PEDIATRIC  ORTHOPAEDIC  SURGERY

 

Resident Guidelines - PEDS 2

 

INPATIENTS:

 

 

A.  The following are suggested:

  • Please enter notes daily on all patients; also, same-day post-op check on all  patients.
     
  • Please allow the attending to write summary part of note and sign.
     
  • Please print list of all inpatients and rooms each morning before rounds and  include prior days' laboratory results.  Include needed work.
     
  • Whenever patients are admitted emergently and are in pain, please call the Pain Service to request PCA.  The beeper is 3-2060.  This also applies to night cases. Ask the anesthesiologist to call the Ped pain service while you are doing the case. It must be a doc-to-doc call.
     
  • If you are requesting assistance from Pediatric Residents (drawing blood,  starting IV, checking doses, etc.), please communicate with them in person.  They are usually very willing to help.
     
  • Consults should be seen by residents initially and staff by requested attending, or by Attending-of-Week if unspecified.  Let staff know the day you receive consult, so they can plan ahead.
     
  • Please study cards provided by Pediatric Pain service.  Check your doses carefully. You do not need to specify the volume of liquid medication, only the dose in milligrams.  This should decrease errors.   Please be sure to prescribe enough pain med upon discharge; running out of medication is a frequent and aggravating problem.   Be aware that liquid oxycodone is not available in many pharmacies, so try to anticipate the need for this and let parents pick up discharge meds before the weekend.  To request Pediatric Pain service after hours, beep 3-2060.
     
  • When removing casts from young children, remember that the skin is more sensitive than it is in older patients. This is especially true when the patient is asleep and cannot tell you when they feel the saw. Cuts from the cast saw occur periodically and we want to try to avoid them as much as possible. Use the cast saw carefully. Plan your cuts to avoid bony prominences, flexion creases or particularly thick areas of the cast. Place your finger under the cast to get a sense of depth. 
     
  •  Remember to add time of day and you physician ID# to your orders.
     
  • Technically, we cannot write orders on patients not on our service. Contact the patient's  attending service to write the orders, schedule the tests etc.
     

B. Medical Students

  • When present on rounds, discussion of patient's pathology should be included when appropriate.
     
  • Encourage students to examine all pre-op patients, especially those they will be able to observe. If time permits, review physical exam with them, and suggest readings. A collection of CIBA Pediatric Orthopaedic Symposia is available for students through the office.
     

C. Cerebral Palsy & Myelomeningocele Patients:

  • When dictating discharge notes on Cerebral Palsy or Myelo patients, have a copy sent to the appropriate clinic at KKI.
     
  • The date for cast removal after discharge or transfer should coincide with one of our clinic days, so that the patient can be seen by an Attending or Resident.
     
  • On patients transferred to Kennedy or Mt. Washington, please make clear all dates for cast removal, clinic visit or transfer, and have a copy of discharge sheet sent with patient. Contact clinic supervisor to authorize cast removals.
     

D. Attending Coverage

  • One attending will be assigned to service coverage including daily x-ray and Team Rounds, Pediatric Resident Clinic Coverage, Trauma and Consult staffing.
     

E. Discharge Summary

  • Please send a copy to referring doctor. This is listed at the bottom of our H & P.

 

 

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