Respiratory Rundown
General
The respiratory ward has two teams: the cystic fibrosis team and the TB/NIV team. Both teams take general respiratory patients e.g. empyema or COPD exacerbation.
CWR twice a week (days depend on the consultant), other days are registrar/HO rounds. Try to do some admissions with the on call registrar (three different registrars hold the phone in a day – morning, afternoon and evening).
Ward 72 and 7a computers have a HOs-shortcut folder under ‘documents’ with useful info and pro-formas for the TB discharge summaries. The code for the patient list on RCP is 192. When discharging patients and organising the outpatient follow-ups, simply put the expected follow- up time and SMO clinic that they need an appointment with in your discharge summary plan and the fantastic ward clerk Teresa will book this for you.
Cystic Fibrosis team
The HO will usually admit CF patients. These tend to be “planned admissions” whereby the SMO and CNS have agreed for the patient to come in directly to the ward. The CF nurse specialist Cath Lamont will give you an individualised pink “cheat sheet” for each patient with the plan, investigations needed and what antibiotics to chart etc. Use this when seeing the patient and completing the admission note.
CF patients admitted with exacerbations tend to be started on IV abx for a prolonged course. When admitting, check what access patients have as some may need PICC lines organised. Tobramycin dosing is dependent on trough levels, the nurses and pharmacists tend to be very good at sorting these, but always ensure these are being done and monitored.
Note: CF patients wake up late and so are generally rounded on last.
Lung Transplant team
No formal house officer, only a registrar. Cystic fibrosis HO is occasionally asked to do jobs for these patients so you need to have a peripheral awareness of what’s happening with them. Some bosses may want you to be more involved (i.e. come on transplant ward round).
TB/NIV team
Usually the best team for the PGY1 HO as it is less heavy on the physiology.
TB:
You will need to be mask fitted when you start.
Important to get three sputums for AFB, MSU and three early morning urines if sterile pyuria.
All patients must have HbA1c, baseline LFTs, hepatitis screen and HIV screen.
When in doubt talk to Jenny Paynter (TB CNS).
NIV:
Often required to do admissions for overnight oximetry in the late afternoon.
Require ABG on arrival.
Any issues talk to Ma (CNS NIV) – Ma even does the discharges!!!
On call
After hours you cover the medical specialties. All transplant patients should be dealt with by the specialty registrars on call. Each specialty has a registrar on till 10pm, on nights there is one med specs registrar.
When it comes to Haematology and Oncology patients the Haematology page on the intranet is gold.
On weekends you are not expected to round with any subspecialty team but usually you round with your own specialty, although head off from the ward round if jobs start coming in via the iBleep.
Oxygen
Home oxygen options: short term, long term and palliative (different funding and providers). If unsure, talk to Jean Merringon (oxygen CNS).
The blue STOT/LTOT folder on the ward above the notes has the forms you need. All patients needing long term oxygen initially get it on a short term basis (unless palliative). Do not fill out the ‘Domiciliary Oxygen Request’, just complete the ‘Respiratory services prescription’ and the ‘Agreement for Oxygen Equipment Loan’ forms.
Book into oxygen clinic in 4 weeks. Clearly write prescription for oxygen on the discharge and that they will be reassessed for eligibility for long term oxygen at this review.
If they qualify then the registrar/consultant fills out the “Domiciliary Oxygen Request” form.
Teaching
Thursday 1400-1500 journal club, level 8 radiology seminar room
Thursday 1500-1600 difficult case conference, level 8 radiology seminar room