ADMISSIONS
 Admit orders need to be completed within 30 minutes of the patient’s
arrival on the floor
 When admitting a patient, the following needs to occur:
 All patients should be admitted to “Pediatric Green”
 Make sure Allergies are already documented (you can't admit if
allergies are not in placed)
 Admission medication reconciliation BEFORE admit order is placed
 Initial admit orders:
 order to admit
 vital signs
 isolation
 bag and mask at bedside
 diet
 IV fluids
 medications
 labs
 consults
 ancillary services
 nursing orders
 Order a bag and mask to the bedside for the following patients on
admission:
 < 12 months of age
 Cardiac defect
 Respiratory admitting diagnosis
 Seizures
 Neuromuscular disorders
 Ask the family who the PCP is and communicate with the PCP regarding
the patient’s admission
 Renal patients: make sure they all have daily weights and accurate
ins/outs
 There will be a person(s) designated by the admit senior each morning to
take day admissions
 Interns and medical students should perform separate history and
physicals on admission
 H & Ps should have a section designated “Discharge Criteria” at the end
 Senior resident must addend each intern’s H & P with a 1-2 paragraph
summary
 Interns and residents may refer to medical student note for
PMH/SH/FH/ROS either as a separate note or as an addendum
 Each admission should be discussed between the senior resident, intern,
and medical student
 The Senior resident should inform attending of new admissions that
arrive before 3 pm
 DO NOT REFUSE any admission to the floor (from the ED, direct
admissions, or other hospitals) without notifying Dr. Curtis (pager 3801)
first
 All arrangements for direct admissions and transfers should be
completed and communicated to the outside hospital within 45 minutes to
one hour of the initial phone call
DISCHARGES
 Discharge medication reconciliation has to be completed even before the
discharge order can be placed
 Can place preliminary discharge orders “Pending MD Clearance”, but need
to coordinate medications and follow-up in preparation for final discharge
order
 When team makes the decision to discharge, write the order immediately.
 The morning of or day prior to discharge, ask the clerk to schedule a
follow-up appointment
 All patients being discharged with a nebulizer should have an Asthma
Action Plan filled out completely, with the name of the physician to follow
up with
 Discharge summaries are to be completed within 24 hours of the
patient’s discharge
 If a progress note is performed on the day of discharge and a D/C
summary is to be provided later, then no physical exam is needed within
the D/C summary
 If a D/C summary is the only documentation for the day, the physical
exam must be included in the D/C summary and must be completed by 3
pm that day
 Strongly consider calling the PCP on the day of discharge or shortly prior
to discharge with the follow-up plans. Document this conversation in the
note (eg. “Spoke to PCP, at 312-555-1234, regarding discharge
medications and necessary follow-up visits.”).
 48 hour Discharge Notes are only for infusion admissions (ie. Albumin,
IVIG, and blood transfusion admissions that last < 24 hours, dialysis only
and pH probes)
 All patients need post discharge hospital follow up within 2-3 days.
PEDIATRIC CONSULTS for Surgical Specialties
 All surgical specialties will have an automatic pediatric consult upon
arrival to the floor
 General pediatrics will write ALL ORDERS FOR ORTHOPEDIC
PATIENTS ON THE PCA and the first oral dose to transition off of the
PCA
 The on-call senior is responsible for examining and addressing the
following concerns upon patient arrival to the floor:
 Pain management
 Constipation
 Hydration
 Chronic diseases and home medications
 Other immediate medical issues
 The on-call senior (or consult senior if during the daytime) should page
the primary service with our recommendations. Ask the surgery service
whether they desire us to place these orders immediately
 Documentation of the consult should be performed by the consult senior
prior to rounds each day
 If there is difficulty addressing an issue on a patient, ALWAYS page the
general pediatric attending on service to discuss and troubleshoot
 Non-emergent consults received from the inpatient psychiatric unit
should be directed to Dr. Stahl (pager 7608). If emergent, we will
perform the consult.
 Initial consults should:
 Be as thorough as an H & P (includes ROS, FamHx, etc.)
 Title should read: Peds General Consult
 Beginning of consult should read:
 Reason for consultation Pain/Fluid Management/Constipation
 Consult requested by Dr. Surgical Attending
 Detail the procedure performed/medications rec’d/fluids rec’d in
the OR and PICU, if transferred out
 List only our Recommendations regarding pain, fluids, etc. (this is
not the “PLAN”)
REQUESTS FOR CONSULTS
 Place order in Cerner and notify the consultant verbally of the requested
consult
 Discuss with the general pediatric attending prior to obtaining a consult
unless it is an emergent surgical consult
 Discuss with the general pediatric attending prior to instituting
consultant’s recommendations
DOCUMENTATION
 Do NOT cut and paste any labs, radiology reports, pathology reports, or
other consultant’s notes
 Only make note of the relevant and new labs in the notes. Include the
date and time the labs were obtained.
