DEPARTMENT PROFILE HISTORY
Era of Conception When the hospital opened its doors to the public in 1967, there was already a Department of Pediatrics, ably chaired by Dr. Gracia Fernandez-Ramos with 2 other consultants in the staff: Dr. Narcisa Quaioit-Fajardo and Dr. Aida Mariano-Castro. They had 2 general practitioners on 24-hour duty shifts to specifically care for pediatric patients. Slowly, the number of consultants grew with Dr. Priscila Reyes joining the staff in 1969 and Drs. Iole Rabor and Librada Manaligud following soon after.
Era of Struggle In 1974, Dr. Fernandez-Ramos relinquished her position to Dr. Fajardo who took over as Chairman of the Department. Dr. Mariano-Castro, likewise, left for abroad. With a handful of pediatricians left in the department, Dr. Fajardo felt it was time to take in new medical graduates whom they could train in the field of Pediatrics. Dr. Rabor assumed the role of the Residents‟ Training Officer. Regular department conferences and rounds were essential in the training program. The residents also provided service to hospital dependents through well-baby check-ups. In 1978, the Metro-Manila Integrated Residency Training Program (later, to be SEC registered in 1992 as the First Integrated Residency Training Pediatric Program or F.I.R.S.T.), was created. It was formed by The Medical City General Hospital with three other neighboring private hospitals that eventually became PPS-HAB IIa/b accredited, namely: Cardinal Santos Medical Center, Our Lady of Lourdes Hospital, and Polymedic General Hospital (now known as Victor R. Potenciano Medical Center). A program of conferences, workshops and lectures, organized by the consultants of each member hospital, provided the residents‟ exposure to a wider and more diverse field for teaching and learning that complemented the hospitals‟ individual training programs. At about this time, the Philippine Pediatric Society (PPS) was implementing the rules of the Hospital Accreditation Board (HAB), responsible for maintaining the quality and elevating the status of pediatric residency training programs all over the country. As Dr. Rabor was a member of the PPS-HAB Specialty Board, she encouraged Dr. Emelita Lazaro-Leh, then incumbent Chief Resident, to work for the department‟s accreditation. The department achieved accreditation to a Phase I status in October 1981. In 1984, Dr. Rabor passed away. It was a big loss for the department for she was a well-loved academician, a compassionate and idealistic practitioner, who served as an inspiration to all those who were privileged to train under her wings. On that same year, Dr. Fajardo begged off from the chairmanship.
Era of Growth Dr. Priscila C. Reyes then embraced the role of Chairman of the Department in 1985, with Dr. Carmelo A. Alfiler as Training Officer.
OPM No. 23 Department of Pediatrics
Accreditation was upgraded yearly to Phase IIa and then Phase II a/b. This consequently qualified our resident graduates to take the pediatric specialty board examinations given biannually by the PPS. The department increased its resident staff from the initial 1-2 to 9-12 staff members (having 3-4 doctors per training year). The consultant staff likewise grew; diplomats, fellows and invited subspecialists of the PPS joined the distinguished roster of pediatricians. With excellence achieved in academic performance, in addition to award winning research output acknowledged in intra- and inter-departmental as well as inter-hospital research paper contests, it was no surprise that The Medical City was cited as Outstanding Hospital within the FIRST. With recognition abounding, Dr. Priscilla Reyes fondly called this time as our “Golden Period”. IV. Era of Sustainable Development In 1996, Dr. Carmelo A. Alfiler took over as Chairman of the department. He appointed Dr. Elizabeth Palmero-Reyes, a former Chief Resident, as Training Officer. Armed with a vision-mission statement and trailblazing plans, Dr. Alfiler carried the department into a bold new era in its history. The consultant staff grew to 41 regular and 44 visiting staff members, with a good balance of general and sub-specialty pediatricians among the consultant staff. Just as importantly, 15 sub-specialty sections were filled up with at least two sub-specialists each, all ready to develop and conduct their own fellowship training programs and have 15 faculty members with post-doctoral degrees who can offer masters programs in the future medical school. The number of slots for residents increased to 22, including plantilla for a 4th year (as Chief Resident, for the very first time in 2003 and again in 2004), to cover five service areas --- Pedia ER, NICU, Ward, OPD/community and PICU. Numerous scientific activities and medical symposia provided extensive exposure for consultant and resident staff. Out-patient well-baby and sick child services, pediatric emergency room rotations and cases admitted to the hospital‟s Divine Mercy Program for service/charity patients provided additional opportunities for learning and handling of pediatric patients. In-house preceptorships for general and subspecialty pediatrics for our residents began in 2001 and 2002, respectively. V. Era of Expansion Into the new millennium, The New Medical City, once only a dream became a reality, relocating to its new site and structure along Ortigas Avenue in Pasig City by early 2004. By then, Dr. Alfiler, who had worked passionately to achieve the department‟s goal of Phase III accreditation status, had moved on to become the Medical Director of the country‟s premiere state-run hospital, the UPPGH, and passed on the baton to Dr. Elizabeth Palmero-Reyes, the department‟s first graduate ever to become Department Chairman. The past chairman of the RTC, Dr. Carlos Paguio was then appointed Training Officer. Under its new and young chairman, the department was more than ready to thrust its best foot forward, having achieved Phase III status and working to maintain this seal of excellence. Plans are being organized to prepare for a future affiliation with the Ateneo University School of Medicine and Public Health. Presently, the staff includes 45 regular and 66 visiting consultants and 18 residents. Achievements of its staff in academics and research and accomplishments of its distinguished staff that pursue further studies here and abroad have been duly recognized and hailed by the hospital and the whole medical community, as well.
OPM No. 23 Department of Pediatrics
To date, the department boasts of 75 graduates, 12 of whom have trained further in their respective sub-specialties and 5 of whom hold Masteral Degrees in Health Professions Education, Health Services Administration and Health Care. Ninety-four percent (94%) of graduates have been duly board-certified by the Philippine Pediatric Society and forty-two percent (42 %) of graduates are now currently on the staff. It is not typical of the department to remain complacent in its present status, but rather, it is in its character to strive and achieve more than what it set out to be. As this history unfolds, the department has come up with pioneering and showcase programs (e.g. Comprehensive Health of Adolescents‟ Program or CHAP, Barangay Ugong Community Development Program), and other services integrated with the hospital‟s niches (Cardiovascular, Neurosciences, Cancer, Organ Transplantation), all of which will certainly prove that the Department of Pediatrics is indeed a vibrant player in The Medical City. VI. Administration The Philippine Pediatric Society Hospital Accreditation Board (PPS-HAB) has duly accredited the Medical City Department of Pediatrics as Phase II A/B hospital since 1986. It has since been accredited as a Phase III hospital with an effectivity date of January 1, 2004 to December 30, 2007 (please refer to Attachment A). It has since been revisited at the new site in Ortigas Ave. last March 1, 2005.
OPM No. 23 Department of Pediatrics
Service Delivery Improvement 1. Develop new and sustain existing group activities designed to foster interpersonal understanding.
Vision We envision to provide optimum quality pediatric care. Continuously developing and implementing feasible and sustainable strategies that will promote & realize the highest of academic. in the future. Recruit and train needed professional manpower Eligible general and subspecialty consultants Eligible junior consultants and. Inculcating the highest moral and ethical standards into all our department practices and personnel. including post-doctoral studies Up-to-date and relevant library and information technology materials 2. residency and post-residency fellowship candidates. duly certified by the Philippine Pediatric Society. Generating resources for the optimum & sustainable implementation of departmental policies. Review and make relevant service policies C. local and international Professional development. collectively working to pursue academic & patient service programs for the benefit of the hospital and the community.
OPM No. Acquire and upgrade essential pediatric equipment 2. training & service-oriented goals in every section of our department. 3.
Mission We commit ourselves to fulfill our vision by: Aligning our strategies with those of The Medical City. 2. Staff Development 1. that are similarly focused on child advocacy & child health. Upgrade consultants‟ and Junior consultants‟ capabilities through: CME and research.
Strategic Thrusts of the Department of Pediatrics A. specially. Generate funds for staff curricular requirements B. values and group dynamics. anchored on the principle of “Keeping our patients on center stage and service of greater worth”. staffed by highly competent pediatricians. Participate in seminars/ workshops that cater to ethics.DEPARTMENT THRUST
III. Department Camaraderie 1. the children we serve. 23 Department of Pediatrics
. Establishing mutually beneficial relationships with agencies & institutions. Initiate and maintain service networks 3. both here & abroad.
D. Intra/Extra-Hospital Recognition 1. To work on the status as the “leading” clinical department in The Medical City Iloilo. 2. Devise unique programs worthy of acknowledgement by The Medical City, Philippine Pediatric Society (P.P.S.), Philippine Medical Association (P.M.A.) and various local / international institutions. IV. Developmental Plans The department is planning to work on the fulfillment of its short and long-term goals. Proposed programs and activities are always consistent with this developmental plan, which is in turn, aligned with the hospital‟s developmental plans.
OPM No. 23 Department of Pediatrics
Organizational Structure The department‟s organization structure was revised during the first quarter of 2007. The Management Committee was expanded with the addition of the Operations Division head. All the divisions are under the headship of the Department Chair.
Board of Directors
Chief Executive Officer
Clinical Services Director
Coordinator, Continuing Pediatric Education
Coordinator, Office of Research & Extension Consultants
Coordinator, Patient Care In-patient Svcs Newborn Services Intensive Care PICU
Consultants Junior Consultants Junior Consultants Human
Advocacy & Training Publication
Emergency Out Patient
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Services Offered A. Adolescent Medicine 1. Adolescent Growth & Development 2. Consent, Confidentiality, and other related issues 3. Transition to Adulthood 4. End-of-life Issues in adolescent health care 5. Medical Health Issues a. Obesity and other Eating disorders b. Rheumatic disorders c. Endocrine disorders - Thyroid problems diabetes d. Genitourinary and Renal disorders e. Cardiovascular disorders f. Malignant diseases g. Disorders of the skin h. Infectious diseases i. EENT disorders j. Neurologic disorders k. GIT Disorders l. Adolescent Hematology m. Musculoskeletal disorders 6. Sexual and Gynecologic health a. STD b. Menstrual disorders c. Breast disorder d. Contraception in the adolescent e. Sexual abuse in the adolescent f. Adolescent pregnancy 7. Sports Medicine 8. Mental health a. Depression b. Suicide c. Substance abuse d. Disruptive behavior & other mood disorders e. ADHD f. Schizophrenia in adolescents g. Psychosomatic disorders 9. Preventive Health & Maintenance a. Immunization b. Counseling Issues and techniques c. Health risk behavior assessment d. Caring for adolescents in the clinic/ office B. Allergy and Clinical Immunology 1. Mastery of the Immune System a. Anatomy and Physiology b. Immune Response 2. Clinical Evaluation of a child with allergic or immunologic disease a. History b. Physical examination
OPM No. 23 Department of Pediatrics
23 Department of Pediatrics 8 Rev3Iss4 01-Apr-2010
. History taking skills from newborns to adolescents 7. Managerial skills for children with acute and chronic illnesses or disability 9. Insect Allergen Skin Testing d. behavioral and educational surveillance 3. Adverse Reactions to Food 13. Teaching/mentoring/counseling skills 10.3. Mastery of: a. Administration of Therapeutic Modalities: a. Atopic Dermatitis 11. Patch Testing 4. Allergic Reactions to Insect Stings 15. Pediatric Cardiology 1. Allergic Disorders of the Upper Respiratory Tract 9. Systemic Reactions and Anaphylaxis 8. Anesthetic Agent Testing f. Food Allergen Skin Testing c. Allergic Disorders of the Eye 10. Vaccine Testing e. Pathogenesis and pathophysiology of cardiovascular diseases and its complication in infants. Health supervision visit principles to include anticipatory guidance and biomedical and psychosocial risks 2. Basic principles of research 6. X-rays and CT Scans 5. Immunotherapy b. Aeroallergen Skin Testing b. Bronchial Asthma 12. Community pediatrics/social pediatrics 5. children and adolescents All acyanotic heart diseases All cyanotic heart diseases
OPM No. Performance and Interpretation Diagnostic Procedures: a. Urticaria and Angioedema 16. Communication/interpersonal skills with parents and trainees D. IVIG Treatment 6. Interpretation of Laboratory and Radiologic Diagnostic Procedures: a. Immunologic work up d. Child abuse and neglect 4. Developmental. Primary and Secondary Immunodeficiency Diseases 7. Ambulatory Pediatrics 1. Patient Education C. Peak Flow Reading / Spirometry b. UNICAP Allergy Tests c. Allergic emergency management c. Adverse Reactions to Drugs 14. Normal anatomy and physiology of the cardiovascular system b. Physical examination skills from newborns to adolescents 8.
Expertise in the performance or interpretation of the following: a. infant & adult skin 2. Simple surgical techniques excision & punch biopsy electrocautery of superficial skin lesions e. Pediatric Dermatologic 1. Arrhythmia d. Juvenile Rheumatoid Arthritis 3. b. warts curettage of superficial skin lesions manual extraction of superficial cysts & warts Cryotherapy with the use of liquid N2 (nitrogen) 4. Other arthritis syndromes a. Vasculitis syndromes a. Anatomy and Physiology of the Skin a. Structure and function of neonatal. Cardiac cyanosis in the newborn c. cardiac catheterization data 3. 23 Department of Pediatrics 9 Rev3Iss4 01-Apr-2010
. Systematic treatment c.g. Cardiovascular cases in an ICU setting e. EKG and chest X-ray b. Ankylosing spondylitis b. Collagen Vascular and Other Multisystem Disorders 1. Skin development b. Competence in managing all cardiovascular disease most especially: a. Postinfectious arthritis c. Dermatologic history and P. Scleroderma 5. Topical treatment b. Systemic Lupus Erythematosus 2. Post op management of cardiac surgery E. Pediatric dermatology disorders
OPM No. Two dimensional echocardiography c. Clinical Diagnostic test 3.E. Polyarteritis Nodosa d. Diagnostic and therapeutic principles of cardiovascular diseases and their complications 2. 24 hour EKG e. Henoch-Schonlein Purpura b. CHF b. Takayasu arteritis c. Kawasaki Syndrome F. Cosmetic treatment d. Arthritis of inflammatory bowel disease 6. Principles of diagnosis in pediatric dermatology a. Rheumatic fever/rheumatic heart disease Other acquired heart diseases Others c. Principles of therapy in pediatric dermatology a. Stress testing d. Dermatomyositis 4.
type 2. Others 2. behavior and learning problems d. Community pediatrics f. math etc) Networking with other professionals and community resources to support interventions H. Calcium and Phosphorus metabolism b. Psychometric evaluations (Wechsler intelligence test etc) 4. Family counseling and support g. Carbohydrate metabolism a. Growth. chronic and terminal illnesses b. hearing impaired etc) 2. Communication Disorders. c. f. b. Mental Retardation. Developmental disabilities: Autism. j. Bone and Mineral Metabolism a. Autism b. Attention Deficit/Hyperactivity disorder Sensory impairments (visual. Normal growth and development: Principles of child development Theories of human development from prenatal to adolescent stage b. e. Developmental assessment testing (Griffith‟s or CAT-CLAMS or other developmental assessment tool) b. Diabetes mellitus (type 1. Competence in managing all developmental disabilities and behavioral/learning problems: a. Community resources and support groups for families 3.a. Hypoglycemia c. d. Knowledge and understanding of: a. genetic counseling c. hearing) and multiply-handicapped Learning problems and disabilities (reading. Hyperglycemia d. Psychological aspects of acute. i. Mastery of: a. g. Special issues like child abuse and neglect. Giftedness d. Communication Disorders c. Pediatric Endocrinology 1. h. 23 Department of Pediatrics 10 Rev3Iss4 01-Apr-2010
. Expertise in performing and/or interpreting: a. Global developmental delays and Mental retardation d. Problems in Adolescence e. Vitamin D related disorders
OPM No. transient) b. Developmental and Behavioral Pediatrics 1.
Neonatal skin disorders Genodermatosis Disorders in keratinization Diseases of the mucosal membranes and skin appendages Reaction patterns Neoplasm and systemic diseases Infections and infestations Drug eruptions Physical injuries and environmental hazards Psychosocial Development in children with cutaneous disease
G. Brain development and learning c. Multiply handicapped (visually impaired. comprehension.
GI bleeding k. Diarrheal diseases. Parathyroid hormone disorders d.
6. Pediatric Gastroenterology 1. Others Lipoprotein and lipid disorders Other hormones
I. Others Diseases of the Pituitary/ Hypothalamus a. Enteral and parenteral nutrition 2. Acid peptic diseases including peptic ulcers l. Hypothyroidism c. Nutritional disorders p. Abdominal mass m. Precocious Puberty b. Pituitary/ hypothalamic dysfunction secondary to chemotherapy/ irradiation c. Variceal sclerotherapy d.
4. Knowledge of GI drugs. Neonatal cholestasis e. Percutaneous endoscopic gastrostomy
OPM No. Variceal legation e. Functional GI disorders o. GI infections g. Metabolic liver diseases c.3.
8. Polycystic Ovarian Diseases d. 23 Department of Pediatrics 11 Rev3Iss4 01-Apr-2010
. Foreign body removal c. Viral hepatitides f. Diagnostic and therapeutic/interventional endoscopy a. Others Growth disorders Diseases of the reproductive endocrine system a. Hyperthyroidism d. 7. Osteoporosis Diseases of the thyroid gland a. Portal hypertension j.
5. Pancreatitis h. Knowledge in the following diseases: a. 9. Rickets and osteomalacia` e. Congenital GI anomalies b. Inflammatory bowel diseases n. Congenital Adrenal Hyperplasia b. Biliary tract diseases i. nutritional products 4. Tumors of the pituitary/ hypothalamus b. Knowledge of GI physiology and anatomy 3. Gastroscopy b. acute and chronic d. Delayed Puberty c. Adrenal tumors c. Goiter b. Others Adrenal Disorders a.
detailed physical examination to ascertain normal and abnormal morphogenesis: major anomalies. bone marrow aspiration. Bioethics i. immunophenotyping. immunoelectrophoresis. Research e. Skill in peripheral blood smear preparation and bone marrow aspiration and/or biopsy b. Fetal pathology regarding congenital anomalies e. PT. Emphasize on the development of patient management skill h.) d. An approach to the diagnostic recognition of patterns of malformations g. Human embryology b. Principles of human genetics 2. flow cytometry. sucrose lysis test.e. Colonoscopy 5. Information transfer Counseling of patients and families K. etc. Collection of a detailed history with respect to both prenatal and postnatal periods Family history and pedigree construction History of potential teratogenic exposure Prenatal and postnatal growth and developmental histories c. Interpretation of common hematologic test (i. osmotic fragility test. minor anomalies. Information synthesis Pedigree interpretation Interpretation of medical history and physical examination Differential diagnosis of single primary defects or multiple malformation syndromes Critical analysis of the medical literature and computerized databases Diagnostic synthesis Longitudinal follow up of patients d. 23 Department of Pediatrics
. Paracentesis J. Percutaneous liver biopsy 6. Aptt. Pediatric Hematology 1. bone marrow imprints (optional: core biopsy) c. Understanding of methods. Performance of a careful. Interpretation of peripheral blood smear. Practice a. Mechanisms of abnormal morphogenesis Malformations Deformations Disruptions Dysplasias d. coagulation assays hemoglobin and serum electrophoresis. TT. Genetics 1. Research
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OPM No. Normal growth and development c. principles and interpretation of immunopathologic tests. fibrin degradation product. cytogenetics g.f. normal variants b. cytochemistry. Teratology f. Proficiency in blood banking and transfusion medicine f. Principles a. Expected competencies: a.
