Clinical Site Resource Manual
Carraway Methodist Medical
Center
Nurse Anesthesia Program
School of Health Related Professions
The University of Alabama at Birmingham
TABLE OF CONTENTS
A.
Location and Directions / 1
B.
Phone and Fax Numbers / 1
C.
Pictures of Personnel / 2
D.
Faculty Anesthesiologist / 3
E.
Faculty Nurse Anesthetist / 3
F.
Anesthesia Technicians / 3
G.
Rotation Requirements / 4
H.
Additional Information / 5
I.
Pharmacy Requirements / 6
J.
Clinical Objectives / 7
K.
Demographics of Clinical Site / 9
Section 2
A.
Preanesthetic Evaluation Form / 8
B.
Anesthetic Record / 9
Nurse Anesthesia Program
School of Health Related Professions
University of Alabama at Birmingham
Carraway Methodist Medical Center
- Clinical Orientation Handout Location
Hospital:
1600 Carraway Blvd.
Birmingham, AL 35234
205 / 502-6000
Directions to Clinical Site
Head east on University Blvd. At 0.9 mi you will go underneath the
expressway, turn left at the light onto 31 North expressway. Stay in
the left two lanes and exit onto Carraway Blvd. At the 5th traffic light
(2.9 mi) turn left onto Carraway Parkway. The Parkway turns into
25th St North. At the next traffic light you will be 3.2 mi from UAB
and one block away from the parking garage. On the left hand side
you will pass the Life Saver helicopter port, the parking garage is
on your left next to the Life Saver landing site.
(from the Webb Building)
Anesthesia Department / Operating Room
Anesthesia Office:
Joanna, Secretary
2nd floor Lewis Building
205 / 502-6817
205 / 502-5152 (FAX)
Anesthesia “Ready Room”:
2nd floor Lewis Building
205 / 502-5194
Main OR Desk:
3rd floor hospital
205 / 502-6270
Mike Nelson, CRNA
Nurse Anesthesia Resident
Manager:
888-1363 (beeper)
481-9977-(H)
E-mail: JMNskydive@aol.com
CV NARM: Melissa Benton
Description of Clinical Site Caraway Methodist is a 600+ bed acute care facility currently
providing level 3 trauma/ emergency services. CMMC provides
clinical training affiliations to many educational institutions including
UAB medical school/ residency programs, UAB nurse anesthesia
program, and multiple nursing and ancillary healthcare related
programs. Currently surgical services are provided in the following
specialties: neuro, general, ortho, ENT, GU, Vascular, thoracic/CV,
plastics, and limited pediatrics.
Pictures on the way
Department of Anesthesia Clinical Faculty
Physicians
Chief of Anesthesiology:
Mark S. Williams
Assistant Chief of Anesthesiology:
Staff Anesthesiologists:
Beverly Harrison
Rick Judson
David Kraftsow
Greg McCabe
Jack Nicholas
Joe Nicholson
Ted Sartin
Janie Williams
Nurse Anesthetists
Chief Nurse Anesthetist:
Vickey Szymela
Assistant Chief Nurse Anesthetist:
Mike Nelson
Nurse Anesthesia Resident
Manager:
NARM CV:
Mike Nelson
Staff Anesthetists:
Melissa Benton
Terry Bonville
Tammy Galbreath
Lisa Gallagher
Mark Isaacs
Jim Matthews
Ray McAffee
Cathy Post
Ken Seale
Harvey White
Anesthesia Technicians
Rice, Veronica
Willis, Rod
Vann, Jodi
Rotation Requirements
1. Be on duty at 0615.
2. Scrub suits, mask, cap, and new shoe covers are required in the OR. Lab coats are to be worn over
scrubs at all times when leaving the O.R. suite. Mask, cap and shoe covers are to be removed when
leaving the O.R. suite.
3. Lockers in the male/female dressing areas are labeled “CRNA Student”.
4. Daily assignments and surgery are posted on the “Schedule Board” across from the surgery desk.
5. Report to the clinical resident manager to receive your assignment for that day.
6. Set up anesthesia cart and room according to the instructions of your clinical instructor and/or
standard Carraway Anesthesia Department protocol.
