Information for Obstetrics and Gynaecology

Locum Induction information for the Department of Obstetrics and Gynaecology, North Devon District Hospital

This information pack is intended primarily for locum junior doctors but also requires to read in full by locum middle grade locums who require to be aware of what is expected of and not expected of junior doctors.

DEPARTMENTAL LAYOUT

The Obstetrics and Gynacology Dept is currently exclusively housed in the Ladywell Unit. The main wards are :

  • Petter Ward Level 2 (ext 27772 / 2332)
  • Gynaecology Ward: Bassett Ward Level 1 (ext 2612 /3645)
  • Antenatal and post natal: Labour Ward Ground floor (ext 2605 / 3796)

DUTIES AND RESPONSIBILITIES

Normal day shift – 9.00am to 5.00pm
Theatres 08.15 – 17.15
On-call day shift – 9.00am to 9.00pm.
Night shift – 9.00pm to 9.00am.

Half day off per week – to be arranged with the relevant Consultant during normal weeks.

Night shift commences on Saturday 9.00pm and ends on Saturday morning 9.00am.
There is a baton bleep (299) to be handed between the on-call junior doctors. At an absolute minimum there should be 3 junior doctors present between 9.00am and 1.00pm. You are entitled to one half day off per week for non-educational activities. This cannot be a Wednesday afternoon until teaching is finished. You must be flexible to the needs of the service on that particular day.

ON CALL WARD ROUNDS

There are two Ward Round per day – 9 am and 9 pm.

The morning on call ward round, commences at 9 am sharp on Labour Ward. This is led by the Consultant on call and is attended by the whole on call team for the day. Colleague from anaesthetics and paediatrics may also attend at the start. The duty junior doctors coming off duty, is required to create a hand-over form at the end of every 12 hour shift. This is kept on the Public access X drive and is accessed once you are awarded clearance by the IT support team. Log on using Novell username or password, then :

Start → My computer (→ Public) → obs & gynae → handovers

The last 12 hours hand-over sheet is updated to include al patients on labour ward, Bassett Ward and Petter Ward. It is particularly important to remember to include outliers eg in ITU, on surgical wards etc. Likewise relevant patients in the community (eg receiving methotrexate for management of ectopic pregnancy and those with active obstetric concerns) should be added to this sheet, so all members of the team are aware of their presence in the community. At the next ward round, the hand-over sheets are collected and disposed of in the Confidential Waste container on labour ward.

WORKING WITH THE MULTI-DISCIPLINARY TEAM

The on call ward rounds are but one aspect of the MDT approach we utilise in caring for our patients. There is a regular Obstetric MDT (last Wednesday of each month) that is attended by as many obstetricians and midwives as possible. We also have regular Governance Days (half day every second month) at which a variety of topics are discussed relevant to both midwifery and obstetrics. On a day to day level, please try to avail yourselves of the many opportunities for teaching especially on the labour ward. The midwifery co-ordinators for that particular day, will help you both see and participate in as many normal deliveries as possible and will also assist and supervise you in practical skills eg perineal suturing. They are happy to teach – so take advantage !

LEAVE ARRANGEMENTS

No leave is to be taken whilst rostered for night duties.

One week of compensatory leave is rostered for the week following night duty and many people like to take the week following this as part of their annual leave in order to extend their leave options and, all things being equal, would be given priority in this situation.

ONLY ONE JUNIOR DOCTOR TO BE ON LEAVE AT ANY ONE TIME – unless agreed by SHO rota co-ordinator (currently Dr Greg Pearson) and by College Tutor (currently Mr S Bennett)

Annual leave and study leave forms from Medical Staffing need to be countersigned by your Consultant and all leave requests must be co-ordinated with the rota co-ordinator (currently Dr Greg Pearson). Please ensure all completed forms reach Medical Staffing at least 6 weeks before intended absence.

During your leave, the clinics, theatre lists, pre-operative assessments and routine ward work all need covering by colleagues and it is the responsibility of the person on leave to organise this in conjunction with the rota co-ordinator who will produce a list in advance for Consultants affected by absence of their junior doctors detailing who will be covering the various duties.

Flexibility of on-call rotas is allowed, but if duties are swapped with colleagues it is the responsibility of the person on call to notify switchboard, Labour ward, Bassett ward and Petter ward and to make sure that these changes are detailed on the ward duty rosta. It is unacceptable to expect ward staff to chase around trying to find out who is on-call when confronted with an emergency on the ward because they have not been notified of duty changes.

In the rare circumstances you are unable to attend work on account of sickness you must inform:

a. The Consultant for whom you are working that day directly via switchboard
b. The on-call junior doctor or on-call Consultant if you are the on-call SHO
c. Medical Staffing (ext 2421)

WARD RESULTS

All blood results, histology reports, etc, are placed on clip boards on Bassett and Petter ward and should be signed off on a daily basis and given to the ward clerk for filing. Please ensure that you take the time to do this as the ward staff have been instructed to contact the duty junior doctor to sign off results if these have not been done at the end of the day and your colleagues will not appreciate having to do your work for you !

If you are unsure whether or not abnormal results have been acted upon, ask the Ward Clerk to request the notes or speak to the Consultant responsible for the case.

