Transcript Orientation: Surrey Memorial Hospital

SMH Psychiatry:
Intro to Call, Notes & Orders
Dr. Arun Jagdeo
PGY–V
January 2016
[email protected]
http://genesix.ca/residentPortal
SMH Psychiatry
• Introductions
• Attending psychiatrists
• Rotations
• Review the portal:
• http://genesix.ca/residentPortal
Safety
• Safety is paramount
• When in doubt, let someone know of your discomfort and exit the
situation
• Panic buttons on units
• Ekahau tags in ER
• Nursing/Security to be present when entering security room
• Review, throughout the rotation, safety issues and skills including de–
escalation
On–Call
• 4 evening calls & 1 weekend call
• Attending & resident will be in house with you
• Review of your contact information to ensure it’s up to date
• If your scheduled attending or resident are not in the ER when you
arrive, contact them
• Weekdays
• 5pm–11pm (in–house, i.e. you’re on site, physically, in the ER)
• Weekends
• 9 am until the work is done (in-house)
• Your responsibility to ensure coverage–can switch with same level for
same type of call » must notify the chief residents asap so we can
update the call schedule
Psych Call
• Weekday call = new assessments
• Weekend call = new assessments & follow ups
• Do not see patients on your own before first discussing with your
staff
• Discuss with attending/resident:
• Which patients you will see (aim is to enhance and optimize your learning
through diversity of experience and addressing areas in which you may
require more in–depth learning)
• You cannot discharge any patients on your own
• Review the patient history, labs, imaging, mental status examination,
impression and plan with the attending
• If senior resident on call (PGY–4 or PGY–5), they may ask you to review with
them first before you review with the attending
• Ask lots of questions, and when in doubt, ask!
Inpatient
• Units
• 4 east (4E)
• 4 west (4W)
• PAU (Psychiatric Assessment Unit)
• Inter–disciplinary rounds times vary depending on attending
• Usually in morning, once weekly
• Room across from Connie Staley’s office
• You will interact with members of the inter–disciplinary teams on the
units
Inpatient
• Daily assessments
•
•
•
•
•
Review nursing notes
Review use of PRN medications, especially over the last 24h
Use of SR (seclusion room) over last 24 hours?
Any messages on psychiatrist clip–board?
Any medical issues being reviewed or pending for review by hospitalist?
• SOAP notes
• See example
Dictations
• Dictation systems & codes
•
•
•
•
•
•
•
1-855-666-3240
Personal dictation ID
Facility code = 17
Work type = 104 (consult), 107 (discharge)
2 = start/stop
5 = end
6 = flag as urgent (all ER consultations should be flagged as 6)
• “this is ____ dictating for Dr. XXX” at the start of each dictation
• Outpatients: Discuss dictations requirements with Dr. Martina Smit
• Inpatient: All discharges must be dictated
• ER: All consultations and discharges must be dictated
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/Legal 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
•
•
•
•
•
Psych ER Orders sheet
AD-DAVID
Don’t forget nicotine replacement therapy
Consulting other services
There is a pre–printed order sheet @ SMH ER that is printed as part of the
admit pack; you can check off many things, but specific medications will need
to be put in via your own handwriting; confirm all orders with
attending/resident
• On unit
•
•
•
•
Levels of observation
Day passes – specify accompanied or not
Overnight or weekend passes – write “with meds”
Consult social work (SW), occupational therapy (OT), etc.
• *write reason for the allied health consultation in orders
Expectations
• Know & utilize MediTech
• Utilize various sources of collateral information
•
•
•
•
Family, police (ER)
GP or community psychiatrist
Prior consultations
Police/law enforcement
• *do not give any information about the patient to law enforcement; only get
information from them
• Professionalism
• Check with attendings/residents
• Remind them of your scheduled teachings, half-days, in addition to
informing them at the start of your rotation
• Complete the safety checklist at the start of your rotation
Teaching Schedule
• MSI Teaching on various topics, schedule is TBD, mostly early
weekday mornings
• Friday Mornings
• Journal club 1st week
• Psychopharmacology rounds 2nd week
• Grand rounds 3rd week
• Most Fridays 11:45am–1pm
• OSCE rounds
• Occasional Fridays
• Jeopardy August 8th
• Ask lots of questions on the rotation!
MSI Teaching
• Core psychiatry lectures
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
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
Others…
• Most lectures posted on http://genesix.ca/residentPortal; if any materials
are not there, please ask your chief residents
• Any questions? E-mail chief resident(s) @ [email protected]