Haematology Rundown

Motutapu ward - level 11 of the support building

General

Generally, the Haematology House Officer job is a great one and you are well supported by a bunch of great Registrars. The patient load can vary dramatically between each side, so it’s important to help out the other team if they are a lot busier. The patients themselves have very complex conditions that will be confusing initially, but you will become more comfortable dealing with the longer you stick around. As on-call House Officer you cover Medical Specialties from 4pm–10pm.

Team Structure

The ward is divided in to three smaller subspecialised teams; each has a consultant and registrar. The three teams are Bone Marrow Transplant (BMT) team, Leukaemia team (Team 1), and Non-Leukaemia team (Team 2- Lymphoma/Myeloma).

If there are two house officers, which is standard, one will go to the BMT, the other to the Leukaemia team, with no HO on the Non-Leukaemia team. House officers usually swap teams half way through the run.

There are other registrars on Haematology and they are the Day stay Registrar and the Consults Registrar. There are also 2x Lab Registrars that you will meet during your run.

Consultant round days are variable depending on the boss. They usually look after one team for 1 month at a time and rotate through the various teams.

Each House officer carries their own phone. All the nurses on the ward carry a phone during the day so they are super accessible as well.

Daily routine

0800-0830 ward round on Motutapu ward. Often have multiple outliers in all parts of the hospital. Check Clinical Portal in the morning to see if any new admissions overnight. The Haematology code on Clinical Portal is 30.

You are expected to prepare the list in the morning, including adding updated bloods. Consultants will ask you for Hb/Plt/WCC results.

Following the ward round, you complete jobs until 4pm, then go home. The registrars are all rostered to stay until 5pm.

Put up blood forms in the Motutapu doctor’s office in the afternoon. All bloods (and IVLs) are done by nurses. There is an easy-to-follow list of what bloods to do on what days.

Haematology day stay is like being a GP for the Haematology patients. These are patients who come in on an outpatient basis for chemotherapy, follow up appointments, prescription, reviews for nausea/vomiting, Side effects of chemotherapy, procedures. This is usually run by registrars, but when you are more comfortable with the job and have a manageable work load, this can be a great way to continue to follow up your old ward patients.

Weekly events

Haematology specific considerations:

Prescribing on the ward is heavily protocolised, so make sure what you are charting won’t interfere with chemo. For example, take into account a patient’s platelet counts before charting simple things like pain relief.

Make sure all patients are on required supportive medications when on chemotherapy – these are noted on the chemotherapy prescriptions and generally include PCP prophylaxis, antifungal prophylaxis, antiviral prophylaxis.

Be familiar with the neutropenic sepsis guidelines which can be found on the intranet under Haematology as generally all patients, especially those with acute leukaemia, will have at least one episode of this.

The Haematology intranet page is probably one of the best pages on the website. It is updated often so if any questions, look here first.

A few niche things that you’ll get used to are organising central access for patients, with various different types of groshong/PICC/Hickmann.

You will also have to think about preserving fertility for patients, and referring quickly for this. Also, use the run as an opportunity to practice LPs and bone marrow biopsies, there are plenty to go around.

Useful resources

• Te Pūriri o Te Ora – Regional Cancer and Blood Service

• Haematology Department