EMERGENCY THEATRE CASES

In general, we attempt to book emergency cases on to the end of scheduled lists in the Gynaecology Theatre 7 whenever possible. When such cases are booked please be aware that not only do Theatre 7 need the details but the case must also be booked on the emergency list in Main Theatres in order that staff allocations can be juggled. If the case is being booked at the end of a consultant’s list, the anaesthetist undertaking that particular list and the Consultant Gynaecologist will expect you to check with them personally before adding the patient and either/ both may get very disgruntled if this is not done.

When booking a patient on the main theatres list you should let the on call staff grade (013) know to ensure that they are happy to perform the operation. If they are happy to do so, bleep 256 (theatre co-ordinator) to inform them of the patient. They will ask you to let the on call anaesthetist know. They can generally be reached on bleep 508. Finally if appropriate and you are able to do so, consent the patient for the operation so that they are ready to go to theatre without delay when the emergency theatre send for them.

ELECTIVE THEATRE CASES

Patients for morning theatre lists on Monday, Tuesday, Thursday and Friday will start coming in to the ward 7 – 7.30am. Patients for elective c/s arrive on Bassett Ward at 12 pm. The on call junior doctor is to consent unless the ST doctor is doing the case in which case they require to do the consenting The junior doctor on night duty should therefore be on Labour Ward / Petter ward from 8am to start clerking and consenting patients on these days.

ADMINISTRATION

Junior doctors working for Consultants or covering annual leave for their colleagues should ensure that they call in to the relevant Consultant ’s office every day to sign off letters and complete any other administration.

E-discharge letters need to be filled out for every patient who attends Petter ward, either as an in patient, a day patient, an emergency patient or a ward attender and should be sent out on the same day the patient is discharged. In exceptional circumstances they can be done the following day, but under no circumstances should there be a longer delay than this (the hospital does not get paid for work carried out if there is a delay in notifying the GP).

Bassett Ward and Labour Ward also have results that need to be reviewed / acted upon and these should be checked daily.

TTAs need to be prepared for your team’s patient ready for their discharge.

TIMESCALES FOR DISCHARGE

In keeping with Enhanced Recovery Protocols, patients should be discharged out of hospital as soon as practically possible. There is good evidence that rates of hospital acquired infection and thrombo-embolic disease reduce with prompt discharge. Generally patients do not need to wait till they have had their bowels open prior to discharge. Generally, follow up is arranged post-operatively for 6 weeks at the clinic nearest to their home. In some cases, eg post endometrial ablation, review after several completed menstrual cycles is more appropriate.

OPEN ACCESS

You can give patients “open access” to the ward, which allows them to attend directly to the ward if they have any problems related to their original attendance. This is usually granted for a week or so. Please record this in the relevant Ward Work book.

TEACHING

As a department we put a high priority on releasing our Junior Doctors for formal teaching commitments. VTS Trainees are expected to attend their scheduled training days and Specialist Trainees the regional SWOT days, but please be aware that this needs to be booked in advance as with any other annual or study leave. NB: It may require your attendance during scheduled week off after week of nights. These specific days are the only occasions when the rule regarding only a single junior doctor to be absent at any one time can be waived. Please note that if you are absent when scheduled for one of the case presentations detailed in the previous section, please swap with one of your colleagues.

You will all have been issued with a copy of the departmental teaching timetable and you will see that each week one junior doctor is rostered to do a case presentation. This can be any case that you have encountered during your attachment in the department and does not necessarily have to relate to the topic being taught by the Consultant or Staff Grade at the same session. The case presentations are an opportunity to read around particular topics and should include a brief (10-15 minutes) mini tutorial for the benefit of your colleagues.

The Obstetric MDT is on the last Wednesday of the month. This incorporates the Perinatal Mortality Meeting in place of the regular teaching sessions. The Consultant you woerk for may ask you to present a case. If you know of a case to be discussed, it may be beneficial to pre-empt this and get the notes early.

EPAC (Early Pregnancy Assessment Clinic)

These are run on a 5 daily basis on Petter ward with ultrasound scanning currently being undertaken by the SAS doctors and Staff Nurse Teresa Poole. The clinics start at 10.00am. We allocate 15 minute slots to each patient and GPs will contact the on-call junior doctor for the day to book patients with threatened miscarriage, etc, and the on-call SHO should therefore check the diary each morning at 9.00am in order to be aware of the timings for the available slots that day.

A laminated algorithm in EPAC, details the agreed management pathways with patients with bleeding in early pregnancy, and if managing such patients yourselves it is important to adhere to this management plan and if you see patients being managed contrary to this by your senior colleagues it is perfectly appropriate to ask them the reasons for this.

These sessions are a very valuable learning and teaching resource and we do expect junior doctors to be in attendance and to send out e-discharge letters to the GP on every patient at the end of the clinic.

CONSENT

Most pre-operative consent is taken in the out-patient department by Consultants and middle grade doctors. For common procedures that you are familiar with (eg dilatation and curettage and diagnostic laparoscopy) you may be expected to consent. Please do not consent patients if you are not happy that you can explain adequately to the patient, the procedure and especially the “serious or frequently occurring risks”. There are laminated RCOG guidelines in pre-assessment on Petter, for consent taking with common procedures. If not familiar with these, please familiarise yourselves with them to ensure informed consent is obtained. For other procedures, if you are uncertain, it is very important that you check with your Consultant or a Staff Grade doctor rather than just ignoring the matter altogether. The F2 doctors are exempt from taking ANY consent at the Deanery’s request.

Mr S Eckford Lead Clinician
Mr S Bennett RCOG College Tutor 24.11.10

Last updated: October 3, 2017