Contents Page
Introduction 3
Background Information 4
Staff List 5
Teaching & Training 6 7
Roles & Responsibilities 89
Massive Rapid HaemorrhageProtocol 10
Leave 11
Audit, Critical Incidents & Guidelines 12
Other Information (Bleep, rota etc) 13
Support 14
Module Supervisor list 15
Teaching Programme 16
Clinical Governance & Audit Meeting Dates 17
Forms to sign 18-19
Blueprint of WPBA to be completed 20-22
Dear Dr
Welcome to the Lincoln County Hospital Department of Anaesthesia. This handbook is intended to provide a guide to your period of training in the department. It is a source of reference and support for both the hospital induction package and the face to face induction whichyou will receive on joining. It contains practical information aboutthe department, for example how to find the weekly and on call rotas, how to book annual and study leave and how to seek help, advice and support within the department.
Summaries of the educational resources and units of training available within thedepartment are also included. This should help you to plan your training needs and in guiding your learning. It should provide a guide to what you can expect from us during your training here. The standards of attitude and behaviour we will expect of you are also included.
Copies of the departmental guidelines for anaesthesia and ICU are available separately in the anaesthetic office and in the ICU for reference as needed.
Your Educational Supervisor/Mentor for this placement will be
We hope your time in Lincoln will be both enjoyable and educational.
Dr A Wolverson (PanTrustClinical lead for Theatre & ICU)
DrI Bashir (Head of Service)
Dr M Kakkar (RCoA Tutor)
Dr C ODwyer (Leave Coordinator for Trainees)
Dr VJaggernauth (Rota Coordinator)
Stephen Pitwell (Operation Service Manager)
Becky Shaw (Business Manager)
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Back Ground Information
Lincoln County is a large DGH, serving a large rural population base, and is the largestof 3 major hospitals in the United Lincolnshire Hospitals NHS Trust.
The hospital has over 800 acute beds and the Anaesthetic Department providesAnaesthetic services for all surgical specialities except neurosurgery, cardio-thoracic, Specialist paediatric and plastic surgery which are provided elsewhere on a regionalbasis.
The hospital has a 10 theatre main operating suite with additional day surgeryand Obstetric theatres in the Maternity Wing. In addition to elective theatre lists there are daily emergency and trauma lists.
The department also provides Acute and Chronic pain services, Obstetric Anaesthetic services and Critical Care both within the 20 bedded ICU and as a hospital wide critical care outreach service. Critical Care services are provided as part of the Mid Trent Critical Care Network.
The department has 32 consultants (23 General 9 ICU), 19 NCCG`s, Core /intermediate/senior anaesthetic trainees &Foundation trainees and 4 PAs. All trainees rotate from either Nottingham or Leicester Schools of Anaesthesia.
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Consultant Staff
Dr Adams ICU, General
Dr Aldridge Maxillofacial
Dr Andrew, Obstetric, Trauma
Dr Awad Orthopaedics, Trauma
Dr Bashir Chronic Pain, Orthopaedics, Regional Anaesthesia-Head of Service
Dr R Barber, ICU
Dr Cowley ICU, GI Surgery
Dr Craggs Maxillofacial, Gynaecology, General, Urology, Orthopaedics, ECT, Allergy
Dr J Dedhia Chronic Pain, Trauma
Dr Dolling ICU
Dr Wilbourn, ICU
Dr Feerick ICU, Orthopaedics
Dr Gaylard Orthopaedics
Dr Hall ICU, Emergencies General
Dr Jaggernauth Obstetrics, Trauma, General. Rota Coordinator
Dr Kakkar Chronic Pain, Urology. RCoA Tutor
Dr Liddle ICU, Urology
Dr Mahajan Chronic Pain, Regional Anaesthesia, Orthopaedics
Dr Moores ENT
Dr Nair Obstetrics, GI
Dr O’Dwyer Emergency, ENT,Trainee Rota Coordinator
Dr O’Regan Trauma, Emergency,
Dr Szypula, Emergency Anaesthesia
Dr Padhiyar, Orthopaedics, Trauma
Dr Powles Paediatrics, ENT,
Dr T Rashid Obstetrics, ENT
Dr Thiagarajan, Obstetrics
Dr Tyler ICU
Dr Victoria General Surgery, Gynaecology. Audit Lead
Dr Webb Paediatrics, Vascular, Acute Pain
Dr Williams Paediatrics, GI/General Surgery
Dr Wolverson ICU, Vascular
SAS Speciality Doctors
Dr Barker, Dr Barczak, Dr El Kasier, Dr Kamal, Dr Pillai, Dr Wahdan, Dr Sagi,Dr Jain,
Dr Razaque,Dr Vyhnal, Dr Orasanu, Dr Grabowska, Dr Ho, Dr Slavova, Dr Hemeng,
Dr Viswanathan & Dr Chava
.
