Older People's Health - Mana Awhi Rundown
Teams and wards
Marino and Awatea wards (level 14 support building)
Rangitoto and Remuera wards (level 13 support building)
Admissions
For every discharge you’ll get an admission (usually after lunch). There is a triage meeting in the morning where daily admissions are discussed. Check with ward clerk/charge nurse/ward diary.
Marino ward has a fast-track NOF # system where Geriatric patients under Orthopaedics who have had a NOF # get transferred to the Marino ward immediately or the day after their operation.
Clerking on Clinical Portal: ‘Add a new document > Re-ablement admission note’. Meds are charted electronically on MedChart. You will have training if you haven’t used it before. For patients coming from other wards – ideally there will be a transfer summary written by the patient’s original team. You can copy + paste this into the OPH admission note. If there is no transfer summary and the patient’s admission has been complex or prolonged, you may need to contact the previous team’s HO to write one. To save time you can go down to the ward that the patient is coming from and do your admission there. Your admission includes a social history where you will need to fill out ten boxes on the newly revised OPH admission note template. You may need a collateral history if the patient has memory impairment.
Hand over any admissions you find out about after 1530 to the on-call HO. Try to at least have the admission document filled in with as much information as you have access to for the OCHO to complete the rest.
For patients from the community or via the Frailty Pathway – usually clerked in by the frailty registrar. Sometimes you will need to chart medications on MedChart for these admissions if the frailty reg is busy, or if there is a relieving registrar without access to MedChart.
Put geris bloods up (U&E, FBC, calcium, folate, TFTs, LFTs) for all admissions. Check if DVT prophylaxis required, if patient was under Ortho this should be well documented (check the op note). Consider charting bone protection – always discuss with a registrar and check the CrCl first.
Discharges
If patient had zoledronic acid copy+paste the standard advice into ‘Advice for GP’ (in OPH folder). Do not finalise discharge until MDT have added their bit.
Yellow card required unless discharged to private hospital or rest home. Ask ward pharmacist for this. For blister packs, fax scripts day prior to discharge. If there have been changes to the patient’s regular medications during their admission, you will need to supply the rest home/private hospital a month’s script for all the regular and new medications.
Rest homes and private hospitals are strict with the patient’s arrival time (before midday is preferred). Discharges will need to be early, so prep them in advance. You can check the estimated discharge date with the ward clerk/charge nurse/MDT. Facilities may also decline admissions on a Friday.
HOWR (House officer ward round)
Consultants usually round twice a week. Other days will be a registrar or house officer ward round.
Things to check on your ward round:
Review the MedChart for under/over usage of analgesia, laxatives, ?bone protecting Rx etc
Review the Obs chart Note low-grade temperatures of 37.5 could signify infection/sepsis in elderly
Wound chart for any pressure areas or ulcers that need reviewing
Inputs/outputs fluids, urine, bowel Review clinical notes of events overnight
MDT meetings
Usually 2x weekly. The days vary by ward. On other days, there is a rapid round involving the MDT that either the HO or reg needs to attend.
On call
Pretty cruisy most of the time, prep discharges. You cover all OPH wards (this includes ward 51) and Gen Med outliers.
Ward 51 is home to Stroke Rehab patients and you will receive iBleeps for them. Check on Whiteboard what team the patient is under as you cover rehab patients only (not general Neuro patients).
To escalate concerns from Marino, Awatea, or Rem call OPH Reg. For patients on Ward 51 call Neurology Reg.
If there are any patient(s) that are being transferred from other specialties to the OPH wards after 3.30pm up to 10pm, you will likely have to do the admission(s). This may include patients who are POD0 (e.g. NOF #s from Orthopaedics).
Most common problems you will encounter are delirium and agitation, falls, and fevers, and taking bloods/cannulating.
Overnight you also cover Gen Med and Psychiatry. Security can drop you to TWT if raining/dark.
Weekly events
Every House Officer has to do a teaching session. This teaching roster will be emailed to you at the start of your run. Teaching is usually a 20 minute presentation, on a topic related to OPH, followed by 10 minutes of question time.
Radiology conference – email patient details to AKRadConf@adhb.govt.nz by 10am the day before the conference. Day of conference varies by team.
Tips for OPH
Opioids – low dose, less often. e.g. sevredol 5mg or oxynorm 2.5mg po Q2h. Oxynorm tends to be the drug of choice over Morphine as most patients have renal impairment. NB: Consultants differ in their preference for opioids, some do not like oxynorm. Tramadol is almost never used due to causing confusion, hallucinations, etc.
Laxatives – Almost every patient ends up needing them, so good practice to prescribe on admission. Lactulose and Movicol/Lax-Sachets® are often not used together.
Codeine and ondansetron are not preferred as they can cause constipation which can then perpetuate delirium Enemas: use following order: glycerol suppositories > microlax enema > Fleet enema.
For questions about patients who have come from ortho, contacting the ortho team’s CNS can be a good place to start.
Send referrals to the MHSOP (Mental Health Services for Older People) for any Psychiatry input (fax 25158). You can also call the MHSOP CNS directly if you need more urgent input.
Contact Teresa the wound care CNS for OPH for any wound care/pressure ulcer advice.
Weekends
Fridays 1500: Handover of jobs to the weekend team occurs in the Remuera ward workroom (level 13).
On weekends: The registrar and SMO will round on all new patients, you don’t have to round with them. The registrar will then be admitting new patients and going through their weekend job list. Your job is to go through all the weekend jobs handed over to you and attend to the MedTasker jobs. You cover all General Medicine outliers (General Medicine patients not on wards 65-68 and 63) from 4pm onwards on the weekends. Call the Gen Med reg (not OPH registrar) for advice on Gen Med outliers.
On alternate weekends, you cover a Gen Med team 0800-1600, if not assigned to a team, you will be assisting the MOSS in ED/CDU with admitting. Go to the Gen Med handover at 8am in the glass room by the Auditorium on level 5. You will be emailed weekend jobs the day prior. At 4pm reconvene where the morning handover was to hand over any tasks to the evening house officer.