From WardWiki - Foundation Doctor Helper
This article covers patients as seen on a normal ward round. Wardwiki believes the most senior member of the ward round should be at least a fully registered doctor; F2 or above. House officer ward rounds yield very little information and practical management and can result in problems being missed early on.
They are also completely unsupervised and run contrary to the training programme laid out for foundation doctors. Making sure the ward round goes smoothly requires much preparation from the house officer, that is sadly taught seldom during undergraduate training. Try to look ahead for potential questions from the consultant and be ready with appropriate answers.
Before the ward round
- Have a jobs folder
- Have a work list with patient details, clinical problems, medical history, key investigations, results and referrals
- Go through the notes, drug cards, obs charts and results. Know your patients.
- Document relevant investigation results in notes, or print out results if practical
- Make sure all pages in the notes have a patient detail sticker and that there are enough space and paper to write on
- Check times for outstanding investigations
- Ensure the outstanding tasks fromt he day before have been carried out
- Think about management issues you want answered
During the ward round
- Ensure a nurse to come join you. much time is wasted later filling gaps in a the nurses' plans.
- They are also useful for chaperoning
- Alternate note writing, it is impossible for one doctor to document in every set of notes.
- Thrust alternate sets of notes into the keen arms of the older house officer, the SHO, to make them feel more included. This incidentally ensures they write in half of the notes, freeing up your time.
- Always present a patient using the same logical way. "Mr Jones is a 52 years old man which presented with 2 days of vomiting", then past medical history, investigations results and management plan.
- Spare time can be used to fill out blood and x-ray forms; keep a few spares with you
- Make sure to ask consultant about further management issues; i.e. stop antibiotics, switch to oral antibiotics, continue iv fluids, when to be seen in clinics after going home. IV medicines consume much nursing time, the less they hae so the more time they have to help foundation doctors.
- Be honest! Do not make results up if you have forgotten to do something, nor be rattled if a senior expects you to know the serum albumin of a random patient by heart; those days have long gone happily; leave the results up on the the computer.
After the ward round
- Divide jobs among the team members
- Prioritise the jobs. Always identify the critically ill patients and do their investigations first.
- Urgent clinical, urgent clerical, non-urgent clinical and non-urgent clerical is the right order
- Ask senior advice early on if you are unsure how to perform a job.
Note entry example
19/06/10 WR Mr Roberts 08:45am Day 2 post cholecystectomy Patient comfortable, pain controlled and apyrexial No nausea or vomiting, passed stool this morning Good urine output Obs: BP 130/80, Pulse 78 Temp 36.7 RR 16 Sats 96% on room air. O/E: Abdomen soft non tender, wound clean Plan: - Recheck bloods inc. LFTs - Drain out tomorrow - Can eat and drink - Aim for home tomorrow, clinics 6/52 K. Webb F1 - Bleep 124