Transcript Welcome to the HOT UNIT

Welcome to the
HOT Unit!
Purpose of these Slides
 What
you can expect from us.
 What we can expect from you.
 Pointers
What you can expect from us
A fun and interesting month.
 Exposure to common
hematology/oncology/and transplant
issues.
 Rounds that start and end on time
(usually)!

– Teaching Rounds 0830
– Patient Rounds start 0900, end 1100….
Goal is 1 hour each for Oncology and BMT.

Teaching at the bedside and at the
board/computer.
Teaching / Learning Opportunities
 0830
to 0900 Monday → Thursday
– Lecture series to cover general topics
– Slides will be on the website
 On
Rounds
– topics of interest; patient-specific
 Elsewhere
– Ask us!
What we can expect from you
A
fun and interesting month.
 Interest in common oncology and
bone marrow transplant issues (and
maybe some hematology too!)
 Being ready for rounds to start on
time (defined as 0830).
 Taking responsibility for patient care.
Pointers - The Computer


Sunrise has a lot of information.
Look at the “patient info” tab for many key
long term issues.
– Health issues

Long and short term health problems and procedures
– Significant events



Consents (blood product, research/treatment protocols)
Blood product info (CMV status; premeds if needed)
Transplant info
– Visit History


you can use this to find the Home Meds visit, where all
the patient’s current outpatient medications are listed
Look under documents tab for dictated
consults, clinic letters, H&Ps etc.
Pointers - The Computer:
Home Med Visits
The home med visit is there for you to
use at the time of admission.
 It also requires that you update it at the
time of discharge.
 If the people in the clinic keep the home
visit updated, and you do too, then it’s
very easy to see what drugs a patient is
on at the time you are seeing them!!
 You will know when the last time it has
been updated by the “home medicine
updated” order date.

Pointers - The Computer:
Home Med Visits - Admission
To order the patient’s outpatient meds that are listed in the
home visit into the inpatient visit:










Put the weight and height into the visit.
Click on the “orders tab”.
Click on the “order” icon (upper left) and be sure to put in the
date.
Then hit “hide worksheet”
Now, click the “reorder” button on the bottom of the screen.
In the reorder/order window, use the “active held pending”
filter and put in medications to get medications.
Then choose the copy from chart button and find the “home
med visit”. Use select all to get all the active orders.
Do the same to get fluids/TPN by filtering for active held
pending fluids/nutrition.
Make sure you hit “submit orders”
Double check your orders with parents and nurses
Pointers - The Computer:
Home Med Visits - Discharge
To update Home Meds by ordering meds that are in the
inpatient visit into the home visit:










Put the weight and height into the visit.
Make sure you don’t “reorder” things that are already there.
Click on the “orders tab”.
Click on the “order” icon (upper left) and be sure to put in the
date.
Then hit “hide worksheet”
Now, click the “reorder” button on the bottom of the screen.
In the reorder/order window, use the “active held pending” filter
and put in ‘medications’ to get the meds.
Then choose the copy from chart button and find the “current
visit”. Use ‘select all’ to get all the active orders.
Do the same to get fluids/TPN by filtering for active held pending
fluids/nutrition.
Make sure you hit “submit orders”
– Double check your orders with nurses and MAR
– Double check the medication start and stop dates
Pointers - Note Writing




The progress note is way we document and
communicate information about the current
status of a patient in the medical record.
You should be able to tell what is going on by
reading the notes!
Please do, and document, a physical exam with
pertinent positives and negatives (it is our job to
teach you these on rounds).
Please include an ASSESSMENT with your plans.
This includes explaining why something is in your
plan. Differential diagnoses, etc. can be very
helpful.
For Oncology, please
– use the back half of the ‘chemotherapy progress note’ if
you run out of space on the front
– leave the right hand margin free for the attending MD to
write a progress note
Pointers - Rounds
Be ready for rounds.
If the attendings are not there, page them!
 Be prepared to present your patients using
a systems oriented method.
 If you are post call, ask to go first to
comply with the 80/30 rules.
 If you are not presenting, use the computer
for order entry.
 Stay interested. That will lead to more
teaching and more enjoyment!

Pointers - Sign Outs
One of the most important jobs for a
resident is a good sign out.
 If an intern is on, back up must be
included in sign outs.
 If a patient is “ill”, bedside sign outs are
best.
 Ask the attending to walk around with
you in the afternoon.

Pointers - Psychosocial



The HOT unit can be very stressful. This is
because the children are often very ill, their
families are very anxious, and the nurses and
docs (including you) are passionate about
what they do.
Together, these can put a “rotating resident” in
a difficult place.
Pointers
– Do not argue with a parent or nurse. Tell them you
will talk to the attending, and call the attending.
– Try to sit in on “big picture discussions”
– Ask for “mental health” help from the attending,
your peers, the Chiefs, etc. if you need it
Pointers - Mental Health



When you get stressed, talk with peers, staff, and
the chiefs.
If one of your patients dies, if you wish, people
will cover for you to go to a visitation and/or
funeral.
It’s ok to be sad and depressed when your
patients are ill. How you deal with those issues is
an important part of your learning. Please talk
with us about those issues.

BMT Team
Oncology Team
James Casper MD
Mary Eapen MBBS MS
Bill Grossman MD PhD
Dave Margolis MD
Julie An Talano MD
Meghen Browning MD
Bruce Camitta MD
James Casper MD
Sachin Jogal MD
Michael Kelly MD PhD
Anne Warwick MD MPH