Surgical CT Princess Royal Hospital Information
A previous PRH surgical F2 writes some advice to future F2s here. The F2 posts have now subsequently been changed in to CT core surgical trainee posts.
Induction to Princess Royal Hospital for Surgical F2s
Contents:
Consultants operating
Layout of wards
Where to go
Handover
Bleeps
Daily commitments
Consultant preferences
Teaching
Leave
Health and safety
Clinical incident reporting
General Surgery (Upper and lower/colorectal GI) Consultants Operating
Mr Etienne Moore
Mr Phil Ridings
Mr Paul Farrands
Mr Jeremy Clark
Mr Peter Hale
Mr Don Manifold
Mr Marc Lamah
Mr Mokthar Uheba
There are also occasional Vascular consultant lists
Layout of Wards
ANSTY WARD – this is a day ward (it should not have patients at night, and is usually closed over night). ALL patients will be placed on Ansty ward pre-operatively. Most day cases patients will then return to Ansty post-operatively.
HURSTPIERPOINT WARD – This is a medical/surgical ward. It is where the patients who are not day cases will be transferred and managed post operatively.
ALBOURNE WARD – this is an orthopaedic ward, occasionally due to bed pressures post operative patients can be transferred and managed here.
Where to go
The hand over is traditionally the first Wednesday of the designated month. The bleeps will be waiting for you in the Surgical Office. This is located on the first floor opposite Twynham Ward. Once you have picked up the bleeps it is best to go to Ansty ward (also on the first floor) as this is where the consultant operating that day will begin his pre-op ward round and consent each patient.
Handover
Each morning the secretaries very kindly place a list of the planned procedures for that day on the desk in the Surgical Office. If you cannot find this list one can always be obtained from the secretaries who are located on the same corridor as the Surgical Office. A copy of this list will also be displayed on the wall in Ansty ward (this list will also display which beds the patients are in).
A computerised record of the inpatients is not kept for general surgery, this is because most cases are day-cases and the turnover is so high it would not be efficient. However, on the day of handover the leaving team should leave a computerised list of the current in patients, their planned procedure, any problems, and their planned treatment. This list should be left on the desk in the Surgical Office. It is the only way to ensure a safe handover of patients.
Example:
Patient Details
Location
Planned Procedure
Problems
Plans
Bleeps
There are two bleeps for general Surgery bleep 038 and 230.
Bleep 038 is the more commonly used bleep and functions as the on call bleep.
Daily Commitments
Meet the consultant operating each day on Ansty ward at 8am. They will do a round of the pre-op patients and gain consent.
Review the in-patients. There will always be a number of patients who remain overnight. This is either due to co-morbidity, late operating time the day before, planned admission (some operations require a longer stay) or complications. These patients need to be seen daily. If there are any problems there is usually a consultant or registrar operating who can be asked for advice.
Carry out all routine requests made by ward nursing staff daily, such as re-writing drug charts, writing TTO’s, acting on messages left in the ward doctors book, review the need to continue intravenous fluids and medications daily, sign results promptly so that they can be filed.
Although most consultants will bring their registrar with them, it may be necessary for you to assist in theatre. This is almost always the case when there are registrar operating lists.
Pre-operative clerking is primarily nurse led, but you may be contacted about any queries/ abnormal ECGs etc. However, all patients who are to be operated on at the RSCH site require a pre-operative clerking carried out by a doctor. These are carried out in the Hicksted Unit (ground floor). The nurses will bleep you when the patients are ready to be seen.
After 5pm the general surgery and orthopaedic wards are covered by an on call F2/SHO. They carry bleep 040. This is one of the orthopaedic bleeps. It is best to bleep and collect it just before 5pm. The rota is a combination of orthopaedic and general surgery F2s / SHOs / trust grades. See emergencies promptly at the request of ward staff. If there is a problem discuss this with the on call SpR via switch board. If the problem is medical contact the medicine SpR on call (bleep 044).
At night the hospital is run by the Hospital at Night team (H@N). You are part of this team led by the medical SpR. Although your main role is to cover the surgical and orthopaedic wards you may be required to assist the physicians with basic tasks if they are very busy. H@N means cross cover under the leadership of the medical SpR as team leader.
Referrals from other specialties – medical referrals and neurology/ neurosurgical referrals may be seen by yourself initially and investigations obtained. ALWAYS discuss these with the SpR as transfer of the patient to RSCH may be appropriate.
Consultant Operating Schedule
Monday – Uheba / Lamah
Tuesday – Manifold / Hale
Wednesday – Moore / Ridings
Thursday – Clark / Farrands
Friday – An afternoon list (consultants / registrars vary)
There are also Ad Hoc SpR/Trust Grade lists throughout the week.
Consultant Preferences
Mr. Uheba likes someone to assist him with his afternoon clinic on a Friday.
Mr. Moore likes the consent forms to be filled out (although not signed) before his ward round on a Wednesday morning to get surgical F2s thinking and learning about what is important for surgical consent. He will fill in anything that is missing on the form and then use it to gain patient consent with his signature. As you progress in your F2 post you will find that you make less and less mistakes on the consent form and you will leave knowing how to consent for routine surgical ops such as laparoscopic cholecystectomies and hernia repairs.
All consultants like to have a recent (last 6/52) set of blood results (LFTs) and a copy of the latest ultrasound printed and attached to the front of the notes for all cholecystectomy patients.
Teaching
There is a weekly tutorial programme for F2s which is compulsory. This is on a Monday between 12.30-2pm. It is usually held in the clinical skills room on the second floor, opposite the education office. Lunch is provided.
Leave
Adequate notice of leave must be given. A leave form must be filled out and cover arrangements signed by your colleagues. Only one member of the team is permitted to be away OR on nights at any time. Book this well in advance and do not leave it until the end of job as it may not be possible to take your full allocation. The leave forms must also be signed by Mr. Ridings.
Health and Safety
All staff have a responsibility for health & safety, and should make themselves familiar with the health & safety policies which can be found in each clinical area and on the hospital’s intranet.
The fire bells will either be:
Intermittent – Fire alarm in adjacent area. Close doors and windows and prepare for evacuation if it becomes a continuous ring
Continuous – Indicates that the fire is in your immediate area. The area should be evacuated by lateral evacuation into a neighboring area behind a set of fire doors.
Clinical Incident Reporting
An important part of reducing risk involves the reporting of incidents and near misses.
A Clinical incident (or adverse healthcare event) is defined as:
“An event or admission arising during Clinical Care causing physical or psychological injury to a patient.”
Near misses can be defined as:
“An unplanned event which does not cause injury, damage or loss, but has the potential to do so.”
The incident reporting system allows the Trust to investigate incidents quickly, to review practice and to identify trends and patterns. It also allows any problems resulting from inadequate procedures, lack of training or pressure of work to be identified and resolved as soon as possible. The Trust expects all staff to participate in incident reporting and co-operate fully in any investigation. Each incident will be investigated, and appropriate action taken in consultation with all those involved. All disciplines of staff can expect to be treated fairly and equally.
Please report all clinical incidents immediately to:
Clinical Risk Manager, on extension 5616.
Ben Talbot, Surgical PRH F2, March 2009
