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PAEDIATRIC INTENSIVE CARE – CLINCIAL PRACTICE GUIDELINE
Guidelines for student/resident/fellow coverage in the Pediatric Intensive Care Unit
Objective of Guideline:
To make clear points referring to affected person care protection and work for the assorted care suppliers within the PICU
Caregivers within the PICU and stage of responsability
a.Day attending: Main attending or consulting/co-attending on all pediatric sufferers and chosen grownup sufferers admitted to the PICU
b.Backup attending: A backup attending is obtainable in the course of the day and is known as on the discretion of the day attending
c.Night time attending: Night time attending for admission, cross protection, transport calls/consults, code workforce response.
d.Sedation attending: Out there some days
a.Pediatric residents: PL2 and PL3. Residents every take sufferers primarily. PL3 ought to try to mentor and information the PL2 as wanted with PICU or hospital procedures.
b.Emergency Medication Intern. The EM intern will take sufferers primarily. Not all months have an EM intern.
Three.Fellow Protection (varies by month)
a.PICU Fellow. The PICU fellow will act in a supervisory capability, underneath the path of the PICU attending, for all sufferers admitted to the PICU.
b.Cardiology Fellow. The cardiology fellow will act in a supervisory capability, underneath the path of the PICU attending, for all cardiology or cardiac surgical procedure sufferers admitted to the PICU. The cardiology fellow might go to the cath lab or OR for optimum academic experiences.
c.Anesthesia Fellow. The anesthesia fellow will take sufferers primarily together with the Pediatric residents and EM intern.
d.Surgical Fellow. The function/duties of the surgical fellow will fluctuate relying on their academic objectives.
a.Subintern (MS4). The subintern will comply with sufferers as the first caregiver. One of many pediatric residents ought to be assigned to “back-up” the subintern on every affected person.
b.Scholar (MS3). The coed will comply with sufferers as the first caregiver. One of many pediatric residents (usually the PL3) ought to be assigned to comply with the affected person together with the coed. (see pupil data web page for extra particular tips re MS3 expertise)
Obligations of Main Resident/pupil:
1.Write admission orders and admission be aware (medical affected person) or assessment admission orders and write admission be aware (surgical affected person)
2.Pre-round on sufferers and be ready to current on rounds. (be aware, residents mustn’t pre-round on subintern sufferers, and may very briefly pre-round on MS3 sufferers)
Three.Write each day notes. Surgical sufferers don’t want notes on the day of switch (besides cardiac surgical sufferers, who switch to the cardiology service on the ward/dncc).
Four.When gone from unit (publish name, clinic, and so on), talk/signal out with resident/s who stay within the unit. Please additionally notify the attending that you’re leaving and summarize any affected person care duties that also have to be performed.
5.Write switch be aware for medical sufferers, talk affected person knowledge to receiving resident.
6.For Shriner’s discharges or house discharges, dictate admission (college students mustn’t dictate).
Division of Sufferers:
1.Pediatric PL2, Pediatric PL2, EM PL1, sub-intern, and anesthesia fellow will take sufferers primarily
2.The above caregivers will distribute sufferers comparatively evenly, throughout the following tips
a.The EM intern and pediatric sub-intern ought to take extra easy medical and surgical sufferers till he/she is comfy with taking tougher sufferers. They need to comply with as much as Three-Four sufferers
b.The anesthesia fellows usually should not have substantial pediatric expertise, and often should not accustomed to “ get issues performed” at OHSU. Due to this, initially they need to have fewer sufferers in order that they will familiarize them selves with the assorted hospital/unit procedures. They need to comply with as much as Three-Four sufferers.
c.The Pediatric PL2 and PL3 ought to comply with as much as 5 high-acuity (nursing acuity 6 or 7) or a most of eight sufferers primarily. A few of these sufferers may also be by a MS3.
d.The Sub-intern ought to comply with 1-Three sufferers (backed-up by one of many pediatric residents)
e.The MS3 ought to comply with 1-Three sufferers (co-followed with Pediatric resident)
Three.Sufferers admitted by the cross cowl residents ought to be divided up the next day, with consideration to night up the distribution of sufferers in response to the above tips.
Triage of labor when the unit is busy or there are fewer caregivers
1.Spherical on sicker sufferers first. If not all sufferers may be pre-rounded on, surgical sufferers who’re anticipated to switch to the ground after a someday keep ought to be rounded on final. If not all sufferers are pre-rounded, their knowledge shall be reviewed by your complete workforce on the time of labor rounds.
2.The evening resident ought to embrace an evaluation of whether or not or not the affected person would possibly switch to the ground in sign-out.
Three.If pressing switch to flooring orders are wanted previous to rounds starting, the cross cowl resident ought to do them.
Four.Day by day notes should not wanted on surgical sufferers transferring to the ground.
5.If unable to finish each day notes on all sufferers, prioritize medical sufferers over surgical sufferers.
6.Switch notes for sufferers transferring after someday may be very temporary.
7.If unclear about what duties ought to take precedence, ask the attending.
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