Transcript Introduction to Pediatrics at MSKCC

2007-2008
Pediatrics at
MSKCC
Overview
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GME folders and beepers
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Organization of the clinical
services
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Expectations of residents,
fellows, NPs
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Daily schedules
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Administrative Procedures
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Computer information
First day at MSKCC
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On your first day, please go
to M9 first at 7AM
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No need to stop by the GME
office anymore
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Once on M9, you will first
receive sign-out from the
post-call resident, and then
you will be given a brief
orientation
GME folder and beeper
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GME office = M2101
Please sign all paper work including:
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Confidentiality agreement
DEA acknowledgment
HIPAA security form
“White card” with general phone numbers, your
institutional DEA number, and all computer passwords
Blue prescription card
ID slip (security office, basement Memorial Hospital),
scrubs/lab coat requisition (general stores, basement
Memorial Hospital)  MUST obtain these after rounds
on first day
Organization of clinical services
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M9 – Inpatient, Pediatric Observation Unit (POU), and Pediatric Day
Hospital (PDH)
Two teams on M9 Inpatient – two medical teams (“green”, “blue”)
POU – step-down unit for peds  PICU at NYPH
PDH = outpatient clinic:
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Primary teams include attendings, NPs, social work:
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leukemia (Drs. P. Steinherz, Yurasov)
lymphoma (Dr. Trippett)
sarcoma (Drs. Meyers, Wexler, Merola, Merchant, Chou)
neuro-oncology (Drs. Dunkel, Khakoo, Lyden)
neuroblastoma (Drs. Cheung, Kramer, Kushner, Modak)
surgery (Drs. LaQuaglia, Kayton)
long-term follow-up/endocrine (Drs. Sklar, Oeffinger)
Cardiology (Dr. L. Steinherz)
BMT (Drs. O’Reilly, Boulad, Kernan, Small, Prockop, Scaradavou)
Open M-F from 7:30am until 7:30pm
Sees approximately 120 - 150 patients/day
Meet the Staff
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Primary teams include
attendings, NPs, social work:
Leukemia (Drs. P. Steinherz,
Yurasov)
Lymphoma (Dr. Trippett)
sarcoma (Drs. Meyers, Wexler,
Merola, Merchant, Chou)
Neuro-oncology (Drs. Dunkel,
Khakoo, Lyden, Gillheeney)
Neuroblastoma (Drs. Cheung,
Kramer, Kushner, Modak)
Surgery (Drs. LaQuaglia,
Kayton)
Long-term follow-up/endocrine
(Drs. Sklar, Oeffinger)
Cardiology (Dr. L. Steinherz)
BMT (Drs. O’Reilly, Boulad,
Kernan, Small, Prockop,
Scaradavou)
Meet the Staff
M9 Inpatient Service
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GREEN Team – general oncology
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Attending
Fellow
PGY-3 senior resident from
Downstate
3-4 PGY1/PGY2 from Cornell, St.
Barnabas, Harlem, Lincoln
2-3 NPs (Courtney, Rebecca,
Angela)
Case manager (Megan Behringer)
BLUE Team – BMT
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Attending
Fellow
PGY-3 senior resident from
Downstate
3-4 residents from Cornell,
Downstate , Metropolitan
NP (Heidi)
Case manager (Megan Behringer)
The Nurses
Role of the Nurse Practitioners on M9
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Provides continuity of care for patients
NPs fulfill several roles on the inpatient unit
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Patient care
Work-flow facilitator
Education
Administration
NPs do not work on weekends and thus their patients
are covered by housestaff on weekends
Surgical NPs (Carol, Courtney, and Rebecca) take
primarily post-op surgical patients. If there are not many,
they will then assume responsibility for general oncology
patients
Role of the Fellow
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Mentor, supervisor, educator
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There is ALWAYS a fellow
available
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Fellows are notified about all
admissions to the floor
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Fellows are responsible for
writing all of the chemotherapy
orders for all patients
Housestaff at MSKCC
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6 residencies throughout NYC: Cornell, Downstate,
Lincoln, Harlem, Metropolitan, St. Barnabas
Without you, MSKCC cannot function!!