Structure of hemoglobin. Diagnostic and therapeutic procedures
OPM No. Genetics h. Microbiology and anti-infective agents in the compromised host l. History and physical examination 3. Disturbances of iron metabolism g. Bacterial Infections b. Nutritional anemias f. Knowledge in related basic sciences: a. its function and the reticulo-endothelial system f. white cells. Pulmonary Diseases 1. Immunization 2. Immunodeficiency i. Coagulation and platelet functions c. Leukemias j. Thrombocytopenias and thrombasthenia k. L. Bone marrow failures. complete knowledge of the application of multimodal therapy. myeloproliferative diseases e. Malnutrition o. family and staff in dealing with terminal illness with development of skills in communication and counseling. iron metabolism and bilirubin b. Clinical evaluation of a child with pulmonary disease a. diagnosis and management of hematologic and oncologic diseases b. and platelets. Blood group and transfusion j. Nosocomial Infections g. FUO‟s M. Histiocytic disorder 3. Hemoglobinopathies h. Acquired basic knowledge in: a. Phagocytic system e. Tissue typing m. Experience in the support of patient. Immunology-immunohematology g. Management of : a. Bone marrow transplantation and graft versus host n. cancer and blood disorders making good observations and keeping accurate patient data p. Principles of radiation therapy i. 23 Department of Pediatrics 13 Rev3Iss4 01-Apr-2010
. Viral Infections d. Knowledge of anti-infectives 3. Child and adolescent diseases c. Infectious Disease 1. coagulation defects d. Pathophysiology. pharmacology/pharmacokinetics of chemotherapeutic agents k. Cell kinetics d. Characteristic. Fungal Infections in Immuno-compromised hosts e. Spleen. Congenital and acquired disorders of red cells. learning to function as member of the team.2. CNS Infections f. TB c. Learn the staging and classification of tumors. Anatomy and Physiology of the lungs 2.
a. Chest imaging c. 6.g. Abnormal newborn a. Antenatal Identifying antenatal conditions associated with high risk deliveries and know the impact of these illnesses on the fetus and newborn Know the methods of assessment of fetal well being Identify the commonly used maternal drugs and their effects on the fetus b.4. IVH. Identify the components of the newborn screening tests and its clinical implication e. retinopathy. LGA. 5. etc. Respiratory RDS and its complication (BPD. Know the difference between physiologic and pathologic jaundice. pneumomediastinum) Persistent pulmonary hypertension Apnea Meconium aspiration
OPM No. Bronchoscopy b. Know the diagnosis and management of: Deviation from normal intrauterine growth (e. Perinatal Anticipation of low and high risk deliveries Familiarization with the equipments needed for resuscitation and their proper usage (e. 23 Department of Pediatrics 14 Rev3Iss4 01-Apr-2010
. Pulmonary function tests d. Know delivery room management Evaluation. Thoracentesis/bottle system e. General care of the newborn a. 3. Normal Newborn a. suction machine. decision making and prompt action Goals of resuscitation Inverted pyramid of resuscitation Sequence of resuscitation as recommended by the Neonatal Resuscitation Program (NALS) 2. 7. IUGR) b. Know how to perform a thorough physical and neurological examination b. Know gestational age assessment by Ballard/ Dubowitz and correlate with obstetric estimate c. radiant warmers. Mechanical ventilation Respiratory disorders in the newborn Pleural diseases Respiratory tract infections Non-infectious disorders of the respiratory tract Acute respiratory failure Chest tumors
N. Pediatric Neonatology 1. incubation set) c. 9. SGA. Know routine newborn care Temperature regulation Proper umbilical cord care Vitamin K prophylaxis Nutrition – emphasis on breastfeeding Rooming in d. 8.) Air leaks (pneumothorax. Oxygen supplementation f.
thoracostomy. hypocalcemia) f. hyponatremia. GI ( e. Paroxysmal disorders in infants and children
OPM No. Must have clinical exposure in a. Elements of normal anatomy and physiology of the kidneys b. Pathogenesis and pathophysiology of renal disease c.g. Pediatric Neurology 1.g. 23 Department of Pediatrics 15 Rev3Iss4 01-Apr-2010
. pneumonia. Endocrine/Metabolic Disorders 4. Dual lumen. meningitis) d. NEC. sepsis. Major cardiac anomalies (cyanotic and acyanotic heart disease) e. Extracorporeal dialysis modalities P. Interpret chest x-ray studies d. 10 syndromes in Nephrology Acute nephritis Nephrotic syndrome Asymptomatic bacteriuria Acute renal failure Urinary tract infection Urinary obstruction Tubular diseases Hypertension Nephrolithiasis b. Must be equipped in doing: a. Perform the following: intubation.g. Basic principles in peritoneal dialysis and hemodialysis e. Competence in the diagnosis and management of common pediatric neurological disorders/ conditions such as: a. Knowledge and understanding of: a. Infection (e. I and D O. Chronic peritoneal dialysis catheter insertion b. Knowledge in the following diseases a. Transient tachypnea of the newborn c. Interpret blood gas analysis and be able to correlate clinically c. hypoglycemia. Pediatric Nephrology 1. Acid-base disorders 2. Has interest in research and has output of at least one retro and prospective study while on fellowship 4. Fluid and electrolyte problems c. Kidney biopsy 3. Transplant immunology and knowledge of indications and contraindications of transplantation f. Acute and chronic hemodialysis c. Acute and chronic peritoneal dialysis b. subclavian or femoral catheter insertion c. Know the basic principles of mechanical ventilation and recognition of respiratory failure and the need to ventilate b. Hyperbilirubinemia – conjugated and unconjugated h. Neurological (e. atresia) g. Diagnostic and therapeutic principles of renal disease d. Others a. jugular. Basic knowledge of transplant related medical problems 5.
Evoked potentials (VER. Neurological manifestations of systemic illness g. 23 Department of Pediatrics 16 Rev3Iss4 01-Apr-2010
. Neuroimaging procedures Brain CT scan Brain MRI Cranial ultrasound Skull and vertebral x-rays b. Increased intracranial pressure 2. BAER) 3. Characteristics of specific and common poisons Household agents Over-the –counter drugs Pesticides Heavy metals Plant and Animal/Marine Toxins Drug abuse Chemical warfare Hazardous wastes d. Electromyogram/Nerve conduction studies d. Head injury . including febrile seizures. Expertise in the interpretation of common diagnostic procedures/laboratory results such as: a. Exhibits an competent level of skill in the performance of common neurological diagnostic procedures such as: a. Basic Analytical and Forensic Toxicology f. movement disorders. Neurometabolic disorders f. Cerebrospinal fluid examination e. Lumbar puncture b.accidental and non-accidental traumatic brain injury e. syncope b.Headaches Seizures. Subdural taps for evacuation of subdural effusions/empyema Q. epilepsy. Motor weakness i. Principles of Clinical Toxicology c. Skills a. Brain tumors (medical management of complications) d. Electroencephalography c. Basic Principles of Environmental Health and Toxicology e. and symptomatic seizures Pseudoseizures and non-epileptiform disorders such as Tics. Psychomotor retardation k. General approach to management of poisoning cases Emergency stabilization Clinical evaluation Limitation of absorption Enhancement of elimination and excretion
OPM No. CNS infections c. Alterations in consciousness h. Clinical Toxicology 1. Problems with balance and coordination (ataxia) j. Adverse drug reactions / drug interactions 2. Knowledge a. Basic Pharmacology and Toxicology of Drugs and Chemicals b.
Do research as databases for common poisoning cases and case reports for interesting/uncommon toxicities h. occult bacteremia Pathogenesis. complications. management. diagnosis. Growth and Development Anthropometric Behavioral b. Newborn General care of the newborn Diagnosis and management of common diseases of the newborn e. Rational use and proper interpretation of toxicologic screens and analytical laboratory examinations e. 23 Department of Pediatrics
. incubation period. Infectious Diseases Immunizations Diagnostic approach to FUO. transmission. Management of chemical incidents f. Must have general knowledge on: a. incidence. diagnosis and management of asthma f. Identify and manage adverse drug reactions g. fungal and parasitic infections
OPM No. Identify toxidromes especially for unknown poisoning c. Immunology and Related disorders The major components of the immune system Signs and symptoms and the basic management of a potentially immunodeficient child General and specific diagnostic tools in allergic disorders General preventive measures for allergic disorders Principles of management for allergic disorders Pathophysiology. prevention and prognosis Common viral. bacterial. complications and treatment for sepsis General spectrum of infectious diseases in children including etiology. Attitudes a. Genetics/Dysmorphology Different patterns of inheritance General clinical principles in counseling for genetic disorders Common chromosomal abnormalities d. Management and detoxification of drug abuse patients d. Wholistic approach in the management of suicidal patients and drug abusers b. diagnosis. Awareness of bioethical and medico-legal implications of poisoning cases c. clinical manifestations. Share knowledge through lectures/ rounds/discussions of poisoning cases 3. General Pediatrics 1. Practice toxicovigilance through poison prevention programs and information dissemination R. Allergy. Nutrition and Nutritional disorders Normal nutritional requirements Infant feeding Deficiency states c. Use and administration of specific antidotes Supportive management Sound disposition b.
parenchyma General signs and symptoms of respiratory disorders Gastrointestinal Disorders General signs and symptoms of digestive tract disorders Common diseases of the gastrointestinal tract Fluids and Electrolytes Composition of body fluids Acid-base physiology Electrolyte abnormalities Basic principles of fluid and electrolyte therapy Renal disorders Normal function of the kidneys General signs and symptoms of renal disorders Common specific disorders Renal failure Cardiovascular disorders Common clinical manifestations of cardiovascular disorders and their onset Ancillary procedures which are useful in the initial evaluation Treatment of CHF and other related medical complications Congenital heart diseases Acquired heart diseases Metabolic and endocrine disorders Signs and symptoms of the more common errors of metabolism/endocrine disorders Screening tests in the neonatal period Specific metabolic conditions Growth Disorders of the blood/neoplasms Erythrocyte. dosages. lower airway. 23 Department of Pediatrics
q. Vascular. ear.
k. neurocutaneous disorders Disorders of eye. pigment.
Indications/contraindications. pain Developmental disorders Congenital disorders Acquired disorders Skin disorders General principles of diagnosis and treatment of skin disorders: infectious.
j. g. nose and throat Common disorders and their management Adolescent medicine/gynecology
18 Rev3Iss4 01-Apr-2010
OPM No. limping.
i. leukocyte and platelet disorders Coagulation disorders Tumors Neurologic disorders General signs and symptoms of neurologic disorders and their management Infections Developmental malformation/static neurologic deficit Seizures Spinal cord diseases Musculoskeletal disorders Common manifestations attributable to musculoskeletal disorders: gait.
p. mode of administration and major adverse effects for each group of anti-infectious agents Respiratory Disorders Common diseases of the respiratory tract: upper airway.
Emergency care Trauma Burns Seizures Near-drowning Bites and stings Anaphylaxis/shock Poisoning u. respiratory and cardio-pulmonary failure t. Others Sports medicine Environmental health Ethical issues in pediatrics
OPM No. 23 Department of Pediatrics
. Adolescent development Sexuality Cognitive and moral development Social development Health issues of the adolescent s. Critical Care General signs and changes of impending systemic failure Emergency life support Recognition and management of shock.
which ultimately redound to departmental and hospital welfare. The overall training coordinator-in-charge of the departments‟ academic programs. Represents the department in intra-hospital and inter-hospital meetings. clinical and miscellaneous functions. The Department Chair and Executive Committee assigns special tasks. Executive Committee The Executive Committee is the highest body in the organizational structure of the Department of Pediatrics. 23 Department of Pediatrics
4. Liaison Officer In-charge of communications between the department and the hospital. It serves as a policy-making and decision-setting committee. Department Chair The voice of the department in the hospital community and in the Philippine Pediatric Society. non-scholastic affairs and administration.STAFF QUALICFICATIONS. patient service.
OPM No. FORMULATE DUTIES & RESPONSIBILITIES
The active staff meets regularly and as the need arises. Helps the Chair and the Executive Committee implement and monitor departmental projects. and between the department and organizations outside of the hospital. Assigns specific duties and responsibilities to departmental consultants. training. Implements the academic policies and guidelines formulated by the Executive Committee. 2. (PPS) Approves the policies and guidelines formulated by the Department (Executive Committee) and the other committees of the department. DUTIES AND RESPONSIBILITIES A. Junior Consultant Is the voice of the residents in the Executive Committee Fulfills administrative. Approves the acceptance of new junior consultants. The members of the Executive Committee are the following: 1. Coordinator of the different areas FORMULATE DUTIES & RESPONSIBILITIES
3. It was formed in 1996 and is tasked with the formation and execution of departmental guidelines. among other things.
She is in-charge of giving recommendations for further staff development in the different subspecialties (as reviewed and approved by the Academic Personnel Board). He coordinates with the different component committee heads under this service c. Adolescent Medicine Allergy & Immunology Ambulatory Pediatrics Cardiology Endocrinology Hematology-Oncology Infectious Disease Nephrology Neonatology Neurology Pulmonology Developmental Genetics Gastroenterology 4.Pediatric Office Complex . c. implementing.B. Administrative Services Coordinator a. Service. Physical Facilities Committee . It was expanded in 2003 with the addition of the Administrative Services Division and the Subspecialty Sections. This committee convenes regularly to discuss updates. She coordinates with the head of each section. 23 Department of Pediatrics 21 Rev3Iss4 01-Apr-2010
OPM No. monitoring and evaluation. regarding their program activities and needs. Subspecialty Sections Coordinator a. monitoring and evaluating programs proposed in their areas of specialty.Pediatric Staff Assistance Office . He represents the department in intrahospital and interhospital academic affairs b. Each committee is responsible in developing. The members of the Management Committee are the following: 1. b. All the members of the Executive Committee 2. Non-scholastic Activities and Nursing Services.Comprehensive Adolescent .Ad Hoc PPS HAB Accreditation . implementation. She is responsible in ensuring the proper functioning of the following components. Each section is responsible for program development.IT office Networking Special Projects Committee . Training Coordinator a.Skills Training 3. Management Committee The Management Committee was formed in 1996 and is composed of the members of the Executive Committee and the Coordinators for Training. plans and problems in the different sectors of the department.Health Maintenance Program . Research.
c. improvements and maintenance of patient service facilities/needs. b. The heads of each unit periodically evaluates the efficiency of his area of responsibility. She coordinates with the heads of component committees.
Graduate Programs Committee Post Residency Training Committee Residency Training Committee Internship Training Committee
5.Ugong Community Service Special Service . Research Coordinator a.Patient Education 6. The heads of the different sub-committees are: Personality Development Committee Sports and Physical Fitness Committee Socio-cultural/Religious Committee Resource Generation Alumni Relations
DEPARTMENT POLICIES AND PROCEDURES I. Patient Services Coordinator a.TMC . Each service unit is free to recommend projects that redound to the upgrading. Nonscholastic Activities Coordinator a. each with the function of disseminating or propagating researches in appropriate for a: Intrahospital Research Committee Interhospital Research Committee Scientific Publications Committee Library Service Committee 7. She is responsible for coordinating non-scholastic activities within and outside of the hospital b. She coordinates with the heads of the Research Committee. She is the over-all coordinator for residents‟ research b. Service To provide excellent health care to all pediatric patients with the availability of the proper equipment and diagnostics To ensure quality of care by maintaining a competent medical staff
OPM No. Learning Research Center. She represents the department in intra-hospital and inter-hospital research activities c. Objectives A. Ward Service PICU Service Newborn Services Division Pediatric Emergency Room Service OPD Committee . She makes sure that all the service units are functioning as expected. 23 Department of Pediatrics
A group of consultants is assigned as preceptors for each of the services who conduct teaching rounds or small group discussions with their service residents. 23 Department of Pediatrics
. Although our floors are departmentalized. Background The Medical City has a total of 500 beds. nutritional chart and flow chart of labs 7. Progress notes 8. The 9th floor has a total of 35 beds while the 10th floor has 33 beds. pediatric patients may still be admitted in other floors as needed. All subspecialists should be board certified.
To be able to extend medical assistance to those in need through our Divine Mercy Program
B. The 9th & 10th floors are dedicated for pediatric patients. resident‟s call room and conference room. Separate Gastrointestinal Ward and Respiratory Ward with six beds each are found at the 6th floor. Head The responsibilities of the Core Group Head are as follows: a. At present. Duties of the Core Group 1. Oversees all the activities of the service
OPM No. During these teaching rounds. We have a full complement of subspecialists and associates who work as a team in caring for our patients. Each floor has its own fully equipped treatment room. 6. residents are graded using the following criteria: Grading Sheet 1. General knowledge 9. 4. we have 41 Active Consultants and 71 Visiting Consultants. Our residents are divided into three services based on geographic locations of the patient. To provide specialized quality care. Service 1 resident handles patients on the 10th and 11th floor. A. 2. Service 2 residents handle patients from 9th and 8th floors. 3. Staff Profile It is required that our staff should either be certified diplomates or fellows of the Philippine Pediatric Society. The rest of the floors (other floors) are handled by the Service 3 resident. Punctuality and courtesy 15% 15% 10% 10% 10% 10% 10% 15% 5%
B. History taking Performance of a good physical examination Interpretation of laboratory results Diagnosis and differential diagnosis Management and rationale Complete laboratory results. the floors are departmentalized. Training To provide our trainees with sufficient clinical cases that will complement the lectures given by consultants II. 5.
which could be seen and understood by the consultants and residents involved in the care of patients
OPM No. Randomly checks the completeness of charts c. and also make sure at least five consultants of the service are present during the mini-audit. d. Encourages the consultants of the service to admit patients under the Divine Mercy program d.encourage more consultants to admit more patients under the program Makes sure the services are running smoothly. e. 97 – A Securing of Patients Inform Consent) b. weighing scale. The goal is to make the service residents know their cases by heart. All the physicians who see the patient should indicate their complete assessment and plan of management in the chart. The co-head may assign a resident in the service to be in charge of informing the service consultants of the miniaudit c. Meets with the service residents for their chart rounds touching on the history.) Gives suggestions to improve the service Assigns consultant moderator for the service Grand Audit Delegates tasks as necessary
2.conduct weekly teaching rounds with the service residents and supervise the members of the core group Mini Audit – moderates the discussion of cases encountered by the service for the month Divine Mercy Program . (e.
Teaching Rounds . physical examination and laboratory examinations. pulse oximeter. General Policies 1.
b.g. make sure the history and physical examination are complete and done properly and that the management of cases are guided by clinical practice guidelines if applicable. As a group. c. In the absence of the service head. all medications needed should be available in the wards and are administered correctly) Regularly checks on ward equipments to make sure that they are complete and functioning properly. Supervises the monthly mini-audit of the service. Core Member The responsibilities of the core member are as follows: a. Conducts weekly teaching rounds with the service residents and supervise the members of the core group with the goal of teaching the residents their b. etc. 23 Department of Pediatrics 24 Rev3Iss4 01-Apr-2010
. Gives suggestions on anything concerning the ward service and if problems are encountered. determines the interesting cases which can be presented for discussion during Grand Audits d. takes over his/her responsibilities 3. (Please see Appendix A – OPC No. f. Core Group Co-Head The responsibilities of the co-head are as follows: a. this will be done with the knowledge and consent of the attending physician. discuss them with the head of the service and head of the ward. If the management of the case will be discussed. (Nebulizers.
IN-PATIENT SERVICES (FLOORS AND WARDS) I.