7. You are expected to see your first patient of the day preoperatively. An adequate and correct pre-op
should be written on this patient. This information should then be shared with the MDA and/or CRNA
responsible for the patient. Pre-op medication should be ordered, this includes any medication the
patient takes on a regular basis such as pulmonary, cardiac, or hypertensive medication. If sedation
or medication for the patient’s diabetes is required, contact the attending MDA and/or CRNA to help
you decide on the optimal medication and dosage.
8. Your location while on duty must be known by the clinical instructor or the clinical coordinator at all
times.
9. In case of illness, a call MUST be made to the hospital and to the Nurse Anesthesia Program to
report your absence BEFORE 0600. You must speak to someone in the Anesthesia/Surgery
Department. The O.R. number is 502-6270.
10. Narcotic sign-outs will be made through your clinical instructor. SRNA students may sign-out
narcotics but, drugs must be accounted for by both the SRNA and the CRNA. No exceptions. The
pharmacist has asked that both student and CRNA’s last name be on the sign-out sheet.
11. Professional behavior is expected at all times.
12. An in-depth anesthesia orientation will be provided on the first day of your clinical rotation.
13. You are expected to discuss each anesthetic care plan with the attending MDA and/or CRNA before
the beginning of each case.
14. Anesthesia inservices and conferences will be posted in the CRNA Ready Room. You will be
expected to attend and participate.
15. After performing routine machine and equipment checks each a.m., Make a notation on each
anesthesia record (graphic sheet) indicating that equipment checks were done.
16. On each anesthesia record (graphic sheet) please note patient’s “NPO status” and “chart reviewed”.
17. When signing your pre-op and post-op records. both DATE and TIME should be included.
18. Please insure that the Anesthesia and Surgery START and STOP times on the anesthesia record
coincide with the START and STOP times on the O.R. records. NOTE: Time of entrance with the
patient into the R.R. is the “In R.R. Time”. “Anesthesia Stop Time” is the time you leave the patient
in the R.R. RN’s care.
19. Please insure that all anesthesia charge sheets are fully completed; i.e., procedure, start, and stop
times, etc.
20. Please indicate on the anesthesia supply sheet any supplies that were used.
21. If you anticipate having to transfuse blood during a surgical procedure, you may request that the
blood products be brought from the blood bank to be refrigerated in the O.R. If not used, the blood
products may be returned to the blood bank; however, if left unrefrigerated for more than 30 minute,
the blood cannot be returned and should be wasted.
Additional Information
1. The cafeteria is located on the second floor. Meals are reasonable priced and you are free to go
there with a lab coat cover during your 15 minute breaks or 30 minute lunches. Additionally free
coffee and a refrigerator are located in the CRNA “Ready Room: on the 2nd floor of the Lewis
Building.
2. Parking is free and is located off 25th Street across from the Lewis Building in the parking deck next to
Lifesaver.
3. Once the residents have completed 2 rotations, call becomes an option. Call is for 8 hrs (e.g., 3-11)
with the next day off. Call can also be taken on weekends for 8 hrs (this is rarely done by residents
though). The afternoon call can be more active than the night call. The usual resident averages
taking call 1-2 times per month (maximum).
Pharmacy Requirements
MEMO
TO:
ANESTHESIOLOGY RESIDENTS
FROM:
O.R. PHARMACIST
SUBJECT: DRUG ACQUISITION FROM O.R. PHARMACY
1.
2.
3.
4.
5.
6.
7.
8.
All drugs are supplied through trays:
a. general medication tray
b. cardiac drug tray
c. narcotic tray
Narcotic trays must be exchanged on a daily basis (either in the afternoon after all
cases are finished or in the morning before cases begin).
General and cardiac trays can be exchanged on a PRN basis (but at least
once/week). If more than 1 item is needed on a tray at a time, it is better to
exchange it our rather than request each item separately.
Anything needed that is not included on any of these trays may be verbally
requested for from the OR pharmacy.
Pentothal concentration is 25mg/ml or 500 mg/20ml.
Anectine and atracurium are stable for 2 weeks out of the refrigerator; please help us
watch these expiration dates; if you are going to be off for several days in a row,
please turn in to the pharmacy so they won’t go out of date.
Before turning in narcotics, be sure to record all narcotics used and all information
pertinent to the patient.
