1. Pediatric Ward Orientation
For Clinical Clerks
Welcome to MacPeds!

2. CTU Structure Team 1 & 2: General Pediatric Inpatient Teams
Patients located on 3C +/- ER
Team 3
Chronic complex care team
4C consults
As of January 2017, team 1 and 2 patients will be on 3C +/- ER
Team 3 patients will be on 3Y

3. A Day in the Life… 7:15 or 7:35 Morning Handover 8:00 Morning Teaching
9:00 Patient Care
10:15-12:30 Rounds – Walk around
Afternoon – Complete notes, Consults, Update List
15:00 – (Depends on day) Subspecialty or Bedside Teaching
16:40 or 17:00 Evening Handover
Teaching schedule currently in the process of being looked at – keep in touch with residents about monthly teaching schedule

4. Morning Teaching Morning (8 – 9am)
Monday: Gen Peds Grand Rounds (4E20)
Tuesday: Resident teaching (1A3) or RRT (3A14)
Wednesday: Heart-to-Heart Cardiology Rounds (1J7) - 1/month
Thursday: Pediatric Grand Rounds (MDCL 3020)
Friday: Case Based Learning (3E26)

5. Protected Time
Please let your attending and senior resident know at the start of your rotation when you have protected teaching time. Please write these times beside your name at the top of the handover list.
Attendance at all teaching sessions is mandatory! If you are attending to a sick child, please notify the staff or senior resident that you have protected teaching time so they are able to take over their care.
Update the list and touch base with your team before leaving!

6. Multidisciplinary Rounds
Team 1: Tuesday 13:00-13:30
Team 2: Tuesday 13:30-14:00
(Team 3: Thursday 13:00-13:30)

7. Team 1 admits on ODD days, Team 2 admits on EVEN days
AM Handover
AM handover starts promptly at 7:15 or 7:35am
AM handover on weekends start at 8:30
Team on take that day has the later AM & PM handover times
Ensure you print a list and bring it to handover
The on call residents/clerks will briefly review new admission and any overnight issues
Team 1 admits on ODD days, Team 2 admits on EVEN days

8. Guide to presenting new consults
Spend 2-3 minutes on each new patient and discuss
Name, age, main presenting complaint
Brief HPI focusing on pertinent positives/negatives
Brief summary of objective findings (physical exam, investigations)
Admitting diagnosis and plan

9. PM Handover
PM handover occurs at 16:40 or 17:00
Remember that JPRs may cross cover CTU and may not know the patients from the ward
Day team is in charge for printing 2 updated patient lists for the night time team
IPASS format for handover!

10. PM Handover – iPASS

11. Handover - Sample

12. Team Lists Team lists are located on the Citrix handover site
Please update the lists everyday and include any overnight / weekend instructions
Don’t wait to the last minute to update a list as there can only be one checked out list at a time
Be sure to check your lists back in so that others can edit them
Remember: The patient lists contain confidential information! Do not leave printed copies in the handover rooms or on wards! Dispose in confidential waste bins at the end of the day!

13. How to access the Handover List

14. Appscriber- Search for ‘service Handover’

15. Open the Clinical folder

16. Open Service Handover

17. Choose your team list

18. Check out to Edit

19. **Save and Check in before you exit **

20. Press OK

21. Documentation Every patient requires a daily progress note
Exact details (ie labs and vital signs) are part of the electronic chart. It is important to capture these by documenting trends and providing interpretations.
The most important part of your note is the impression and plan:
Make sure you detail the rationale for pursuing one treatment versus another or reasons for changes in mgmt.
Include working diagnosis or differential diagnosis.
Important to include a disposition plan

22. Documentation
On Fridays, each patient should have a more detailed note outlining the treatment plan for the weekend, especially if the patient is a predicted discharge
Please try to have planned weekend discharges organized (prescriptions written, appointments arranged, CCAC arranged etc.)
You are responsible for the discharge dictation if the patient has been admitted for longer than 48hrs

23. CTU Scut Sheet

24. ROUNDING Efficiency is KEY! How can you help?
Make sure the charts are on the cart by 10:15am
If you are not presenting a patient, someone should have the chart and write down orders/fill scripts/DI req’s etc as the plan is being decided for the patient
Use the rounding checklist to help guide you when presenting your patients. Feel free to ask JPRs/SPRs for feedback.

