Wards
Wards:
Ward 30 & 31 - Orthopaedic trauma / elective wards
Ward 32 – Day cases / short stay patients / TCI patients (NB The Wells Suite is next door & this is the private ward. These patients are not seen by orthopaedic juniors except at the request of your seniors)
Hedgehog / Woodlands – Paediatrics wards
SAU (surgical assessment unit) – This tends to be an overflow of A&E & patients are often transferred here if they are approaching their 4 hour time limit in A&E. However, patients may also stay here for a day or so.
Outliers – Patients may be transferred to several other wards due to bed shortages including AMU, Gynaecology, Ward 20 (medical), Ward 10 (medical), ITU.
The ward and post-take SHO shift (08:00 - 17:00)
Post Take Ward Round
This is led by the consultant who was on call the day before, attended by the team SpR and trauma coordinator. Trauma coordinator and the theatre staff will need to know if there are any new changes to the trauma list. The new set up of juniors within the department means a single junior will now be ‘on-take’. This means if any take patients fall into your allocation, you must be present during the post-take round so you know the plan. The round will come to you (or more accurately your patient), just make sure you’re around.
Daily Ward Round
All patients must be seen daily. Ward rounds are often done by the consultant / SpR, but you will also have to do your own ward rounds at times. Remember, senior help is always available for advice. If you can’t contact the SpR or consultant responsible for the patient then the on-call SpR may be able to help.
Notes should be written clearly to include:
- Time and date
- Names of people on the round
- Problem list
- Observations
- Investigation results
- PLAN
- Signature and bleep no.
Things to consider:
Observations recorded (inc bowels & urine output)
Post-op plan – see Operation Note
Post-operative haemoglobin level / recent bloods
Cannula or urinary catheter - still required?
Prophylactic LMWH & TEDS
Sometimes you will need to make referrals to Tertiary centres (e.g. for plastic surgery). Many of these referrals are done online. We are made an easy access page for these various referral portals.
If you don’t know what the plan is or if you have concerns you should ask a senior.
Always communicate your ward round plans to nursing staff, physiotherapists and other relevant health care professionals. Merely documenting that you want an MSU sent will not guarantee it goes – tell the staff nurse looking after that patient!
Consultant and SpR ward rounds will commonly be dictated and your consultant’s secretary will type and place the dictations in the notes. Sometimes this can take a few days so it is best to document important plans from these ward rounds as the round progresses. It is also your responsibility to check the dictation has made it into the notes.
Patients who return to the ward following an operation will have a post-operative plan written by the surgeon. These are either typed or hand-written in the medical notes. The post-operative plan will contain information regarding post-operative x-rays, bloods, weight-bearing status, need for antibiotics, discharge planning etc. Follow them!
When discharging a patient write the EDN at least a day in advance so medications can be sent from pharmacy. Write a full primary diagnosis and all secondary diagnoses on the EDN because it is from these diagnoses that the Trust is paid by the PCT for caring for their patients! NB it is good practice to do EDNs as early as possible (if for nothing else to stop nurses bleeping you!). Patients should not be discharged unless you have stated clearly in the notes that they are medically fit (although it can happen if their EDN is done!).
The Twilight SHO shift (14:45 - 22:45)
Orthogeriatrics
There is an orthogeriatric consultant who sees all #NOFs, and will compile a medical management plan. As there are no OG juniors, it is YOUR responsibility to action the plan. Standard bloods include Vitamin D, B12, Folate, LFTs, TFTs, Calcium.
Most patients will be vitamin D deficient so need replacement. We use cholecalciferol 50000 units OD for 5/7 followed by maintenance of 1600 units for 3 months. Adcal-D3 is an alternative for maintenance after these 3 months or if they are not deficient when initially tested). Alendronic acid if no contraindications (ie GI bleeding or renal impairment). Does the patient need a DEXA scan? Do you need to do a myeloma screen? See Prescribing below for further information. Occasionally some patients are ‘missed’ by the Orthogeriatricians and these should be flagged up to them as soon as possible. It is also important that all the patients have their Abbreviated Mental Scores (AMTs) recorded both pre and post-op.
We aim to get all our #NOFs within 36 hours of admission (or diagnosis) so please ensure they are appropriately worked up beforehand.