Induction

Sanjay SuriRCPCH Tutor

Children and Young People’s Health Service Rotherham4 Feb 2015

SERVICE

We are…

• 8 consultants

• Different speciality interests

• Areas of work

CW/CAU/SCBU/Wharncliffe/Clinic

CDC/Comm clinics/Special schools

• Hospital/community split

You are…

• Ist on call9 ST 1-3s(5 VTS ; 3 Career ;1 F2)

• 2nd on call9 ST 4-8(including 2 community)

Ward-based practice

• 1:7 ward based rota

• 1630-1630 Friday – Friday

• All admissions under WBC

• Weekend handover at 1230 in CAU SR

• On call – different Consultant

• Child protection under on call Consultant unless admitted

Guidelines

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FILES AND FOLDERS

Handover

• Start on time

• 3 handovers a day – update sheets

• 0830 ; 1600 ; 2030

• Morning handover WBC led

• Sickest (CHDU) and newest first, then old

• Who can be discharged….

• Staffing and bed situation

Middle grade support

• ST1-3/F2 – do not work beyond your expertise

• Crash calls/Deliveries – middle grade to accompany

• If in doubt, please ask

Children’s Assessment Unit

• Single point of referral into the Children’s ward (A&E and GPs)

• 0800 – 2000 7 days a week• 1xST1-3/F2 and 1x Registrar• 1xtrained nurse/1xHCA• Ward based Consultant cover • Key performance indicators (Standards)• Discourage ward attenders

Spotting the sick child

CHDU

• On the children’s wards

• Use of the PEW tool

• Criteria = sick enough to require 1:2 nursing

• Inform anesthetist

Discharge letters

• Discuss all clinic follow up decisions with WBC• End of the ward round • Behind nurses station opposite CHDU• Cover ST1-3/F2 to action • >10 summaries – ward clerk WBC• > 20 summaries – divide equally • Number on the handover sheet • CW – complex and SCBU – Badger by middle

grade

Lab results

• E-folder for urgent outstanding results • Process for the actioning of paper results • Normal – sign • Abnormal – check the e-folder – actioned – sign • Abnormal – not actioned – “notes please” – don’t

sign • > 10 sheets ward clerk to inform WBC • > 20 sheets ward clerk to divide up and inform

team leader and WBC

Photopheresis

• Medical procedure for GvHD• One of 3 centres in the country• Haematology lead : Dr Taylor/Dr Alfred• Paediatric lead : Dr Suri • Joint initial assessment • Daily ward round for day cases (Registrar

responsibility)• Rarely as inpatient• Audit of documentation this house

Rapid Access Clinic

• 4 days of the week (Tuesday – Friday)

• 1330 – 1530

• Consultant delivered

• Child protection cases can be seen if slots

• New urgent (non emergency) referrals by GP/A&E

Day Area

• Located within the Children’s clinic

• Investigations and patient education

• Junior doctor’s role in day area

• Not for ward reviews/clinics/emergency work/child protection medicals

Clinics

• Middle grade do supervised clinics

• ST1-3/F2 observe in clinics

• Middle grade guide to clinic in Induction folder

• Clinic information on the monthly rota

SCBU

• 14 cots (2 x ICU; 2 x HDU ; 10x SCBU

• Consultant and middle grade led

• BADGER summaries

• Consultant ward round – Tues and Thurs

Communication

Email accounts All must access Trust email

accounts

Baton bleeps are carried by Neonatal RegistrarPostnatal tier 1 doctor Sister SCBU

Paediatric RegistrarPaediatric tier 1 doctor

Wharncliffe

• Postnatal ward

• ST1-3/F2 responsibilty

• Middle grade supervision

• Ensure letter for all referrals

• Baby checks in a timely manner

• Paediatric alerts

Consent 0-18y

Datix

• Incident reporting

• Insite Applications Datix web

• Self explanatory

Infection control policy

• Hand-washing

• Bare below the elbows

• Follow guidance

TRAINING

Introduction

• You are in a training post

• Team working

• Training vs Service

• Use all educational opportunites

• Keep e-portfolio uptodate

Clinical supervision

DO NOT WORK

BEYOND YOUR EXPERTISE

• Allocation to Consultants for appraisal

• Day to day supervision is different

Appraisal meetings

• Minimum 3 meetings – your responsibility

• Initial meeting within 2 weeks (30 mins)

• Mid-post meeting 3 mo into the job ( with mid-post feedback forms) (45 mins)

• Final meeting end of post (30 mins)

Educational programme

• Weekly programme• Vocation-specific

GP VTSSPROG/SPRAT/DiplomaF2

• Additional training sessionsCRUMPET (Faye Marshall)Ventilator training (Bev Lomas)Resuscitation training (Bev Lomas)Safeguarding level 3 (Carol Boote)Audit meetings (Dr Harrison) (1st Monday of the month)Perinatal meetings (Dr AlSafi) (4th Monday of the month)

We all work in an NHS that places huge demands on us .

Working with babies & sick children, busy workloads & challenging situations has a personal impact on us every day.

It can feel hard to keep our care and compassion alive.

Monthly multidisciplinary meeting for all direct care staff

Facilitated by Catherine Wright (psychologist) with the support of local managers.

Confidential meeting, for colleagues to discuss their work together6 month pilot and if successful will continue and perhaps be extended to other clinical settings. 

Weekly programme

Day Session Time Sign Register

Attended by

Monday X-Ray meeting 1300-1400 √ All

Tuesday ST4-8 teaching 1230-1330 √ ST4-8 only

Wednesday ST1-3/F2 teaching 1230-1330 √ ST1-3/F2 only

Thursday Clinical meeting/

Medication DATIXes

1230-1330 √ All

Friday Problem of the week

1230-1245 x All

Feedback

• Informal may have to seek when things go well/wrong

• Formal work place assessments (CbD ; CEXs)in-house MSF mid-postmid-post Consultants and senior nurses meeting Evaluation forms

• Junior Doctors forum once/monthbilateral issues

Support

• Clinical supervisor

• (Educational supervisor/GP trainer)

• RCPCH Tutor – Dr Sanjay Suri

• PGME Director – Dr Alison Cooper

• Service Manager – Faye Marshall

• Team leader – Denise Brookes