Induction Sanjay Suri RCPCH Tutor Children and Young

Induction Sanjay Suri RCPCH Tutor Children and Young People’s Health Service Rotherham 4 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 call 9 ST 1 -3 s (5 VTS ; 3 Career ; 1 F 2) • 2 nd on call 9 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 CLICK ON DR TED ICON ON SOME COMPUTERS OR GO TO INSITE (RFT INTRANET) HOME PAGE CLICK ON APPLICATIONS CLICK ON C&YPS CLICK ON CHILDRENS WARD/NEONATAL GUIDELINES ARE ORGANISED ACCORDING TO SYSTEMS

How To Access The Shared Drive MY COMPUTER PAEDIATRICS ON THE ‘TRFTSTORE 00DEPT_HOME’ (I: ) PCS 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 • ST 1 -3/F 2 – 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 • 1 x. ST 1 -3/F 2 and 1 x Registrar • 1 xtrained nurse/1 x. HCA • 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 ST 1 -3/F 2 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 Gv. HD 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 • ST 1 -3/F 2 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 ; 10 x 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 Registrar § Postnatal tier 1 doctor § Sister SCBU § Paediatric Registrar § Paediatric tier 1 doctor

Wharncliffe • • • Postnatal ward ST 1 -3/F 2 responsibilty Middle grade supervision Ensure letter for all referrals Baby checks in a timely manner Paediatric alerts

Consent 0 -18 y

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 VTS SPROG/SPRAT/Diploma F 2 • Additional training sessions CRUMPET (Faye Marshall) Ventilator training (Bev Lomas) Resuscitation training (Bev Lomas) Safeguarding level 3 (Carol Boote) Audit meetings (Dr Harrison) (1 st Monday of the month) Perinatal meetings (Dr Al. Safi) (4 th 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 together 6 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 ST 4 -8 teaching 1230 -1330 √ ST 4 -8 only Wednesday ST 1 -3/F 2 teaching 1230 -1330 √ ST 1 -3/F 2 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 (Cb. D ; CEXs) in-house MSF mid-post Consultants and senior nurses meeting Evaluation forms • Junior Doctors forum once/month bilateral 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