Clinical Site Resource Manual
Le Bonheur Children’s Medical Center
Nurse Anesthesia Program
School of Health Related Professions
The University of Alabama at Birmingham
TABLE OF CONTENTS
Section 1
CLINICAL SITE RESOURCE MANUAL
A.
Location and Directions / 2
B.
Phone and Fax Numbers / 2
C.
Pictures of Personnel / 3
D.
Faculty Anesthesiologist / 5
E.
Faculty Nurse Anesthetist / 5
F.
Anesthesia Technicians / 5
G.
Rotation Requirements / 6
H.
Apartment Information / 7
I.
Additional Information / 8
J.
Clinical Objectives / 9
K.
Demographics of Clinical Site / 11
Section 2
FORMS USED AT LE BONHEUR CHILDREN’S MEDICAL CENTER
A.
Cover Page of Pediatric Anesthesia Resident’s Manual / 12
B.
Pediatric Drug Doses Part A and Part B / 13
C.
Preanesthetic Evaluation Form / 15
D.
Anesthetic Record / 16
E.
Anesthesia Medication Record / 17
F.
Anesthesia Charge Forms / 18
1
Nurse Anesthesia Program
School of Health Related Professions
University of Alabama at Birmingham
Le Bonheur Children’s Medical Center
- Clinical Orientation Handout Location
Hospital:
50 North Dunlap
Memphis, TN 38103
901 / 572-3060
Directions to Clinical Site
Detailed directions are provided by Ms. Elizabeth Hoss, Office
Manager or Mr. John Brooks, CRNA, MNA. Directions to the
anesthesia office: after entering the main entrance to the hospital
off Dunlap, follow the “Cashier” signs. Adjacent to the cashier’s
office is an outdoor playground. The anesthesia office is located
across from this play area.
(from the Webb Building)
Anesthesia Department / Operating Room
Anesthesia Office:
1st floor hospital
901 / 572-3060
901 / 572-5102 (FAX)
OR Lounge:
2nd floor – located behind the OR desk
Main OR Desk:
2nd floor hospital
901 / 572-3056
Outpatient OR:
901 / 572-3138
John Brooks, CRNA
Nurse Anesthesia
Resident Manager:
418-6231 (beeper)
E-mail: jbrooksj@midsouth.rr.com
Description of
Clinical Site
Le Bonheur, meaning "hour of hope", was opened in 1952 as an
89-bed Children's Hospital in 1952. It is currently a 225-bed
hospital and is recognized as the region's pediatric specialty and
subspecialty referral center. More than 100,000 children are cared
for each year. Patients primarily come from 95 counties in six states
- Tennessee, Mississippi, Arkansas, Missouri, Alabama and
Kentucky. Children also come from many foreign countries to
receive medical care. Le Bonheur provides strong programs in
cardiovascular medicine, critical care, surgery, transplantation;
including heart, liver, and kidney transplantation; rehabilitation,
neurological disorders; including cerebral palsy, brain tumors,
epilepsy, and muscular dystrophy; allergy and immunology;
nephrology, and urology. In addition, Le Bonheur operates the
region's only pediatric emergency department, and houses a
pediatric intensive care unit, and transitional care unit. It is also a
Pedi-Flight – level I trauma center for children.
2
John Brooks, MNA, CRNA
Nurse Anesthesia Resident Manager
Le Bonheur Children’s Medical Center
Rao Paidipalli, MD
Chief Anesthesiology
Le Bonheur Children’s Medical Center
3
Ms. Elizabeth Hoss
Office Manager
Pediatric Anesthesiologist, P.A.
Le Bonheur Children’s Medical Center
Anesthesia Conference Room
Le Bonheur Children’s Medical Center
4
Department of Anesthesia Clinical Faculty
Physicians
Chairman Department of
Anesthesiology:
Paidipalli, Rao
Staff Anesthesiologists:
Adwell, Charles
Cancio-Babu, Connie
Ernst, Thomas
Karkera, Mohandas
Patchen, Mary Jane
Watson, Susan
Nurse Anesthetists
Chief Nurse Anesthetist:
N/A
Nurse Anesthesia
Resident Manager:
Brooks, John
Staff Anesthetists:
Benz, Charlene
Blatchford, Martha
Corder, Gordon
Milby, Mary
Sessums, Janet
Tipton, Jack
White, Francis
Anesthesia Technicians
Anesthesia Technicians:
Thompson, Geraldine
5
Rotation Requirements
1. Tennessee RN license – this license must be on file in the UAB Nurse Anesthesia Program’s office
prior to beginning your rotation at Le Bonheur. The Tennessee Board of Nursing phone number is
615 / 532-5166 and the web site is http://www.state.tn.us/health. Anticipate a minimum of 2 months
for complete processing. Cost is about $75.00 - $135.00 for a permanent TN RN license. Included
within this price range is the option of obtaining a temporary TN RN license– which can expedite
processing for a permanent TN RN license. The temporary license permits you to work in the state
for 3 months.
