HMO Daily schedule: ward rounds and handovers

Handover:

• 0800-0830: Handover in meeting room room with night registrar and whole day team including nursing and often allied health
• Usually there is no need to come early, the night registrar will prepare the running handover sheet
• HMOs will bring up pathology and radiology during the meeting
• Also try to spot time-critical and quick jobs you can do

 
AM ward round:

• < > – depending on number of patients until approx. 1000-1100 (consultant will often join around 0900/0930 on weekends)You will usually round about 2 times a day with the consultant
• A handover list that is updated by HMOs and registrars on the G drive throughout the day (should be updated for the day before night handover)
• Ward rounds are done using the COW or Microsoft tablet (please don’t forget to charge these afterwards)
• While visiting each bedside and the consultant/registrar is doing the clinical review it is the HMO’s responsibility to write notes during this round, generally on every patient unless you have keen / competent medical students
  • Basic information to include in ward round notes:
    • Patient issues
    • ABCDE and examination
    • FASTHUGS +/- FIDDLER
      • F - fluids
      • A - analgesia
      • S - sedation
      • T - thromboprophylaxis
      • H –head up
      • U – ulcer prophylaxis
      • G – glycemic control
      • S - skin
      • F - feeding
      • I - infections
      • D - drugs
      • D - dialysis
      • L - lines
      • E - electrolytes
      • R - research

 
Following ward round:

• Generally there will be a list of jobs needing to be done after the rounds eg referrals, imaging, calling GPs, line insertions etc, you will divide these up appropriately with your registrar
• If you do a procedure it needs to be documented on an online form, and a procedural sticker placed in the progress notes. Enter the procedures into the ICU Procedure Logbook (found at ). This can be collated at the end of your rotation as an individual logbook
• Update the handover sheet: It is useful to update the list with all active and previous issues and what action was taken to correct the issues so when it comes time for discharge planning, you can easily copy-paste these into your summaries as the issues list. Also on the handover list is a jobs column where you can track your own jobs and things to pass onto the next shift.
• Go around to each of the nurses and ask if they need any orders written up – they often need drug/flush lines, noradrenaline infusions etc., and you can do them all at once instead of being chased all day.
• Complete admission paperwork for a patient
• Make sure all patients have blood/imaging request forms for later in the day if needed
• Check through each patients’ bloods and check any pending cultures
• Start/Update discharge summaries, see below

 
PM ward round:

• Second consultant round occurs in the afternoon, fairly variable time approx. 1600-1900
• Usually quicker

 
Night shift handover:

• Night shift = 2000 – 0530 for HMOs (Registrars = 2000 - 0830). If the ICU is busy, you may be asked to stay on longer. This is always paid overtime.
• From 2000-2030, the day registrar/HMO gives a handover to the night registrar/HMO

 
Night ward round:

• Depending on patients and the situation there may be a consultant ward round at night approx. 2200
• A lot of the time, if patients are stable, the registrar will just call the consultant instead
• At the beginning of night shift you will round with the night registrar or divide up the load and report back to your registrar