2/26/2016

NURSERY

PGY I – Nursery (Pediatrics and NICU)

Olive View-UCLA Medical Center

Goals:

To provide learning opportunities that will enable residents to develop or refine the attitudes, knowledge and skills necessary to appropriately diagnose, manage and stabilize the newborn in the peri – partum period, with the appropriate use of interventions and the proper disposition of the patient after birth.

Objectives:

Residents will:

Patient Care and Medical Knowledge

  1. Gain clinical experience in the evaluation of the newborn infant
  2. Gain clinical experience in the management of possible meconium aspiration
  3. Gain clinical experience in the management of the newborn requiring airway management, including oxygen therapy and intubations.
  4. Understand the transition from intra-uterine life to extra-uterine life
  5. Understand the physiology of the newborn
  6. Gain clinical experience in the evaluation of common newborn issues including jaundice, rule out sepsis, and heart murmurs.
  7. Understand the indications for a septic work – up
  8. Perform septic work – ups
  9. Perform work – ups for hyperbilirubinemia
  10. Follow newborns from birth to discharge
  11. Understand the ethical issues surrounding neonatal care
  12. Gain clinical experience to determine the appropriate disposition of the newborn
  13. Gain clinical experience in common procedures on newborns, including endotracheal intubation and lumbar puncture.
  14. Gain clinical experience in the care of the pediatric patient in the urgent care setting

Practiced Based Learning and Improvement

  1. Be able to use the internet to access current literature about the medical problems of newborns
  2. Be able to critically evaluate literature about current neonatal medical management
  3. Be able to work well in the context of the neonatal intensive care unit and newborn nurseries
  4. Be able to implement changes in patient care based on new information obtained from Attending Rounds, clinical experience, review of the literature and other sources
  5. Be able to apply the above skills in the pediatric urgent care clinic

Interpersonal Communication Skills

  1. Communicate effectively with the families of newborns
  2. Be able to communicate any underlying illness the newborn may have, as well as the treatment plan and prognosis in a manner understandable to the family
  3. Be able to listen to and address the concerns of the parents of newborns
  4. Be able to communicate the anticipated needs of the newborns after discharge
  5. Be able to communicate to pediatric patients and their families in a similar manner when working in the pediatric urgent care clinic
  6. Communicate effectively with colleagues
  7. Be able to work efficiently in the context of both the newborn nursery and the Neonatal Intensive Care Unit in a county hospital
  8. Be able to clearly communicate with the supervising attending regarding newborns in both the newborn nursery and Neonatal Intensive Care Unit
  9. Be able to work efficiently with the support staff in the care of the newborn patient
  10. Be able to work efficiently with support staff, medical students, residents and attendings in the pediatric urgent care clinic

Professionalism

  1. Demonstrate cultural competence
  2. Demonstrate the ability to act in the best interests of the patients
  3. Respect for confidentiality
  4. Respect for family autonomy
  5. Respect for patient autonomy
  6. Be professional in all aspects of patient care
  7. Accept personal responsibility for patients
  8. Accept feedback in all aspects of care, including the six core competencies
  9. Timeliness
  10. Appropriate attire

Systems – Based Practice

  1. Demonstrate understanding of the care of the newborn patient in the context of the current health care system in a county medical facility
  2. Coordinate care with ancillary services to improve the healthcare of the patient
  3. Assist the parents of newborns in both the newborn nursery, and in the context of a sick child in the Neonatal Intensive Care Unit
  4. Be able to apply the same principles to the pediatric patient cared for in the pediatric urgent care clinic

Logistics:

Contacts: Scheduling:Admin: Location:

Victoria Niklas, MD
Division Chief
Alan Quillan, MD Neonatology 3A-108 OVMC
(818) 364-3233 / Rashmi Sekhon, MD
/ Lupe Cervantes
Office Administrator
Dept of Pediatrics
(818) 364-3233 / Olive View Medical Center
14445 Olive View Drive
Sylmar, CA 91342
NICU and Nursery – 3C - NICU
Pediatrics Clinics – 2A – 105

Continuity Clinic – You will have 2 clinic sessions per week during this rotation, Tue PM and Fri PM.

Sunday – Day off.

Call Schedule – This is a no – call rotation

Educational Half Day – You are not excused to attend EHD.

Additional Information – The NICU is on 3rd Floor. Be sure to be in the NICU at 8 am on your first day and ask for the NICU attending.

NORMAL NEWBORN ROTATION AT OLIVE VIEW-UCLA MEDICAL CENTER

Daily Schedule

8 amsign outs for nursery from NICU hospitalist, begin newborn exams

8:30amgeneral pediatric talks on ward 4C in resident rounding room

9am-?Rounds in NICU each day (if many discharges on Tuesday and Friday, may ask NICU attending to be excused) Friday is xray conference and may be down in the radiology conf room.

Continue to complete newborn nursery work Tues and Fri

? 10am-Normal nursery rounds with NICU attending (when rounds are finished in NICU).

15-20 minute talk by NICU attending.

