Mother Baby Unit
Rotation Director:
Name: Sheevaun Khaki, MD
Email: khakis@ohsu.edu
Office: CDRC 2234
Phone: 503-494-2712
Pager: 16869
Overview:
This rotation provides direct clinical experience working with newborns in our well baby nursery.
Rotation goals and objectives:
Residents will be able to provide effective teaching and anticipatory guidance to families regarding newborn care
Residents will be able to successfully provide routine newborn care and with be able to recognize and treat common disease processes including neonatal jaundice and hypoglycemia
Residents will be able to provide direct educational opportunities for other learners around routine well newborn care
Prior to the start of the rotation:
Residents MUST review the “Basics for Interns” document, which reviews pre-rounding, documentation, and schedules. This is located on box.
Residents should start their rotation knowing how to complete a routine well newborn examination and know the pertinent history needed to provide newborn care
Resource for newborn examination: Stanford Newborn Exam
Resource for info on well newborn care: http://pedsinreview.aappublications.org/content/pedsinreview/33/1/4.full.pdf Warren JB, Phillip CA. Care of the Well Newborn. Peds in Review. 2012; 33 (1).
Residents should receive sign-out from the previous resident
Residents should make sure they know how to gather information from patient and mother’s charts within EPIC
First day of the rotation:
Come prepared by receiving sign-out and other tips and tricks from your colleagues
Please arrive to the unit (13C in the main hospital) by 7a. You will receive signout from the covering NICU team either via page, phone call, or in person
Pre-round on all infants with the pediatric attending listed (this is how you know they are on the pediatric team). You do not have to examine infants prior to the start of rounds.
Attend multidisciplinary rounds in the lounge at 8am (9:30 am on weekends)
Attend morning report at 8:30am
Be ready to round by 9am, after morning report. Please note that a mobile computer is not consistently available for rounds so you will need a printed list
Resident Expectations:
At the beginning of the rotation, identify your learning goals
Set expectations for your learners. Ask your attending to clarify his/her expectations if s/he hasn’t
You are the team leader! On rounds, identify infants who will need to be seen first for discharge or medical needs. Lead the discussions and examinations in the room. We are there to back you up.
Use this rotation to work on teaching skills – teaching families and medical students.
Have discharge summaries fully prepared before rounds. Your attending may assist with documentation to facilitate patient care, but you are expected to complete the bulk of note writing.
You do not need to examine patients before rounds. As a team, we will perform a FULL physical exam on the day of admission and focused exams on subsequent days.
Keep patient problem lists updated
General Schedule:
M-F: 7am to 6pm (apart from your clinic day)
7am – get signout from covering NICU team
8:00– multidisciplinary rounds
8:30 – morning report
9-11:45 – rounds
12:00 – noon conference
Afternoons are usually spent seeing patients, teaching, and following up on patient care or anticipatory guidance with families. With the exception of your continuity clinic day, you are responsible for the care of your patients on the MBU until 6pm when you sign out to the NICU team. You must be able to respond to pages, triage patient care, and communicate with your attending as needed. If you are paged about an infant who needs evaluation in person, you should be able to return to the unit within 30 minutes. (Note: ACGME rules do not allow interns to make clinical decisions about new patients from off-site locations – ie, you cannot give a nurse advice over the phone from your home about a newborn who you have not yet examined).
Saturday and Sunday: 7 am until the work is done (typically early afternoon). One weekend per block.
If you are going to be absent for all or part of a day:
Please contact (page or text) chief on call as soon as possible to arrange coverage. A verbal exchange must happen with the chief on call because you may need to contact other individuals.
Any resident missing more than 2 days (or 4 half days) may be required to make up the difference at a future date at the discretion of the rotation director, chiefs, and program leadership.
There is no defined jeopardy for the clinic or MBU.
The NICU team covers the babies in the MBU overnight. There is a shared pager number (#17270) that is transferred from the MBU team to the NICU team at 6pm and back at 7am. When you leave for conti clinic, please forward your pager to your attending.
Resident Resources, Helpful Tips, and Further Readings:
Vaccines for Parents Workflow Steps
1. If parent expresses interest, ask if they are an OHSU Employee. If so, they may want to get their dose through occupational health for ease.
2. Have the parent fill out 2 forms (can be found in the shelves above the desk)
a. MRN creation form- if they are not an OHSU patient
b. Vaccine Administration Record (VAR) form
3. In the vaccine room prep the vaccine dose for the parent if there are no contraindications
4. Supplies: cotton ball, bandaid, VIS form
5. Attach 1” needle to prefilled syringe, make sure it’s screwed on tight!
6. No need to push out air bubble
7. Administer the vaccine using IM technique (at 90 degrees 2-3 finger breadths below the olecranon process) and give the parent the VIS.
8. Place the sticker from the pre-filled syringe on the back of the VAR form and make a copy the parent needs it. Place the sticker at the site indicated by the blue arrow below.
9. Please place the completed forms in the shelf above the desks in the yellow folder. MRN request will be faxed to Registration (the number on the form) and the VAR forms will be sent to Maggi Frey by interoffice mail to be entered.
10. When the supply of vaccines is low (< 5 vials of Tdap or Flu), please contact Savannah Coe (coesa@ohsu.edu ) to order more supplies!