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The PICU 2.0

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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The PICU 2.0

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  1. The PICU 2.0

  2. 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!

  3. 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)

  4. 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

  5. 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”

  6. 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)

  7. 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

  8. 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

  9. 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

  10. 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

  11. Any questions???

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