5 mEq/L .0 mg/dL indirect or total bilirubin CO2 combining power shows non-compensated acidosis/alkalosis by arterial blood gas documenting either HCO3 < 20 mEq/L or > 36 mEq/L or PaCO2 < 30 mmHg or > 50 mmHg . or orthostatic hypotension and other symptoms of dehydration including sunken eyes or fontanels.Loss of sensation--any body part . Parents may look at the chart upon the attending physician‟s approval.Serum sodium < 130 mEq/L or > 150 mEq/L . Their notes are written on the chart after each visit to the patient.Serum potassium< 2. in a previously ambulatory person Physical findings . lethargy.55 (identified within the last 48 hours) . nursing and other services responsible for patient care collaborate to analyze and integrate the different assessments.000 µ/L . Admission Criteria Laboratory-blood .Serum bilirubin> 15.Hematocrit (Hct) < 24% or > 55% . Medical.Metabolic acidosis with venous lactate level > 2 mEq/L Functional impairment (identified within last 72 hours) .*Observation for head trauma
OPM No. 3.Arterial blood pH < 7.Hemoglobin (Hgb) < 9 g/dL or > 20 g/dL with signs of volume depletion .Unconsciousness .30 or > 7. syncope.Dehiscence/evisceration .Change in mental status from baseline or an abrupt deterioration over previous functional level . weight loss > 5% and/or decreased urine output < 1ml/kg/hr . light-headedness. decreased skin turgor.Severe articular restriction and somatic dysfunction .2.Continuous hemorrhage from any site .0 mg/dL (for ionized calcium values see newborn criteria) . 23 Department of Pediatrics 25 Rev3Iss4 01-Apr-2010
.Serum calcium< 7. Diagnostic tests to ascertain need for admission shall be ordered according to the needs of the individual patient based on the assessment of the Attending Physician. the needs of the patient are prioritized.Generalized edema .Hemoglobin (Hgb) 10 g/dL or less with active bleeding or a 3 g/dL drop from baseline .Wound disruption (requiring closure) .Clinical signs of dehydration to include two or more of the following: altered mental status.Penetrating wounds . 4.Toxic drug level as evidenced by laboratory report .Seizures uncontrolled by medication .Congenital abnormality admitted for surgical intervention requiring hospitalization . and the family is made aware.White blood count < 3.Delirium . tachycardia.Fall with inability to ambulate. 5.000 µ/L or > 16.Positive blood culture .Motor function loss--any body part . These are all recorded. dry mucous membranes.Disorientation . Physicians involved in caring for the patient have access to the patient‟s record.Documentation of malignancy and admitted for treatment requiring hospitalization .Present or potential respiratory depression .5 mEq/L or > 5.
Vomiting and/or diarrhea with dehydration Shock or potential shock *Physician documentation must substantiate the need for greater than twenty-four hours monitoring. Pediatric: < 8 weeks > 100.3 years < 60 or > 170 bpm > 3 years .12 years < 60 or > 160 bpm > 12 years . performing procedure. subtract one degree.Admitted for day surgery procedure (indication for procedure is documented) and patient has American Society of Anesthesiologists (ASA) Classification of Physical Status of III.Failure to thrive . IV.Blood pressure: Systolic (mmHg) Diastolic (mmHg) Pediatric: birth to 1 year < 65 or > 100 < 30 or > 65 > 1 year .12 years < 15 or > 40/minute > 12 years .4° F (38.1 year < 70 or > 180 bpm > 1 year . Patient Identifiers shall be used in verifying a patient‟s identity for all transactions and services/procedures (i.3° C) > 1 year .000µ/L .17 years < 80 or > 170 < 50 or > 100 Related areas .Pulse: beats per minute (bpm) Pediatric: < 6 weeks < 80 or > 200 bpm 6 weeks . treatment. Vital signs (taken at rest) . 23 Department of Pediatrics 26 Rev3Iss4 01-Apr-2010
.1 year < 25 or > 60/minute > 1 year .17 years < 12 or > 30/minute .000µ/L > 3 years .e. charging of procedure/medications.17 years > 104° F (40° C) with WBC > 16.12 years < 80 or > 130 < 50 or > 90 > 12 years .3 years > 102° F (38. To convert rectal temperatures to an oral value.Suspected or proven child abuse/neglect . and/or observation post procedure. or V.Temperature: Pediatric values reflect rectal or tympanic temperature readings. etc.Suspected apnea > 20 seconds (0 .3 years < 15 or > 40/minute > 3 years .) b.17 years < 50 or > 140 bpm .1 years) Others .Suspected or known ingestion of foreign body .Admitted for surgical procedure which required hospitalization (indication for the surgery is documented) .9° C) with WBC > 15. patient inquiry.1 year > 101° F (38. patient admission. collection of specimen/blood samples.0° C) 8 weeks .6 years < 80 or > 115 < 50 or > 80 > 6 years . or Classification of Heart Disease III or IV
6. Patient Identifier shall be as follows:
OPM No. administering of medications. Patient Identification a.3 years < 75 or > 110 < 45 or > 75 > 3 years .Respirations: Pediatric: Newborn (first 12 days of life) > 60/minute sustained or Pa O2 < 50 mmHg on room air with O2 saturation < 90% > 12 days .
the Attending Physician (AP) shall be the one to explain with the patient or patient‟s guardian prior to the conduct of the test/procedure. 7. 166 – Prescription Writing and Appendix C – OPC No. difficult IVF insertion. serum electrolytes in dehydrated patients. the individual/physician communicating the result/order . 175 – Medication Management and Use) 12. Treatment Room a. must ensure/confirm that the relayed information was understood and heard correctly by the receiving staff-in charge by requesting the receiving staff to repeat or „read back” the information. For diagnostic tests and procedures that require an informed consent. 8. 168 – Complaint Management and Appendix E – OPC No. Any incorrect or unclear information must be clarified by both parties immediately. 13. Patient identifiers shall not be confirmed with patients using questions answerable by “YES” or “NO”. Handling of Complaints Involving professional attitude and behavior shall be referred to Appendix D . Informed Consent a. All the treatment rooms are properly equipped. When ordering a test/procedure or medication. (For detailed policies and procedures. 103-B – Classifying. etc. To confirm a patient‟s identity. Reporting and Analyzing Unanticipated Clinical Events and Near Misses. 175 on Medication Management System. at least two (2) of the identifiers should be used. CT scan. Diagnostics tests to ascertain need for admission shall be ordered according to the needs of the individual patient based on the assessment of the Attending Physician. (For the detailed policy guidelines. etc.OPC No. Patients will be transferred to other healthcare organizations based on individual preference. General Guidelines Transfer to other organizations will be guided by the following principles: Patients will be transferred to other healthcare organizations if the hospital does not have the requisite staff and/or facilities to provide the needed service. Service residents should follow up official x-ray readings. 2D Echo) not readily available at the patient‟s location. b. b. All initial laboratory results have to be relayed to the consultants ASAP e. Intrahospital In cases where the patient is requiring additional care or procedure (e. 14. Treatment room can be used for procedures such as lumbar tap. c. 11. Handling verbal and telephone communications In cases where verbal or telephone communication is necessary. Transport and Transfer of Patients a. 23 Department of Pediatrics 27 Rev3Iss4 01-Apr-2010
.g. Patient‟s Complete Name Birth Date Patient Identification Number (PIN) c. Medicine prescriptions should comply with OPC No. please refer to Appendix A – OPC No. 166 on Prescription Writing and No. Medication a. CBC. platelet count in dengue patients. transporting the patient should be given high level of care and consideration. the Attending Physician/Prescribing Physician shall note the corresponding clinical indication. There should be a written order from the
OPM No. 97-A – Securing of Informed Consent) 10. laboratory results of their patients themselves and make sure that these are incorporated in the chart. Diagnostic Tests Required a.g. Ordering of tests a. 9. please refer to Appendix B .OPC No. MRI.
(For detailed policies and procedures. c. existing problems and present condition. The service resident should contact the PICU resident and properly endorse the patient which would include the patient‟s diagnosis and present health condition. 15. During transport. then the patient would not be accompanied by the resident but the designated medical or paramedical staff of that ambulance service. 23 Department of Pediatrics
. There should be a written order from the physician that the patient would be transferred to the ICU. Based on the Attending Physician‟s assessment. Interhospital In cases where the patient is for transfer to another institution. the nurse-in-charge. 1 – Emergency Department . The patient should be properly endorsed to the receiving staff. Discharge Criteria and Procedures a. please refer to the OPM No. The patient should have a stable medical condition that would allow for transfer. Criteria Vital signs Vital signs within the following limits for age for 24 hours prior to discharge or an abnormal reading within 24 hours. diagnosis. followed by a subsequent normal reading
Temperature (all ages): Blood pressure:
Oral Rectal Systolic (mmHg)
< 101° F (38. as well as the patient‟s record. The patient would be accompanied by the resident to the receiving institution. there should be an order from the attending physician to do so and would be based on the patient‟s needs for continuing care.Ambulance Conduction). The nurse-in-charge must schedule the patient to special services where the test or desired management is to be done.9° C) Diastolic (mmHg)
OPM No. Patients requesting for “out on pass” shall seek approval from their Attending Physician (AP). patients shall be granted out-on-pass privileges for a period not to exceed 24 hours unless otherwise indicated. During transport. Orders will be documented in the patient chart.3° C) < 102° F (38. If the conduction would be made through an outside ambulance service. This should be properly coordinated with the receiving unit. necessary equipment and the patient‟s records. 16.physician that the patient needs to undergo a certain procedure and it should be properly coordinated to the receiving unit by the nurse-in-charge. the orderly/auxiliary. then utmost care should also be observed. The service resident should endorse the patient to the receiving institution. the patient should be accompanied by the senior resident. If the patient would be transferred via ambulance conduction then the service resident should endorse the patient to the resident in charge of ambulance conduction. which would include the patient‟s history. the patient should be accompanied by the orderly/ auxiliary or nurse in charge. Policy on Out-On-Pass a. medications and other management measures. If the patient is for transfer to the Pediatric ICU. management received.
110 80 .Infant has demonstrated good sucking mechanism . voiding activities in an alternative setting.140
30 . please refer Appendix F .120 90 .80 60 .Responsible caretaker demonstrates ability to care for infant/child Above 1 year old to below 19 years old: .6 years > 6 years .65 50 .3 years > 3 years .Infant able to maintain body temperature in an open crib .Prescribed diet tolerated for last 12 hours prior to discharge without nausea/vomiting.17 years
65 .12 years > 12 years .17 years Respirations: Pediatric: < 1 year > 1 year .No apnea for 24 hours . Procedures (For detailed policies and procedures.130 80 .Infant has grown or shown a steady weight gain on po or tube feedings .3 years > 3 years . 23 Department of Pediatrics 29 Rev3Iss4 01-Apr-2010
.6 years > 6 years .Pediatric: birth to 1 year > 1 year .12 years >12 years . 28-B Servicing of Patient Discharge)
OPM No.12 years >12 years . or hemodialysis/continuous ambulatory peritoneal dialysis (CAPD) .70 50 .Parenteral analgesic administration not to exceed one dose within 3 hours prior to discharge. excluding patients expected to require regular analgesic administration for a persistent condition b.OPC No. patient having received maximum benefits of education in hospital Functional Infant (Below 1 year old): .17years Pulse: Pediatric: < 1 year > 1 year .100 75 .80 70 – 85
Beats per minute (bpm)
80-160 bpm 80-130 bpm 70-120 bpm 70-110 bpm 50-105 bpm per minute
30-50 20-40 15-30 12-25
Patient education Patient and/or family competent for care.3 years > 3 years . excluding chemotherapy patients Self-initiated and self-effected activities of daily living or documented provision for such in an alternate setting Voiding or draining urine without difficulty for last 12 hours or arrangements have been made for drainage of urine.
OPM No.17. 23 Department of Pediatrics
. Divine Mercy Program (For detailed policies and procedures. please refer to OPM No. 8 – Corporate Services Department).
For problematic patients. Management of patients is based on existing local and international clinical practice guidelines from the Philippine Pediatric Society. 3. 5. Acute Gastroenteritis B. which is the assigned Infectious unit. 10th or 6th floors). Service residents are required to do their own In-service notes and this shall be incorporated in the chart within 24 hours. if the said floors are filled up. Admitted patient shall be seen within 30 minutes by the service residents or the residentson-duty. 5. The senior service or floor resident shall be informed immediately so that he/she can assess and manage the case with the ER resident until the patient is stable enough to be transferred to the floors or the PICU. these guidelines are reviewed yearly by the subspecialists. eye examination. Admitted patients shall be endorsed to the floor resident by the ER resident who admitted the patient. if applicable.ADMISSION AND CARE OF PEDIATRIC PATIENTS I. The guidelines include those on pneumonia. they may be admitted at the other floors. febrile seizures. General Policies 1. the floor residents shall immediately update the Attending Physician.
Policy Guidelines A. 4. and American Academy of Pediatrics or World Health Organization. Those requiring isolation because of the infectious nature of their illness are admitted at the 14 th floor. The floor residents shall make their own admitting notes and assessment of the patient upon arrival in the room. Clinical Pathways are also being developed by the hospital on the following diseases: Pneumonia. Objectives To establish standard policies and procedures in the admission of pediatric patients To ensure efficient flow of communication and coordination among the medical staff involved in the process
II. Guidelines for floors or wards admission are the following: Patients with stable hemodynamic. 4. 2. ER residents shall inform consultants of all admissions the soonest possible time. 2. Pediatric patients who are not candidates for admission at the pediatric intensive care unit (PICU) are preferably admitted at the assigned pediatrics floors or wards (9th. The admitting notes shall be completed and in order. Department of Health. Residents and Interns being trained at The Medical City shall be allowed to assess and admit Pediatric patients. All patients aged 0-18 years and 364 days shall be admitted under a pediatrician duly licensed and accredited by the Philippine Pediatric Society. etc. they shall be initially managed and stabilized by the ER resident. These guidelines are adapted to individual patients‟ resources. 3. Admission of patients at the Pediatric Intensive Care Unit (PICU) is based on the critical care admission criteria 6. Emergency Room (ER) Admissions 1. Through regular updates by the PPS.
OPM No. acute gastroenteritis. After seeing the patient. neurologic and respiratory status Patients who do not need very close monitoring However. 23 Department of Pediatrics
4. Service residents shall assess the patient within 1 hour upon arrival at the floors. the residents will be excused when teaching rounds or conferences are on-going. 3. The senior resident is required to make notes regarding the referral. These assessments done outside should not be older than 30 days. service junior residents together with the senior residents should make their rounds once in the morning and once in the afternoon. HMO Admissions 1. Direct Admissions 1. intravenous fluids. For non problematic cases. 2. D. The doctors‟ admitting orders shall include frequency of vital signs monitoring. Each HMO has its own roster of consultants.
OPM No. Attending physicians shall be immediately informed by the service or floor resident of their admissions. patients are referred to a subspecialist with the consent of the family. patients are referred to subspecialists affiliated with the HMO but if there are none. E. If no referral notes are available. Official referral to a pediatric consultant is necessary before the pediatric resident admits a patient to the floors. input and output monitoring. All these shall be written down on the chart. immunization developmental Psychological and physical exam Diagnosis Management 7. These patients shall be advised to go directly to the ER with their admitting orders for immediate implementation. previous assessments done outside are verified by phone or fax. The admitting notes shall contain the following: History of the present illness Birth history Past medical history Social. 23 Department of Pediatrics
. All service residents should make rounds with their service consultants. 8. 2. this of course will take precedence. In the event that the coordinating physician has been encoded as the attending physician during admission and there is a transfer of service of attending physician who is the primary physician orchestrating the planning and delivery of care of the patient. Direct admissions are admissions straight from the attending physician‟s office with admitting orders. nutritional. However. economic. When there is a need for a subspecialty referral. 2. Ward/Chart Rounds 1. Consultants shall inform the senior residents when they have problematic cases to be admitted. For problematic cases they should make their rounds as often as needed. 3. Patients who were initially seen at other institutions shall have their referral notes attached to the chart. and diagnostic exams. medications. the nurse in charge shall inform the admitting office and allied services of the transfer of service. Pediatric residents should see patients admitted or referred to the pediatric consultants only. But if a patient is problematic and warrants immediate attention. C. Any changes from the previous report are noted on the patient‟s chart.6.
5. If unsuccessful. 6. a referral to the Department of Anesthesia can be made. umbilical cannulation must be done before 1st year residents are allowed to do the procedure independently. Results of laboratory or other ancillary procedures done on the patient should be attached to the chart. If in cases where the residents have difficulty in inserting IV. The physician‟s name in print and signature should be written on the chart. G. 3. objective findings. For children less than 2 years-old. Replies to the referral should be written down as well by the resident or the subspecialty consultant. All patients are reassessed at regular intervals. 2. Doctors‟ orders are written on the doctors‟ order sheet. For patients >2y/o. After office hours. 3. or more frequently as needed. Referrals to other subspecialties shall be written down either by the Attending Physician or the service or floor resident. This is written by the attending physician. then inform and update the subspecialty consultant. All ECG tracings are officially read by the cardiology consultant on the same day. present status of the patient. 2. and he or she should indicate his or her complete assessment. IV Insertion 1. and the service or duty residents. He/she is required to write his/her referral notes. present assessment and reason for referral. the 1st year resident can try 2x before referring to the senior resident. The attending physician visits the patient daily during the acute phase and is reassessed before until discharge. 4. NGT insertion. Progress notes must be done on all patients daily. ECG 1. OGT/ NGT Insertion 1. which includes the history. physical examination. The patient should be assessed first by the resident subspecialty rotator. H. Referrals 1. In case of patients referred for opinion. I. assessment and plan). the Cardiology rotator shall read all ECGs done during the day and shall refer to the Cardiology consultant. All ECG ordered for the day shall be initially read by the senior resident. the physician should see the patient at least once. Assessment should be written on the patients‟ charts. orders of the attending physician will take precedence. F. 2. pediatric interns are allowed to attempt once. All the reassessments are documented and written down on the left side of the doctor‟s order sheet. residents on duty make rounds in the evening and early morning the following day. other doctors caring for the patient. Furthermore. 7.3. physical examination. rotating interns are not allowed to insert IV. 23 Department of Pediatrics
. Five successful supervised OGT. at least twice a day by the service resident. All orders written by other doctors are carried out upon the approval of the main attending physician. impression and suggestions. These should be complete with history.
OPM No. The notes take on an SOAP format (subjective findings. If with conflict. Reassessment of problematic patients is done as often as deemed necessary by the attending physician or the resident in charge.
The form is attached to the patient‟s record. Dietician to assess patient within 24 hours of admission
OPM No. All admitted patients have a nutritional assessment using The Department of Pediatrics Nutrition Screening Form accomplished by the parent/guardian and the resident upon admission. In elective cases. An anesthesia assessment is recorded before the use of anesthesia. the attending physician should have a medical assessment prior to the procedure. Review of systems d. patients are classified as priority 1. The elements of assessment are the following: a. The consensus reached by all the consultants is explained and relayed to the patient and his/her family. Medication i. If there are more than 4 consultants in a case. Initial assessments must be conducted by physicians within 2 hours for emergency cases and 12 hours for elective admissions. 5. Family history f. Nutritional Assessment 1. Patients for Preoperative Evaluation 1. Plan 3. 2. A pre-operative diagnosis is written down on the chart. Immunization j. 4. including all diagnostic test results done prior to surgery. 3. Physical examination findings l. History of present illness c. Chief complaint b. Neurological Examination m. Past medical history e. Re-assessments are conducted by physicians at least once every 24 hours. 2 or 3. Children admitted for surgery should have a preoperative evaluation no more than one week before the scheduled operation. L. Based on the Nutrition screening form. medical assessment may be performed by the senior pediatric resident on duty with the approval of the attending physician. Priority 1 – High risk to develop malnutrition. J. Assessment n. and is re-evaluated just before the procedure. The Patient Database Form (PDF) is a tool used in assessing and examining patients upon admission at The Medical City (please refer to Attachment B). In emergency cases. all the consultants should meet with the main AP as needed for the diagnosis and other issues. Birth Maternal g. 2. For patients referred for co-management. Developmental state k. 23 Department of Pediatrics 34 Rev3Iss4 01-Apr-2010
. K. The anesthesiologist also determines if the patient is a good candidate for the planned operation. Initial Assessment 1. 2. Discussions among them are also recorded in the chart.4. Nutritional h. the patient must be managed in collaboration with the attending physician so long as the need arises.
