Download Handover Rover Example

ROVER
XXX Rural Referral Hospital
JMO Rolling Term Handover (ROVER) Form
There are 6 sections to this form. It is not mandatory to fill in all of the sections – they are
intended only as a guide.
Term Name: ICU
Term Supervisor(s): Dr T
Registrar: various
NUM:
Other Important Staff:
1. Roles and Responsibilities
Eg. Start times, daily routine, average patient load, how ward rounds are run, entries in notes, general expectations, role of the registrar
-Handover at 8am, 2pm, or 10.30pm, depending on the shift. There is a typed handover
sheet with the current patient list, jobs and important aspects of the patient’s management
on a USB on one of the ICU computers closest to entrance of the department.
-7 ICU beds, 3 HDU- sometimes CCU patients will take up front beds (unstable because of
arrhythmias or chest pain), be aware of them, but don’t have to clerk them
- Ward rounds start at around 8am. Depends on the boss as to how they run and to how
sick patients are. Dr T does a quick walk around initially and assesses the patients briefly,
giving some directions for management eg. extubate, then comes back (after his coffee!)
and does a full ward round. (Don’t write in the notes during his walk around, wait til the
proper round). Dr H usually rounds in order of severity of illness. Dr M also does a miniward round/handover before doing a proper ward round usually starting from bed 1.
-Dr H will give you a set of questions to do as an introduction to ICU that are a useful
learning tool to work on throughout the term.
-Dr H likes to use a typed proforma for ward round entries (these are available on one of
the bottom shelves of the nursing station near beds 6 and 7)
- Can be VERY busy at times, and often ward rounds may go all day because of MET calls
and retrievals. When there is no boss, do jobs or discharge summaries.
- Try to get radiology requests and pathology in early (usually the night person will
complete these)
- You will be asked by teams for PICC line requests which go in the white PICC line
bookings folder behind the doctor/nurses station – these need to be booked in and
discussed with the specialist and nurse in charge, usually tues/thurs afternoons.
- You can also be asked to assist with difficult IVC on the ward, although Anaesthetics can
also assist with this
2. Resources
E.g. Useful protocols, go-to people, roles of allied health, where to find information for patients etc.
-Nursing staff are very experienced, can be good source of information, especially when
writing up medication infusions and dosages.
-Lots of protocols for medications, use them they live in the red folder or out the back.
-CIAP useful
-ICU questions
-BASIC course
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ROVER
XXX Rural Referral Hospital
JMO Rolling Term Handover (ROVER) Form
Referrals
E.g. How to get an allied health referral or send someone to a rehab facility
-ECHOs – call the cardio reg / use consult form
-Physios are in the department daily- there is always 1 or 2 physios permanently in ICU.
-Use consult forms for involving other teams with a phone call or a verbal consult as the
teams are rounding in ICU
-Consultation liaison psychiatry (direct phone 78695)
3. Common Conditions
E.g. conditions commonly encountered on this term and routine management i.e. general management measures, length of stay, etc.
-Intubated and ventilated patients, for various reasons.
-Post op high risk patients for HDU
-Pneumonia
-DKA
-Severe asthma
-COPD requiring BiPAP
-Severe sepsis
-CVA & reduced GCS for any reason
-Trauma
-Cardiac arrests
4. Medications
E.g. Commonly used medications (analgesia, anticoagulants, aperients, etc) and doses
Analgesia/sedation infusions
 Fentanyl (on chart write 500microg in 50mL N/S or 5% dextrose)
 Morphine (write 50mg in 50mL N/S - titrate)
 Midazolam (50mg in 50mL N/S - titrate)
 Propofol (500mg in 50mL N/S)
Other infusions
 Actrapid insulin infusion (50units in 50mL N/S)
 Aminophylline (125mg in 50mL N/S)
 Aramine- drug to boost BP if have spinal or if no CVC for inotropes. Can give it in
peripheral line in 0.5mg-1mg boluses (10mg in 50mL N/S)
 GTN (think its 15mg in 50mL 5% dextrose)
 Noradrenaline (single strength: 4mg in 50mL 5% dextrose, double strength: 8mg in
50mL 5% dextrose etc.)
