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The PICU 2.0. Goals. Improve resident experience in the PICU by improving consistency Reduce redundant information presented on rounds Include nursing input in a formalized fashion Improve resident ability and opportunity to formulate problem lists and plans Go LIVE October 18 th !.

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goals
Goals
  • Improve resident experience in the PICU by improving consistency
  • Reduce redundant information presented on rounds
  • Include nursing input in a formalized fashion
  • Improve resident ability and opportunity to formulate problem lists and plans
  • Go LIVE October 18th!
expectations residents
ExpectationsResidents
  • You know all of the patients in the unit
  • Stay involved on rounds on everyone’s patients
  • See all of the sicker patients first- prioritize order of seeing patients and acting on needs
  • Check and write orders on the “non-urgent” pad every 1-2 hours (if possible)
expectations nurses
ExpectationsNurses
  • Present for rounds on their patients
  • Ask for the orders they need during rounds
  • Use the non-urgent pad
  • Ask questions of the backup attending during rounds
expectations attendings
ExpectationsAttendings
  • Discuss our expectations and requests on the first day
  • Be consistent in our expectations on rounds
  • Help write notes when residents overwhelmed
  • Let residents “be the doctor”
rounds
Rounds
  • SOAP note format
  • Avoid reporting the same information in more than one place
  • No need for reporting of non-involved organ systems
  • Improve quality of assessment- do NOT cut and paste (today’s assessment should be different from yesterdays)
rounds1
Rounds
  • Subjective: Overnight events (major)
  • Objective:
    • Vitals (ranges but if outliers, need to presents most common)
    • Exam
      • CNS
      • Resp: Vent settings, blood gasses, CXR result
      • CV: Inotrope, pressor doses, ECHO results, CVP/LA/PA line readings
      • FEN/GI: Weight, feeds, TPN, I/O’s, electrolytes
      • Heme: CBC, blood loss
      • ID: cultures, antibiotics
rounds2
Rounds
  • Nursing report
    • Respiratory/secretions- ready to wean, frequency of suctioning
    • ID- line days, foley days, can they come out?
    • Wounds
    • Pain
    • Correct any resident mistakes, omitted data
rounds assessment
RoundsAssessment
  • Assessment: 3yo female POD#4 from appendectomy now improving with a complicated postoperative course, including:
    • Problem list: No discussion or editorial comments, just the problems from head to toe, for example:
      • Respiratory insufficiency
      • Septic shock
      • Hypotension
      • Hypocalcemia
      • Anemia
      • Nutrition
      • Sedation/analgesia
rounds plan
RoundsPlan

If there is not an issue in that organ system, you do not need to discuss it!

Think through the problem list and plan before rounds- this will help you stay organized