Welcome to the Anaesthetic Department of the North Devon District Hospital (NDDH). We are part of the Northern Devon Healthcare NHS Trust.
This document is intended to help you in becoming familiar with the ways of working here at NDDH and to ensure that you are safe and competent at your new job.
When you First Arrive
The Departmental Manager is Lisa Howse and she should be your first port of call. Her telephone number is 01271 322756 or extension 2756 from within the hospital. Lisa is responsible for the day to day running of the Department, including the rotas. She will explain your duties and, if you have any specific requests for experience in a particular area of anaesthesia, we will do our best to accommodate you.
It is your responsibility to attend a Trust Induction Day. All new staff are required to attend. An Induction Day takes place every ?day in ? at ?am. A photo ID card will be made for you at this time and a Departmental Induction Programme has been devised for you to include the following areas:-
Responsibility for Induction
All trainees will be met by the College Tutor (currently Dr Guy Rousseau) who will conduct an initial appraisal. The Lead Clinician or Consultant delegated will meet all other new staff. An Educational Supervisor will also be allocated to you. At this meeting you should address areas such as your level of experience, competencies and expected duties. Any expected duties outside your level of competence should be identified so that urgent training can be undertaken. It is each doctor’s responsibility to declare whether they are capable of performing their allocated duties. Attached is a form for you to complete showing your competence in the basics of our speciality. Please complete it as soon as possible and return it with your induction tour sheet to Lisa for filing.
Lisa will delegate a department member to take you on a guided tour of the hospital. This will start at the Admin Anaesthetic Office on level 3 during the tour you will visit the main clinical service areas including A & E, maternity, critical care areas, theatre and recovery. It should also include the location of the main surgical wards including paediatrics. Finally you should visit the Basil Muir Anaesthetic Dept on level 1.
Medical Education Centre
Your tour should include a stop at the Medical Education Centre which is on level 1. Close to hand on the same level are a medical library with a journal supply service and several computers with intranet and internet access. Caroline Rawlings is the ME Manager and arranges study leave. Requests for study leave must be agreed with your supervisor and is appropriate to your current learning needs. Dr Julian Cox is the Director of Medical Education (and also a consultant paediatrician). They will be delighted to show you the facilities, the educational opportunities and the programme of the multidisciplinary lunchtime lectures.
Lisa will provide you with a bleep. She will also give you forms to fill in so you can be issued with a security pass for entry into the new buildings. Please provide your contact details for the file in the office at this time. To use the bleep system, dial 74, then your bleep no. and extension. Wait for confirmation and hang up.
Medical Staffing/Occupational Health
Hopefully you have already completed and returned all the required documentation prior to commencement but please make sure you visit the personnel department on your tour to check everything is in order.
Familiarisation with Equipment
It is your responsibility to ensure you are capable of using any medical equipment provided. All the theatres have similar machines/monitors etc. Please check prior to starting a list that you are familiar with the equipment and if not, ask. The Anaesthetic nurses / ODPs should be able to assist you in most cases. You will have been given a competency form on arrival. Any areas in which you feel yourself lacking in expertise should be identified on that form and training can be directed towards rectifying the situation. It is not acceptable to learn on the job; you must be trained. There is always a duty consultant available in theatres for advice on cases/equipment.
Policies, protocols and procedures
There are departmental protocols and procedures available in the anaesthetic department. They are kept in a large white folder next to the pigeon holes. The protocols for critical care are kept on ICU. It is the trainee’s responsibility to ensure they are familiar with all the local policies and procedures. Advice on epidurals/analgesia protocols can be sought from the Acute Pain Team, Dr Andy Walder, Sister Lucy Bates and SN Jennie Walder
All trainees must be competent in both adult and paediatric resuscitation. Ideally, a current ALS and PALS/APLS certificate should be held. If not, an ‘in-house’ resuscitation day must be attended. Michelle Cobby & Rob Tyacke are the Trust Resuscitation Officers. They can be contacted via the portal Michelle and Rob are very helpful and will provide one to one refreshers on BLS/ALS if asked.
Sources of Advice
On arrival you will be allocated an Educational Supervisor for career development advice. You will also be offered a Mentor who will be available for more informal discussions of personal difficulties if required. For clinical matters there is a duty consultant for both theatres and critical care. It is expected that any complex cases will be discussed with a consultant. If you are in any doubt about a case – whatever hour of the day or night – ASK.
Minimum Period of Supervised Practice
New starters to anaesthesia will usually receive 3 months supervised practice. During this time competency will be assessed. If a satisfactory level is reached, trainees will be allowed to undertake appropriate independent practice. Again, more experienced staff will be always available for help/advice.
It is expected that a locum will conform to the standards required by the department including completing the induction process.
The Trust has systems in place intended to minimise clinical risk. It is your responsibility to familiarise yourself with these procedures.
The system depends on reporting of Critical Incidents (CIs) – a sample form is enclosed. A CI should be filled out if there is appropriate cause. Particular attention should be paid to the policies relating to infection control, patient safety & sharps handling.