 “See Cerner” is not an acceptable notation
 Document all temperatures in the same unit measure. (eg. both ED and
floor temps should be in either Fahrenheit or Celsius, not both) in your
presentations so that things will be uniform).
DAILY PROGRESS NOTES
 Should be completed and finalized by 3 pm each day
 Notes should contain the 24 hours vitals (7am to 7 am), not the last 5
vitals provided in the rounding report
 Use the templates provided in orientation email. Do not use the autotext
templates notes currently in Cerner
 Residents may co-sign medical student notes, however, the “addendum”
must contain a full note (due to billing issues)
SIGNOUT
 All interns must sign out to the covering or on-call intern in written and
verbal form
 Signout should be conducted in group format. If this is not possible for
the post-call intern, then signout should be supervised by the senior
resident
 Senior residents should conduct a cursory team huddle each afternoon
that can include signout
 Signout should occur in a room where there are minimal interruptions (eg.
call rooms)
 All general pediatric consults should be signed out daily to the on-call
senior
FLOOR PROCEDURES
 Perform all procedures (eg. blood draws, NGT placement, IV pokes, etc.)
in the procedure room (located in the Stepdown hallway)
 There is a 3 POKE LIMIT per person for procedures and blood draws
 Blood draw times are at 0600 and 1800, unless it is an absolute STAT lab,
drug level, or new admission. Make sure the order states these times
only
 Page or get a Child Life Specialist (Lindsay, pager 8530) prior to
performing a procedure
 Ask Lindsay (the day before or the day of) to do role play with children
who will be undergoing MRIs, CT scans, PICC lines, central lines. Children
are always anxious about the unknown.
ROUNDING
 Rounds will start at 9 am (during the weekdays)
 Rounds will be family-centered (Family Centered Care). This implies the
following:
 Presentations will be at the bedside (or hallway for semi-private
rooms)
 Parents (and adolescent patients) will be invited to participate on
rounds
 Charge nurse will be present on rounds
 Any other medical staff, including nursing students, social workers,
dietician, PT/OT will be invited to participate on rounds
 Please ask the parent the night before if they want to be awakened in
the morning to join rounds
 We will round on the post-call resident’s patients first
 The post call senior is expected to attend rounds
 If there is sensitive information (eg. pt is sexually active—don’t mention
this w/parent on rounds unless permission is granted by the patient)
 Information that may be embarrassing to the parent mention privately to
the attending before the patient/parent joins the rounds. You may also
show the attending the H &P that contains the sensitive information
during your presentation (in a subtle way)
 Please knock and introduce yourself to the patient and their family when
you enter the room
 During rounds save side conversations for outside of the room. The room
is the patient’s temporary ‘home’, so please be respectful.
 Each Tuesday at 11 or 11:30 am there is a multidisciplinary team meeting
where complex patients are discussed with social work, child life,
discharge planning, OT, PT, dietary, the school teacher, and other
individuals
MENTORING MEDICAL STUDENTS
 The following bullet points reflect feedback that medical students have given
about their 5 West Inpatient Pediatric Rotation
 Each call night there should be a discussion with the senior resident +/- the
intern regarding the patient the medical student saw. In other words, the
student should be presenting their patients to the residents overnight—prior
to rounds.
 The Consult Senior and/or the Admit Senior should give feedback on the daily
progress notes. This does not necessarily mean co-signing the note.