 Pantoprazole infusion (80mg in 100mL N/S @ 10mL/hr)
ALL patients if ventilated (or even if not) need
1. Ulcer protection (Ranitidine 50mg tds IV or 150mg bd oral or pantoprazole 40mg
daily IV/PO)
2. Coloxyl and senna (2 daily) and lactulose 20mL daily, depending on age / bowels /
NIDDM status
3. TEDs, SCUDs and clexane / heparin
Patients who are commenced on TPN will also tend to be started on
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ROVER
XXX Rural Referral Hospital
JMO Rolling Term Handover (ROVER) Form
 IV MTEFE 1 ampoule in 250mL over 4 hours daily
 IV Thiamine 100mg TDS
 IV Folate 5mg daily
 IV Vitamin K 10mg weekly
 IV Cernavit i ampoule daily
Electrolyte replacement options
- K, PO4 and Mg often need replacing in ICU patients
Potassium (depends on boss, some like K to be around 4 to reduce risk of arrhymias)
 Slow K - can’t crush or give NG
 Chlorvescent – can be given via NGT, 1 tablet apparently contains 40mmol K
 KCl comes in 10mmol in 10mL (neat) ampoules, can be given via syringe driver at
10mmol/hour, only can administer via CVC or PICC.
 KH2PO4 comes in ampoules (each ampoule containing 10mmol K, 20mmol H,
10mmol PO4). Each ampoule can be given over at least 1 hour. This is an option if
you don’t want to give the patient too much chloride.
Magnesium (depends on boss, some like Mg to be around 1 to reduce risk of arrhymias)
 MagMin
 MgSO4 10 or 20mmol in 100mL N/S @ 10mmol/hr
5. Miscellaneous Tips
E.g. Particular consultant preferences, ward quirks, and hints for getting things done
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If you don’t know the answer, ASK!! The bosses are all approachable and don’t mind
being called.
On nights, look at the plan that the day team has laid out and follow that. Don’t
make any major changes to management (without BOSS involvement). Good idea to
sit down and go through all micro results and sensitivities etc at night
Gown, glove, mask & hat for all procedures - for art lines, CVC, ICC, PICC etc.
Review how to read CXRs and know where various lines should be. Eg. end of ETT
should be 2-3cm above the carina, any lower than this and there is a risk of going
down the right main bronchus. End of CVC or (a PICC line if being used for TPN)
should be in the SVC. Ask the bosses to go through this with you early in the term
because will often have to verify position of various things O/N or without a boss.
When a patient is going to the ward and you have specific things you want to be
watched or managed, make sure you do a discharge summary from the database and
put it on the front, write the plan in the notes and often call the resident to ensure
they know too, ensure med charts and IVF charts (blue) are up to date.
Keep a log of all procedures you have performed and the level of supervision
There is a handover ward round at ~4pm each day; there is usually an ED registrar
and/or consultant who are first and second on call respectively for any problems
that night. You generally call the ED registrar (1st on call) if the patient has come up
from ED in the last 24 hours. You usually call the consultant if it is a patient they
know and the ED registrar doesn’t.
Mon 2pm Microbiology meeting with JHH over videoconference, chance to discuss
all of your patients, have a sheet ready with all sticky labels and a brief history, any
relevant micro & antibiotic choice
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ROVER
XXX Rural Referral Hospital
JMO Rolling Term Handover (ROVER) Form
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Gentamicin level targets: 1-2 (trough, 8hrs post-last dose), 5-8 (peak)
ICU Fax machine no: 6766 9134
6. Learning Opp0rtunities
E.g. Great learning opportunities (eg particular procedural skills, particular conditions) unique to this term that it would be a shame not
to take advantage of.
Art lines, CVC, ICC, PICC
Airway Management – elective intubation
Updated 23/11/14 – TD
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