Somerset Hospital Weekly Schedule

Admin

Daily duties

Theatre

OPD

Ward

Endoscopy

Calls

Cover

Welcome to NSH Surgery

• NSH is a great institution, particularly  for laparoscopic training
• Hospital staff are entitled to 10% discount at Woodies and Origin coffee!
• Switch board = 9 from any landline
• Our x-rays are digital – images can be accessed via the PACS program.
• Username= x-rays
• Password= x-rays
• Please dress smart and professionally at all times, scrubs may be worn after hours when on call.

Admin

• Time sheets are completed electronically and can be obtained by the department admin officer)
• Leave requests should be discussed with the HOD  
• Inform the HOD if you are sick and you would like to remain absent.

Daily duties

• Divided into Ward, Theatre, OPD and Endoscopy
• Expected to be here at 07:15 to pre-round
• Ward round at 08:00 everyday
• Rooms are allocated according to your duty for the week.
• Ward cover person sees rooms 1 and 2
• Endoscopy person sees rooms 2 and 3
• OPD person sees 9 – 7
• Cover person sees rooms 7 - 4
• If only 2 registrars are allocated to NSH, then the ward person would see rooms 1 - 2, cover  3 - 4 and OPD person 5 - 9
• It is ultimately the registrars’ responsibility to ensure that all patients are seen before the round and that plans are made, but interns and students may also assist.
• Blue boards must be updated daily (feeding, analgesia, IV Fluids etc.) and prescriptions should be rationalised according to patient requirements.

Theatre

• Emergency list on a Monday, starts at 12:00 and every other day at 08:00
• General surgery is in theatre A
• Registrars are to be in theatre at 07:30 to prepare the first case
• WHO surgical safety checklists should be done for every patient every time. WHO Checklists should be placed in the box in the recovery room labelled WHO safety checklist.
• The Theatre person is to see all admissions the day before, confirm an appropriate indication, consent and ensure patient readiness. E.g. lap chole and LFTS, spontaneous hernia in elderly and investigation for NBL, appropriate anaesthetic workup, International Hernia Mesh Registry (IHMR) Forms 
• NSH assists in collecting data for the IHMR. Forms can be found in the pre-op room or with the second floor clerk. All patients with ventral hernias need to fill out this booklet pre-op. It is also important to document the Height and Weight as well as the comorbidities on the front of the booklet.
• Hand in the theatre list by 12:00 to in charge Sister
• Discuss with consultant re: list order/ special requirements
• Our operation notes are typed out and printed. If you are going to use a template then please remember to change it accordingly.
• Op notes should be saved in the appropriate months folder and in a specific manner i.e. surname – initial – procedure – date. (e.g. Abrahams B SMA 12 July 2015 or Adams C Lap Chole 7 April 2016)
• If lost and unable to find the surgery operation notes folder/ database:
  • Open up a web-page and click on the star in the top right hand corner (If you are unable to open up a web-page then switch the computer off and on via the main power button. A web-page will then be displayed on the screen)
  • Then click on ‘health’ (with the red icon)
  • Find ‘Recent places’
  • Scroll down until you see the folder ‘SURGERY OPERATION NOTES’
  • NSH uses a Database to keep a record of procedures.
  • Please make use of drop down menus to eliminate variables
  • Check in the folder to see which facility referred the patient. If the patient presented directly to NSH EC then select Direct to ED
  • Try not to use ‘Other’ as a diagnosis or procedure, rather search for the most appropriate option from the lists. If it is unavoidable then write a short note in the comments section for future reference.
  • Print out op notes and file it in the folder.
• Post-op orders should be written for every patient who comes to theatre. Try to be specific about fluids, diet, observations
• All patients who have undergone a laparotomy should be put on a morphine infusion post-op in the absence of a better alternative.
• All patients should receive thrombo-prophylaxis post-op unless contraindicated (Heparin 5000u S/C TDS).
• Patients for amputation need a pre-op Hb of > 11 for their procedure

