Induction & Handover Presentation for Surgical Juniors

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?