25. Rounding Presenting on rounds:
Step 1: Patient ID – Age, gender, reason for admission with pertinent past medical history (if relevant) and POST if any?
Step 2: Prioritized issues list
Step 3: Overnight issues
Step 4: Present Issues/updates according to issue list
Ex. Bronchiolitis – any O2 requirements, last fever, last puffer use?
Ex. Gastro – Any IVF requirements, ?po intake, last emesis or diarrhea, last anti emetic
Step 5: Comments on feeding is not previously mentioned
Step 6: Physical Exam – fever? O2? Changes in PE? Ins/Outs?
Step 7: Monitoring – CRM, BW, PRN meds etc.
Step 8: Assessment – 1 line summary of current patient status and diagnosis
Step 9: Plan for Day

26. Rounding Resource
Can be found on the MacPeds Website  Subspecialities  General Pediatrics

27. Dictations
Every Consult and Discharge requires a dictation within 24-48hrs
Exception – PICU transfers do not need a dictated consult note
When dictating, ensure you indicate the relevant staff (the one who reviews the consult with the senior/fellow or you) and please SPELL their name
Dictations should be done AFTER review with staff to incorporate all information and decisions
The Pediatric Survival Guide can be used for templates for dictations
Make sure you write down the dictation number on your consult note, or on the discharge face sheet
Note: exception is admission of PICU transfer – no dictation

28. Discharges
Face sheet must be filled out for every patient at the time of discharge
Please put the dictation job ID on the face sheet once the dictation is completed
Chronic patients will have a “chronic patient checklist” that must be completed before discharge
Ask your SPR if you think your patient might qualify as chronic

29. Who to call if you need help
Senior Resident (or any other resident on the team)
The SPR is available for any questions or to be support if you are concerned about a patient
NEVER feel worried to get a more senior member of the team if you are feeling uncomfortable about a patient
REMEMBER – there is always either a SPR or staff carrying pager 1645

30. PACE Paediatric Assessment of Critical Events Team includes:
Call paging or page 75030
Team includes:
PICU resident and fellow
PICU nurses RT
PICU staff
Activation criteria available on PACE cards
ANYONE who is concerned about a patient based on these criteria can call PACE

31. On-Call Arrive to handover at 4:30pm to introduce yourself to the team
You do not need to print team lists
You may be dismissed from handover to start seeing consults
Throughout the evening, the SPR will page the clerk/JPRs as they receive consults
The SPR will see the patient briefly to ensure they are stable
If you are concerned about your patient at any time, page the SPR, get the ER MD or activate PACE
All consults need a written and dictated note
While waiting to review, write your note, and start an admission order set

32. Admission Order Writing
Please use the Pediatric Admission Order Set when admitting patients
Look for the “order set” icon on your citrix, and search under the pediatric tab on the right
Be aware or ask your fellow residents if there are specific order sets that you should be using ie. bronchiolitis, asthma, DKA, UTI etc.
We encourage you to try to start the order set on your own if you are waiting to review

33. Meditech access

34. Select “Live Applications”

35. Remember HAH!!

36. Enter your username and password

37. Choose Patient Care Inquiry

38. More than one way to find your patient
Search by Name, Number
Search by Location – scroll down to MI-3C

39. Recent Investigations

40. Meditech
Patient Flowsheet for Vitals, Ins/Outs

41. Patient Flowsheet Hit ‘F12’
*If it asks you for a facility – type in ‘M’
If asks you for facility – always put in ‘M’

42. Flowsheet
Key tabs – Vital signs (Pain Mgmt), Vital Signs graph, Intake/Output, Cumulative I/O

43. Vital signs – Pain Mgt
Helpful if looking for o2 requirements and amount of O2

44. VS – Graph

45. Intake and output -Daily charted weight
-Fluids, Feeds, PO intake charted per hour
-Voids (volume or frequency), BM, Emesis, Drains

46. Cumulative I/O Helpful to look at fluid balance
Note – In babies, can be misleading to calculate u/o from the total output as some might be urine mixed with stool. Better to use the Intake & Output flow sheet

47. Useful Resources
Website, CTU handbook, Scut sheet, rounding and handover guide and articles:

48. Have a great rotation!
We want to create a positive learning environment for you so please give us feedback on how we can make things better!