Tripple Threat

Night Float Sign-out

I thought I would send you some documents relevant to the life of night float. The document on ENT-urology-plastics nightfloat is very helpful. The only change from that is the current Plastics chief prefers pt numbers Beneath the name (i.e. exactly the same as Urology list), 4 spaces in between each pt for Main list, no space in between for Consult list (paste on same page).

In brief, my night routine is as follows: Pre-6PM:  - print out daily progress notes for 3 services, fill in names/ MRNs / 1 liner background assessment - print out Urology and ENT OR list for next day; Urology is BICS --> se --> uro + BICS --> st --> uro (compare/contrast/supplement); ENT is BICS --> se --> OTO (double-check stàE.N.T too since some cases get added on); Plastics OR list may still change at night whenever chief assigns residents to all of the cases and in case of add-on's so it is best to print out Plastics OR list after MN for up to date info (BICS --> st --> PLA); Dr. B. Pomahac's cases also sometimes do not show up on the plastics list, so do a quick search by surgeon to verify that any Pomahac cases are on the OR list. Ơ        Print urology, ENT, plastics surgical schedules & format to fit one page. In BICS you can copy and paste into a word document (font=courier new; margins=0”). Select is CTRL-SHIFT-M. Copy is CTRL-Insert. Paste into word CTRL-V

6PM:  - sign out Urology (17000), ENT intern (35221) 8PM:  - sign out Plastics NP (14000) 00:01 or as soon after MN as possible: - print Plastics Main (4 spaces in between), Plastics Consult (0-1 space in between) on the same page, & Urology Main (4 spaces in between, + Additional Information) lists from BICS - print Plastics Main and Urology Main Inpatient Sign-out info from BICS --> utilize this to fill in on the lists: Top row : HD/POD | Antibiotics w/ day # (C = cipro, L = levofloxacin, V = vanco, An = ancef, F = flagyl, Lin = linezolid, Clin = clindamycin, cefepime/ceftriax/ceftaz need to be written out; note that antifungals are often Not listed under "Antibiotics" section of the Sign-out sheets, must scrolls through meds to see Ertapenem/Tigecycline/Imipenem/etc); Bottom row : Nutrition | Fluids @ rate (or HL) | Anticoagulation (SCH/hep gtt @ #/fragmin/coumadin/plavix/bival) | pain meds (oxy, tyl, MS, dil, dil PCA, bupiv pcea, onQ for plastics DIEP pts) - print ENT list from www.hotmail.com, username: longwoodorl@hotmail.com, password: bwhbidmc - look for the most recent email with list attached (note: this may be further updated in night/AM by the senior consult resident, so check back before 5AM to ensure no alterations to list) - print Plastics OR list, tape and shrink 78% (if originally 2 pages) or 50-64% (if originally 2.5-3 pages) to condense onto 1 page

12:30-3AM: - gather numbers, check on patients' flaps and incisions as appropriate while rounding During the night:  PLASTICS: Plastics senior takes care of all consults at night - DIEP flap patients require the most vigilent attention/regular checks throughout night on POD 0; see attached DIEP Protocol; things to note are: Doppler signal, Vioptix, room is at 80 degrees (floors will often neglect this detail, ICUs usually remember), pt on 6L oxygen via NC no matter what (100% saturation is not good enough, must maintain on 6L) - VAC troubleshooting : a non-functional VAC is a breeding ground for infection; VACs must Not be off for more than 2 hrs; most of the time, changing of the tubing or extra air-proof tape can fix suction issues, have nurse order VAC sponge (which comes with the tubing) via BICS; if the sponge itself has to be changed, call Plastics senior if uncomfortable with procedure; when rounding for numbers, peek in to make sure VAC is working - often they get unplugged/run of battery/get disconnected when pt goes walking, which lies unreported for multiples hrs

UROLOGY: hematuria, Foleys, outside patient calls, 1st pass at consults before calling senior (although consults are not officially your responsibility – feel free to defer to on-call resident)

ENT: ENT senior takes care of all consults at night

5:20-5:45AM: plastics sign-out first since they round at 5:45 in Cutler; ENT/Urology signs out before 5:50; if the Plastics intern is the night-float, the ENT and Urology interns must finish sign-out Before 5:40 to allow the Plastics intern sufficient time to get to rounds.

