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RCH ADULT ROTATING RESIDENTS

Welcome to those residents who are about to join us in the ICU at Royal Columbian Hospital!

Your call schedule will be posted under RCH Resident Schedule shortly before your rotation starts.

If you have questions or problems could you please contact Dr. Craig Fava. We hope you have a terrific rotation, and we look forward to working with you!

Resident Expectations and Duties

Residents are expected to stay in the ICU until after sign out rounds and not leave before 1700

Post-call residents should leave by noon.

  • Give detailed sign over to the resident(s) that are remaining for the day.

Residents are expected to manage the day to day care of patients in the ICU under the supervision of the ICU attending.

Residents are expected to write admission notes and orders on all patients admitted to the ICU.

Residents are expected to examine their patients daily by 0845.

Residents are expected to follow-up on all tests and investigations on their patients by the end of the working day.

Rounding Schedule

  • 0800 Start time (0700 on Tuesday and Thursday for AM lecture
    • Assign resident to each patient and identify on patient board
    • Examine patients
    • Check bloodwork and cultures
  • 0845 X-ray rounds in ICU viewing room in Radiology department
  • 0915 to 1300 bedside rounds with ICU attending and multidisciplinary team
    • resident to identify problems and plans for their patients
    • progress note written daily to reflects the patients' status and management plans for the day
  • 1300 to 1700
    • procedures to be performed on residents' patients
    • follow-up on all tests ordered
    • detailed transfer notes written on patients being transferred out to a ward
    • complete transfer orders written on patients being transferred out
    • 1600 detailed sign out rounds to the night resident and attending.

Resident Reminder Checklist

ICU Evidence-Based Care:

Each patient has:

  • DVT prophylaxis
  • Ranitidine (for ventilated and/or coagulopathic patients)
  • Head of bed elevated 30 - 45o (unless otherwise contraindicated)
  • Transfusion trigger: Hb of <70 g/l (unless myocardial ischemia, postoperative cardiac surgery or actively bleeding)
  • RASS sedation target
  • Nutritional goals met
  • Glycemic control
    • does patient need iv insulin infusion?

Housekeeping:

For each patient:

  • Arranged any of the following immediately after AM rounds
    • diagnostic tests and scans
    • consultations
  • Results of diagnostic tests, scans and consutations reviewed and reported to team
  • Examined all venous/arterial catheter sites and wounds for signs of infection
  • Reevaluated the need for any central venous catheter, pulmonary artery catheter or arterial line
  • Reviewed the medication list (MAR) and:
    • Discontinued medications no longer being used
    • Adjusted medication dose and frequency for changes in renal function if required
    • Substituted oral for intravenous medication if my patient is tolerating enteral feeds
    • Reassessed sedation (too much/not enough? and considered daily sedation interuption to allow reevaluation of patient requirements and neurological status, specify RASS sedation target)
  • Reviewed antibiotics (type/dose/duration of therapy) and culture results
  • Reassessed bloodwork orders (frequency and type)
  • Reassessed need for daily CXRs/EKGs etc.

Patient Centred Care:

  • I have updated my patients and their families and addressed their questions and concerns
    • Family meeting note documented in chart

   
 
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