Complete work in normal nursery

Attend deliveries as they occur

Non Daily Expectations

8-9am Perinatal Rounds, 1st Friday of the month

8:30-9:30Pediatric Grand Rounds, Wednesdays in main auditorium (check with peds office for which Wednesdays, x3233)

11:30amWednesdays, NICU Multi-disciplinary rounds 4C in resident room

12-1pm or 1-2pm Chief Resident education, Thursdays

8:30-9amPediatric Radiology rounds in Radiology conference room, Fridays

Attending Discussions (please initial these talks yourself when they are done, these are core discussions that should be done):

2/26/2016

  1. Bilirubin ______
  2. Newborn infections (sepsis)______
  3. Newborn rashes______

2/26/2016

  1. Fluid and Nutrition______
  1. Respiratory distress______
  2. Hypoglycemia/IDM______
  3. Newborn resuscitation______
  4. SGA/LGA______
  5. Physiological changes/circulation______
  6. Feed a baby in NICU or Nl nursery under nurse direction: ______(nurse initials)

EXPECTATIONS FOR FP INTERNS

IN THE NEWBORN NURSERY (NBN) AND ROOM-IN AREA (3D)

Overall Responsibilities

  1. 3D/NBN:
  • Read and master the Newborn Nursery Manual during the first few days of your rotation. Ask attendings about questions or doubts. You are here to learn. Mark up the nursery manual with notes; it is yours to keep.
  • Admit, care for and discharge infants in the newborn nursery and room-in area.
  • Keep track of all infants in 3D/NBN. For routine deliveries, the delivery pager system may not be used; check in the morning and periodically for any new arrivals.
  • Prioritize your work so that discharges and admissions are completed first, followed by routine care.
  1. Deliveries and Resuscitation:
  • Promptly go to all high risk deliveries (any delivery for which the Peds team is paged).
  • Scrub in for all C-sections so that you can receive the infants from OB.
  • You will be expected to stay until 5PM on weekdays, even if your work is done, to maximize your exposure to deliveries and resuscitation. On weekends you may leave after your work is done.
  1. Other Admissions:
  • When transfers from the NBN or 3D to the NICU are necessary, you are responsible for admitting these babies, with the assistance of NICU attendings and NNPs.
  • If things are quiet in 3D and NBN, you may be asked to help with NICU admissions from the delivery room/OR as well.

Evaluation

You will be evaluated based on your performance in the following areas. See the second page of this handout for our detailed expectations for each category.

  1. Attention to detail in patient care
  2. Communication
  3. Documentation
  4. Curriculum and Educational Goals

Responsibility of Attendings

  • Give talks on key neonatal and infant topics (will be done on days when Liesbeth or Jeremy are on, and generally on M,W,andTh)
  • Give feedback at the middle and end of the rotation, based on the criteria in this sheet.
  • On clinic days, the intern should do as much work as possible and focus first on discharges and admissions, and clearly signout to NICU MD/NPN what still needs to be done. The attending or NNP will finish the day’s work.

Attention to detail in patient care

  • Babies with disease may present initially with very subtle signs and sicken quickly when there are problems. You will need to pay meticulous attention to detail on this rotation. This includes calculating changes in the weight every day as a percentage of the birthweight, calculating and plotting the rate of rise of bilirubin levels, keeping a list of the infant’s problems and risk factors, and arranging followup for any concerns post discharge.
  • When doing admissions, check the delivery record and maternal H&P for all the information required on the signout record and Form 12. If something is not recorded in the OB records, ask the OB nurse or MD to help obtain that information.

Communication

  • Get signout from NPN or MD attending in the morning, round with the attending after seeing all the babies, and give signout at the end of the day (5pm or noon on clinic days).
  • Promptly notify the NICU attending or NNP of abnormal findings, noticed by you or the RN (including abnormal vitals, poor feeding, respiratory distress, hyper or hypothermia or anything else concerning, or in case of ANY doubt).
  • Be the key contact MD for OB regarding 3D/NBN babies.
  • Communicate with RNs, lactation (Mattie), and social work about 3D/NBN babies as needed.
  • Update parents every day and whenever their baby’s condition changes (e.g., when bili lights are started or the baby needs to be admitted to the NICU). Use an interpreter if necessary.

Documentation

  • Complete Form 12 admission H&P and admission orders on all newborn babies within 24hrs of birth and have it signed by an attending. Review the Form 12 to be sure you’ve completed every section. Complete the discharge part of Form 12 within 24 hours of discharge and have signed by an attending. Put all labs, bili levels, and a problem list on form 12. Include anything that the PMD may need to care for the infant.
  • Complete daily notes on all babies on all other days.
  • Write short event notes whenever you are called to evaluate a baby by an RN or if you notice something abnormal.
  • Keep the computer signout complete, organized and neat. The completeness and quality of the signout will be a prime reflection of your work. Update and reprint the signout before signing out to attendings.
Curriculum and Educational Goals
  • Be able to perform a physical exam on a term infant, including gestational age assessment.
  • Know how to resuscitate a newborn. Know the essentials of the AAP AHA Guidelines.
  • Know the essentials in stabilizing a sick term neonate. Know normal VS, including BP and blood gases. Understand the care for an infant who has respiratory symptomatology and especially those who may develop PPHN.
  • Understand transitional adjustment of the newborn.
  • Understand the management of hyperbilirubinemia.
  • Know the normal variant and common abnormalities (clavicular fx, abdominal distension, vomiting, etc.)
  • Understand who should have R/O sepsis evaluation, who should be treated vs. observed, etc