Trauma nurses

We have four Specialist Trauma Nurses.

They can be contacted on ext 2387

They provide extensive support for the day to day running of the trauma service:

• Identify overnight trauma admissions, collect CC number and history.
• Identify any spare theatre capacity for the day.
• Attend Trauma Meeting-contribute to presentation of cases-agree order of Trauma list
• Document outcome of meeting and feedback to wards and patients respectively
• Re-visit cases in more detail & ensure optimised for theatre. Order any outstanding investigations. Commence e discharge.
• Progress chase trauma patients on Ward 45 and other outlying wards. Ensure clear plan in place. Evaluate patient condition and results and alert medical team.
• Facilitate/ expedite any referrals to Orthotics/plaster room.
• Police trauma admissions from AED to avoid any unnecessary delays.
• Receive referrals from # clinic-maintain diary/trauma board and liaise with admissions or bed bureau. Advise patients accordingly.
• Prioritise patients for Orthogeriatric Input pre operatively and post operatively.
• Provide nursing input for ward rounds to ensure continuity, documentation and actions required.
• Assess all inpatients with fragility fractures in accordance with BOA Standards of Care. Identify Osteoporosis Risk Factors and make recommendations as per NICE guidelines. Facilitate jointly with Orthopaedic Team. In absence of Bone Health Service at COCH refer back to GP via e discharge.
• Give Lifestyle and Dietary Advice both written and verbal.
• Give Falls literature as appropriate.
• Collect Fracture neck of femur data and input onto National Hip Fracture database. Complete # NOF Pathways.
• E-Mail referrals for ELM Falls Clinic
• Conduct 30 day follow up and beyond
• Report on Target-# NOF Time to theatre-all cases within 48 hrs/45% within 24 hrs

Hours of work:

• Mon 08:00 – 20:00
• Tues 08:00 – 20:00
• Wed 08:00 – 16:00
• Thurs 08:00 – 20:00
• Fri 08:00 – 20:00
• Sat 08:00 – 13:00

The Ward

Wards

• The main Orthopaedic wards are 45 (Trauma) and 41 (Elective).
• Ward 46 is in the Green zone on the ground floor opposite X-Ray.
• Ward 52 is on the first floor opposite theatre.
• Paediatric admissions are on Ward 30 on the ground floor in the Women & Children’s block.
• A&E – is located on the ground floor mid way along the corridor.

Ward Patients & note keeping

It is essential that you keep a clear record of your patients’ care. Every entry should have the date, time and your name and grade clearly printed along with your signature. Every patient should be seen every day (by one of the team) and every visit documented. When a ward round is dictated, a brief note should also be handwritten in the notes, in case the dictation is lost or there is a delay in it reaching the notes. The quality of record keeping is audited.

It is all of our responsibility to ensure the notes are kept well ordered. Please make sure, when you have made an entry, that it is filed in the correct place.

Orthogeriatrics

We are supported by Orthogeriatrics who undertake regular ward rounds during the week. If your patient requires review, speak to the nurse responsible for the patient or to the Trauma Nurses, who will inform them and also follow this up with a formal referral on Meditech. Please follow up their suggestions/management plans.

Bare Below the Elbows

Along with most other NHS hospitals, this Trust operates a bare below the elbows policy. You will all be familiar with it and will be expected to comply.

Trauma meeting

This is predominantly a “business” meeting, with some scope for teaching. The main function is to present the previous day’s take and prioritise cases for the Trauma List. Time permitting we also undertake an X-Ray review of the previously treated trauma cases.

We do not take a register but all the Orthopaedic Doctors and the Night on-call Doctor are expected to attend. It is held in the Orthopaedic Seminar Room, starting at 08:00 prompt every day (including weekends). If the door at the end of the corridor is locked the code is XXXX

The Night SHO presents the previous day’s admissions. It is important that the handover is conducted properly and that the patient’s details are recorded on the handover sheet. If you are not sure about the details of the day’s admissions – go and see them before the meeting. You will be expected to know about them.

The previous day on-call SHO(FTSTA/ST1 etc) should manage the trauma board, indicating the order of the day’s surgery.

During the week and Saturday, one of the Trauma nurses will let the wards know who is and who isn’t going to theatre. They don’t work on Sundays. The day ST/SHO should therefore let the wards know who is on the list for that day and the order, and just as importantly let them know who is not going to theatre. This should also be recorded in the notes or on Meditech.

Fracture clinics

These clinics are busy and should not be used for an ‘opinion’. If you are unsure about a case when on-call, ask the SpR to review the patient. Do not just book them for the next day’s # clinic.