Photocopying : - Tower 16 (close to 16B), Tower 12A, Tower 1st fr (Sharf Administration office), Shapiro 8 - 10 copies for Plastics (given PA, residents, sub-I, med student) - 6 copies for ENT - 5 copies for Urology

Door codes: ENT 2+4, then 1; Plastics/Urology 3+2, then 1.

Misc: ask to be added onto the respective email lists for the week that you're on night float to be in the loop for late post-op pts, consults O/N to be added to list, etc

Urology- virtual beeper 17000- sign this out to you

List for order entry: sign into BICS

                                       L (Patient List Options)

                               R (Roster of Patients)

                                       Type ‘URO’ and hit return, scroll down to ‘Urology/labs’

OR schedule: B (broadcast OR schedule)

                               ST (service)- ** different from ENT

                               URO (urology)

                               From date

                               To date

                               Number of copies: 1 (usually just 1, will copy later)

                               Output to printer: hit 'Y'

Do the same with the SE list and compare to ensure no cases are left off.

Rounds: time varies, usually 4B, page 17000 in AM if they haven’t called you by 5:45 for signout

Making list:

               List: use BICS list as above, to print:

<p style="margin: 0in 0in 0pt">                               -alt P, 4 spaces between lines, add horizontal lines and additional information

<p style="margin: 0in 0in 0pt">                               - alt P again and it will print

<p style="margin: 0in 0in 0pt">               Numbers: put postop/hospital days, then antibiotics, then vitals and I/Os all BELOW

<p style="margin: 0in 0in 0pt">                               THE LINE (though this varies by chief, so check w/ resident when you start)

<p style="margin: 0in 0in 0pt">               Photocopy OR schedule (above) on back of list, usually requires shrinking to fit on one

<p style="margin: 0in 0in 0pt">                               page

<p style="margin: 0in 0in 0pt">Updating list: usually not applicable

<p style="margin: 0in 0in 0pt">Consults: NOT OFFICIALLY YOUR RESPONSIBILITY. you will get paged first for consults, and in general, can handle them w/ phone support from you senior; if you think you can handle it (i.e. Foleys), place the Foley, quick note, no need to call senior; for more complicated ones, call senior to see patient

<p style="margin: 0in 0in 0pt">Foley consults- general rule is an MD from the primary service MUST try first, not just the RN, so if you get called for difficult Foley, always ask if an MD has tried - for variety of Foleys (sizes, Coudes), cysto suite on L1 has plenty

<p style="margin: 0in 0in 0pt">ENT- virtual beeper 35221- sign this out to you

<p style="margin: 0in 0in 0pt">List for order entry: sign into BICS

<p style="margin: 0in 0in 0pt">                                       L (Patient List Options)

<p style="margin: 0in 0in 0pt">                               R (Roster of Patients)

<p style="margin: 0in 0in 0pt">                                       Type ‘OTO’ and hit return, scroll down to ‘Otolaryngology/labs’

<p style="margin: 0in 0in 0pt">OR schedule: B (broadcast OR schedule)

<p style="margin: 0in 0in 0pt">                               SE (service) **different from urology/plastics

<p style="margin: 0in 0in 0pt">                               OTO (otolaryngology)

<p style="margin: 0in 0in 0pt">                               From date

<p style="margin: 0in 0in 0pt">                               To date

<p style="margin: 0in 0in 0pt">                               Number of copies: 1 (usually just 1, will copy later)

<p style="margin: 0in 0in 0pt">                               Output to printer: hit 'Y'

<p style="margin: 0in 0in 0pt">Rounds: 6AM in 4D call room (room labeled "ORL-HNS Surgery"); for signout, go to 4D to meet team, or you’re on urology/plastics, page ENT pager 35221 or whoever’s on call that day to sign out and drop off lists

<p style="margin: 0in 0in 0pt">Making list: ** very different from any other service, including urology/plastics, all gen surg

<p style="margin: 0in 0in 0pt">               List- hotmail.com

<p style="margin: 0in 0in 0pt">               login: longwoodorl@hotmail.com

<p style="margin: 0in 0in 0pt">               password: bwhbidmc

<p style="margin: 0in 0in 0pt">               Numbers: put vital signs in each box

