Welcome to the UNC Pediatric Green Team (PMA) Inpatient Wards We have 3 priorities on this service – superb and efficient patient care, learning general inpatient pediatrics and enjoying our work! Ward Team Coordinator AKA “The Bomb”: Jennifer Daniels, NP Services: General Pediatrics, Nephrology, Rheumatology, Metabolic, Neurosurgery and Plastic surgery patients are cared for on PMA-Green. Newly transplanted patients are usually cared for by the residents with the Nephrology attending directly (PMK). Any new trauma cases including NAT must be reviewed with peds surgery prior to admission to a medicine service to help keep UNC’s Trauma level I designation. Before your rotation: Contact the intern you will be inheriting patients from for signout the day before your rotation starts. Read through patient charts to get familiar with the cases. Please communicate individual needs for necessary accommodations or scheduling issues with the chief residents. Log-on to EPIC, ensure you know how to access the Green Team system list and subscribe to the note templates & dot phrases listed under “Epic tips” below SCHEDULE: 6:00 interns arrive 3rd floor lounge, get signout from night team and pre-round. Call consults before AM report if they are clearly needed – check with your resident. It is ok to wait until rounds if unclear. 7:45- 8:30 Morning Report, ground floor children’s conf room 3, Curnen Denny 8:35 Rounds begin by running the list with the charge RN at the 6CH nurses station 8:30-11:00 Rounding on the floors, prioritize unstable patients and discharges. Contact consults in as timely a manner as possible. 11:00 Attending or WTC run list with Case Mgmt. 12:00-1:00 Noon Conference, usually Curnen Denny 2:30-3:00 Teaching session – M-neuro, W-gen, Th-nephro in 6ch conference room. Tuesday- peds radiology in the basement. Feedback Friday! 3:00 Run the list with the WTC and Attg-share new info, anticipate discharge planning and signout priorities for overnight 3:15 -6:30 Finish up daily work, briefly visit and update families, set up discharges for the next day. 1 Intern may signout patients to “late” co-intern when work is complete (work that schedule out amongst the team) 6:30 sign out all patients to the on call team. Presenting on Family-Centered Rounds: - When presenting with families, try to limit medical jargon -New patient presentations should be succinct full H & Ps including a discussion of differential diagnosis and plan. -Follow up presentations should be a brief patient summary with a pertinent update and plan. - Share pertinent learning topics or literature with the team. - Interns and residents are responsible for ensuring all orders, consults and follow up appointments are completed for their patients. WTCs are extremely valuable team members and will assist with the efficient delivery of care but residents are ultimately responsible to ensure the plan is fully enacted and discharge instructions are complete. Specifically call the attending: -When YOU WANT to talk to the attending about ANYTHING or if in doubt. -To discuss any significant change in a patient’s clinical status, serious new lab/study result, a complex or potentially unstable patient, concerning social situations or a dissatisfied family, medical errors or near miss events -Unanticipated transfer, discharge or death, or parents wishing to leave against medical advice. -To seek assistance with communicating with another service or consultant if necessary. -Please discuss with your attending how they would like to be informed about admissions and transfers to PMA Expectations for interactions with medical students on the rotation -Model and demonstrate intellectual rigor and quality assurance that are important for patient care and teaching. Encourage and provide learning opportunities that are active, relevant, experience oriented, problem and patients centered in an enthusiastic and respectful environment. -Be available 5 min before AM report to discuss shared patients & discuss students’ plans -Discuss the goals for the rotation with learners and provide feedback throughout the rotation. Expectations for interactions with others (clinical nurses, ancillary services, etc.) -Residents are expected to interact with all members of the health care team in a respectful and supportive manner. In particular, the bedside and charge nurses are extremely valuable resources. -Nurses often consider carefully whether to page you. It doesn’t hurt to ask “would you like me to come see the patient?” Expected attendance at conferences and teaching sesssions -Residents are expected to attend all teaching sessions/conferences (AM Report 7:45, Noon Conference in Curnen Denny and 2:30PM brief session on 6CH) except in patient care emergency situations. Reminder: Thursday there is no AM Report but grand rounds 8-9a in 4th flr Old Clinic with a break in the summer months. Please access the following brief handouts on the Peds Website and review: -Medical Team Steps to Home -Family Centered Care -Physician Scripting and Rounds -Note the Choosing Wisely & Clinical Guidelines links on the website as well Notes & EPIC Tips: Complete documentation in a timely manner. The H&P and daily notes should be completed the day of service. A full Discharge Summary should be completed within 24 hours of discharge (required within 48 hrs). Use problem based note format with an updated problem list daily to reflect accurate diagnoses as they are made. Use extreme care and meticulous revision when pulling a note forward and when using smartphrases. Discharge summaries should be a concise review of the most important highlights of the patient’s hospitalization. Avoid repetition or “copy and paste” of the H & P or progress notes. Be sure the discharge weight is included. On admission, assign the Treatment Team (right click while hovering over the patient on the admit list) with the appropriate daytime intern, resident and attending and assign the correct provider team – search “ped” and choose the PMA service which brings up a window with a choice of consulting or primary. Click on “inpatient, Attending physician, MD” and on “This is the primary team”. Also, update the treatment team assignments if a patient transfers services or levels of care. This will pull the patient onto the right system list viewable by anyone in EPIC including students, nurses and consultants and aid in ease of communication. The easiest way to update the history during admission is by the history tab on the left hand side of the epic navigator. Done correctly, this makes every subsequent visit easier and more accurate since many notes automatically pull this data in. When pertinent, you can add current issues to the problem list from the past history by clicking on “add to problem list” at the bottom of the PMHx list page and vice versa by right clicking in the problem list and click “add to medical history”. Please copy following note templates via the Smart Phrase Manager, under the EPIC button. Search the provider’s name, copy the template, rename if you wish and change the signature to your own. Slight changes to suit your style are acceptable but the basic format should be kept the same. Every H&P should have a completed FHx, SocHx and ROS. Incomplete notes will be sent back to you for revision. Always read through and review with families automatically generated data to ensure accuracy. Preferred H&P: Ashley Sutton .agshpgeneral Preferred Progress note: Christine Williams .pedsprogressnote **Strongly Preferred Discharge Summary**: Keith Robinson .kjrpedsdischarge Discharge instructions for Infants: .jldinfantdischargeinstructions Discharge Instructions for Children: .jldchildgeneraldcinstructions Bonus to make your life easier: Under Jennifer Daniels Discharge Instructions for post-op NSG pts: .jldpedsneurosurginstructions Discharge Instructions – asthma action plan: .ppulmasthmaactionplan Discharge instructions – constipation: .jldconstipation Discharge Instructions – home oxygen order: .jldhomeoxygen Discharge Instructions – broviac care: .jldbroviaclineinstruction Discharge Insructions – PICC care: .jldhomepiccinstructions Discharge Instructions – Port care: .jldportinstructions Discharge Instructions – NG tube: .jldngtsupplies