Pain is also monitored by the resident or attending physician during their ward rounds. For mild pain (1 in Faces scale or VAS score 1-3). The type of medication to be used would be recorded in the patient‟s chart. the resident refers the patient to the Dietary service (For complete policy guidelines. Procedures (For detailed policies and procedures on patient admission. please refer to OPM No. It is considered as the fifth vital sign. Patient is reclassified as priority 2 if not discharged by day 8. For patients classified as priority 1 or 2. oral paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) are given. The pain score is recorded in the standard vital signs monitoring sheet. please refer to OPM No. Priority 3 – Low risk to develop malnutrition. 4. 3. oral paracetamol/opiod combinations or IV Ketorolac are given. 3. Assessment of pain is done using appropriate assessment tools. 23 Department of Pediatrics
OPM No. Pain Assessment and Management 1. The Wong-Baker Faces Scale and Visual Analogue Scale (see below) is used to assess pain. Dietician to assess patient within 48 hours of admission. 34 – Admission and Allied Services Department).Pain Management Clinic) III. Monitoring of the presence and severity of pain is done by the nurses depending on the frequency of monitoring determined by the attending physician or resident. For severe pain (4-5 in Faces scale or VAS score 7-10). (For detailed policies and procedures. Non-pharmacologic approaches could also be used to manage pain. These approaches include distraction techniques. The type of pain medication would depend on the severity of the pain (pain score). please refer to OPM No. No action taken.
Visual Analog Scale (VAS) Wong-Baker Faces Scale
0 1 2 3 4 5 2. guided imagery and comfort measures. A score from 0-10 is obtained depending on the presence and severity of pain. 18 . 72 – Nutrition Management Services) M. All admitted patients would have a pain assessment. For moderate pain (2-3 in Faces scale and VAS score 4-6). IV opiods are given.Priority 2 – Moderate risk to develop malnutrition. Patients are referred to the pain specialist shall be considered for pain score 5 and above.
Severe (symptomatic) anemia: . Jehova‟s witnesses History of Present Illness (duration of illness. Medical History Age Religion e.CARE OF HIGH-RISK PATIENTS I.Hemostasis status: Each ASA classification has a required hemostatic blood exam. degree of incapacitation or compromise) Past and Current Medical History Cardiopulmonary status Acute /recent URTI/allergies Asthma Congenital/ Acquired heart disease/signs or symptoms pertaining to heart problems . (Please refer to Attachment C . To optimize the patient‟s medical condition and develop an appropriate preoperative plan. To inform the parents and the rest of the surgical team of potential risks.Preoperative Evaluation Forms) 2. Policy Guidelines A. To acquire the pertinent medical information. to allow for management strategies that will minimize known risks.Neuromuscular conditions seizures (controlled. anticonvulsants) cerebral palsy hydrocephalus meningomyelocoele myopathies hypotonia . b.Genetic/Metabolic conditions Any syndromes . 23 Department of Pediatrics 36 Rev3Iss4 01-Apr-2010
. Preoperative Basic Health Assessment: a.Medications: last intake
OPM No.g.Endocrine conditions Diabetes Thyroid conditions Obesity Adrenal insufficiency . consultations and laboratory tests necessary to assess preoperative risk. Preoperative Evaluation 1. Goals of Preoperative evaluation: a. c. .Prematurity Age of gestation History of ventilator support Bronchopulmonary dysplasia History of apnea .
children at risk can be identified by a detailed history and physical examination without the need for additional laboratory studies or other investigations.Pregnancy .technique/manner of delivery .duration . palpitations.depth of anesthesia ..patients with anticipated large blood losses Note: The most reliable factors for detecting bleeding disorders were a history of bleeding from minor wounds.duration Anesthesia . congenital or acquired heart disease and other cardiac symptoms
OPM No.cases where minimal postoperative bleeding is critical . murmur. Chest radiography for: suspected acute cardiopulmonary disease stable chronic cardiopulmonary disease without a recent chest x-ray within 6 months Electrocardiography is done for: . However.patients on anticoagulants . 23 Department of Pediatrics 37 Rev3Iss4 01-Apr-2010
. liver disease or malabsorption) or in those receiving anticoagulants or other medications that increase the risk of a bleeding disorder.airway device . in those who have underlying medical conditions that increase the risk of coagulopathy (e.indication or type .g.Known allergies: to medications? Latex? Balloons? .tonsillectomy / CNS surgery cases .Drugs (Substance abuse) Surgical Procedure .infants . Therefore coagulation studies should be considered with those with a positive bleeding history.anesthetic agent .patients with chronic illness .patients with irregular rhythm.growers/ premature infants .known allergies/reactions to previous anesthesia Family history (malignant hyperthermia? Allergies) Physical Examination (Complete PE): Laboratory Tests In most cases.Smoking/alcohol history .patients with history of hemostatic defects . frequent bruising and the use of NSAIDs or platelet function antagonists.patients with recent blood loss Coagulation studies (complete) are suggested for: . it is suggested that a complete blood count (CBC) be done on ALL PATIENTS CBC is specially important for: .cases where coagulation system is particularly needed for hemostasis .
The presence of an abnormal murmur. Serum electrolytes: . mild renal insufficiency. critical airway obstruction. sweating.
OPM No. anemia. advanced renal. Surgery is attempted as last hope to prevent death and is usually part of ongoing resuscitation E (suffix): physical status classification appended with an E when surgery is undertaken as an emergency – an acknowledgment of additional physical risk factors associated with absence or pre-operative stabilization like NPO or evaluation Example: Physical Status I – E: healthy child with testicular torsion for Emergency operation ASA Task Force Recommendations: Guidelines in giving food and liquids 8 hrs – solids 6 hrs – milk formula 4 hrs – breast milk 2 hrs – clear liquids 4.patients with new or unstable cardiac disease Note: If there is any question of a significant structural cardiac abnormality. General Guidelines: a. All patients undergoing surgery should undergo a preoperative evaluation by a pediatrician and an Anesthesiologist. 23 Department of Pediatrics 38 Rev3Iss4 01-Apr-2010
.renal failure . Pierre-Robin syndrome) Class IV: severe disturbances that are a constant threat to life (extreme prematurity. whether or not surgery is undertaken. well controlled asthma) Class III: severe disturbances that interfere with ordinary daily activities (chronic lung disease. Class V: moribund condition in patient who is likely to succumb in 24 hours. preoperative echocardiography and evaluation by a pediatric cardiologist are mandatory. ECG. intractable congestive heart failure. compromising physical abnormalities such as morbid obesity.enteral feeding and GI disturbances 3. decreased exercise tolerance. poor weight gain. insulin-dependent diabetes. After preoperative evaluation. chest radiograph. moderate obesity.intake of diuretics . decreased femoral pulses. asymptomatic heart disease. classify patient as to the American Society of Anesthesiologists (ASA) classification for risk and physical status: Class I: No underlying physical or metabolic disturbances Class II: mild to moderate disturbances that do not interfere with daily routines (<1 year of age.. TOF. cyanosis. pulmonary or endocrine dysfunction. or a precordial heave necessitates a more complete preoperative evaluation (hematocrit. oxygen saturation and cardiology consultation).
Infection Control (For detailed policies and procedures.b. A 4. with 2. 0. Access a. 3 .5% glucose (osmolality = 346 mosm).25 mE'l11 Mg and 40 meq lactate. Fluid is removed by creating an osmotic gradient between the dialysis fluid and blood using varying glucose concentrations. 23 Department of Pediatrics 39 Rev3Iss4 01-Apr-2010
.25% bag should be used once and the fluid status reassessed to prevent too rapid fluid removal and hypotension.25% dialysis fluid in a child with a fistula as hypotension may result in thrombosis of the fistula. Tenckoff catheter
OPM No.5% solution does not remove sufficient fluid.Hospital Infection Control Committee Manual) E. B. The usual dialysate solutions contain 1.' 1. Peritoneal Dialysis The peritoneal membrane acts as a semi permeable membrane to allow solute and water removal from the blood in children with renal failure.25% glucose solution (osmolality = 484 mosm) is available if the child is fluid overloaded and a 2. please refer to OPM No. please refer to Hospital Operations and Procedures (HOP) No. Note: In the event that the attending physician could not come in to do the preoperative evaluation. the attending physician could request another consultant to perform the evaluation.25% solution should not be given without discussion with the nephrologists on call. All elective surgical procedures should have a preoperative evaluation at least 3 days before the procedure. c. Administration of Blood and Blood Products (For detailed policies and procedures. Resuscitation Resuscitation procedures shall be based on the Pediatric Advanced Life Support (PALS) and Neonatal Advanced Life Support (NALS) guidelines. Solutes move by passive diffusion and convection across a concentration provided by dialysis fluid containing 132 mEql1 Na. 63 . A 4.8 mE'l11 Ca. 0. NB: Extreme care should be taken using a 4.5% glucose solutions (osmolality = 395 mosm) used to remove extra fluid.
C. 96 m Eql Cf. 1. The attending physician could also request the senior (third year) pediatric resident to perform the evaluation on his/her behalf.Blood Bank and Transfusion Services) D. he/she could request the walk-in consultant for that week to perform the evaluation.55% glucose solution (osmolality = 298 mosm) is available if the child is dehydrated as this allows fluid to be absorbed from the peritoneum.
Emergency cases would have a preoperative evaluation by the attending physician or the third year pediatric resident and the anesthesiologist. A second cycle of 4. The walk-in consultant is free to refuse and in that case.
An op site dress silk is applied to the catheter at the time of surgery. For acute PlJ catheter. the dry weight should be regularly reassessed in light of improved or inadequate caloric intake. Volume of Cycles 30-40 mL/kg is the volume of dialysis fluid which a child can comfortably tolerate In a child starting dialysis. Double cuffed catheter implanted surgically into the peritoneal cavity c. h. 23 Department of Pediatrics
. a. This has 2 lines. in which case the op site should be removed. 2. b. An automated cycler deliver set amounts of fluid into the peritoneal cavity and drains this automatically afler a set dwell time. The catheter should not be used for 48-72 hours to reduce the risk of leakage e. an inflow line with a fresh bag of dialysis fluid connected and an outflow to allow drainage. The catheter exit site should not be allowed to become wet for 4-6 hours. usually in lCU. Most children have a "last bag option" where fluid is left to dwell before they are removed from the machine. The last bag option allows a different volume to be delivered for the final cycle e. (Occasionally antihypertensive medication is also required). Types of Peritoneal Dialysis Continuous Ambulalorv Peritoneal Dialvsis – CAPD The Free line Solo system involves 3-4 exchanges/day. 1500 mls x 4 and a last bag option of 750 mls. The catheter exit site should not be allowed to become wet for 4-6 weeks. g. d. the volume should initially be 15-20 mlslkg and graded over 7-10 days to prevent leakage
OPM No. "Dry weight" is a clinical assessment of the weight at which the children are euvolaemic and normotensive. This should remain intact for 5-7 days unless there is discharge from the exit site. There is a single connection for the system to be attached-to the Tenckhoff catheter with each exchange. Antibiotics are given as single doses preoperatively to reduce the risk of wound infection and peritonitis.g. Continuous Cvcle Peritoneal Dialvsis (CCPD) CCPD is the preferred form of peritoneal dialysis for children at home. in acute renalfailure this may need to he inserted urgently.b. This provides an increased number of cycles and only one connection and disconnection. the exit site is cleaned with disinfectants and another op site applied f. Dry Weight Most children commencing dialysis are salt ailed water overloaded. Since weight is closely related to nutrition.
OPM No. 23 Department of Pediatrics
soft ankle restraints or vests e. patient should be assessed every hour for skin integrity and circulation. central venous catheters. 31 (11): 2665-2676.Pulse is present above and below restraint Skin Integrity: Skin integrity has been checked under and around the device(s). 23 Department of Pediatrics
. All patients should be assessed every two hours for mental status. intravenous lines and urinary catheters. Assessment. elimination and nutrition. safety and needs related to hydration. soft wrist restraints. Care. To facilitate the performance of bedside procedures in patients who cannot cooperate d. Objective The objective of this policy is to provide a consistent. b. and Monitoring a. The indications for restraints include: (Source: Maccioli. Document assessment and care on the monitoring form b. GA et al. For patients with primary behavioral or psychiatric disorders. Renew restraint order every 24 hours f. Use of Restraints 1. The limb restraints should be removed every four hours and range of motion (ROM) exercises should be done. Date and sign documentation 3.Nail bed blanched in less than 3 seconds . Nurse must sign and verify order for use of restraint c. Crit care Med Vol. For limb restraints. sheet. enteral feeding tubes. intracranial catheters. Document type of restraint used such as hand mittens. h. General Policies a. nasogastric or orogastric tubes. b. 2003. Document clinical justification for use of restraint d. and at all bony prominences and no pressure or reddened areas have developed. tracheotomy tubes.F. chest tubes. The following aspects of patient assessment and care should be monitored: Position: Proper alignment of the restrained limb(s) is maintained Circulation: The affected limb(s) has been checked and device application has been determined not to impair circulation to the extremity: . arterial catheters.
OPM No. Physician must put the date and time and sign restraint order form. d. 2. surgical drains. Restraints are used to ensure patient safety. Document restrained patient care in nurses notes or flow sheet i. Clinical Practice Guidelines for the maintenance of patient safety in the ICU: Use of restraining therapies. Document patient‟s mental status on restraint forms every shift. To decrease the risk of deliberate or inadvertent removal of an essential medical device(circulatory assist devices. c. To limit the patient‟s movement if movement might lead to a new or exacerbate an existing injury. c.) a. or curtain and is protected from public view. Document attempted alternatives to restraint g. Assess every 2 hours and document patient‟s mental status in flow sheet. endotracheal tubes. Privacy: The patient is covered either by gown. clear documentation of the care and management of patients requiring restraints.
either by foley catheter (Only if ordered for other medical necessity) or by offering the patient the bed pan or assistance to bathroom or bedside commode chair. Device Application: The device is applied according to the manufacturer‟s guidelines and in a manner that is secure but not tight. For patients requiring limb restraints. however a physician must be contacted to obtain an order for restraint within an hour of starting restraints b. A physician‟s order is required to restrain a patient. restraints may be applied prior to a physician‟s order. and quick release is possible. oral care is provided at least daily to maintain integrity of oral mucosa. oral fluids are offered at least every two hours. Writes down in the doctor‟s order sheet the following: Date and time of order Indication or reason for the use of restraint Type of restraint to be used Location of the restraint Alternatives attempted to avoid restraint Criteria necessary for release of restraint c. Fluid Needs: Fluids are administered as ordered by the physician. 23 Department of Pediatrics
. ROM exercise is recommended at least every 4 hours. Evaluation for Restraint Reduction or Removal: Need for the use of restraint(s) is evaluated frequently (at least every two hours) and restraints are discontinued at the earliest possible time. the patient is offered and assisted with meals and snacks. Informs and explains to patient‟s family members reason for the restraint
OPM No. If the patient is not on fluid restriction.
4. The following are the guidelines for ordering the use of restraint: Indicate date and time of order Indicate period for which restraint is to be used Indicate alternative interventions employed prior to the restraint order Renew restraint order every 24 hours after assessing for continued need for restraints Verbal/telephone orders for restraints must be signed by the attending physician within 24 hours In case of emergency. Procedures Issuing Orders for Restraint and Patient Monitoring Attending Physician a. and the room temperature is maintained as appropriate to patient‟s condition (generally 2022oC on the room thermostat). Toileting Needs: Elimination needs are attended to. Range of Motion: Active or passive range of motion in the affected limb(s) is completed either by the patient or the caregiver. If oral intake is allowed. The patient's body temperature is checked as ordered by the physician. Nutrition Offered: Nutritional needs are met as ordered by the physician. If the patient is nothing-by-mouth (NPO).
Temperature: The patient‟s skin is comfortable to the touch. Straps are secured to bed or chair frame (never to side rails or other moveable parts).
This is written on the progress notes section of the patient‟s chart.Nurse-in-Charge Carries out doctor‟s order accordingly Monitors patient using the Monitoring Flow sheet Files flow sheet in the patient‟s chart Discontinuing Restraint Attending Physician a. 23 Department of Pediatrics
. Carries out doctor‟s order accordingly b. Writes on the doctor‟s order sheet the order to discontinue/stop the use of restraint to include Narrative note that explains patient‟s change in condition related to the decision to discontinue the use of restraints. Nurse-in-Charge a. Writes down on the Nurses‟ Notes the completion of the task G. Care of the Comatose Child (Please refer to policy on the Care of the Comatose Child under Patient Intensive Care Unit)
Admit all normal newborns delivered vaginally. Supervises completion of patient‟s charts g. medications given and procedures being done c. To be able to identify normal variants and deviation from normal and refer accordingly 4. feeding. Do immediate newborn appraisal. Perform umbilical cannulation. Informs mother/father of the conditions/problems of the babies. 2. Inform consultants of admissions 5. Normal Newborns 1.Must be certified as diplomate by the PPS Sub board of Neonatal Medicine. 23 Department of Pediatrics
. Responsible for teaching the residents and other medical staff e. Makes daily rounds on all babies admitted under his/her service and in-charge of the over-all care and management of patients b. Attending physician reads daily the resident‟s progress notes for level II and III patients. Qualifications Must be an accredited pediatric resident staff of The Medical City PPS Certification in Pediatric Advanced Life Support and Neonatal Resuscitation Program 2. Inform consultants of problems regarding admitted babies
OPM No. Qualifications: Must be an active consultant of The Medical City or a certified TMC Visiting pediatrician For General Pediatrician.A diplomate of the Philippine Pediatric Society (PPS) For Neonatologist . Signs telephone orders as early as possible (within 12-24 hours) i. Attending Physician (General Pediatrician or Neonatologist) 1. Make daily rounds on all babies in the transition nursery b. Responsibilities: a. B. 2. In case of abnormal developments 1. Gives instructions to mothers on daily care. and gastric lavage 2. Responsibilities: First Year Resident a. Makes appropriate referrals to other subspecialties when needed f. Gives the final diagnosis h.THE MEDICAL CITY (TMC) NEWBORN SERVICES DIVISION QUALIFICATION AND RESPONSIBILITIES OF THE STAFF A.A diplomate of the Philippine Pediatric Society . Residents 1. Have complete maternal and obstetrical data in the newborn chart and do the admitting orders and progress notes 3. lumbar punctures and cardio-pulmonary resuscitation upon the supervision of a senior resident and the attending physician 3. Answer calls for IV insertion. bathing and follow-up of newborns prior to hospital discharge d. blood extraction.