2. All RNAs are required to contact Ms. Hoss (901 / 572-3060) a minimum of 4 weeks prior to arriving
in Memphis.
3. The Pediatric Anesthesia Resident Manual (130 pages) should be completely read prior to arriving in
Memphis. This manual will be provided to all RNAs scheduled to rotate to Le Bonheur – compliments
of Pediatric Anesthesia Associates of Le Bonheur. Memorization of the PEDIATRIC DRUG DOSES
card (see page 12 and 13) will also improve the RNA’s transition to this specialty site.
4. Daily evaluations are required during the Le Bonheur rotation.
5. You should be on duty, dressed in scrubs by 0615. Your assignment will be made the day before by
Dr. Paidipalli.
6. Scrub suits, masks, cap, and new shoe covers are required in the O.R. Lab coats are to be worn
over scrubs at all times when leaving the O.R. suite. Mask and shoe covers are to be removed when
leaving the O.R. suite.
7. Ask the Nurse Anesthesia Resident Manager or Jennifer Stratton, RN, OR nurse for a locker at the
beginning of the rotation.
8. Scrubs are obtained at a table outside of the lockers.
9. Assignments are to be determined based on your clinical needs as well as your ability to make wise
choices on your own. You will be allowed some freedom in choosing your assignments. If your
choices are not acceptable, you will be reassigned.
10. Set up the anesthesia cart and room according to the instructions of your clinical instructor for the
day. On most days you work one-on-one with an anesthesiologist.
11. You are expected to see your first patient of the day preoperatively in the “bunny room” (preop
holding area). A thorough and accurate anesthesia preop evaluation should be conducted on this
patient. This information should then be written on the appropriate form shared with the
anesthesilogist and CRNA responsible for the patient. Preop medication should be given as ordered.
Oral midazolam may be given prn after surgical permit checked. All lab values should be on chart,
including an AM glucose for diabetics.
12. Your location while on duty must be known by the clinical instructor, nurse anesthesia resident
manager, or anesthesiologist at all times. You will be provided with a beeper during your rotation.
13. In case of illness, a call must be made to the OR desk, Ms. Hoss, and Ms. Barnhill in Birmingham.
Call between 0500 and 0600 to notify them of your absence.
14. Narcotics will be obtained from the OR pharmacy. Pharmacy personnel will give you a policy and
procedure manual that you will have to sign. All wasted narcotics are returned to the pharmacy.
6
15. Professional behavior is expected at all times.
16. You are expected to discuss each anesthetic care plan with the attending anesthesiologist and/or
CRNA before the beginning of each case.
17. This clinical rotation is a service rendered to private and non-private patients within the community.
Expedient turnover time for the anesthesia team is expected. If you are having difficulty in setting up
your room between cases, it is your responsibility to discuss this problem with the attending
anesthesiologist and/or CRNA to get recommendations to decrease the amount of time to set up your
room. Courtesy to all staff and patients are expected at all times.
18. Anesthesia inservice and conferences will be held on Tuesdays at 1400 (schedule permitting) in the
first floor conference room. You will be expected to attend and participate unless it is a staff meeting.
19. The daily evaluations should be given to Ms. Hoss at the end of each day. The forms will be
completed by the CRNA or anesthesiologist and returned the next day or by the end of the week to
the RNA for review.
Apartment Information
1. Your primary contact person for making arrangements to occupy the apartment (e.g., obtaining keys)
is Ms. Elizabeth Hoss, Office Manager, Pediatric Anesthesiologists.
