Canterbury DHB

Information for Registrars and House Surgeons

Registrar Handy Hints

Refer to Registrar Handy Hints for valuable advice which helps to make each of the registrar roles easier (Ward Registrar, Laboratory Registrar, Out-patient Registrar, Transplant Registrar and Transfusion Registrar).

Cluster Location Manual

The Canterbury Regional Cancer and Haematology Service (CRCHS) Location Manual orientates staff to the CRCHS. It provides an overview of the service and is a central location for all cluster-wide policies and procedures. This information applies to all staff that work for, or work collaboratively with, the CRCHS.

Incidents and Consumer Feedback

See Incidents and Consumer Feedback.

House Surgeon Handy Hints

Weekly schedule

• Daily – nursing handover on B6
• Tuesday 1200 – Registrar teaching in Lab office.
• Tuesday 1500 – Infectious disease meeting on B6
• Wednesday 1320 – Radiology meeting. Refer patients on HCS (electronic order entry) by Tuesday afternoon.
• Friday 0900 – General MDT meeting and ward round. HS and Registrar present all ward patients. Keeping an up-to-date sheet of the patients on the computer is very valuable.

Requesting blood tests

Place blood request forms in the two boxes in the nurses station, i.e. CVAD bloods and Peripheral bloods. Peripheral bloods rounds are at 0745 and 1130.

It is usual to request CBC+D and HEMA (standard biochemistry profile), but most patients don’t require this every day (e.g. CRP and renal function may be adequate).

Do a coagulation profile once a week for patients on broad spectrum antibiotics.

Note: Let nurses know when blood products, fluids, and drugs have been charted. Aim to give all blood products in the morning shift.

Newly diagnosed patients need a range of blood test and investigations on presentation including HLA typing. See a list of these tests on the following pages:

• Pre-Treatment Investigations for New AML Patients
• Pre-Treatment Investigations for New ALL and Burkitt's Lymphoma Patients

Check and accept all results daily. This duty can be shared, as convenient, with the Registrar. You will be shown how to do this in Concerto training. Some results, particularly microbiology, take some days to be finalised, and until they are finalised they will continue to return to you for acceptance, even after you have accepted them one or more times already. The patient may have been discharged when the result is finalised, so they will not appear on your daily list of ward patients. Therefore you have to search for outstanding unaccepted results for this patient on a daily basis. Do this by searching under Clinicians enquiry > Unaccepted results > Clinical Haematology team. If you do not know how to accept results, ask the consultant to show you.

Useful links

• Preventing Infections
• Summary of Antimicrobial Prophylaxis for SCT
• IV Fluid and Electrolyte Replacement
• Nausea and Vomiting
• Tumour Lysis Syndrome

Managing Electronic Results in Haematology

Seeing, actioning and signing off electronic results is regarded as a very important daily task within the Haematology service.

When you start in Haematology

• On joining the team as a new Registrar or House Surgeon, you need to set up your Clinician Enquiry so you have saved searches for any section of the service that you cover or may need to cover if someone is on leave.
• In the case of the Ward Registrar and House Surgeon, this is the "Haem Team" patients. For the Registrars working over in Outpatient and Lab area, you also need to save a search for each of the Consultants.
• View the power-point presentation on how to do this and other Health Connect South-related functions.
• Do the Eclair Electronic Sign-off tutorial on the CDHB intranet.

Daily procedures

• Before going home each day, the Ward Registrar and HS need to go into the "Haem team" results via Clinician Enquiry and sign off all outstanding results. This is particularly important on our patients as sensitivities may become available or culture results may be updated a number of days after they are taken and so may be missed otherwise.
• If you are not sure about the significance of any result, forward it to the consultant running the ward or the patient's own consultant.
• Registrars: you are encouraged to sign off results as you see patients in outpatients, unless you are unsure of the significance.
• If a consultant is away, it is the responsibility of the OP registrar to sign off their results on a daily basis. Occasionally, if is felt for example that one of the more senior registrars may be more appropriate to do this, then the consultant will arrange this specifically with the registrars concerned.
• The consultants will likewise set themselves up with their own saved searches for their outpatients and the inpatient "haem team". Since there are still a small number of results that are registered to other sites, a further saved search to cover all their own results is encouraged. The consultants are aware of the need to sign results via clinician enquiry on a daily basis.

Bone Marrow Aspiration and Trephine Biopsy Techniques

See:

• Protocol for Bone Marrow Aspirate and Trephine Biopsy
• Bone Marrow Biopsy on Healthinfo

Haematology Case Notes

Patients who have previously attended Haematology Outpatients will have Haematology notes separate from the usual hospital notes. These can be obtained during normal working hours by phoning the Secretary of the appropriate Consultant, and out of hours by phoning the Haematology Technologists on 80373. Haematology Outpatient notes need to be on the B6 by the following day. Previous outpatient letters are available on Health Connect South.

Accurate note keeping is essential for all hospital inpatients. This is particularly important in Haematology, as treatment is often complex and prolonged.

All entries in the notes should have a time and date, be signed legibly, and have a page number.

Consent Forms for Haematology Patients

The following procedures require verbal consent, and an entry indicating that this has been obtained should be made in the notes.

The following procedures require written consent, i.e., the relevant form must be signed by the patient and consent discussion documented in medical notes.

Forms:

• Request / Consent For Treatment
• Tissue Banking Consent
• Consents for SCT

Topic Code: 4649