OPM No. j. Second Year Resident a. 23 Department of Pediatrics
. Abnormal / Problematic Newborns: 1. Make daily rounds on all babies in the transition nursery In case of abnormal developments: 1. b. normal CS. Supervise and teach the First Year residents. neonatal history. and roomed in babies.a. Observe and assist the senior resident in the care and management of problematic babies. d. Complete the infectious surveillance form of congenital / nosocomial infection and submit it at weekly basis f. interns. Answer calls for IV insertion. and NICU proper admissions and discharges. c. Attend all abnormal / problematic deliveries and manage perinatal problems arising there from under the supervision of a 3rd year resident or attending physician 2. Isolation Room. Inform attending physicians of mother‟s discharge g. Make rounds on all roomed – in babies and refer problems to the senior NICU resident. To be able to identify and manage basic pathologic conditions in the newborn 4. Attend to all babies delivered by Caesarean section. all essential procedures related to their care 5. Check and update the logbook of NICU Referral. and progress notes of all problematic newborns 3. and gastric lavage 2. if needed. Follow-up consent for newborn screening for inborn errors of metabolism and for hearing screening tests. normal CS. Inform consultants of problems regarding admitted babies 4. maternal and obstetrical history. Prepare the monthly audit of normal newborns: NSD. Do the complete history and admitting orders. Do immediate newborn appraisal. Admit all normal newborns delivered vaginally b. e. h. lumbar punctures and Cardiopulmonary resuscitation upon the supervision of a senior resident and the attending physician 3. Inform consultants of admissions d. Keep data and update logbook for newborn screening for inborn errors of metabolism Normal Newborns: a. Prepare the monthly audit e. k. Monitor critically – ill neonates and perform. Observe and assist the senior resident in the care and management of problematic babies. Make rounds on all roomed – in babies and refer problems to the senior NICU resident. Have complete maternal and obstetrical data in the newborn chart and do the admitting orders and progress notes c. Perform procedures for newborn screening for inborn errors of metabolism. Follow-up consent for newborn screening for inborn errors of metabolism and for hearing screening tests. Perform procedures for newborn screening for inborn errors of metabolism. Inform subspecialist of referrals made to them c. and roomed in . Accompany babies for diagnostic procedures and / or transfer to other hospitals 6.babies. i. Inform attending physicians of mother‟s discharge. and nurses in the NICU d. Perform umbilical cannulation. Prepare the monthly audit of normal newborns: NSD. f. Update the attending physician and subspecialist on problems or new developments arising during their NICU duty 7. blood extraction. b.
Third Year Resident a. Refer all problems regarding critical care and management directly to the attending physician 3. Make rounds and progress notes on all problematic neonates 5. To be able to identify and manage basic pathologic conditions independently and more complex pathologic conditions with supervision 4. NICU / Isolation Room / NICU Referral: 1. Endorse all problematic cases and procedures to the senior residents on duty at the end of the day 6. Perform duties of the second year if no junior resident is available
OPM No. Take care of newborns admitted to the above-mentioned 3 areas 2. 23 Department of Pediatrics
. Assume command responsibility over junior residents and interns during her tour of duty or rotation 7. Supervise the training and service activities of residents and interns in the whole NICU 8.
Newborns admitted to various levels of the nursery. C. the baby could be admitted from the ER or the attending physician can write admitting orders and the baby could be admitted at the outborn unit. B. who may be greater than 4 weeks in age should be considered for admission to the newborn services.
Policy Guidelines A. Same as level II criteria plus the following: 2. All neonates born outside The Medical City Obstetric Delivery Rooms who need admission to the hospital are admitted here after (all levels of care) and being stabilized in the ER. 5th Floor 1. 5th Floor 1. If outborn. Babies already roomed-in with the mothers who are previously discharged who need to be re-admitted to the NSD written admitting orders are also required. require written admitting orders from the admitting physician or resident on duty who pers the consultant.
OPM No. If not sure about the level of care needed by the baby. Level I Normal Newborn Nursery. 2. 2. Level II Intermediate or Special Care (Inborn) Nursery. 3. Level II (Outborn). consult attending physician/ neonatologist/ NICU director or assistant director as to where the baby will be admitted. Any baby less than or equal to 5 kg in weight. Stable high-risk infants with the following diagnosis are admitted here Hyperbilirubinemia Fever R/O sepsis (“Any infant from the delivery room suspected of having sepsis should be isolated in an incubator”. 3. Normal newborns are admitted here immediately after birth for transitional care until transfer to mother‟s room for rooming-in. D.GENERAL GUIDELINES
I. 5th floor 1. Infants who meet criteria for isolation should be admitted/transferred to the Isolation Room) Babies completing IV antibiotics/medications Premature babies >2000g not needing NICU care Growing premature babies on full nipple feedings who are not ready for discharge Congenital birth defects not meeting NICU admission criteria. Newborns <28 days not requiring intensive care maybe admitted to the other areas of the hospital if the patient cannot be accommodated in the NICU. Normal baby whose mother has ongoing obstetric or medical problem/s cannot be roomedin. Decision Points 1. Rooming-in: Normal Spontaneous Delivery (NSD) Package – within 6hrs Caesarian (CS) Delivery Package –within 24 hours Non package deliveries (NSD/CS) 6-24 hours 3. 5. 4. 23 Department of Pediatrics
5th floor 1.Hypotonia/ rigidity .Cyanosis Neurologic Distress: . major malformations .Persistent tachypnea .ABG imbalances . true apnea which requires O2 for >1 hour .E.Life threatening.Intracranial hemorrhage .Asphyxia . The condition requires continuous cardiopulmonary monitoring plus at least one of the following: Congenital Anomalies causing functional impairment: . Unstable high-risk non-infectious infants with the following diagnosis or conditions are admitted here: Premature babies <2000 g Respiratory distress conditions requiring O2 / Respirator support Apnea Seizures Acute life-threatening event (ALTE) Cardiac conditions Acute surgical conditions pre and post-op (except those with colostomy who will be admitted to isolation) Babies on hyperalimentation Babies for exchange transfusion Surfactant replacement therapy Blood transfusion Congenital birth defects needing NICU care 2. Ca imbalances .Persistent altered respiratory rate as defined .Congenital icthyosis Pulmonary Distress: . hypotension .Heart murmur after 24-49 hours in presence of symptomatology .Persistent oxygen saturation <94% in room air after 1 hour of life .Persistent cyanosis. grunting.Poor perfusion.Adrenal insufficiency Cardiac Distress .Na. retracting. 23 Department of Pediatrics 49 Rev3Iss4 01-Apr-2010
.Lethargy/ irritability .Inborn error of metabolism . flaring. K.Hyper/hypothyroidism .Cardiac arrhythmia such as supraventricular tachycardia or congenital heart block .Needing ventilatory support Metabolic Distress: . Level III Neonatal Intensive Care Unit.Congenital malignancy .Apnea
OPM No.Circulatory abnormalities as previously defined .Seizures .Severe hypoglycemia or hyperglycemia .
stooling within 24 hours . Syphilis) Maternal AIDS Maternal Chicken pox Staphylococcal skin diseases Culture negative sepsis who are clinically septic (sclerematous. cleft lip/palate) . Rubella. 23 Department of Pediatrics 50 Rev3Iss4 01-Apr-2010
.<34 weeks gestation Condition requiring surgery within 48 hours after birth . Persistent: defined as symptoms . etc.Laboratory and cardiopulmonary monitoring. voiding. leukocytosis.Presence of congenital abnormalities (eg.Significant vomiting or abdominal distention requiring NPO status with IV fluid administration Sepsis . Daily progress notes in SOAP format shall be written for level 2 and 3 babies by the pediatric resident assigned to the patient.Unstable blood sugar .) Acute diarrheas (It is recommended that babies who do not require close monitoring be admitted to private room of choice.lasting > 1 hour .) Babies with Ostomies Post-operative patients needing intensive monitoring Babies with audible cough 2. 2. G.Requiring IV antibiotics and CP monitoring . IV line .High risk for sepsis (eg. neutropenic. If admission to the NSD cannot be avoided. Progress notes should also be written after any significant event or change in management
OPM No. Infectious neonates whether inborn or outborn who fulfill isolation criteria are admitted or transferred from other areas of the nursery Culture positive sepsis Culture positive pneumonias Omphalitis Meningitis Congenital infections (Toxoplasmosis. Chorioamnionitis) Prematurity or significant IUGR .Must need NPO status.g. All babies delivered at TMC OR-DR under potentially septic conditions (e.<1800 grams .Presence of clinical symptoms with abnormal CBC (admitted at the isolation room) . Herpes.demonstrated more than once
Reference: South Dakota Medical Assistance NICU F. NICU-Isolation Unit 1. Progress Notes Policies 1.Hydrocephalus GIT Abnormalities .
. CMV. without proper aseptic preparations) shall also be admitted in this unit. then strict isolation guidelines should be followed.Inability to establish feeding.
3. Pediatric residents shall be assigned to each patient. 23 Department of Pediatrics
OPM No. Any procedure done on the patient shall be written on the order sheet. 4.
3. Admission to the Level I Nursery 1. Clinical practice guidelines shall be used to guide patient assessment and reduce unwanted variation. Gloves shall be worn by the nurse or midwife when the newborn is received from the OR/DR staff. 11.5 mg IM 9. sex. Policy Guidelines A. Subsequent management of patients will conform to accepted standards of care. physical examination. Hepatitis B immunization at birth shall be given by the Pediatric Resident-On-Duty (PROD) on the right thigh. 8. time of delivery. Hepatitis B immunization. 2. This could include consent for newborn screening for blood and hearing tests. Vitamin K injection shall be given thru IM at the left thigh as follows: For babies >1 kg: 1 mg IM For babies < 1 kg: 0. and Infection Control procedures are based on existing recommendations of the Philippine Pediatric Society. mother‟s name and attending physician and shall be compared with the newborn record. The appropriate hospital forms for history. 23 Department of Pediatrics
. Pediatric Infectious Diseases Society of the Philippines. Pediatric Ophthalmology Society of the Philippines and the American Academy of Pediatrics. All patients admitted into the Unit shall be assessed by the Pediatric resident-on-call within 15-30 minutes and the Attending Physician within 12-24 hours. 5. Cord dressing shall be done by cleaning the base of the cord with povidone-iodine followed by 70% isopropyl alcohol in a circular and upward motion. 60 minutes. The ID band and data sheet shall be checked for the date.
OPM No. 3. The anthropometric measurement of the baby shall be taken as follows: Head circumference: from the occiput to the glabella and the supraorbital ridges Chest circumference: taken at the level of the xiphoid cartilage or substernal notch Abdominal circumference: taken at the level of the umbilicus Length: from the tip of the toe to the top of the head 7. Nurse-in-charge shall fill up the admitting checklist and shall accomplish the data sheet and diploma. Erythromycin eye ointment shall be applied on both eyes from the inner to the outer canthus. Vital signs monitoring shall be done and recorded on admission. and maturity testing shall be filled up by the admitting resident under the supervision of the Attending Physician. A bassinet with droplight shall be prepared for the admission. 2. Consent for admission to Newborn Services Division shall be signed by parent or legal guardian. hearing screen. 12. 30 minutes 45 minutes. These data sheets shall be incorporated in the baby‟s chart within 24 hours. 4. at 15 minutes. B. Babies delivered via Normal Spontaneous Delivery (NSD) shall be placed in a bassinet under droplight while Caesarean Section (CS) deliveries shall be placed in a prewarmed incubator with O2 or in a warmer. Protocols on Newborn screening. This could include consent for newborn screening for blood and hearing tests.ADMISSION OF THE NEWBORN I. 10. 6. General Policies 1. then every hour thereafter for 4 hours 13. The cord shall be cut one inch from the base and a sterile disposable clip cord shall be used to clamp the stump. Foot printing shall be done at the back of the baby‟s newborn record.
All infants admitted to the neonatal intensive care unit are usually made NPO (nothing by mouth) for at least 6-24 hours. Whether the patient is in stable or critical condition shall be noted. 4. Condition. 8. Admission checklist. The management depends upon the condition of the baby and the order of the attending physician. Other parameters include blood pressure.
OPM No. data sheet and diploma shall be filled up and accomplished by the nurse-in-charge. specific diet orders shall be written. Diagnosis. 6. The admitting diagnosis shall be listed. since it is a bedside procedure. data sheet and diploma shall be filled-up and accomplished by the nurse. weight. Consent for admission to level III shall be signed by parent or legal guardian. 2. if not yet accomplished. Routine VS monitoring includes continuous HR. Babies shall be placed in a pre-warmed incubator or could remain in a bassinet as indicated. until they are assessed and stabilized. and O2 sat and BP hourly unless otherwise ordered E. 2. 3. 5. every 2 hours and BP monitoring every 4 hours is standard unless otherwise ordered D. Diet. This could include consent for newborn screening for blood and hearing. Admit. The frequency of Hgt testing is included in this section. Admission to the Level II Nursery (SCN) 1. Vital Signs. 7. The location of the patient (eg. pulse. Request that nursing staff record accurate input and output of each baby. this means to handle the infant as little as possible and record all vital signs off the monitor. 2. Admission checklist. Routine monitoring includes HR. When appropriate. if not yet accomplished.) Also require that a daily weight and head circumference be recorded. At most centers. length and head circumference shall also be obtained on admission. Consent for admission to level II should be signed by the parent or legal guardian. 4. This notation is used for infants who react poorly to stress by dropping their oxygenation. Axillary temperature shall be specified. RR. level II or III nursery) and the attending physician in charge and resident in charge shall be specified. and respiratory rate. This record is especially important for infants on intravenous fluids and those just starting oral feedings. 23 Department of Pediatrics 53 Rev3Iss4 01-Apr-2010
.C. This could include consent for newborn screening for blood and hearing. Babies are placed directly in pre-warmed incubator. 3. chest percussion and postural drainage orders and endotracheal suctioning with frequency. Input and output (I and O). Respiratory care (ventilator setting. 3. How often you want the urine tested for specific gravity and glucose shall be specified. The desired frequency of monitoring of vital signs shall be stated. The management depends upon the condition of the baby and the order of the attending physician. Nursing procedures. such as those patients with persistent pulmonary hypertension. Admission Orders The following format is useful for writing admission orders for babies admitted to Level II and III Nursery: 1. RR. Admission to the Level III Nursery (NICU) 1. Activity. All are at bed rest but one can specify “minimal stress or hands-off protocol” here. 4.
10. These are any other orders required but not included above. 23 Department of Pediatrics
.9. giving specific dosages and routes of administration. It is useful to also include the milligrams per kilogram per day dose of the drug to allow cross-checking and verification of the dose ordered. ECG and ultrasound. State drugs to be administered. Symptomatic drugs. such as x-rays. 11. Extras. plus routine laboratory orders with frequency shall be included 13. 12. Laboratory data drawn on admission. Every medication or fluid order should include current weight of the infant. Specific Drugs.
OPM No. These drugs are not routinely used in a neonatal intensive care unit and would include such items as pain and sleep medications. Laboratory data.
Physical examination findings are documented using the standard physical examination form upon delivery. Daily physical examination shall be done by the nursery resident and attending physician. Monitoring of the patient using standard monitoring form (See attached form) shall be done by the nurse in charge. 3. Discharge physical examination findings shall be documented using standard discharge physical examination form. 23 Department of Pediatrics
. Complete history and physical examination of the baby shall be done by the senior resident on duty. initially every 30 minutes until stable then every 2-4 hours until discharge. 2.
OPM No. B.ASSESSMENT OF NEWBORN I. and any deviation from normal shall be duly noted. Follow policy guidelines of item A. complete assessment of the baby shall be done by the first year pediatric resident-on-duty and appropriate referral to the attending physician shall be done within 30 minutes of admission. Policy Guidelines A. These histories shall be done within two hours of admission of the mother and shall be incorporated in the chart. This form shall be accomplished by the resident in charge. The following factors should be documented: fetal bradycardia or tachycardia meconium staining maternal fever time of rupture of membranes any signs of maternal infection signs of chorioamnionitis pertinent laboratory abnormalities in the mother On admission at the nursery. Complete assessment of the admission is to be done by the senior pediatric resident on duty and appropriate referral to the attending physician is to be done within 30 minutes of admission. Any abnormal finding shall be referred immediately to the resident on duty and the attending physician. All normal babies shall be roomed-in with the mother. Level II & III 1. Obstetric and maternal histories shall include the following: Name of the mother and the father Address of the parents Pertinent history of the present pregnancy History of previous pregnancies and their outcomes Personal and Social History Family History History of past illnesses Significant maternal factors should be duly noted on the chart. numbers 2 and 3. Level I Complete obstetric and maternal histories shall be obtained by the first year pediatric resident on duty from the mother or a reliable informant.
OPM No. Daily physical examination and progress notes must be done by the senior resident until discharge and any abnormal findings must be duly noted and referred to the attending physician. Second year residents are required to make daily problem-oriented progress notes on all patients. Discharge physical examination must be done on all patients by the senior resident and all findings documented on the standard physical examination form. 6. Physical examination findings are documented using the standard physical examination form (See attached physical examination form) 5. Monitoring of the patient is done by the nurse in charge every 2 hours for level II and hourly for level III and duly noted on the monitoring form.4. 23 Department of Pediatrics
. indicating the assessment and plan of management as discussed with the Attending Physician. All patients in Levels I-III will be assessed periodically as deemed necessary.
or „successful intubation with ET tube in appropriate position‟ in the case of endotracheal intubation) 5. These notes shall be documented in the Progress Note section of the patient‟s chart. and immediately after the procedure. All orders shall be written in the Order Section of the patient‟s chart.CARE OF PATIENTS I. and resuscitation shall be documented in the Progress Notes Section of the patient‟s chart as a specific Procedure Note. noting the time the order was given and the time the order was carried out. Verbal orders shall be documented by the resident in charge or nurse in charge in the same section. The division head and/or staff physicians shall hold monthly meetings involving the nurse manager to address current patient care issues and insure uniformity of patient care. b. attending physician/physician-in-charge. The division has designed policies and procedures to ensure uniform care and reflect relevant laws and regulations. All plans and resolutions arising from patient care team meetings. Plans carried out shall be documented in the Progress Note section. during. All persons involved in the patient‟s care shall have access to the patient‟s chart. All orders shall be documented/written as soon as possible under the Order Section in the patient‟s chart. 23 Department of Pediatrics 57 Rev3Iss4 01-Apr-2010
. The patient‟s chart. These are then reviewed by the primary physician and written in the Order Section once a decision is made to carry out the suggested plan. which contains all notes relating to the patient‟s care. Late orders shall be noted as “Late entry”. In complicated cases. umbilical catheter placement. The specific aspects of care provided to the patient shall be documented in a timely manner in the appropriate forms in the patient‟s chart as noted above d. chest tube placement. b. The division shall utilize the same protocol for each procedure in its various settings. Consulting services shall be asked to document their suggested plan of management under the Progress Note section of the chart. nurses and ancillary staff involved. a. This note describes the patient‟s condition prior to. shall remain at the patient‟s bedside at all times. a. a. including formal meetings with family members shall also be documented in the chart in the same section. Only Pediatric residents rotating in the Newborn Services Division and the attending physician involved in the case are permitted to write orders in the Order Section of the patient‟s chart. and nurse in charge shall perform daily rounds on each patient admitted under the Division of Newborn Services. Policy Guidelines 1. a. the process involved. The residents. 2. lumbar puncture. All major procedures such as endotracheal intubation. b. Only orders written in the Order Section of the chart shall be carried out. the type of procedure. c. peripheral arterial line placement.
OPM No. The patient‟s care plan shall be carried out by the physicians. the Nurses Notes section. and any complications occurring at the time the procedure is performed. The daily plan for each patient shall be documented in the chart in the Attending Physician‟s Progress Note or Resident‟s Progress Note. The Procedure Note shall include results or immediate outcomes (such as resolution of pneumo/hemothorax in the case of chest tube placement. These are documented in the Policy and Procedure Manual of the Division of Newborn Services. The progress note is written in problem-oriented format and is written at least daily. central line placement. or cases where consulting services are involved. and/or the Medication Sheet in the patient‟s chart. discussions between services shall be documented in the patient‟s record under the Progress Notes section. 4. 3. Current problems shall be discussed and a specific care plan shall be designed.