2. Address:
Pediatric Anesthesiologist
c/o your name
810 Washington Avenue
Apt 819
Memphis, TN 38105
Phone number:
901 / 521-0345
3. The two-bedroom apartment has a queen size, full size and a twin bed stored in the closet, a
kitchen, living room, 2 bathrooms, and small balcony that is located just off the living room. The
Anesthesiology group has purchased the furniture in the apartment.
4. Accomodations
Telephone, TV, microwave, stove, refrigerator, freezer
Outside swimming pool, exercise room
Computer room – in lobby – access is limited to 1 hour intervals; the computer has internet access
Dishes, pots and pans, utensils, coffee pot, toaster, washer, dryer, mop, vacuum sweeper
Gated parking is available at the apartment. The Anesthesiology group has secured parking permits
/ spaces for two vehicles.
* Items you must bring include linen, bath items, cleaning supplies;
optional – VCR and answering machine. RNAs may not want to purchase cleaning supplies until
their arrival in Memphis – some RNAs leave supplies behind for others to use.
RNAs are expected to leave the apartment clean and report immediately to Ms. Hoss any damages
sustained to the apartment (e.g., carpet stains). Any reports of RNAs not leaving the apartment
clean for the next occupant will be counseled in Birmingham by Mr. Williams and Mr. Kossick, a
decision will be made after the meeting as to how the offender(s) will have to compensate for their
7
unprofessional conduct.
5. Occupancy Guidelines
The occupancy guidelines are as follows: no individuals other than the scheduled RNAs will be
permitted to live in the apartment throughout the week. Weekend visits by spouses is acceptable
only with prior approval (in writing) from Ms. Hoss and by the RNA’s roommate. Prior to a
spouse visitation, a letter with Ms. Hoss (and when applicable the RNA’s roommate) signature must
be faxed to the Nurse Anesthesia Office that documents approval/acceptance of spouse visitation.
The letter should indicate the name of the spouse and the specific date(s) they will be visiting. As a
reminder, the apartment’s primary purpose is to provide housing for the RNA(s) during their clinical
training at LeBonheur – not to accommodate social contacts. Each RNA always has an option to
make their own housing arrangements (at their own expense) so as to accommodate any special
needs such as having family members with them in Memphis. Such special arrangements must be
submitted in writing to the program’s office one month prior to the start of the RNA’s rotation. At no
time can more than two individuals stay at the apartment over night.
Specific dates for vacating and taking occupancy of the apartment must be strictly adhered to.
RNAs should plan accordingly to make sure they have adequately cleaned the premises before
arrival of the next SRNA. RNAs are expected to begin rotations on the dates listed on the Le
Bonheur clinical schedule. This means the RNA occupying the apartment must be completely
moved out prior to the next RNA’s arrival date. Considerations for modifying move-in and move-out
days that fall close to a weekend will be made by the Director of Academic Education in consultation
with the Program Director.
RNAs rotating to Le Bonheur Children's Hospital with a classmate (2 staying at the apartment at the
same time) are NOT permitted to have spouses or significant others stay within the apartment
provided by the Le Bonheur Anesthesia group. The apartment has two bedrooms and two beds (a
full-size and twin). Private arrangements to have spouses stay at an outside hotel (at the SRNAs
own expense) is an alternative.
There are two keys for the apartment for security purposes. Ms. Hoss should be contacted to
arrange for picking up the key.
Pets are not permitted in the apartment (e.g., cats, dogs, fish).
Additional Information
1. Mandatory courses such as ACLS, BCLS, PALS, etc. need to be completed before or after this
specialty rotation. Clinical time at Le Bonheur can not be used to attend such courses – including
Review Courses.
2. Free parking is available via a parking card, which will be issued to each student. The card will open
the entrance gate located on the right side of the hospital.
3. The cafeteria is located on the first floor. You are free to go to the cafeteria with a lab coat cover
during your 15 minute breaks or 30 minute lunches. Additionally, free coffee, doughnuts, and
muffins are provided daily; also a refrigerator is located in the OR lounge on the 2nd floor.
4. Each student will be assigned a mailbox near Ms. Hoss desk.
5. Adjacent to the anesthesia office is an anesthesia conference room. Within this room is a computer
with internet access.
6. Examinations for UAB classes are usually taken at the designated course examination time.
8
7. The code for gaining entrance to the anesthesia office after hours can be obtained from Ms. Hoss.
Clinical Objectives
1. Assess each patient preoperatively and obtained an adequate history and physical. Categorize each
patient according to ASA guidelines. Reveal significant pre-operative information to the
anesthesiologist and CRNA responsible for that particular patient.