PAs
S Armstrong, K Harrington, S Kennedy & H Kerman
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Education
The purpose of your rotation to Lincoln is to further your anaesthetic training. TheDepartmentoffers teaching & training across a wide range of specialities. Training is module based and aims to be in keeping with the RCA guidance onCompetency based training.
You should discuss your unit of training /training requirements at the earliest possibleopportunity with your educational supervisor/mentorand organize the same with the rota coordinator. Please inform the college tutor of the units of training you are planning to complete at the beginning of your attachment. In case of any difficult in organizing your units of training please discuss the issue with the educational supervisor/mentor/college tutor at the earliest.
Formal educational supervision is based around the Gold Guide recommendations and the use of Personal Learning Plans is required to help you maximise the learning opportunities available.
Keeping a Log Book and ensuring you get the assessment forms required by yourparent training programme including work based assessments completed during your attachment is your responsibility, without them your training cannot be signed off!
Educational Supervisors
A named Educational Supervisor will be allocated to each trainee at their educational induction. You will arrange to meet your educational supervisor a minimum of 3 times in every twelve month period. These will allow your educational progress to be reviewed and appraised, using constructive feedback, support and guidance. They are responsible for writing the formal educational supervisors structured report that is essential for the Annual Review of Competence Progression. They also complete an annual workplace based NHS appraisal.
Unit of Training Assessor/Clinical Supervisor
Supervises the individual unit of training and completes the trainee assessment form for time spent in that module/unit. The unit supervisor acts as a point of contact between consultants in that field and trainees. A list of current supervisors is attached at end of this booklet.
Clinical Supervisor
Any Consultant that is supervising your training in the workplace, e.g. training lists in theatre, clinics, critical care. They will provide input to the assessment process through communication with the unit assessor/supervisor. They are responsible for patient safety during a training session.
The College Tutor is the local point of contact with the RCA for trainees. College tutor represents the RCA at each hospital and organises training, oversees examination preparation, facilitates professional development and gives career advice.
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Educational Resources
Departmental Library - key available from the Anaesthetic secretary.
Computers - available within the department for trainee use, with full Internet access,
MS Office (PowerPoint, Word Excel etc) and access to a large number of anaesthesia related CD ROM’s - passwords available from Stephen Pitwell.
NB: you must agree to and abide by the Trust Internet Policy at all times.
Hospital Library - off the lower main hospital corridor ext. 3954 (0900 - 2100
weekdays, 10.00 - 1700 Sat Sun)
Tutorials - Alternate Wednesday whole day, there will be about 10 teaching session in 6 months.Attendance at the teaching programmes is mandatory. You are expected to maintain a record of you attendance which you must present for consideration at ARCP/Educational supervisor meeting. Reasonable reasons for absences from teaching include being:
On-call
Post on-call
On leave
Theatre Lists - Minimum of 3 training lists per week (averaged over a unit of training). For core trainees these will be directly supervised, as trainee’s progress through intermediate training some will be indirectly supervised which may increase as appropriate through higher training. It is important that for all training lists direct or indirectly supervised, there is a named consultant trainer available at all times to assist and support your training list.
Trainees are expected to see patient’s pre-operatively for these lists for educational reasons,if you find you are not getting the minimum training lists requirements, please keep a diary and discuss the issue with the rota coordinator and college tutor.