23 Department of Pediatrics
. The patient‟s needs and condition shall be constantly evaluated and the plan shall be adjusted accordingly. Clinical Practice Guidelines for certain conditions in the newborn have been designed by the Division of Newborn Services and are used as a guide to patient care. Changes in plan shall be documented in the Progress Notes section and the Orders section of the chart. These shall be used as a guide to patient care. The Division of Newborn Services has designed specific clinical pathways for certain conditions in the newborn. The patient shall be evaluated on a regular basis throughout the day and throughout his/her hospital stay. 7. care shall be based on universally accepted standards of practice. care is based on universally accepted standards of practice 8.a.
OPM No. 6. In the absence of clinical practice guidelines. In the absence of clinical pathways. A care provider may access other provider‟s care notes by viewing them in the Progress Notes section of the patient‟s chart.
and Exchange Transfusions. b. the Orders section. Situations in which physical restraints may be used are written in the Policy and Procedure Manual of the Newborn Services Division under “Special Considerations: The Use of Restraints” b. This is documented in the patient‟s chart in the Consent for Blood Transfusion. 23 Department of Pediatrics 59 Rev3Iss4 01-Apr-2010
. Certain specific guidelines. Orders regarding infection control are to be written in the Order Section in the patient‟s chart as soon as an infant is diagnosed with a communicable disease or as being immunesuppressed. The division has designed policies and procedures to ensure uniform care for high-risk patients. Care provided in emergency situations is documented in a timely manner in the Progress Note and Orders sections of the patient‟s chart.
OPM No. The care of patients with a communicable disease is guided by the “Isolation Room‟s Infection Control Guidelines for the Newborn Services Division”. 4. The use of restraints is based on the above policy/procedure and is documented in the Order Section as well as the Nurses Notes section of the patient‟s chart. The Division‟s staff is trained in the use of its policies and procedures as a guide to patient care. Minutes of these meetings are documented and filed. Patients and services considered as “High-Risk” have been defined in items B. Peripherally Inserted Central Catheter Placement. These orders are based on the above-mentioned policies and procedures. Such procedures include Endotracheal Intubation. use and administration of blood and blood products are guided by The Medical City Blood Bank‟s Policy on the Handling. such as a guideline for “Do Not Resuscitate” are included in the Policy and Procedure Manual of the Division of Newborn Services. 3. Policies and procedures guide the care of patients on dialysis. a. or in the absence of such. Policy Guidelines 1. a. The care of immune-suppressed patients is guided by the “Isolation Room‟s Infection Control Guidelines for the Newborn Services Division” b. 8. 2. All neonatal staff involved in patient care is oriented to new policies and procedures prior to implementation. 6. Peripheral Arterial Catheter placement. C and D of The Medical City Newborn Services Division on page 37. Resuscitation services in the Newborn Services Division are provided according to the guidelines created by the Neonatal Resuscitation Program. 7. Use and Administration of Blood and Blood Products. a. 5.CARE OF LEVEL II AND LEVEL III AND PROVISION OF LEVEL II AND LEVEL III SERVICES I. These are documented in the Policy and Procedure Manual of the Division of Newborn Services under the section for High-Risk Patients and Services. The Division‟s physicians discuss and develop new policies and procedures as needed during its monthly meetings. Care provided to emergency patients in the Newborn Intensive Care Unit is according to its policies and procedures as noted above. The handling. Resuscitation is guided by policies of the Neonatal Resuscitation Program. Specific policies and procedures pertaining to the care of emergency patients have been designed by the division and are contained in the Policy and Procedure Manual of the Division of Newborn Services. and the Blood Transfusion Form. Policies and procedures guide the use of restraint and the care of patients in restraint. The care of patients on life support is guided by policies and procedures as documented in the Nursing Manual of the Newborn Services Division. 9. is in accordance with universally accepted standards of emergency care. The care of vegetative patients is guided by universally accepted standards of care a. c. Umbilical Vessel Catheterization.
its attendant risks and possible alternatives. potential complications. a.10. Each patient‟s surgical care is planned by the Surgeon-in-Charge. The anesthesia used and anesthetic technique are entered into the patient‟s record by the anesthesiologist in the “Anesthesia Sheet” of the Operative Record in the patient‟s chart. or with the assistance of a qualified nurse. c. The surgical plan is documented in the patient‟s chart under the Surgeon‟s Consultation Note in the Progress Note section of the chart. are discussed. 19. The risks. monitoring is a routine for patient‟s requiring intensive care. 14. The Division of Newborn Services has created a Policy on Moderate and Deep Sedation. Monitoring findings are entered into the Vital Signs Record of the patient‟s chart. 23 Department of Pediatrics 60 Rev3Iss4 01-Apr-2010
. The patient‟s physiologic status is continuously monitored during anesthesia according to protocols of the Department of Anesthesiology. As part of the discussion regarding surgery. a. an infant undergoing moderate sedation must be monitored by a licensed physician training in Pediatrics or a more senior physician. The Operative Note shall also contain a description of the surgical procedure. as well as a qualified nurse. dependent children is guided by universally accepted standards of care. 11. This evaluation is performed by an Attending Anesthesiologist. prior to administration of anesthetics. a.
OPM No. 12. a. b. any findings. 13. This plan is documented in the “Anesthesiologist‟s Pre-Operative Note”. b. while moderate sedation may be performed by a licensed neonatologist. during physician discussions with the family regarding the patient‟s condition. Parents are asked to consent for minors in the event of necessary procedures/interventions. under supervision of an Attending Anesthesiologist. and options are discussed by the anesthesiologist with his/her family and documented in the consent for anesthesia. Patients are monitored during the immediate post anesthesia recovery period as dictated by protocols of the Department of Anesthesiology. as well as the patient‟s family. An infant undergoing deep sedation must be monitored by an anesthesiologist. As stated in the Policy on Moderate and Deep Sedation. dependent children receive care according to universally accepted standards. This pre-operative discussion is performed by the surgeon and/or primary attending physician. a. a. The Policy on Moderate and Deep Sedation states that Deep Sedation must be performed by a qualified anesthesiologist. or by an anesthesiologistin-training. The anesthesia care of each patient is planned by the anesthesiologist after an evaluation of the patient and discussion with the surgeon and/or the patient‟s primary physician. Surgical planning is performed based on all clinical findings and available laboratory information. 15. an anesthesiologist. potential complications and options related to the planned surgical procedure in the process of obtaining consent for the procedure. A preanesthesia evaluation is performed prior to administration of anesthetics and is documented in the patient‟s chart in the “Anesthesiologist‟s Pre-Operative Note”. a. 17. and any surgical specimens obtained. A preoperative diagnosis is an essential part of the Surgeon‟s Consultation Note. The care of young. which is contained in the division‟s Policy and Procedure Manual. The patient‟s family/decision-makers are educated on the risks. benefits. 16. the need for transfusion of blood/blood products. The results of monitoring during administration of anesthesia are documented in the “Anesthesia Sheet” of the Operative Record in the patient‟s chart. This note is contained in the Operative Record in the patient‟s chart. a. a. 18. in coordination with the patient‟s primary Attending Physician. Young. A postoperative diagnosis is documented in the surgeon‟s Operative Note. Once the patient is transferred to the Neonatal Intensive Care Unit. as well as prior to this.
b. The names of the surgeon and surgical assistants are documented both in the Operative Record and in the Anesthesia Record in the patient‟s chart. c. The surgical record is placed in the patient‟s chart within 6 hours of completion of the surgical procedure. 20. Each patient‟s physiologic status shall be monitored continuously and documented as written above. 21. Each patient‟s medical, nursing and post-surgical care shall be planned by his/her primary physician in coordination with the anesthesiologist, surgical team, and bedside nurse. This plan shall be documented in the Progress Notes and Orders sections of the patient‟s chart.
OPM No. 23 Department of Pediatrics
DAILY CARE OF THE NEWBORN I. Policy Guidelines A. Anthropometric Measurements 1. Anthropometric measurements (Head circumference, chest circumference, abdominal circumference, weight and length) shall be taken upon admission and shall be plotted on the percentile graph adapted from Lubchengco LC, Hansman and Boyde and shall be incorporated in the baby‟s chart (see attached sample). 2. For babies who are not roomed-in, daily weight shall be taken and recorded accordingly. Unusual weight gain or loss shall be reported to the resident on duty that will recheck the weight and will then look for the underlying problem. B. Temperature 1. The neonate‟s temperature is maintained between 36.5-37.5C. The axillary temperature is preferred over the rectal temperature. 2. For babies inside isolettes, skin temperature should be ideally maintained at skin temperature of 36.5C with the probe located over the area of the liver. C. Bathing 1. After delivery, once thermo regulated, all normal and non-septic babies shall be given their first bath using a mild antiseptic soap/solution. 2. Thereafter, all normal babies are bathed daily using a mild soap. Premature and critically ill babies shall be given daily sponge baths inside their isolettes in the presence of the resident on duty. D. Cord Care 1. The umbilical cord is cleaned daily with 70% alcohol followed by Betadine paint. Cord clips are removed prior to discharge, but not earlier than the second day of life. E. Diaper Change 1. Disposable diapers shall be used on all infants. 2. The perineum shall be cleansed with water with each diaper change and disposed off immediately into the dirt utility. They shall not be placed in trash cans inside the nursery.
REFERRALS, SPECIAL PERMISSIONS AND COVERAGE
OPM No. 23 Department of Pediatrics
Policy Guidelines A. Referrals 1. Referrals to other pediatric subspecialties shall be made when needed. 2. The subspecialty consultant referred to must be a Diplomate of the Philippine Pediatric Society and Board Certified by their corresponding subspecialty society. 3. The hospital policy on referrals is followed: a. An active consultant of the Medical City may refer to either an active or visiting consultant staff. b. A visiting attending pediatrician must refer to an active staff. In subspecialties where no active staff is available, a visiting attending pediatrician may refer to a visiting subspecialist. c. The list of active and visiting staff are updated and listed in the office. d. Referrals must be seen within 12-24 hours and in cases of emergencies, as soon as possible. e. Referral form must be accomplished prior to the referral. It becomes part of the chart once completed. B. Special Permissions 1. Special visiting privilege may be granted for a single occasion. 2. Special permission for visiting privilege in the nursery may be granted to the following: Fellow emeritus of the Philippine Pediatric Society and other subspecialty societies under the Philippine Pediatric Society. Certain Pediatricians and Subspecialist referred by the Department Chair or Hospital Administration. However, he/she must be PPS board-certified and certified by their appropriate subspecialty board of the PPS. 3. Special visiting privileges given should have the written approval of the Department Chair. 4. Special permission form must be completed and signed by appropriate authority and becomes part of the chart. C. Coverage There will be occasions when the attending pediatrician and subspecialist referred to have to go on leave. During these times, the policy on coverage or transfer of responsibilities is as follows: 1. The attending pediatrician must transfer responsibility for care and management of the newborn to another pediatrician or neonatologist who is either a staff or visiting pediatrician of the hospital. 2. When a subspecialist goes on leave, she must transfer responsibilities for care and management of the newborn to another subspecialist who is either a staff or visiting consultant of the hospital. 3. In instances when there is no subspecialist available to take over the responsibilities of the subspecialist going on leave, a subspecialist who is not a visiting staff may be asked to take over. However, this subspecialist must be certified by their corresponding subspecialty society and must have written approval from the Department Chair.
OPM No. 23 Department of Pediatrics
OPM No. 23 Department of Pediatrics
.TRANSPORT OF BABIES I.
2. summary of labs. the anesthesiologist and a NICU nurse. the baby must be accompanied by the Senior Pediatric Resident. etc.and post-op transport for surgery. 6.A. During pre. 23 Department of Pediatrics
. Transport of Babies Within the Hospital 1. 5. 3.
ROOMING-IN POLICIES AND PROCEDURES
OPM No. Mode of transport outside the Newborn Services Division will depend on the patients‟ level of care. a medical personnel from the ambulance service should accompany the baby. All necessary paper work shall be accomplished (e. 4. If the baby will be conducted by a TMC ambulance. Babies for transfer to another unit for certain procedures or for admission should be accompanied by medical personnel. If the baby will be conducted using other ambulance services. All babies for transport should have adequate coordination and preparation with the receiving unit in The Medical City or other hospitals.g. 3.) C. Babies admitted at the Newborn Services Division (Level I-III) who require procedures that will be done outside NICU have to be accompanied by a junior/senior resident. 2. transfer summary. senior nurse and any ancillary personnel needed. a junior or senior resident and a NICU nurse should accompany the patient. Transport of patients using private vehicles is not allowed. The chart is brought with the baby and necessary equipment. copy of x-rays. B. Transport of Babies Outside of the Hospital 1. Transport of Babies for Surgery 1.
Only one watcher or visitor will be allowed to stay in the room at any one time. 5. without any complications or problems can be roomed-in depending on the assessment of the attending physician. 6. After reassessment by the pediatrician. the Newborn Screening test will be done in the mother‟s room or the procedures room on the floors by the resident assigned to the Newborn Services Division prior to the baby‟s discharge if the test was not done prior to rooming-in.Rooming-in is encouraged among mothers giving birth in this hospital. Mothers are required to provide for all the baby‟s needs (clothes. the baby may be transferred back to the Newborn Services Unit in the appropriate division (Level II or III or Isolation). the nursery staff endorses the baby to the floor nurse for identification. 11. Those parents who want to room-in will sign consent for rooming-in upon admission to the hospital. the father is given a chance to take care of the child early. 3. policies and procedures are explained during the early prenatal visits. The attending pediatrician makes daily rounds on all roomed-in babies. avoiding the use of prelacteals and expensive milk formula. This arrangement of placing the newborn infant in the same room as the mother encourages early maternal bonding and facilitates breastfeeding. and breastfeeding advice is given. Upon rooming-in. This includes: Bathing Cord dressing Administration of Vitamin K Crede‟s prophylaxis Weight and anthropometric measurement Suctioning and oxygen if needed Hepatitis B vaccine Newborn and Hearing Screening test 4. burping and diaper change will be done by the mother or the watcher. or a duly authorized pediatric resident. clips. The cost of hospitalization is minimized because mothers are encouraged to breastfeed early. When breast milk is not available. 8.) Feeding. etc. All roomed-in mothers and babies will have limited visitors. mittens. Babies and children are not allowed to stay or visit. All babies who are roomed-in are to be breastfed. The hospital will provide a bassinet for each baby. Policy Guidelines 1.
OPM No. the attending pediatrician may recommend other forms of feeding. All expectant mothers should be primed and encouraged to room-in early by their obstetricians. 2. All visitors must observe proper hand washing before handling the baby. the baby maybe transferred to the mother‟s room. 9. 7. At the same time. Proper instructions about the care and follow-up are given prior to discharge. blankets. In case the baby develops problems while roomed-in. For babies who are roomed-in. 10. 12. A member of the nursery nursing staff makes daily rounds on all roomed-in babies where cord care. 23 Department of Pediatrics
. bathing. The attending pediatrician will give the orders for the care of the baby. I. All babies born by normal spontaneous delivery (cephalic and breech) and Lamaze methods. The obstetrician will in turn refer to and coordinate with the pediatrician of choice for rooming-in instructions. Routine vital signs monitoring or roomed in babies will be the responsibility of the floor nurses. The neonate will be observed in the Level I area for 6-24 hours. Routine newborn care is given to the baby upon admission to the Newborn Services Division. Babies for rooming-in may be placed with their mothers in the Baby Friendly unit or any private room in the hospital.
The Newborn Services Division resident will inform the attending pediatrician of discharges of roomed-in babies. 15. Home instructions for babies will follow the standard Home Instructions Form. 14. Babies already roomed-in with mothers with hearing screening test results of “refer” will be bought back to the Newborn Services Division for repeat hearing screening test prior to discharge.13.
OPM No. 23 Department of Pediatrics
3. Definition of Terms 1.POLICY FOR BOARDERS I. Well-babies and growing preemies stay shall be limited only up to the age of 3 months.
OPM No. Parents will sign the guidelines for viewing and visiting of boarders. 4. Boarder . II.defined as a sick baby who stays in the NICU after the mother goes home. 23 Department of Pediatrics
. Mothers who leave their babies as boarders will have to accomplish duplicate copies each of the NICU Boarder‟s Data and Boarder‟s Contract. or a well baby whose mother has been discharged. Policy Guidelines 1. 2. Names of persons who may view the baby boarder will have to be indicated by the parents.
For babies not undergoing Newborn Screening test for inborn errors. Waivers/Refusal 1.) 2. B. (See attached waiver/refusal form.
OPM No. Circumcision shall be done in the Operating Room by the mother‟s Obstetrician or Surgeon. a waiver/refusal form has to be signed. Parents who refuse rooming in shall sign a waiver (For detailed policies and procedures on securing informed consent. Consent 1. 7-A – Securing of Informed Consent). please refer Appendix A – OPC NO. 23 Department of Pediatrics
. Parents shall need to sign for refused procedures 3.CONSENT AND WAIVERS I. Other procedures can be done at the Newborn Services Division. 3. Only parents or legal guardians are authorized to give these consents. Policy Guidelines A. A consent form is required for the following procedures: Ear piercing Circumcision Release of tongue tie Blood transfusion Exchange transfusion Lumbar tap Newborn and hearing screening tests Surgical or other invasive procedures Invasive radiographic procedures 2.
4. Level I Nursery will be open for viewing daily only on specified times of the day: Monday to Sunday. Mothers doing kangaroo care for preterms and growers are allowed to stay longer but must be situated in the Breastfeeding Room. NICU Outborn Unit or Isolation rooms.
OPM No. Routine visit from parents should be one at a time. limited to 5 minutes. Policy Guidelines 1. 3. 2. have no specified time for such visits. they will be advised to limit their visits to 10 to 15 minutes at any one time. Gowns and slippers are provided for the parents of these sick neonates. Babies admitted at Level II. 11:00 AM to 12:00 NN and at 5:00 PM to 6:00 PM. one person at a time. Only parents/ legal guardians/ grandparents are allowed to view their baby at the NICU on a case – to – case basis.POLICY FOR VIEWING I. Fathers are allowed to visit in the evening after viewing hours. They are allowed to touch their babies after proper hand washing. 23 Department of Pediatrics
. III. however. 2-3x a day.
Other instructions pertaining to special medical care (medications. Proper identification of the baby is done in front of the mother by checking the foot tag which should correlate with the crib tag. The mother shall then sign the discharge logbook. The appointment slip is given to the parent. a discharge summary is written and included in the chart. the representative should bring the following: Letter of Authority Hospital name tag of the mother and ID of the mother One ID with picture of authorized representative 13. Subspecialist(s) in the case of discharged babies will be informed and will give their discharge order. The contents of the admission kit. Newborn screening date done and newborn hearing screening is found there.