OPD

• Starts at 11:00 on Monday, and 08:30 every other day
• Instructions should be written on the white piece of paper in front of the folder, but the necessary paperwork should be completed (e.g. imaging request forms, lab forms etc.)
• If required, Nurses will take bloods, do ECGs and do dressings in the dressing room
• For elective surgery bookings contact the allocated consultant and fill in the elective surgery booking sheet. Please ensure that the correct mobile phone number is included.
• Indicate whether g-scope urgent
• All c-scope bookings have to be discussed with a consultant
• Bowel prep preferred is 'klean prep' (4 Sachets), particularly in the high risk patient
• Local list bookings are on Wednesdays for small lipomas, sebaceous cysts, toenails etc.
• The person allocated to OPD is responsible for the local list. It starts at 10 o’clock in D theatre.
• There are on average 5 cases booked for the local list each week. They will arrive in OPD on the Wednesday morning. Patients should be consented and changed before bringing them up to theatre.
• Patients are to be brought up to the back entrance of theatre.
• All SOPD over-bookings to be booked via consultant, the alternative is to bring the patient back to EC/Ward
• Proctosigmoidoscopy and haemorrhoid banding equipment is available in the dressing room and is indicated on all patients with Ano-rectal complaints.
• Biopsies for suspected cancer should be marked as urgent
• A prescription chart is at the back of the front cover of the folder, this is only for one month supply of medication. For a chronic script please use the CDU booklet. 

Ward

• Responsible for all referrals and ward issues during the day before the on call persons takes over
• Bulk of workload is imaging requests, emergency theatre bookings, referrals etc.
• U/S and CT request forms should be dropped off at the radiology department and labelled according to urgency i.e. A, B, or C
  • A- Urgent – immediately affects management (e.g. suspected gall bladder empyema)
  • B- Semi-Urgent – requires inpatient care and diagnosis but can be delayed by 24 hours (e.g. Acute Cholecystitis)
  • C- Non-Urgent – inpatients who require imaging as workup (e.g. Biliary Colic, staging CTs)
• Referrals
• HPB
• ERCP referrals should include
  • A referral letter
  • A consent
  • Recent blood results (FBC, U&E, LFTS and INR)
  • Imaging results
• Vascular referrals require a minimum of a letter which includes the patients pulse status and an ABI +- imaging if required
• Breast clinic is a walk in clinic every Friday at GSH
• Patients who attend the combined colorectal clinic at LE34 need a pack which would include
  • A referral letter
  • A copy of the colonoscopy report
  • A copy of histology result
  • A copy of the CT Abdo report +- MRI result if out already
• The pack should be copied and handed to Professor Chu prior to the LE clinic appointment date.
• Colorectal cancer patients are allocated urgent MRI slots in 2 week blocks at GSH MRI department. These slots should be utilised in order to get a MRI Pelvis prior to the LE clinic appointment date.
• In house referrals can be done by contacting the registrar on call for the specific department. A pink referral letter should also be written for all patients.
• Allied heath referrals should be done early in the ward round to improve efficiency. Please write a decent referral asking for assistance in their area of expertise.
• Booth/step down referrals should be anticipated and completed early, particularly in amputees where a long stay is likely.
• Surgical site infections, complications and deaths should be captured in the database once noted in the ward. The complication should be inserted into the appropriate block in the patient’s most recent operation.
• All discharges are done via ECCR. Potential discharges should be identified early to expedite the discharge process and improve turnover.

Endoscopy

• Scope lists are on a Monday, Wednesday, Thursday and Friday 
• Colonoscopy patients should be consented and IV lines inserted especially for Professor Chu

Calls

• On call room is situated in St Leger
• The key (with the orange tag) is kept in the doctor’s office on second floor. If the key is lost, then one can be obtained from the matron
• Calls are on-site. In the event that you have to leave then please inform the intern, consultant on call and switch board.
• The on call registrar is responsible for all surgical patients in the hospital, particularly the ICU patients
• The on call team should be aware of where all the admissions are in order to lead the ward round in a structured manner.
• All down referrals from GSH should be discussed with the consultant on call
• Patients are NOT to be accepted if there is no ward bed as patients are not allowed to be transferred from a ward to the EC
• All patients who require ICU need to be discussed with the consultant on call.
• It is the responsibility of the on-call registrar to see any surgical patients in the ICU before the ward round
• Scoring systems used:
  • We use a scoring system for patients with UGI bleed (KATI score) in order to identify high risk patients who warrant emergency endoscopy. All patients with a score of 3 or more need to be discussed with the consultant on call.
• All sick and/or pancreatitis patients need an apache score to assess severity
• All burns and crush injury patients need surface area to be assessed with the rule of 9’s
• After hours theatre: Anaesthetist available until 12:00 am in the week and 6:30 pm on the weekend. After this only life or limb, but short quick cases are possible if labour ward is quiet e.g. abscess
• Our paediatric surgery admissions are limited to patients over the age of 10 for common surgical emergencies e.g. appendicitis/abscess

Cover

• One person is allocated to cover the post call person’s duties for the week and will hence do different tasks every day.