry. If you again with all our future talks, it will be on the It'll be on your shoes. So don't worry if you can attend allies. Of course, if you're 10 live that you can ask questions. Andi, don't worry. If you can't make it, you commercial the weapon off to be recorded. Just a reminder. We will have a talk about deteriorating patient run by medical register or so that will be quite useful for you guys. Goes more than a week except donations. I'm not too. Sure about that one has a dinner? Uh, I'm not sure is. Well, sorry. Awesome. What you can do is, if you want to make a donation, you can contact Mind a bleep by Facebook. Well, my email. I'm getting touch with that. And with the doctor. My other doctor Cash. So she was actually a, um, endocrinology. Write a straw. I'm sure he would. I don't know if he would accept it, but it's worth having that discussion with him if you're very keen on dilating. 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