Hand injuries: Plastics/Ortho:

To avoid confusion regarding hand injuries and who they are admitted under: In general soft tissue hand injuries and most bony injuries distal to the MCP joints are taken by Plastics. Metacarpal and more proximal fractures are taken by Orthopaedics.

Ellesmere Port Hospital Transfers

Patients are often transferred to Ellesmere Port Hospital for rehabilitation, particularly following femoral neck fractures. They now require a form to be completed before the patient can be transferred. This can be found on Sharepoint under EPH.

Registrar timetable

Referrals

Referrals are made through meditech, they are printed by the secretaries and kept in the office. The registrar should look at the referrals each day and prioritise them according to urgency and see them accordingly.

Talking Point/Dictation

We use digital dictation here. It’s called Talking Point. There are handsets attached to the PCs in clinic & Theatre. Laminated instruction sheets are by most of the machines. Select the Consultants name from the drop down menu and use the patient’s unit number to identify them.

Computer system

The Hospital system is Meditech. You will receive training in this in your first few days. It is used mainly for requesting orders and retrieving results. XRays are on PACS which is accessed through the Meditech system. You will get training in these systems as you start.

The Hospital has also moved to Electronic Prescribing(EP); you will be given training when you start.

There is Orthopaedic teaching in the Orthopaedic Seminar Room on thursday mornings at 12:30.

It is run by Mr Wood and his SpR.

Topics will be allocated in advance.

There is also a Journal club, run by Mr Rao on Tuesday lunchtimes monthly. You will be allocated a topic and expected to produce and briefly review a key paper in that area.

Morbidity & Mortality

We monitor and regularly report on our Morbidity & Mortality (M&Ms) within the department. There are folders containing the yellow forms in the clinics and on the wards. Once completed the forms should be placed in the box in the trauma room.

Rolling Half Days

The trust operates a rolling half day programme. The afternoon sessions are used for Morbidity & Mortality/Audit.

The morning sessions will be used for teaching.

See attached timetable.

Educational Supervisors

The Assigned Educational Supervisor for the SpRs is Mr Wood.

The Assigned Educational Supervisor for the SHO/CTs is Prof Harrison.

You need to contact their secretaries to make arrangements for your initial meeting within the first couple of weeks of your post.

You will also be assigned to a Consultant team – these will act as your Clinical Supervisors.

Audit

We expect everyone going through the department to complete an audit and this forms an integral part of your training and assessment. You should aim to agree a topic with your trainer within the first 2 weeks. It will need to be registered with the Audit department who will help you with casenote location, processing & presentation of the data. Try to pick a topic that will lead to a change in practice – it is always asked about in interviews.

Annual and study leave guidance

We require at least 6 weeks’ notice for leave. Ideally you should try to plan it further in advance, across the duration of your time here, as there are always people who cannot take their leave when it is left until the end of the job.

• We do not allow more than 3 SpRs off at any one time.
• We do not allow more than 2 F2/STs off at any one time.
• The SpR & Middle Grade from the same team (Upper Limb, Lower Limb, Foot & Ankle) should try not be off at the same time.

Before submitting your application you need to check the leave diary, this is set up as a Google calendar: missing link

If there are not already people off, the next step is to ask your Consultant to sign the form. Then get Ms Thomason’s signature. The forms will then be passed on to the most senior SpR who coordinates weekday cover. The form is then sent to Medical Staffing. Only leave approved by Ms Thomason is placed on the calendar.

For the ST/F2 etc you will be expected to nominate cover for your daytime duties when you are away on leave. This should be clearly documented and agreed. There is a form. You are expected to formally hand your patients over and should provide a written summary detailing your patient’s condition and ongoing issues.

Any on-call swaps should also be notified and the appropriate form completed, which should be handed to Hayley Parry.

Please ensure that you inform your Consultant’s secretary of your leave dates so clinic numbers and lists can be amended.

SpR Study Leave

You are allocated 30 days study leave per year. 20 of those are taken up with the assumed 40 half day SpR regional teaching sessions.

This leaves 10 days per year for courses etc.

Which means 5 days per 6 months.

Any extra is at the discretion of the Trust.

Medical students

You may examine a patient if they are awake and give consent. Under NO CIRCUMSTANCES should an examination take place if the patient is under anaesthetic/ sedation, even if the patient has given consent. Students should refuse to perform an examination on a patient who is under anaesthetic/ sedation if they are asked by a senior doctor.

There are plenty of learning opportunities for medical students:

• Surgery
• Day Cases
• Clinics
• Bedside teaching