Primary caretaker when patients are admitted to M9
Typical census = 5-6 patients/resident
Responsible for all orders (medications, IVF, diagnostic
tests [labs, radiology], admission orders, discharge
orders) except chemotherapy
Prescriptions upon patient discharge
Admission notes, daily progress notes, acceptance
notes, discharge notes, off-service notes
Role of the PGY-3 Senior Resident
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Works closely with the Pediatric Chief Resident, Pediatric Fellow
on-service, and the Pediatric Attending
Serves as a knowledgeable resource of general pediatrics to PGY1 / PGY-2 residents, nursing staff, and NPs
Supervises PGY-1 and PGY-2 residents on the rotation
Responsible for knowing all of the patients on their team
Takes on patients and/ or does admissions/ discharges of their own
when necessary
Aids in the distribution of admissions
Takes in-house, overnight call 4-5 times a month
Attends own continuity clinic at their home institution
Attends Tuesday and Friday Morning Report in addition to all
resident conferences (core lectures, tumor boards, grand rounds)
Role of the Chief Resident
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Assists with new resident orientation
Maintains communication among the resident staff and pediatric
hematology/oncology fellows.
A liaison to the pediatric administration, nursing, and all ancillary
services to improve work relationships on the inpatient unit
Identify issues and work on solutions to improve resident well being
and patient care
Make the schedule of rotating residents, provide residents with feed
back on progress, complete resident evaluations, communicate
with Outside Chief Residents
Organize daily noon conferences, give didactic lectures on topics of
interest in general pediatrics and pediatric hematology/oncology
Be informed of all “sick” patients on M-9, provide advice to
Attendings/ Fellows/ Residents regarding patient care
Admissions
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Fellows are notified of all admissions to the floor
Patients being admitted will be posted on the patient
board on M9
Typically, admissions from 9am-5pm come from the PDH
after being assessed by the primary team
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Once a patient’s name has been posted on the admission board,
you do not have to wait until the patient physically comes onto
the floor before evaluating them. You can go to the PDH to start
the admission process.
After 5pm, they usually come from UCC after being
assessed by the fellow on-call
Many patients come with typed admission notes BUT
this does not mean you don’t take a full H & P on all
admitted patients.
Discharges
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Anticipate discharges so you can get prescriptions filled
and follow-up appointments set-up early on.
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Communicate with the case manager, Megan (b. 4547,
x2331) for setting up home-care, getting supplies, etc.
requires advance planning
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Discharge orders and instructions are computerized in
HIS
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Please write a discharge note summarizing the hospital
course/admission
Consults
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Main MSKCC page operator =
7900 or 2000
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Contact main MSKCC page
operator to obtain numbers to call
(telephone and/or pager) for most
consults
Medication Reconciliation
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Accurately and completely reconcile medications across the
continuum of care.
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Definition
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Implement a process for obtaining and documenting a complete list of
the patient’s current medications upon the patient’s admission to the
organization with the involvement of the patient.
This process includes a comparison of the medications the organization
provides at admission, transfer, and discharge to the medications on the
list.
A process for obtaining a complete and accurate list of the patients’
current home medications , including OTC’s and herbals, and
comparing the practitioner’s admission, transfer, and/or discharge
orders to that list.
Instructions found in Resident Manual
A “typical” day
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7 am: sign-out/sign-in (weekdays/weekends)
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Pre-round on your patients, obtain vital signs, I/Os, PCA doses/
attempts
RENEW ORDERS for IVF and narcotics
9 am: Start of attending work rounds
11 am: Radiology rounds in PDH classroom (M-F)
1 pm: Core conference and lunch (M-F)
2 pm – 5 pm: Admissions, Discharges, etc.