It is useful to meet with trainers in advance of training lists to agree what subjects you would like to discuss during teaching lists. If your list finishes early or a case is cancelled it is expected that you will liaisewith theon call consultant covering emergency theatre to see where you may be re-deployed.
If you are on a‘longday’ on a weekdayi.e. ‘on call’ you will be based in theatres as a core trainee carrying the first on call bleep. As a registrar you will be carrying the second on call bleep in ICU if doing your ICM unit of training but based in theatre if NOT doing your ICM unit. This will allow you to undertake your modular anaesthetic training on your long days until18.00 hrs. After 18.00 you will cover ICU for the twilight hours 18 – 20.30 hours.
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Roles and Responsibilities
CT1/2 trainees –First on call
On call commitment is 1:8 full shifts. ACT1/2 will normally take responsibility for
Compiling the on call rota. Start time will be at 08.00.
Responsibilitiesare primarily to provide first on call anaesthetic cover to the main theatre emergency and trauma surgery and also to carry the cardiac arrest bleep. Support is provided by both an on call consultant and a second on call senior trainee based in ICU.
You are expected to liaise with your senior on call colleague and to providesupport to your senior colleague if you are not working in theatres.
Novice trainees will not be placed on the on call rota until 3 months of anaesthetic training
has been undertaken and initial tests of competence satisfactorily completed.
Daytime work is based in theatres/ICU/pain sessions.
Most lists run from 9-12.30 and 2-5.30 unless specified (although occasional overruns are inevitable!). Daytime ICU sessions from 08.30 to 18.30
Senior – ST3 or higher trainees – Second on call
On call commitment is 1:8 full shift (or at times 1 in 7). A senior trainee will normally take responsibility for compiling the on call rota. Responsibilities on call are to provide cover for ICU, for anaesthetic/critical care support to A&E and ward areas (part of Trauma Team). and to support the first on call in main theatres. Support is provided by both an on call general anaesthetic consultant and an ICU consultant on separate on call rotas.
You may be required to undertake interhospital transfers when necessary. A separate SAS rota provides obstetric cover.
Daytime work is based in theatres/ICU/pain sessions.
Most lists run from 09:00-12:30 and 14:00-17.30 unless specified and daytime ICU sessions from 08.30 to 18.30.
Competence
Trainees must undertake duties that are within their competence andexperience, and with appropriate levels of supervision.
“No trainee should be required to assume responsibility for, or to perform unsupervised clinical operative or other techniques for which they have insufficient experience or expertise. Trainees should only perform tasks without direct supervision where both they and the supervisor are satisfied regarding the competence to do so. Both trainees and supervisors should at all times be aware of their responsibilities for the safety of patients in their care.”
All trainees are required to have successfully completed the RCA Initial Test of
Competency prior to undertaking any anaesthetics without direct (in theatre)
supervision.
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Trainees should have received appropriate training in practical procedures (such asCVP or epidural insertion) as documented in a record of work placed based assessments before undertaking such procedures unsupervised.The level of responsibility taken will obviously depend on individuals training andexperience but as general guidance the following is recommended.
Seek advice and if appropriate supervision for:
CT1/2 trainees
All ASA III cases and above.
All children
All cases likely to require post op high dependency/critical care
All CEPOD 1 cases
All cases to be undertaken after midnight (usually CEPOD 1 only)
Any suspected difficult airway
Any case with a history of significant problems with previous anaesthesia including
awareness
Any case where the surgical procedure is unfamiliar
Any case you are not feeling confident that you can appropriately manage.
CT 1/2 trainees should not work without direct supervision in this isolated theatre suite even for routine daytime lists.
ST3 and more senior trainees
All ASA IV cases and above. Most ASA III cases.
