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.
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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