Verification of Registration/Ongoing Appraisal
It is the responsibility of all staff to ensure they are registered with the College. Lisa can help with the appropriate form. The upkeep of a Logbook and Personal Profile is mandatory. The College Tutor can advise you on this. All staff will be required to show evidence of competence assessed according to your level of training. Records need to be kept in your personal portfolio.
As with most hospitals, this is a difficult area. Lisa will provide you with the correct form to apply for a permit.
Operating Lists and Start Times
The majority of operating lists start at either 08.30am or 13.30pm. There are however some exceptions. If you are down to do a list with which you are not immediately familiar, please check the start time with theatre reception (2710) or with Lisa Howse. If you are the sole anaesthetist for that list it is imperative that you are available to start the list on time and this takes precedence over other commitments (such as the morning meeting). Except in exceptional or emergency circumstances all patients should be seen by an anaesthetist on the ward prior to surgery.
If you are scheduled to do an accompanied list you may wish to contact the consultant with whom you will be working to seek advice regarding pre-operative visiting and list start times. Lisa Howse has mobile or pager numbers for all the consultant anaesthetists whom you should feel free to contact at any time during office hours should you wish to discuss work related matters.
For every operating session there is a designated consultant-on-call. It is imperative you discuss with the on-call consultant any patient abut whom you have undue concerns or whom you feel is inappropriate for your level of experience. The name of the consultant-on-call can be obtained from the weekly rota or switchboard.
There is currently one trainee assigned to cover ICU during the day. An additional trainee is allocated to the morning Trauma list and the afternoon CEPOD list. After 18.00 one of these trainees covers both these clinical areas. At 20.30 a handover takes place with the night-time trainee. A second-on-call rota is currently running at night time to cover the most junior trainees they start at 20.00 and finish at 09.00. These anaesthetists are either ST2 or NCCG, they have variable competencies it is the responsibility of the Consultant –on-call team to decide the division of duties.
Emergency out of hours theatre work is covered by the first-on-call anaesthetist who is normally a relatively Junior ST1, NCCG doctor or an ST2. This rota is a one-in-nine. The General –on- call Consultant covers the first- on –call in theatre.
The General -on-call Consultant anaesthetist has overall responsibility for the maternity unit. However the first on-call trainee covers the epidural service and the second-on-call person will cover operative procedures if they have the appropriate experience.
The first on-call is also responsible for care of patients on the Intensive Care and High Dependency Unit and for responding to cardiac arrest and trauma calls. They also provide anaesthetic/airway support to the Accident and Emergency Department. The first-on-call doctor may also be asked to advise on problems related to acute pain or epidural infusions. There is a separate Consultant –on-call covering the ICU. In addition to their other duties, either the first, or second -on-call may be asked (other clinical commitments allowing) to give assistance with intubations or other technical procedures to the ICU-on-call (who may or may not be a trained anaesthetist?). They may also be asked to undertake inter-hospital patient transfers if they are deemed sufficiently experienced. They may be asked to cover the ICU/cardiac arrest/trauma calls on a temporary basis if the ICU doctor is themselves occupied on a patient transfer. In exceptional circumstances such duties may take them past the end of their normal shift time when time in lieu will be offered at a later date.
Tutorials and Meetings
Meetings are held in the department every Monday lunchtime. They commence at 12.30 and finish at approximately 13.15. The topics covered are wide ranging and include journal review, morbidity and mortality and Intensive Care topics. Attendance is compulsory except when on annual leave/study leave.
Examination tutorials take place on Thursday mornings during normal working hours and the College Tutor will be able to give you more details as appropriate.
Departmental audit meetings occur on a rolling basis approximately every 3 months. Attendance is compulsory and records are kept and will make up part of your appraisal.
Rotas and Annual Leave
On call and working hours for all trainee anaesthetic staff is aimed to be New Deal and European Working Time Directive compliant. If you have any concerns with regards your overall working pattern/working hours you should bring your concerns to the attention of the College Tutor who during your initial briefing can discuss working hours in more detail.
Should you have any request with regards your elective list allocation, please discuss this with Lisa Howse or Guy Rousseau.
The day to day compilation of the trainee on-call rotas has become the shared responsibility of the Lead Clinician, the College Tutor and Lisa Howse. Once the rota has been written any ‘swaps’ must be cleared with Dr Kate Tipping and also notified to Lisa Howse ASAP.
All Study leave requests should be discussed with Lisa Howse as soon as possible and will be submitted to the College Tutor and Lead Clinician for final approval. No leave is to be taken without completion of the appropriate documentation. During some parts of the rotation, annual leave can only be taken on certain weeks to fit in with the overall shift rotation. Again, Lisa Howse should be your first point of call. If your circumstances are exceptional, i.e. examinations, interviews, compassionate leave, planned sick leave, you should discuss your situation with Dr Garry Henry.
We hope you enjoy your time in NDDH. It has always been a pleasant department in which to work, with high standards, wide clinical experience, good success rates at examinations and excellent future employment prospects. It is up to all of us to try and maintain this level. If you feel we are falling below this standard, please make your constructive suggestions known.