WHEN TO NOTIFY THE ATTENDING
 If you have any patient questions or floor issues at any time
 All admissions that occur before 3 pm
 Any patient that is sick, whether or not there is a possibility of transfer
to PICU or Stepdown
 Consults, unless it is an emergent surgical consult
 Every evening at 9 pm to review all of the patients
4 West MOTHER/BABY PATIENTS
 The on call senior will receive sign out on the mother/baby patients each
day from the 4 West Mother/Baby senior
 The on call intern will receive sign out from the Mother/Baby intern
 If there are any questions, please call the mother/baby attending on for
that day
INTRA-HOSPITAL TRANSFERS (PICU5W; 4W5W; NICU5W)
 Acceptance notes must be separate from the transfer note (not as
addendums)
 Interns must document an acceptance note for each transfer
 Senior residents must addend the intern acceptance note with a 1 -2
paragraph summary
 The general pediatric attending MUST be notified immediately for all
patients that may warrant transfer to the PICU or stepdown unit
 All patients transferred to the PICU/Stepdown/NICU should have a
transfer note documented by the senior resident PRIOR to transfer
 Information that should be included in the transfer note (also, if the
referring units do not have this information in their note, you should
request it):
 Name, age, history (eg. cc, brief hx, symptoms, current dx)
 Therapy performed and patient response
 Critical/Important labs or radiologic studies
 Current vitals prior to tx and the PE
 Current plan and timeline
 “This information was d/w [PICU senior or attending] and they
accepted the transfer”
INTER-HOSPITAL TRANSFERS (eg. from clinics—UIC or otherwise and other
hospitals)
 Interns must document an H & P for each transfer
 H & Ps must be separate from the transfer note (not as addendums)
 In the H & P, document the referring hospital and their contact number.
Do NOT use the notation “OSH” for ‘outside hospital’, indicate them by
name for future reference.
 Senior residents must addend the intern H & P with a 1 -2 paragraph
summary
 When accepting a transfer, make sure to request copies of all labs and
radiologic studies
 When receiving a call for a potential transfer please ensure the following:
 Respond to the outside hospital within 15 minutes of the initial call
 If patient is primarily surgical, call surgical service (orthopedics or
general surgery) immediately to ask if they want patient on their
service.
 If the reason for transfer is likely primarily surgical, but they
want to act only as a consultant, accept the patient to the pediatrics
service and page the surgery team immediately upon the patient’s
arrival to the floor. Document this interaction in Cerner.
ORDERING TESTS
 Know the phlebotomy schedule
 Labs are MD/RN to draw when the patient has a Port-a-cath
 Always call the lab to follow-up on results if it's be an appreciable time
since the draw (a sign that the result might be critical or very abnormal
and needed further testing)
 Radiology: note the difference between XR, US, NM, IR, MRI, CT orders
 EKGs can be done STAT and copy of tracing has to be left here in the
floor
 “Routine-Scheduled Phlebotomy”
 order must be in at least 15 minutes before collection time
 indicate the following for the order:
1) “Yes” for Lab to Draw Specimen,
2) “No” for MD/RN to Draw Specimen
3) “No” for Collected
 “Routine-AM Phlebotomy”
 order must be entered by 3:30 am and defaults to the next 6 AM
blood draw time
 “Routine”, “STAT”, or “ASAP”
 this order is ONLY for MD/RN to Draw Specimen (indicate “Yes”)
 this order is NOT for a Phlebotomy Draw.
OCCURRENCE REPORTS (aka INCIDENT REPORTS)
 If something is not right with regard to patient care, file an incident
report. It’s easy and called “Occurrence Reporting” on the UIC Hospital
website, under Quick Links.
EVALUATIONS
 Residents and medical students will be evaluated at the end of the
rotation
 Primary means of evaluation likely occur as a result of notes, H & Ps, and
presentations
 In the monthly interdisciplinary conference, ancillary staff will perform a
360 evaluation
HELPFUL HINTS ABOUT HOW THE FLOOR WORKS
(from a former third year UIC resident)
 There is a multidisciplinary approach towards every patient on the floor
 There are 4 PharmDs, one in each unit ( NICU, ICN, PICU and general floor).
There are residents and students as well. Make sure you know names of your
PharmDs. They are excellent and your safety net.
 Every floor has a
 Social worker (Lucy)—for social issues, abuse cases, or
even needing bus passes, etc
 Discharge planner (Sandra)—for anyone with discharge needs, such
as first time diabetic neeidng glucometer, etc. (for home, for
premature baby going home on apnea moniotr or NG tube feeds etc),
 Inpatient PT/OT personnel (April & Pam-PT, Vanessa-OT)—esp for
children with disabilities, and in NICU/ICN
 Dietician (Jennifer)—she sees most patients at least once, even
w/o consults
 Lactation consultant in-house (Patrice)
 Make full utilization of all the resources available to you
 Make sure you know your nurses well, have a good rapport with them. They
spend more time with patients then we do and are an extremely important
part of medical team.
 Code PINK: If you hear a code pink, stand near the exits and don’t leave or
let anyone else enter or leave the premises until all of the children have been
accounted for. Make sure you don’t enter the stairs/doors at the end of the
patient hallways, these activate the alarm system and send an instant alarm to
the Chicago Police Department.