OPM No. The mother presents her hospital ID tag to the nurse before the baby is given. baby‟s blood type is given and instructions with regards to the hearing screening test and availability of newborn screening test are given to the mothers. The sex is also checked and is also shown to the mother. the attending physician will give the instructions regarding the care of their baby and follow-up. Discharge Policies 1. 10. Proper identification of the baby is done by the staff before dressing the baby. Policy Guidelines A. the clearance will be presented at the Newborn Services Division for the release of the baby. Staff Nurse will fill up the discharge checklist. The Newborn Services Division staff will encode the patient‟s discharge notice to the billing section together with the professional fee of the attending pediatrician and subspecialist(s). (use discharge forms) B. Discharge Instructions 1. Phil Health form should be completed if needed. In cases where the mother sends a representative to bring home the baby from the nursery. For level II and III babies. Home instructions on newborn care and follow up are given by the attending pediatrician or authorized resident. 12. Mothers will provide the layette of the baby. 11. Staff Midwife will bring the baby to the lobby using a crib. The information sheet must be duly accomplished with final diagnosis and signed by the attending physician. Nurses or midwives are allowed to give instructions on routine baby care 4. 15. hepatitis B vaccine card. Foot printing is done at the back of the newborn record prior to discharge. 9. 6. one copy for the mother one copy for the file. 2. he/she may delegate this duty to an approved representative. 2. Prior to discharge of each baby. In the event that the AP cannot give the home instructions. and other therapy) and follow up should be given by attending physician or duly appointed representative 5. When the bill is settled. 14. either another consultant or a senior resident. 3. There must be a written doctors‟ order in the patient‟s chart. 3. 7. 23 Department of Pediatrics
. 8. 5. 4. Discharge instructions should be written.DISCHARGE I.
Discharge medications. If the patient is being sent home on an apnea monitor. 23 Department of Pediatrics
. It is important to include the discharge weight. head circumference and length so that growth can be assessed at the time of the patient‟s initial check up. Attending physician and service caring for the patient Referring physician and address Procedures. Disposition.) Discharge instructions and follow up. Include the name(s) of medication(s). Discharge Summary 1. The easiest way to approach this section of the discharge summary is to discuss each problem in paragraph form. the dosage(s). Also include the type and amount of formula the patient is on and any pertinent discharge laboratory values. Same list as the discharge diagnosis list.g. Problem list. Condition at discharge. A complete physical examination is done at the time of discharge and is included in this section. physical examination and laboratory data as a guide. and length of treatment. Include all invasive procedures Brief history.C. The following information is written at the time of discharge and provides a summary of the infant‟s illness and hospital stay. (For the complete policies and procedures. Hospital course. 28-B – Servicing of Patient’s Discharge)
OPM No. physical examination and laboratory data on admission. It is helpful to indicate tests that need to be done on follow-up and any results that need to be rechecked. it is helpful to include the monitor settings and the planned course of treatment. This is a sample discharge summary for babies admitted to level II and III nursery. Include instructions to the parents on medications and when the patient is to return to the clinic (and its exact location). List in order of occurrence or severity. Use the admission history. home or to a foster home. please refer to Appendix F – OPC No. to an outside hospital. Note where the patient is being sent (e. Date of admission Date of discharge Admitting diagnosis Discharge diagnosis.
4. there shall be proper identification of babies by checking the ID bracelets and crib tags. The same shall be done for babies brought to the breastfeeding room and those for viewing.
OPM No. Appropriate entries should be made on the baby‟s chart by the nurse in charge when there is a need to change the baby‟s ID tag. The criteria for changing ID bracelets are as follows: Loose tag Illegible handwriting Soiling Constricting tags 5.IDENTIFICATION OF THE BABY I. ID bracelets shall be placed on the baby‟s ankle. 2. the baby shall be brought back to the delivery room where the tag is changed. 3. Particular attention shall be given to the mother‟s given name in cases where the babies‟ family names are the same. She will be the one responsible for changing the tag. If ever a newborn is admitted whose tag is placed on the wrist. the attention of the head nurse or senior NOD is called. ID bracelets shall go with the baby. Policy Guidelines 1. If there is a need for a change of ID bands. During endorsement. On discharge of babies. On rooming-in. 23 Department of Pediatrics
. 6. proper identification of the baby shall be done by checking the ID and crib tags of the baby and the mother‟s bracelet.
Cardio-Pulmonary resuscitation (CPR) is unique in that it is initiated without a physician‟s order when cardiac or respiratory arrest is recognized. A specific instruction if necessary is CPR is not to be started. 23 Department of Pediatrics
. (We need to tailor the DNR form to neonate. based on the advice and reasonable medical judgment of their child‟s physicians. Parents are the decision makers concerning treatment for the sick infant. 4.)
OPM No. division. Policy Guidelines A. Definition of Terms 1. The Bioethics Committee stands ready to assist in any case where clarification of options is necessary. Documentation for “NO CODE” 1. “No code” or Do Not Resuscitate (DNR) . 3. A referral to the Bioethics Committee and Legal Office shall be made if there is a need for it. guardian. department chief) to the physician in training Two signatures of licensed hospital staff members present at the conference when the patient. The “no code” or “DNR” order shall be appropriately reviewed to ensure that the order remains current and consistent with the family‟s desire and with the patient‟s medical condition. 2. The “DNR Code” can be cancelled by the parents at anytime. Every necessary measure shall be taken to promote the patient‟s comfort and dignity.an order which communicates to the nursing or hospital staff that resuscitative measures are not to be taken in the event that a patient goes into cardio-pulmonary arrest. or conservator agreed to the DNR order. The parents or legal guardian shall be requested to sign the DNR form. family. A licensed pediatrician in training shall obtain the concurrence of the attending physician (or department chief if needed) and the parents of a legal guardian before initiating a “No code” order. 6.“NO CODE” OR DO NOT RESUSCITATE (DNR) GUIDELINES Rationale Among the therapeutic modalities. 2. General Policies 1. 5. 3. II. Witness/es‟ signature 4. The “no code” or “DNR” order shall be written on the patient care order sheet and signed by the parents and attested to by 2 licensed physicians (attending/resident). The progress note of the physician must include: A summary of the medical situation The name and opinion of the physician who is the senior physician (attending. A DNR progress note is required. The parents shall be offered informed options. I. B. A new “DNR” order shall be written on each admission for those patients who are readmitted more than once.
) shall be admitted to the NICU. 5 ounces) 2. If an immediate assessment is not feasible. unless they expire after delivery (they do not respond to full resuscitation in 30 min. It is unacceptable for a physician to tell the nurse that an infant is non-viable and not write the appropriate orders. 23 Department of Pediatrics
. an immediate assessment by an experienced physician will be done. Very-low-birth-weight (VLBW) infants = birth wt <1500 g (3 pounds. 1ounce). In situations where a DNR is appropriate. and a licensed physician pronounces them dead at the Delivery Room). Extremely-low-birth-weight (ELBW) infants = birth wt < 1000 g (2 pounds. 3. On situations where the viability of the infant is in question.POLICY FOR NON-VIABLE INFANTS I. Incredibly-low-birth-weight (ILBW) infants = birth wt < 750 to 800 g (1 pound. Orders for these infants should include: DNR where the infant should be nursed (crib. etc. 2.
OPM No. Policy Guidelines 1. Definition of Terms Preterm Infant 1. Reference: Schaeffer & Avery Taeusch and Ballard II. then medical intervention including resuscitation will be done until the assessment is complete. 3 ounces) 3. incubator) monitoring instructions whether or not a CPR monitor should be placed on the infant (this is a decision that the MD will make on an individual basis) feeding or IV fluids provision of oxygen. All live born infants who are non-viable (< 24 weeks and < 400 gms. the DNR guidelines will be followed (see DNR guidelines).
23 Department of Pediatrics
5 ml HBIG as soon as possible not later than 1 week after birth.
Vaccine Dose First vaccine dose HBIG
b. This practice has been going since 1997. Policy Guidelines 1. 23 Department of Pediatrics
. The following schedule is followed for Hepatitis B Immunoprophylaxis: a. For Preterm Infants The optimal time for initiating hepatitis B immunization in premies weighing less than 2 kgs is still undetermined. The following are recommendations for hepatitis B Immunoprophylaxis for preterm and LBW infants (< 2 kg. For Term Babies Infant Born to Mother known to be HBSAg Positive Age Birth (within 12 hrs. Seroconversion rates in VLBW infants in whom immunization was given shortly after birth have been shown to be lower compared to term infants.) Birth (within 12 hours)
First Vaccine Dose HBIG
Infant Born to mother with Unknown HBsAg Status Age Birth (within 12 hrs.).POLICY FOR HEPATITIS B IMMUNIZATION AT BIRTH The prevention of Chronic HBV infection is a high priority globally. The Medical City believes that the best way to prevent perinatal transmission of hepatitis B is by routine immunization of all babies born at The Medical City Newborn Services Unit. WHO/ EPI recommended that HB vaccine be included on the National Immunization Programs in all countries with an HBV carrier rate of 8 % or over by 1995 and in all other countries (regardless of HBSAg prevalence) by 1997(1).
OPM No. give 0.) Maternal screening for Hepa B is recommended. If mother is found to be HBsAg (+) following screening. Hepatitis B vaccine is one of the most effective vaccines available. Babies who become infected at birth have a 90 percent risk of chronic infection and may die of chronic liver disease as adults. In 1991. I. Studies have shown that infants of the most highly infectious mothers (HBSAg+ and HBeAg+) who received postexposure prophylaxis with only hepatitis B vaccine (without HBIG) at birth are protected in 90 – 95 % of cases(2).
First dose of HBV should be given at birth (within 12 hours). or .3 additional doses of hepatitis B vaccine starting at 1 month of age should be given Infants Born to HBsAg Negative Mothers . 6 schedule.Infants weighing < 2 kgs. . .
OPM No. give 0.Maternal screening for HBsAg is recommended..5 ml as soon as possible not later than 1 week after birth. 23 Department of Pediatrics
. . 1.PT and LBW infants must receive Hepatitis B vaccine and HBIG with 12 hours after birth regardless of gestational age or birth weight.Three additional doses of Hepatitis B starting at 1 month of age should be given following 0.First dose can be delayed until just before hospital discharge of infants or once the weight is > 2 kgs. Infants born to HBsAg Positive Mothers .Wait until infant is approximately 6-8 weeks of age when routine immunization is given. . Should not have the birth dose of HBV counted as part of HBV Immunization series. If mother is HBsAg (+). Infants born to Mothers whose HBsAg status is Unknown .
23 Department of Pediatrics
. If the child does not pass the screen. If a patient does not pass the screen it does not mean that the child is deaf.NEWBORN HEARING SCREENING PROGRAM PROTOCOL I. respiratory difficulties. Hearing screening using the otoacoustic emission (OAE) machine is done by trained technician (midwife. the mother is informed by the physician or nurse-in-charge of the results but is advised to pick up the results in a few days since even if the baby passed the test. They are best re-screened in 1 to 3 months time. There are many factors that can cause a child not to pass (“refer”). besides the result. a few hours or the next few days (as long as the baby is not yet discharged). 2. a noisy baby. This form is forwarded on the same day to the Hearing and Dizziness Unit and a copy is given to the mother if the child “refers” on at least one ear. a re-screen may be warranted as explained later. The patients that are important to re-screen are all patients who are high risk for hearing loss (whether or not they passed the initial test) and all those who are non-high risk but did not pass the initial screening. For the babies whom the hearing screening test were not done prior to discharge and babies who want to avail of the same procedure.) The best fit ear probe is used on the most available ear of the child to prevent him/her form waking up. 11. Then the head is turned gently to test the other ear. recommendations for re-screening if needed. On the days when they are not available.
OPM No. This will aid in the ease and speed in performing the test. nurse.) before the child‟s discharge once consent is given by the caregiver.) It is usually performed by the Hearing and Dizziness Personnel. Policy Guidelines 1. The preliminary results will tell you that the test was done and whether the infant “passed” the screening test or not. 9. This will definitely reduce the “refer” rate of the hearing screening procedure and is advisable. noisy environment and very small ear canals (some premature infants) may all potentially cause a baby not to pass the test. The preliminary test is done by the technician and the result is also documented in the Newborn Hearing Screening Form. The final result will include. he/she can be screened again either immediately. 8. If the baby “passes” on both ears. etc. low birth weight. For babies who are discharged before 48-72 hours with a “refer” result. a midwife trained in doing the test performs the procedure. Vernix caseosa. 5. a referral to the ENT Pediatric Consultant in-charge of the Hearing and Dizziness Unit will be given for the said procedure. (The Otoacoustic emission machine works performs best when charged for a few hours before the start of hearing screening. For babies who “referred” or did not pass the initial screening. The baby is wheeled into the hearing screening room by the technician and the test is done there. a repeat testing will be done after 30 days by the ENT Pediatric Consultant in-charge of the Hearing and Dizziness Unit (call for scheduling). 7. Final results (of those who passed the hearing screen) are brought to the NICU within 3 working days by the staff of the Hearing and Dizziness Unit for filing. they are (as previously mentioned) given a copy of the properly accomplished OAE results form and advised to have the baby re-screened in 1-3 months time. It is a routine procedure done for all admissions at the Newborn Services Division (NSD). The test is best done 24 hours or more after birth. 3. when the child is sleeping or just resting quietly and when he/she has recovered from any health problems (infections. etc. The technician writes down all the pertinent data and completes the OAE results form. The screening technician for that day will be responsible for this task. 6. 10. The babies for screening are identified by the midwife on duty for that day to assist the Hearing and Dizziness personnel. 4.
Suggestions are: a. High risk factors include an illness or a condition requiring admission of >48 hours to a NICU. The test will be done after feeding the child and will definitely take longer if the child is awake/crying/active during the test. for example) but to bring his/her food to the test site. Washes it thoroughly with water
OPM No. 15. a. Remove the paging system along the hallway of the examination room. stigmata or a syndrome associated with hearing loss. After Newborn Hearing Screening Attending Physician 1. Makes sure that the environment is quiet. Performs the test C. Makes sure that the baby is asleep or is quiet during the test. 3. 16. family history of childhood sensorineural hearing loss. Care of the Machine Hearing and Dizziness Staff-in-charge 1. The parents shall also be advised not to feed the infant 2 to 4 hours prior to the test (unless medically unacceptable – if the child is taking medication. Prior to the Newborn Hearing Screening Midwife-on-Duty 1. D. 23 Department of Pediatrics 80 Rev3Iss4 01-Apr-2010
.12. corridor and the locker room while the test is ongoing. The resident-on-duty at the Newborn Services Division must inform the attending physicians of all babies with a hearing screening result of “refer” prior to the babies‟ discharge. b. 14. The parents/caregiver of the child shall be informed that the test is best done with the child asleep. Requests patient to fill up the information sheet completely 2. For babies who fail the repeat hearing screening test done by the ENT consultant in-charge of the Hearing and Dizziness Unit and requires a BAER. Cleans the ear probes properly. Procedures A. Minimize conversation and noise along the reception area. 2. II. 13. will be issued by the ENT consultant and sent to the Attending Physician. During the Test Hearing and Dizziness Staff-in-Charge 1. Explains properly to the parents the result of the test so as not to unduly upset them. Adds a lock on the Newborn and Hearing Screening Room to minimize moving the machine in and out of the table and also to minimize “rolling” of the thin probe cable which may lead to damage to the machine and delays in testing 2. The Hearing Screening Test is performed daily. craniofacial anomalies and in-utero infection. 2. Prepares the patient in advance by lining him/her up for the test B. Follows up patients who “refer” to make sure they undergo a repeat screening. A re-screen should be scheduled.
please refer to Appendix G – OPC No. 23 Department of Pediatrics
.b. Order new earprobes as necessary (For detailed policies and procedures. Wipes dry.Servicing of Patient Availing of Newborn Screening Procedure)
OPM No. not with needle 3. 140 .
Emergency Surgical Procedures 1. 3. 2. Outborn patients of surgeons may be referred to the Unit for clearance by the neonatologist. chest x-ray). 4. 5. A clearance is not required. 23 Department of Pediatrics
. B. The attending anesthesiologist makes an initial pre-op assessment and a re-evaluation right before the induction of anesthesia. Intra-op monitoring is provided on request by the surgeon. The attending neonatologist stabilizes patient‟s hemodynamic status prior to surgery. 2. Post-operatively patient is transported back to Level III accompanied by the PROD and the anesthesiologist. A. intra-op monitoring and/or post-op care as specified in the referral sheet. These assessments are recorded in referral sheets.NEWBORN SURGERY PROTOCOL
Policy Guidelines All newborns for surgery will be medically evaluated before administration of anesthesia and/or surgical treatment. Tests done outside the TMC are verified at admission. Patient for surgery is transported to the Surgery Suite accompanied by the Pediatrics resident-on-call and nurse-in-charge. Newborns undergoing an elective procedure will be assessed as to cardio-pulmonary physiologic status by the Attending neonatologist not longer than 24 hours prior to the said procedure. This assessment as well as a pre-operative diagnosis shall be based on recorded results of diagnostic laboratory tests requested (CBC. Elective Procedures 1.
and ventilatory changes Q 1-2 hr) Patient receiving peritoneal or hemodialysis Multiple transfusions of blood products – greater than 3/shift Post-op cardiac for first 24 hr. frequent chemstrips.e. multiple ABG’s and multiple chest tube insertions) 2. 1:3 Acuity Continuous IV infusions containing calcium Two or more piggyback medications IDM with frequent chemistries Pulse oximeter with titration of oxygen Chronic patients requiring more than twelve oral medications per shift Scheduled complex discharge instructions taught to parents or primary care giver Suctioning required more than twice per shift Stable Nasal CPAP babies (less than 4 A&B’s per shift and FiO2 of 35% or less) Tracheostomy with CPAP or sprinting to collar Frequent ostomy appliance changes. Low BP) Patient with multiple chest tubes who is unstable (ie. frequent A & B’s. e. Dopamine. multiple IV drips) Unstable IDM (i. B-T shunts (eg: PDA) During exchange transfusions Seizures not controlled by anticonvulsants On IV drip with unstable chemistries Infants who are to go for cardiac catheterization Infants whose respiratory status is unstable (e. Dobutamine) Unstable Nasal CPAP patients (ie. wound care or complex skin care
OPM No. 23 Department of Pediatrics
.g.TMC NEWBORN SERVICES NURSING STAFF SUGGESTED ACUITY GUIDELINES Revised January 1995 A. dressing changes. 1:2 Acuity Trach/Intubated (not meeting 1:1 criteria) who are on a respirator + ABG determinations Stable BP on vasopressors or other drips for cardiac effects (PGE. 1: 1 Acuity Patient who are hemodynamically unstable with multiple IV infusions (ie. Nursing Care 1. frequent IV changes) Post-surgical patients on a respirator 3. conventional vent. Vital signs which require frequent ABG’s. Frequent oxygen changes.g.
4. heplock. Ampicillin and Gentimicin) per 12 hour shift Infants on continuous oxygen who are stable Chronic babies who are on less than 12 oral medications
OPM No. 1:4 Acuity Stable hyperbilirubinemia patient Tolerating feeds Q 3-4 hr Infant receiving 2 or less piggyback medications (ie. 23 Department of Pediatrics
Neonatal Intensive Care Unit (Level 3) The following equipments are recommended for care of the critically ill: intensive care incubator or unit with overhead heating respiratory or apnea monitor (not available) heart rate monitor intravascular blood pressure transducer or surface blood pressure recorder (not available) transcutaneous pO2 monitor (available) or intravascular oxygen transducer (not available) transcutaneous pCO2 monitor (not available) syringe pumps infusion pumps ventilator continuous temperature monitor pulse oximeter phototherapy unit ambient oxygen monitor (not available) facilities for frequent blood gas analyses using micromethods facilities for frequent biochemical analyses including glucose. Special Care Nursery (Level 2) The following equipments are recommended for babies under special care: incubator or cot adequate for temperature control ambient oxygen analyzer (not available) apnea alarm (not available) heart rate monitor infusion pump phototherapy unit access to frequent blood gas analysis using micromethods access to biochemical analysis using micromethods access to equipment for radiological examination
B.EQUIPMENT RECOMMENDED FOR DIFFERENT LEVELS OF NEONATAL INTENSIVE CARE A. bilirubin and electrolytes by micromethods access to ultrasound equipment for visualization of organs such as the brain access to equipment for radiological examination
OPM No. 23 Department of Pediatrics
Newborn Record. Medication Chart. Maturity Testing and Anthropometric Measurement Form 5. Consent Forms. 10. 6. treatment.baby‟s progress and observation report done by the nurses. disposition and other instructions are entered by the AP/ resident.include consent forms for Newborn and Hearing Screening tests. 3. 14. Data sheets for all babies admitted in the NSU should be arranged as follows: 1. 9. contains the Apgar score and delivery data as furnished by the Obstetrician. Patient‟s Data Sheet. Laboratory Report.a record of the baby‟s physical evaluation by the Pediatrician/Resident upon admission and prior to discharge.used by the nurses and midwives for recording vital signs.accompanying record of the baby from the Delivery Room. urine and stool scores. 11. 13. Temperature Chart. Doctor‟s Progress Notes. NSU Monitoring Sheet for Level II and III patients. Doctor‟s Order Sheet.furnished by the Admitting office and based on the baby‟s data slip forwarded to them by the NSU. 2.baby‟s progress and observation report done by the residents 8.RECORDS A. Admission and Discharge PE Sheet. Input and Output form
OPM No.written orders for feeding. 4. 23 Department of Pediatrics
. 12.accomplished by the nurses in recording the medications given. weights. Resident‟s Admitting NICU history and Physical Examination 7. medication.a blank sheet of paper where results of the laboratory examinations are pasted. Nurse‟s Notes.