2. Develop an anesthetic plan for each patient you will be administering anesthesia to and discuss this
plan with the attending MD and/or CRNA before the case is to begin. Develop an alternative
anesthetic plan for each patient you will be administering anesthesia to.
3. Assess medication needs for each patient, correctly and effectively write pre-op orders with
appropriate medication and dosages identified. Discuss pre-op orders written with appropriate
attending and/or CRNA.
4. Set-up the assigned operating room, anesthesia equipment, and anesthesia cart prior to admission of
the patient into the operating room.
5. Start an appropriate size intravenous catheter for IV fluid administration.
6. Prepare the patient for anesthesia induction, which includes:
 applying appropriate monitors for that particular patient
 selecting appropriate drugs and dosages for induction
 having appropriate equipment immediately available for the induction of the patient
 assessing the physical and emotional needs of the patient before induction and implementing the
necessary modifications if needed.
7. Calculate each patient’s estimated fluid deficit and appropriate fluid replacement for surgery.
8. Demonstrate the ability to manage an airway.
9. Demonstrate the ability to intubate an anesthetized patient using standard equipment.
10. Demonstrate the ability to maintain proper ventilation, oxygenation, and normal CO2 levels.
11. Demonstrate vigilance in monitoring the patient during the complete anesthetic process.
12. Demonstrate the ability to interpret information received from the monitoring equipment.
13. Demonstrate the ability to correctly assess monitoring equipment malfunction.
14. Demonstrate the ability to communicate effectively with members of the anesthesia care team and
ancillary staff.
15. Demonstrate the ability to assess anesthetic problems that may arise during a case and effectively
communicate pertinent information to the appropriate anesthesiologist and/or CRNA.
16. Demonstrate the ability to safely maintain a patient under anesthesia.
17. Identify the factors that would necessitate crystalloid versus colloid administration and effectively
communicate this information to the anesthesiologist and/or CRNA.
9
18. Develop an anesthetic plan for the emergence of a patient under anesthesia and communicate this
plan to the anesthesiologist and/or CRNA.
19. Demonstrate the ability to safely extubate a patient that has been intubated for surgery and is
anesthetized.
20. Assess the patient’s physical status and determine the care plan that is needed for the patient in the
PACU.
21. Demonstrate the ability to effectively communicate with the recovery room personnel.
22. Correctly identify the recovery room protocol for emergencies.
23. Correctly identify the chain of command should an anesthetic emergency develop and effectively
communicate pertinent information to the appropriate person.
24. Demonstrate the ability to accurately and effectively perform a post-op visit to obtain pertinent
information on each patient anesthetized by the student.
25. Communicate any adverse reactions or anesthetic problems that the patient had to the appropriate
anesthesiologist and/or CRNA.
26. Demonstrate professional behavior at all times during the clinical rotation. Additional clinical
objectives may vary with each clinical site. It is your responsibility to be informed of these objectives
at each site you are attending.
10
Demographics of Clinical Site
Maximum # students clinical site is able to accommodate
2
Maximum # junior students clinical site is able to accommodate
0
Maximum # senior students clinical site is able to accommodate
2
Hands-on Regional Experience
Commonly
Occasionally
Rarely
Never

Spinals
x

Epidurals
x

Axillary blocks
x

Supraclavicular blocks
x

Bier blocks
x

Other (e.g., caudal block)
Nurse Anesthesia Resident Inserts
Central Lines
x
Commonly
Occasionally
Rarely
Never
Internal Jugular Vein
x
Subclavian Vein
x
Antecubital Vein
x
Pulmonary Artery Catheter
x
Clinical experience includes:
Mask Inductions for children
Commonly
Occasionally
Never
x
x
Maintenance of GA via a face mask
x
Placement and management with LMA
Nurse Anesthesia Resident Administers
Drugs During Induction
Rarely
Commonly
Occasionally
Rarely
Never
x
Taking In-house call is an option
Yes
No
Afternoon
x
Night
x
11
12
13
14
- Preanesthetic Record -
15
- Anesthetic Record -
16
- Anesthesia Medication Record -
17
- Anesthesia Charge Forms -
05.16.03
18