<p style="margin: 0in 0in 0pt">               Photocopy OR schedule (above) on back of list, shrink if necessary

<p style="margin: 0in 0in 0pt">Updating list:

<p style="margin: 0in 0in 0pt">               Check your e-mail throughout night, if seniors e-mail about consults and ask you to add

<p style="margin: 0in 0in 0pt">               them to the list, add a separate line in the appropriate consult section and fill in info

<p style="margin: 0in 0in 0pt">               Change room numbers and position on list as patients move out of PACU

<p style="margin: 0in 0in 0pt">               Send new list as hotmail attachment in AM before you leave

<p style="margin: 0in 0in 0pt">Consults: YOU DON’T DO CONSULTS- if you receive a page for an ENT consult, page the ENT senior or forward the page to them

<p style="margin: 0in 0in 0pt">Plastics- virtual beeper 14000, sign out to you at 6 unless Katy Swanson (NP) is working- she works till 10PM and will cover floor, she’ll page you for signout

<p style="margin: 0in 0in 0pt">List for order entry: sign into BICS

<p style="margin: 0in 0in 0pt">                                       L (Patient List Options)

<p style="margin: 0in 0in 0pt">                               R (Roster of Patients)

<p style="margin: 0in 0in 0pt">                                       Type ‘PLA’ and hit return, go to 1st option ‘Plastics’ (NOT ‘Plastics/labs’)

<p style="margin: 0in 0in 0pt">                                       ***Plastics list has a lot of patients that are not primary plastics patients; you

<p style="margin: 0in 0in 0pt">                                               still have to get numbers on them as they will show up on this list, but you

<p style="margin: 0in 0in 0pt">                                               should not get paged for orders; plastics primary patients will be indicated

<p style="margin: 0in 0in 0pt">                                               w/ an asterisk (*) and you are responsible for these

<p style="margin: 0in 0in 0pt">OR schedule: B (broadcast OR schedule)

<p style="margin: 0in 0in 0pt">                               ST (service)- ** different from ENT

<p style="margin: 0in 0in 0pt">                               PLA (Plastics)

<p style="margin: 0in 0in 0pt">                               From date

<p style="margin: 0in 0in 0pt">                               To date

<p style="margin: 0in 0in 0pt">                               Number of copies: 1 (usually just 1, will copy later)

<p style="margin: 0in 0in 0pt">                               Output to printer: hit 'Y'

<p style="text-indent: 0.5in; margin: 0in 0in 0pt 0.5in">Do the same with the SE list and compare to ensure no cases are left off.

<p style="margin: 0in 0in 0pt">Rounds: 5:45am but  would like s/o & list before 5:30. intern or Steph Ahmed (NP) should page you in morning, or go to Cutler MD lounge on L1 where they round if you have time

<p style="margin: 0in 0in 0pt">Making list:

<p style="margin: 0in 0in 0pt">               List: use BICS list as above, to print:

<p style="margin: 0in 0in 0pt">                               -alt P, 4 spaces between lines, add horizontal lines, NO additional information

<p style="margin: 0in 0in 0pt">                               - alt P again and it will print

<p style="margin: 0in 0in 0pt">               Consult list: you have to put the consult list (aka the back list) on the main list; go to

<p style="margin: 0in 0in 0pt">                               BICS list as above, but scroll to ‘Plastics consults’ instead; hit alt P, select 1 space

<p style="margin: 0in 0in 0pt">                               between lines (instead of 4), add horizontal lines, print; copy this list onto the

<p style="margin: 0in 0in 0pt">                               front list

<p style="margin: 0in 0in 0pt 0.5in">Numbers: put postop/hospital days, antibiotics, dvt ppx, then vitals and I/Os, FSGs all BELOW THE LINE (though this varies by chief, so check w/ resident when you start)

<p style="margin: 0in 0in 0pt">               Photocopy OR schedule (above) on back of list, usually requires shrinking to fit on one

<p style="margin: 0in 0in 0pt">                               page

<p style="margin: 0in 0in 0pt">Updating list: usually not applicable

<p style="margin: 0in 0in 0pt">Consults: YOU DO NOT DO CONSULTS.

<p style="margin: 0in 0in 0pt"> Call room : If you have time, the Plastics/Urology call room on 4D is yours. The code is 3+2 (together), then 1, Enter