SMH Psychiatry: Intro to Call, Notes & Orders Magdalena Casagrande 2014

SMH Psychiatry Introductions Attendings and rotations

Safety Panic buttons on units Ekahau tags in ER Nursing/Security to be present when entering security room

Psych Call 4 evening calls & 1 weekend call Your attending & resident will be in house with you Exchange cell phone numbers / pagers Weekdays 5pm - 11pm (in-house) Weekends 8 or 9 am until the work is done (in-house) Your responsibility to ensure coverage – can switch with same level for same type of call

Psych Call Weekday call = new assessments Weekend call = new assessments & follow ups Assessments = admit or not Do not see patients on your own before first discussing with your staff Safety – MCFD, driving, work Present patient to attending

Inpatient Units: 4E, 4W & PAU Team rounds vary depending on attending Usually in morning, once weekly Room across from Pat McColgan’s office Nursing staff, SW, Pharmacist, Neuropsychologist, Occupational therapy

Inpatient Daily assessments SOAP notes Review nursing notes Review use of prn medications S/R over last 24 hours Any messages on psychiatrist clip-board? SOAP notes See example

Dictations Dictation systems & codes Outpatient: d/w Dr. Smit 1-855-666-3240 Personal dictation ID Facility code = 17 Work type = 104 (consult), 107 (discharge) Outpatient: d/w Dr. Smit Inpatient: discharges Psych ER: consultation & discharges

Dictation Headings: Consultation Identification Chief complaint HPI Past psych hx 1st contact Hospitalizations Past medical hx TBI / seizures / thyroid Meds / All Family psych hx Substance use hx Forensic hx Personal / social hx Investigations MSE Impression Plan Certifiable or not Further investigations / assessments

Dictation Headings: Discharge Summary Discharge dx Discharge meds Identification HPI “For details, refer to consultation by Dr. X, dated July 4, 2014” Presenting MSE Past history Check with attending Course in hospital Behaviour on unit Any issues, passes Medication changes MSE on discharge Discharge plan Accommodations/housing Psych & GP f/u Medications & Rx Special instructions (driving, work)

Orders Admitting orders On unit Psych ER Orders sheet AD-DAVID Don’t forget nicotine replacement therapy Consulting other services On unit Levels of observation Day passes – specify accompanied or not Overnight or weekend passes – write “with meds” Consult SW / OT etc. – write reason for consultation in orders

Expectations Know & utilize Meditech Utilize various sources of collateral information Family, police (ER) GP or community psychiatrist Prior consultations Professionalism Check with Attendings/residents Remind them of your scheduled teachings, half-days

Teaching Schedule Monday, Wednesday, Friday 8am Friday 9 – 10 am MSI teaching various topics Friday 9 – 10 am Journal club 1st week Psychopharmacology rounds 2nd week Grand rounds 3rd week Friday 11:45am OSCE rounds Jeopardy August 8th

MSI Teaching Mon / Wed / Fri 8 – 9 am: core psychiatry lectures Psychiatric assessment & MSE Emergency psychiatry Psychotic disorders & mood disorders including ECT Personality disorders, anxiety & sleep disorders Crash courses x 2 in psychopharmacology Geriatric psychiatry including dementia & delirium EPS & AIMS assessment demo Various child psychiatry topics (week 4) Addiction psychiatry CL psychiatry CRE practice, feedback, Q&A AM lectures at SC4 Conference room Psychotherapy teachings SC7 Solarium