PICU Resident Responsibilities

[slevittMD]

Thanks to Meghan for writing this up

Daily
-Arrive prior to X-ray rounds at 7 am, to get updates on overnight events on your patients from the night nurses, usually around 6 am
-If possible, start writing note    
    o Change vitals
    o Update labs and XR
    o Update interim history and plan as appropriateDo not print notes, will discuss plan on roundsGo to X-ray round at 7 am and listen to sign out from night attending to morning attending
    o Either bring a WOW with you to every room or use the doc work stations (computers with red tape on monitor) so that you can put in orders while rounding
- STAY in the PICU as much as possible. A lot of things happen to the patients all day so you will need to continuously reassess and put in orders throughout the day
- Try to know the general plan with all of the patients so nurses and consultants can speak with any of the physicians
- Keep in touch with consultants to see changes on plans
- If a medical student is on orient and assign them patients but YOU WILL ALSO need to follow that patient
- Please back up the notes on the MD computer “red tape” folder back up PN every other day
- Text/call attending with changes and updates on patients throughout the day and when on call
- Make sure PCPs have been called about the patient being admitted to the PICU (even trauma patients)
- Make sure the floor Attending is made aware of the patient prior to transfer

When on Call
- Make your contact information available; Put your cell or pager number at the clerk’s desk and remind them that you are on call, very important
- The day of your call day, reserve your room downstairs by putting your things in the room. The rooms fill fast and you don’t want to be stuck sleeping in the family room
- Weekday Call
    o You stay all night, do the admits and transfers
    o Write your share of the notes in the AM
    o Round on your patients first then home before 10 AM
- Weekend Call
    o Come in the morning, write EVERYONE’s notes if no resident the night before
    o Stay overnight, do the same thing as weekend call
    o Post call day: write EVERYONE’s notes if no resident coming in
    o Round then out hopefully before 10 am


Admits, Discharges and Transfers

- Admits
    o Either the charge nurse or attending will let you know about the new admit so let them know your cell (better) or pager number. See the patient. Let the attending know once patient is on the floor.
    o You need to put in admit orders. The attending will show you this on your first attempt but you will do this alone subsequent to this
    o Write H&Ps.
    o Do med-reconciliations

- Discharges
    o Write AND dictate discharge summary
    o Physically write Rx medications along with online med-reconciliations

- Transfers from the floor
    o Write accept note but you do not need to dictate this; should include all components of an H & P
    o Go over the orders in the computer to see if anything needs to be changed or added
    o Med-reconciliation

- Transfers to the floor
    o Call the resident on either blue or red team to let them know about your patient. This is very important because sometimes patients are not seen for >24 hours
    o The PICU attending will call the floor attending him or herself
    o You need to do the med-recon yourself
    o Do not forget to d/c all q1H orders (Ex: I/O, vitals) change to q4H or whatever is appropriate because floor patients cannot have anything q1H ordered


Contact Info

- Dr Mata (cell) 734 777-2046 (prefers texts) 
- Dr Pappas (cell) 419 340-9044, (home) 419-829-6452 (call or text)
- Dr Rivera (pager) 419 444-0318, (cell) 917 618-2217 (prefers paging; NO texts)
- Dr Sy (cell) 567 686-5388, (pager) 419 249-1325
- Dr Tourner (cell) 734 660-4515 (prefers texts) 

[kemple]

Just a couple update to this.

1) For H&P's if you put a bar code sticker below the patient identifier sticker you don't have to dictate, they can scan it in.
2) When transferring a patient to the floor, change that days progress note to say PN-TN (Progress note-transfer note) in the computer.
3) Some attendings don't make you do d/c dictations. Sy and Rivera just say to put discharge summary on the daily progress note with disposition of discharge. Honestly you don't d/c much from the PICU, most go to the floors. If you do then just ask the attending to be sure.