All children under the age of 5
(nominated paediatric consultants for all children under 2)
All cases likely to require post op critical care
All CEPOD 1 cases
All cases to be undertaken after midnight (usually CEPOD 1 only)
Any suspected difficult airway
Any case with a history of significant problems with previous anaesthesia including
awareness
Any case where the surgical procedure is unfamiliar
IF IN ANY DOUBT ASK FOR ADVICE / ASSISTANCE
ALL CONSULTANTS ARE HAPPY TO BE CONTACTED WHEN ON CALL
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MASSIVE RAPID HAEMORRHAGE PROTOCOL
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Annual Leave
Maximum 2 Second on call and 2first on call trainees are allowed off at any one time (except for exams). Rota coordinator for Trainees (Dr O Dwyer) MUSTagree any more than this number of trainee to be away before leave is booked or arranged – your request may be refused.
Please plan ahead for study leave around exam times. Consider the needs ofcolleagues also taking the exam so that everyone gets their fair share and distribution of leave.
Requests must go through the Anaesthetic secretary and be written in the diary by themat least 6 weeks in advance.You need to complete your leave card for leave and hand it over to Stephen Pitwell. If there are any on calls during the leave period it’s the responsibility of trainee to arrange the swaps. Once swap has been arranged leave card has been filled and handed to Stephen Pitwell, the information should be sent to Dr ODwyer who coordinates the trainee rota. Only when she approves the leave, will it be granted and the rota changed on the intranet to reflect the same. Please wait until the on call rota is made before booking your tickets/holidays otherwise it will be your responsibility to swap your on calls if they are within your holiday period.
Study Leave
As you all are now aware that Study leave are now booked through Intrepid, please follow the procedure for booking the study leave
All leaves must go through the Anaesthetic Administratorand be written in the leave diary.
AL and SL forms available in filing cabinet in office -return to Anaesthetic Administrator.
All central teaching programme dedicated days must be booked in advance and you will be relieved from normal but not on call duties. These days are not booked as study leave days as per above.
Sick Leave
Please inform the department, as soon possible that you will be off sick. During office hours via the Anaesthetic Secretary, at weekends via on call team.
Please try to speak to someone (on Call consultant are available if you can’t contact Anaesthetic Secretary) rather than leaving message on answering machine. Leaving a message on the department answering machine will not be considered to be adequate information forabsence.
On Call Room
There is an on call room available for trainees who after there on call want to rest before going home. The room is in Hazel house and the keys are kept in ICU .For the sake of ensuring that keys are not lost, please sign the diary kept with it when you take the key out and return it.
As there is only one room available, if both trainees need a room to rest then it has to be booked through HR and the Department will pay for it.Please plan ahead and book the room in advance if you think you will need it
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Accommodation
Trainees may claim travelling expenses for the excess journey commuting to Lincoln compared to their base hospital (Nottingham or Leicester) from home.
If trainees choose to forego travelling expenses and stay in accommodation at Lincoln they need to discuss with the college tutor and HR prior to their arrival.
BEWARE in the past trainees have been taxed on this cost as a benefit in kind by HMRC.
Clinical governance /Audit meetings
There are 11 CG/audit meetings held per year. There is an audit board in the department which sets out the programme for the year.
Trainees are actively encouraged to undertake at least one audit while in the department and support will be provided for this.
Trainees are also expected to do a presentation during these meeting (It can be a case presentation, recent update on a topic or any critical incident they have been involved with) during their time at LCH. .The audit meeting programme for the year is attached at the end. Please identify a suitable date when you would like to present your audit or presentation within a month of your starting the post and let the audit lead know by filling the form attached.
Critical Incident Reporting
All anaesthetic critical incidents should be recorded on department reporting forms
(This can be done anonymously if desired) provided in all clinical areas.Any serious incident must be reported immediately to the supervising / on callconsultant, particularly any case where patient harm may have resulted. Seriousincidents should also be reported via the trust incident reporting system (IR1 forms) which is web based. All forms are available in theatre and ICU.
Trainees are encouraged to discuss any incidents or adverse events with a consultant at the earliest opportunity.
Guidelines
There is a red folder in all the theatre anaesthetic rooms with guidelines included.
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Useful Information
Pigeon holes (Mail)
Named pigeon holes are provided in the anaesthetic department for departmental mail,
rotas and external mail posted to the hospital.