Return the pharmacy copy of the anesthetic record with the narcotic sheet (on
each patient).
If there are any questions please call …….and ask for ……...
Thank you very much for your cooperation.
CLINICAL OBJECTIVES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Assess each patient preoperatively and obtain an adequate history and physical.
Categorize each patient according to ASA guidelines. Write a legible and
informative pre-op note. Reveal significant pre-operative information to the
MDA and CRNA responsible for that particular patient.
Develop an anesthetic plan for each patient you will be administering anesthesia
to and discuss this plan with the attending MDA and/or CRNA before the case
is to begin. Develop a back up or alternative anesthetic plan for each patient you
will be administering anesthesia to.
Assess medication needs for each patient, correctly and effectively write pre-op
orders with appropriate medication and dosages identified. Discuss pre-op
orders written and appropriate MDA and/or CRNA.
Set up the assigned operating room, anesthesia equipment, and anesthesia cart
prior to admission of the patient into the operating room.
Start an appropriate sized intravenous catheter for IV fluid administration.
Prepare the patient for anesthesia induction, which includes:
a.
applying appropriate monitors for that particular patient
b.
selecting appropriate drugs and dosages for induction
c.
having appropriate equipment immediately available for the induction of
the patient.
d.
assessing the physical and emotional need of the patient before induction
and implementing the necessary modifications if needed.
Calculate each patient’s estimated fluid deficit and appropriate fluid replacement
for surgery.
Demonstrate the ability to manage an airway.
Demonstrate the ability to intubate an anesthetized patient using standard
equipment.
Demonstrate the ability to maintain proper ventilation, oxygenation, normal CO2
levels.
Demonstrate vigilance in monitoring the patient during the complete anesthetic
process.
Demonstrate the ability to interpret information received from the monitoring
equipment.
Demonstrate the ability to communicate effectively with members of the
anesthesia care team and ancillary staff.
Demonstrate the ability to communicate effectively with members of the
anesthesia care team and ancillary staff.
Demonstrate the ability to assess anesthetic problems that may arise during a case
and effectively communicate pertinent information to the appropriate MDA
and/or CRNA.
Demonstrate the ability to safely maintain a patient under anesthesia.
Identify the factors that would necessitate crystalloid versus colloid administration
and effectively communicate this information to the MDA and/or CRNA.
18.
19.
20.
21.
22.
23.
24.
25.
26.
Develop an anesthetic plan for the emergence of a patient under anesthesia and
communicate this plan to the MDA and/or CRNA.
Demonstrate the ability to safely extubate a patient that has been intubated for
surgery and is anesthetized.
Assess the patient’s physical status and determine the care plan that is needed for
the patient in the recovery room.
Demonstrate the ability to effectively communicate with the recovery room
personnel.
Correctly identify the recovery room protocol for emergencies.
Correctly identify the chain of command should an anesthetic emergency develop
and effectively communicate pertinent information to the appropriate person.
Demonstrate the ability to accurately and effectively perform a post op visit to
obtain pertinent information on each patient anesthetized by the student.
Communicate any adverse reactions or anesthetic problems that the patient may
have had, to the appropriate MDA and/or CRNA.
Demonstrate professional behavior at all times during the clinical rotation.
Demographics of Clinical Site
Maximum # students clinical site is able to accomodate
2
Maximum # junior students clinical site is able to accommodate
2
Maximum # senior students clinical site is able to accommodate
2
Hands-on Regional Experience
Commonly
Occasionally
Rarely
¾
Spinals
¾
Epidurals
¾
Axillary blocks
X
¾
Supraclavicular blocks
X
¾
Bier blocks
X
¾
Other
Nurse Anesthesia Resident Inserts
Central Lines
Internal Jugular Vein
X
X
Commonly
Occasionally
X(CV)
X(gen)
Rarely
Subclavian Vein
X
Antecubital Vein
X
Pulmonary Artery Catheter
Clinical experience includes:
Commonly
Occasionally
Rarely
Never
X
Maintenance of GA via a face mask
Nurse Anesthesia Resident Administers
Drugs During Induction
Never
X
Mask Inductions for adults
Placement and management with LMA
Never
X
X
Commonly
Occasionally
Rarely
Never
X
Taking In-house call is an option
Yes
No
Afternoon
X
Night
X