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WARD COVER HANDOUT

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					July 2008




   MATER ADULT HOSPITAL


            WARD COVER
             HANDOUT
July 2008


                        WARD COVER BOOKLET

CONTENTS

Important Points ……………………………………………………………….2
Statement of Duties
               Responsible to ……………………………………………………3
               Work hours..………………………………………………………3
               Duties ………………………………………………………….....3
               Patient handover between shifts ………………………………….4
               Term Assessment ………………………………………………...4
               Consultation pathways for clinical queries or ill patients ………..4
               Learning Objectives ……………………………………………...5
Protocols………………………………………………………………………....5
Shift to Shift Handover Template …………………………………………..…6
July 2008



                              - IMPORTANT POINTS –

1. Ward cover is a very independent term

               some RMO’s may feel ‘alone’ during this term, particularly working
                nights
               in order to minimise this, it is important that ward cover RMO’s
                attempt to spend time liasing with other medical and nursing
                staff…..the emergency department can provide a very useful ‘home’
                and ward cover RMO’s are encouraged to spend ‘free’ time here for
                collegiate support


2. Handover is of paramount importance for ensuring patient safety and
streamlining work practices/ workloads

               there are designated handover periods for the interchange between day/
                evening staff (1630 – 1700) and evening/ night staff (2130-2200
                weeknights, 2000-2030 Sat and Sun) during which patients must be
                handed over
               a sample handover template is included in this document, please utilise
                this as a guide
               The weekday (M-F) day/ evening handover MUST be attended by the
                ward cover residents and all medical and surgical residents in the
                MAH (1630 hrs, doctor’s room 9B)


3. Safe working practices and hours are critical to patient safety

               Night ward cover residents ARE permitted to try to sleep during their
                night shifts, provided that all relevant patient care issues have been
                attended to, and provided the resident is readily able to respond to
                emergency issues as needed
               sleeping during overnight shifts must never be at the expense of patient
                safety
July 2008


                                  -Statement of Duties-
Responsible to:

Administratively - Director of Medicine / Dr David Serisier (Chest Physician)
Clinically       - Specialist in charge of patient

Please contact Mr John Laing, Admin officer to Dept of Med. if administrative concerns or
queries (Phone 1565, Level 9, MAH)

Work Hours

Night shift ward call is covered by 2 ward call JHO's who spend one week 'ON', one week
'OFF', working the following hours (total 76.5 pw):

Sunday night 2000 - 0800
Monday - Friday 2130 - 0800
Saturday 2000 – 0800

Evening and weekend day/ evening ward cover is provided by rotating day team residents
undertaking rostered overtime shifts:

Monday to Friday        - 16:30 - 2200            (1630-1700 & 2130-2200 handover)
Saturday                - 12:00 - 2030            (2000-2030 handover)
Sunday                  - 08:00 - 2030            (0800-0830 & 2000-2030 handover)


Duties

The ward cover resident is responsible for covering clinical medical problems of all in-patient
wards of the Mater Adult Public Hospital, under the supervision of on-site medical registrar
staff and on-call Consultant medical and surgical staff.


Ward cover residents are expected to attend to:

1. All requests made by nursing staff of inpatient wards of the M.A.H
2. Any problems identified by inpatient day medical staff and requiring after-hours review by
   an RMO
3. All code blue and code green alerts called on inpatients, including inpatients of the Mater
   Private Hospital Annerley Rd Campus (MPH-ARC)


The following are NOT ward call RMO duties:

       Assisting in theatres (this is the function of the remote call RMO) – in the event that
the remote call RMO has already been called into ED, the surgical registrar must contact the
ED consultant on call, who can then release the remote call RMO to assist in theatres
       Surgical (or other) admissions (day admissions are to be completed by day team
surgical RMO’s; arranged after-hours admissions do not need to be seen by w/c, unless they
are unwell – in which case the relevant on-call registrar must assess the patient)
July 2008


Patient Handover between shifts

Patients requiring ward cover attention must be identified/ handed over at shift changes.

If you do not handover a sick patient, they remain your responsibility until their care is
resumed by day staff – any adverse event occurring during such unsupervised periods that
may have been obviated by appropriate handover remains your responsibility

This includes:
       From in-patient RMO’s/ reg’s of all units at completion of day shifts
       From prior ward cover RMO at change of each shift
(Note there is also a ward cover/ RMO handover whiteboard in ward 9B Dr’s room )


Handover Times:
M-F 1630–1700 hrs (Dr’s room, 9B) This handover must also be attended by available
                           day RMO staff from all MAH units (medical and surgical)

M-F     2130-2200        &       0800-0830
Sat     1200-1230        &       2000-2030
Sun     0800-0830        &       2000-2030


Adequate patient handover is critical for ensuring timely patient review and
ensuring patient safety and is a prime responsibility of all on-call medical staff

   (A sample template giving examples of appropriate information for patient handover is
                           provided at the end of this document)

Term Assessment

Assessment for the ward cover term will consist of a simple ‘PASS’ or ‘FAIL’ score that will
be judged according to:
    1. Feedback from ward nursing staff and medical registrars
    2. Adequacy of observed patient handover
    3. Professionalism/ punctuality/ reliability

The number of ward cover shifts missed due to illness during the ward cover term will also
be recorded on this assessment – if 2 or more sequential shifts are missed, a medical
certificate is required

Consultation pathways for clinical queries or ill patients

        contact the appropriate on-call registrar (e.g. medical patient: on-call medical
registrar, surgical patient: surgical registrar; if surgical patient with medical problem, contact
surgical registrar first)
        In the event of emergency or urgent problem where appropriate registrar not
immediately available, consult medical registrar on-call
July 2008


Learning objectives


During this term, ward cover residents are expected to extend their abilities in the
assessment and management of any medical or surgical problems arising after hours.

An illustrative, but not exhaustive, list includes:
1. the ability to independently assess and manage simple patient issues, including prescription
of adequate analgesia, consideration of the safe and appropriate prescription of sedative
medications, appropriate review and management of laboratory results, etc
2. the ability to appropriately assess and initiate resuscitative measures in acutely ill patients,
including assessment and correction of fluid-balance abnormalities, electrolyte disturbances,
shock and sepsis
3. the ability to appropriately assess and initiate the acute medical management of common
acute medical problems including acute pulmonary oedema, acute cardiac ischaemia, asthma,
diabetic emergencies (hypoglycaemia and hyperglycaemia), sepsis, seizures, arrhythmias and
the acute abdomen
4. Ward cover residents are expected to be competent in the interpretation of ECG’s, CXR’s
and laboratory results
5. Ward cover residents are expected to be competent in the performance of peripheral IV
cannulation, lumbar puncture, endotracheal intubation and cardiopulmonary resuscitation
(advanced cardiac life support), etc

        Initiation of medical care must not be at the expense of patient safety and the ability
to appropriately consult on-call registrar staff in a timely manner for assistance in the
assessment and management of any acutely unwell patient is vital
        In situations where medical knowledge is deficient, it is expected that ward cover
staff will consult appropriate sources of additional information to correct this (texts, internet
sources eg ‘Up to Date’) – this is the responsibility of ward cover residents



                                         -Protocols-
Protocols for a number of procedures and standard management issues can be found in the
Ward Call handbook

Remember that ensuring patient safety by providing exceptional medical care
should be paramount in all medical decision-making processes
July 2008

				
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