5 pm: sign-out (weekdays/ weekends (buddy system))
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Enter AM lab orders for next day
Weekday call
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On weekdays, call starts at 5 pm
You will never be asked to cross-cover other team
On-call resident is responsible for all admissions to the
floor after 5 pm
There is always one fellow supervising. On-call fellow is
responsible for both teams on M9 as well as the Urgent
Care Center
Responsible for making sure all AM labs are appropriate
Midnight rounds with on-call fellow
A call room on the floor is provided; meal cards for
dinner are provided
Weekend calls
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Sign-out starts at 7 am
Attending rounds start at 9 am
On-call resident responsible for daily progress notes on
all patients on the service (may be typed or written)
On-call resident responsible for all admissions,
discharges, and transfers from the POU
Will be supervised by one fellow per team (unlike
weekdays)
Cafeteria closes at 7pm on weekends
Midnight rounds with on-call fellow
Gets AM vitals and I/Os of all patients
A call room on the floor is provided; meal cards for
dinner are provided
Call schedules
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Adheres to ACGME rules (<80 hours/ week)
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Call schedules are made monthly by the Pediatric Chief Resident
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Can be found on-line in Pediatrics shared drive
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Please let the Pediatric Chief Resident know if there are any conflicts, emergencies,
illness as early as you can
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Tawana Winkfield-Royster: [email protected]
Long range pager 917-205-4091, In-house pager #2244, Office x 8398
HIPAA Training
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Currently MSKCC requires that all of its rotating
residents complete its on-line HIPAA training course
(takes at most 40 min)
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START  Reference Manuals & Tutorials  Computer Based
Training  HIPAA CBT
Sign in with your MSKCC employee ID# found on your ID tag
Choose “All Users” under ‘Job Function’
Choose the curriculum labeled “All Other MSKCC Users”
Then make sure to complete the required courses (HIPAA
Awareness and HIPAA Security)
PLEASE complete this as soon as you can…and give
me the certificates when you are done
Computer Information
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Passwords found on back of “white card”
Healthcare Information System – central hub for all
clinical information at MSKCC; integrates order entry,
labs, medical records, radiology, pathology, on-line
databases (UpToDate, Lexi-Comp), on-line calculators
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On-line tutorial = http://mskcbt.mskcc.org
Username: “pedteam” / Password: “pedteam” sign-on for
all computer workstations
Start  Programs  Accessories  Windows Explorer
Peds Shared Drive = H:-drive
On-line HIS Tutorial
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Can be accessed from within
MSKCC or at home
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http://mskcbt.mskcc.org
Log in using "New User“
Then take course called "Clinical
Systems"
Peds Shared Drive (“H:-drive”)
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Must log-in to computer station using “pedteam/pedteam”
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Contains notes, schedules, resident resources
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Start  Programs  Accessories  Windows Explorer
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For inpatient admission/progress notes:
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For monthly call schedule
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H:\notes_M9\M9_GREENTEAM_ONC\M9_GREENTEAM_ONC
H:\notes_M9\M9_BLUE TEAM_BMT\Blue Team_Progress_Notes
H:\Pediatric On-Call Schedules\Fellows Schedules\On Call Schedule
H:\Residents  you will find orientation materials, lecture slides,
review articles, handy databases, etc.
Housekeeping
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Every morning, please renew all IVF and PCAs/narcotics
after checking AM labs and obtaining vital signs
Please also renew all medication orders promptly
Blue meal cards are provided for meals on-call only:
$5.50/meal
Please return all beepers to “beeper drawer” at end of
each day
M9 Hallway Bathroom code = 27368
Important phone numbers:
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Chief Resident: Tawana x2923
Wendy Werner: x 5966
Alexander Chou, MD: 6057, beeper 917-205-1757, e-mail:
[email protected]
When in doubt, please ask
Don’t worry, you’ll be just fine!!