Observe for vomiting. lethargy or any neurologic deterioration while on feeding. 7. 4. 4. 3. Collect 20-30 cc of sterile urine.
OPM No. Collect blood spots for leucine level. feeding schedule for the next 24 hours should contain: a. Strict I and O monitoring.
DAY 4 1. 4.
Evaluate protein intake for the last 24 hours. Once the results of the above tests are normal. Please monitor strictly intake and output. Continue strict input and output monitoring. may increase natural protein intake to 1. 5. Please maintain MSUD formula at 1. Maintain natural protein at 1g/kg/day until the results of the above tests are in. 2.
DAY 2 1. 2. 6. 5. 6. Routine evaluation 2. b. Evaluate status of patient and refer accordingly. c. NIH. Evaluate status of patient and refer accordingly.PROTOCOL FOR PATIENTS SUSPECTED TO HAVE MSUD
DAY 1 1. 3. Collect urine for HVE. Collect blood spots on filter card and send for leucine level at Newborn Screening Laboratory. Natural protein at 1g/kg/day using regular infant formula. 5. Once the results of the above tests are normal.5 g/kg/day of protein free BCAA. Newborn care 3. Collect urine for HVE.5g/kg/day. National Institutes of Health. Evaluate protein intake for the last 24 hours. Once feeding is started. Special MSUD formula – 1. Rest of the requirement to be given as protein free formula (Energivit). 3. may increase natural protein intake to 2g/kg/day.5g/kg/day. 6. Collect blood spots for leucine level. 23 Department of Pediatrics
. 4. Maintain MSUD formula at 1g/kg/day. freeze and submit for High Voltage Electrophoresis (HVE) at Biochemical Laboratory. unusual odor.
DAY 3 1. 2. poor suck. Maintain MSUD formula at 1g/kg/day.
Evaluate protein intake for the last 24 hours. Strict I and O monitoring. 5. Evaluate status of the patient and refer accordingly.
6. 5. Maintain MSUD formula at 1g/kg/day.
Evaluate protein intake for the last 24 hours. Maintain MSUD formula at 1g/kg/day. Evaluate status of patient and refer accordingly. Evaluate status of patient and refer accordingly. 3. Strict I and O monitoring. 4.
DAY 6 1. Strict I and O monitoring.
OPM No. 23 Department of Pediatrics
. Collect blood spots for leucine level. Once the results of the above tests are normal. may increase natural protein intake to 3g/kg/day. Collect urine for HVE. 3.5g/kg/day. 2. Collect urine for HVE. may increase natural protein intake to 2.DAY 5 1.
Evaluate protein intake for the last 24 hours. 6. 2. 4. 5. Once the results of the above tests are normal. Collect blood spots for leucine level.
NIH d. NIH b. Serum lactate (as needed) 6. NIH d. feeding schedule for the next 24 hours should contain: a. Collect blood spots on filter card for leucine level at Newborn Screening laboratory. 23 Department of Pediatrics 89 Rev3Iss4 01-Apr-2010
. 20-30 cc of urine (keep frozen) for urine organic acid and high voltage electrophoresis and submit at Biochemical laboratory. 20-30 cc of urine (keep frozen) for urine organic acid and high voltage electrophoresis and submit to Biochemical Laboratory. Newborn care. Continue strict I and O monitoring
DAY 3 1. Evaluate status of patient and refer accordingly 3. Rest of the requirement should come from a protein-free formula (Energivit) 5. unusual odor. 4. NIH c. If the results of the above tests are normal.
Routine evaluation. Serum lactate (as needed)
OPM No. Blood gas e.5g/kg/day using regular infant formula b. Continue protein free formula (Energivit) 2. Serum ammonia f. Once feeding is started. Natural protein at 0. mitochondrial disorders. organic acidopathies. 3. Evaluate for dysmorphic features. lethargy or any neurologic deterioration 7. Urine ketones g. Blood gas e. 2. Observe for vomiting.
DAY 1 1.PROTOCOL FOR PATIENTS WITH FAMILY HISTORY OF NEONATAL DEATHS/POOR OB HISTORY Among the genetic conditions that can present with neonatal deaths are chromosomal abnormalities and inborn errors of metabolism presenting with acute encephalopathy such as: aminoacidopathies. Strict input and output monitoring
DAY 2 1. may increase natural protein to 1g/kg/day. Urine ketones g. NIH c. poor suck. Serum ammonia f. fatty acid oxidation defects and urea cycle defects. Collect 3 ml of blood on lithium heparinized tube and send on wet ice immediately to Biochem Lab. Collect the following samples: a. Collect blood spots on filter card for leucine level at Newborn Screening Laboratory. send on wet ice immediately to Biochem Lab. NIH b. Collect 3 ml of blood on lithium heparinized tube. Collect the following samples: a.
5g/kg/day. Evaluate status of patient and refer accordingly. Serum lactate (as needed) 2. Continue strict input and output monitoring. If the results of the test done on day 3 are normal. may increase natural protein at 1. Evaluate status of patient and refer accordingly. 2. 23 Department of Pediatrics
. Collect blood spots on filter card for leucine level at Newborn Screening Laboratory.
OPM No. Continue Energivit.
DAY 6 1. Urine ketones g. If the results of the test done on day 3 are normal.
DAY 5 1. NIH d. Collect 3 ml of blood on lithium heparinized tube. send on wet ice immediately to Biochemical Laboratory. 3. 3.2. may increase natural protein at 2g/kg/day. Continue Energivit. Continue strict input and output monitoring. Collect the following samples: a. Evaluate status of patient and refer accordingly. 3. 3. Blood gas e. 2. Evaluate status of patient and refer accordingly.
DAY 4 1. NIH c. NIH b. Continue strict input and output monitoring. Serum ammonia f. Continue strict input and output monitoring. 20-30 cc of urine (keep frozen) for urine organic acid and high voltage elctrophoresis and submit at Biochemical Laboratory.
QUICK GUIDE TO GENETIC TESTING SERVICES Institute of Human Genetics – National Institutes of Health Phone: (632) 5261710 / 5261725 Fax (632) 5269997 Website: http://www. 23 Department of Pediatrics
1 cc plasma from blood collected in green top blue.
2 – 3 weeks 2 – 3 weeks 2 – 3 weeks 3 – 4 weeks
4 days 4 days 4 days
. Transport in ice. Transport in ice.
Transport in ice.
4 weeks Special Arrangement 1 day 1 day
Transport in ice. Store in plasma freezer 1 cc of cerebrospinal fluid in plain tube. Collect 3 cc blood. 3 – 4 cc of blood in green top tube * sent immediately 3 – 4 cc of blood in green top tube * sent immediately 3 – 4 cc of blood in green top tube * sent immediately 2 – 3 cc of bone marrow aspirate in green top blue
Transport in ice. 10 cc of random urine in sterile container.
Total Homocysteine Analysis Urine Ketones Reducing Sugars CYTOGENETICS Karyotyping Peripheral Blood + High Resolution + Fragile X Screening Bone Marrow
Transport in ice. centrifuge at 2700 rpm for 10 minutes. Store in freezer 30 cc of random urine in sterile container. Transport in ice. Store in freezer
Transport in ice.ph Office Hours: Monday – Friday (8:00 am to 5:00 pm)
firstname.lastname@example.org. Store in plasma freezer 10 cc of random urine in sterile container.com. Transport in ice.com. centrifuge at 2700 rpm for 10 minutes. Store in freezer 1 cc plasma from blood collected in purple top blue. Collect 3 cc blood.ph
UNIT BIOCHEMICAL GENETICS Metabolic Profile Organic Acid Analysis Amino Acid Analysis Plasma Cerebrospinal Fluid Quantification
Turn Around Time (Working Days) Routine Urgent* 7 days 2 weeks 2 days 1 day
30 cc of random urine in sterile container.
Product of Conception MOLECULAR GENETICS DNA Extraction With DMD / BMD Testing Fish BCR – ABL DiGeorge PWS / AS Her – 2 (Breast CA) NEWBORN SCREENING Newborn Screening Panel G6PD Confirmatory Amino Acid Thin Layer Chromatography dried whole blood spotted on filter paper * sent immediately 2 – 3 cc of blood in purple top tube plus dried blood Transport in ice spot dried whole blood spotted on filter paper 5 days 7 days 7 days 1 day 3 – 4 cc of blood in green top tube immediately 3 – 4 cc of blood in green top tube immediately 3 – 4 cc of blood in green top tube immediately 3 – 4 cc of blood in green top tube immediately * sent * sent * sent * sent 3 – 4 weeks 3 – 4 weeks 3 – 4 weeks 3 – 4 weeks 2 – 3 cc of blood in purple top tube immediately 2 – 3 cc of blood in purple top tube immediately * sent * sent 2 – 7 days 2 – 3 weeks 1 – 2 cm2 tumor in transport medium * sent immediately 1 – 2 cm2 product of conception in transport medium * sent immediately 4 – 5 weeks 4 – 5 weeks
NOTE: green top tube: Heparin Vacutainer.* sent immediately Tissue a. purple top tube: EDTA Vacutainer * Please call IHG for urgent samples
OPM No. 23 Department of Pediatrics
. Solid Tumor b.
his family of whoever assumes the responsibility of bringing the patient to the hospital. fractures and poisoning Generation of initial orders for patients requiring emergency admission Short-stay holding for observation. 3. 2. Disorder is minor or non-acute. with its complement of skilled and competent medical staff and appropriate equipment and supplies.
III. brief medical evaluation of all incoming patients to determine the nature of the problem. this manual shall serve as an aid in the implementation of effective and efficient health care operations at the pediatric emergency room and shall guide the performance of duties and responsibilities of the emergency room staff. Among its particular capabilities are: Consultation and initiation of diagnostic work-up Cardio-pulmonary resuscitation Initial management of burns. As patient as well as visitor expectations for upgraded and efficient emergency services grow. Such conditions range from those requiring extensive immediate care to those that are diagnostic problems and may or may not require admission after work-up and observation.Requires medical attention within a few hours. injuries. In danger if not attended. Disorder is acute but not necessarily severe. The Pediatric Emergency Room.Requires immediate medical attention. aims to provide immediate and adequate appraisal and care to pediatric ambulatory patients as well as to the critically ill and the injured. drug administration and monitored stay prior to admission or transfer to another facility
93 Rev3Iss4 01-Apr-2010
OPM No. Disorder is acute and potentially threatens life or function. Delay is harmful to the patient. This definition continues until a determination has been made by a health care professional that the patient‟s life or well-being is not threatened.PEDIATRIC EMERGENCY ROOM
I. Emergency . requires immediate medical attention. 23 Department of Pediatrics
. The Pediatric Emergency Room housed inside the main ER complex.Prompt. and assignment for emergency attention. in the opinion of the patient.
Classification of Patients Presenting at the Emergency Department 1. 2.
Introduction The New Medical City Emergency Department is a 24-hour. Urgent .An emergency is any condition that. 7-day service department principally dedicated to the immediate and competent first contact care of patients whose conditions require prompt attention.A true emergency is any condition clinically determined to require immediate medical care.Does not require the resources of an emergency service. the identification of the kind of service needed. 3. Non-urgent . Emergent . Triage . treatment. True Emergency . the level of urgency.
Definition of Terms 1. renders immediate medical assessment and initiates treatment.
Services and Facilities 1. as the first point of contact with the medical system.
and initial treatment of burns shall always be immediately accessible to the pediatric ER staff. please refer to OPM No. These references are not to leave the premises and shall always be kept at a designated place. pediatric emergency room procedures. 23 Department of Pediatrics
. (For complete policies and procedures. 1 – Emergency Department)
OPM No. cardiac monitoring. pediatric decision-making. V. pediatric critical care. pediatric basic and advanced life support. acute management of poisoning.2. defibrillation and respiratory support emergency medications and supplies accommodations and amenities for the 24-hour staff internal and external communications in proper working order
Clinical Reference Materials Clinical reference materials relating to general pediatrics.
The facilities include: 4 main pediatric cubicles (4 beds with cubicle 1 as acute care bed) 1 hydration room with 3 beds 1 isolation rooms (total of 7 beds) 3 waiting rooms behind nurse station(total of 6 beds) 2 rooms for out patient consult 1 nebulization room with 2 chairs machines for suction.
Special Diagnostic& Treatment Services
Pediatric Emergency Room Coordinator
Nursing Supervisor/ Coordinator
Pediatric ER Committee on Training. Service and Administrative Concerns
Head Nurse Pediatric ER Residents Charge Nurse Pediatric Intern
Pediatric ER Staff Nurse
Pediatric ER Clerk
Pediatric ER Clerk
OPM No. Emergency Room
AVP. 23 Department of Pediatrics
General Staff Organization
Ensuring adequate skill and knowledge and the continuing medical education of staff physicians. supplies. 3. Chairman The ED Chairman has the overall responsibility for the professional activities conducted within the emergency department. General Staff Responsibilities A. MD Team Leader
Florianne Valdes. Facilitating pediatric emergency education for ED health care providers. The Pediatric ER Committee on Training. 2. MD
Training Easter Joy Dionio-Lim. MD Fatima Gimenez. policies and procedures. or general pediatrics. rotating residents and interns in emergency care and resuscitation of infants and children. Neva Luna Batayola. Service and Administrative Concerns is composed of pediatricians with special interest in emergency medical care and who are dedicated and committed to the training and supervision of rotating residents and interns to ensure the delivery of quality pediatric emergency care. Overseeing the development and periodic review of ED medications. MD Elizza Senseng. MD Felita Lucena. Overseeing ED pediatric quality improvement.Pediatric ER Committee 2005
Ma. equipment. performance improvement and clinical care protocols. They are either regular or visiting staff of the
OPM No. MD Adviser
Administration & Operations Deanna Lacson. The Physician Coordinator is responsible for: 1. The Physician Coordinator for Pediatric Emergency Services may either be a specialist in pediatric emergency medicine. pediatric intensive care. MD
VII. MD Arcelie Teano. 23 Department of Pediatrics
5. performance improvement and clinical care protocols with the Physician Coordinator. The schedule shall be posted at the pediatric ER. Reporting incidents and deviations from policies and procedures to the ED Chairman and the AVP for Special Diagnostic and Treatment Services. and end at 8 a. clinical experience. 23 Department of Pediatrics 97 Rev3Iss4 01-Apr-2010
. 2. The on-service ER consultant may be called upon by the pediatric ER-ROD for advice on problems that may arise in relation to patient care and ER management concerns. 2. d. She is responsible for: 1. The chief resident of pediatrics shall provide them a copy of the schedule on a monthly basis and shall remind them a week before they are decked to go on-service. they are encouraged to regularly update their certification in pediatric basic and advanced life support.
OPM No. As part of the ER committee. Deanna Lacson Dr. Scheduling.m. ER consultants go on-service on a weekly basis. Providing the ER Consultant/ROD with the necessary administrative support to ensure prompt and efficient patient care at the ED. Nursing Supervisor The Nursing Supervisor/Coordinator must have special interest. Identifying matters that require the attention or decision by higher authorities. like a. e. Lourdes Tanchanco
4. b. The day-to-day administration of the ED on the authority of the ED Chairman and the AVP for Special Diagnostic and Treatment Services. Florianne Valdes Dr. B. Elizza Senseng Dr. ER consultants conduct daily chart rounds with the rotating pediatric residents. c. The on-service consultant is responsible for conducting daily morning endorsement/teaching rounds with all the rotating pediatric ER residents and interns. Fatima Gimenez Dr. 3. Coordinating pediatric quality improvement.
DAILY CHART ROUNDS SCHEDULE Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Dr. Jocelyn Bondoc Dr. The committee shall periodically evaluate the rotating residents in terms of clinical competence and work attitude. All pediatric ER residents and interns are required to attend the endorsement rounds. Felita Lucena Dr. or focused continuing nursing education. disciplining and evaluating the ER nursing staff. organizing.m. 1. Josephine dela Pena Dr.Department of Pediatrics. Morning endorsements start at 7 a. Arcelie Teano Dr. Implementing nursing service policies as they apply to the ER nursing staff. knowledge and skill in emergency care and resuscitation of infants and children as demonstrated by training.
2. 4. of the next day when their relievers shall have reported for duty and after the morning endorsement rounds with the on-service ER consultant. 4. with the rotating intern in attendance whenever possible.m. d. 5. Reports minor and major problems in the ED. However. b. knowledge. Post-call ER Residents shall be given the day off after they have completed the daily logs and documentations and after the morning endorsement rounds with the ER consultants. Coordinates activities and recommends changes in schedules. in circumstances of high patient load at the ER. Competencies are evaluated on a regular basis. Monitors staff compliance to hospital rules and regulations (i. Pediatric ER Residents are 2nd year Residents who have the necessary skill. D. analyzes the source of the problem and makes recommendations to the Supervisor. 5. 23 Department of Pediatrics
OPM No. adherence to policies on patient care delivery). Facilitating ED nursing continuing education in pediatrics and providing orientation for new staff members. C. Assists the Nursing Supervisor in the day-to-day administration of the ED a. Rotating Pediatric ER Residents 1. 2. Monitoring pediatric equipment and medication availability and authorizing the request for purchase of supplies. Emergency Department Head Nurse 1. and training (including basic life support and pediatric advanced life support) to provide emergency evaluation and treatment of children of all ages. c. Otherwise. Assesses plans and organizes therapeutically effective. safe as well as cost-effective ER activities related to patient care delivery. the ER-ROD‟s admitting history should accompany the patient‟s record upon transport from the emergency room to the unit.. Take a concise and accurate clinical history and perform a complete physical examination on all pediatric patients consulting at the ED. 3. uniform code. attendance. they shall go to their designated areas of assignment in the pediatric floors. Performs inventories of all equipment and supplies. Pre-duty ER residents shall be called as backup in situations of heavy patient flow at the pediatric ER. For admitted patients. Their tour starts from 7 a. until 7 a. Two Second Year Residents go on 24-hr duty every 3 days. Assisting in the development and periodic review of policies and procedures for pediatric care. clinical histories may be completed within 4 hours for critically ill patients and within 12 hours for those who are not critically ill. Residents go on monthly rotation at the Pediatric Emergency Room and are under the direct supervision of the Pediatric ER Committee and the Pediatric Consultant staff.m.e. repair or replacement of equipment.3. Functions: The Pediatric ER-ROD shall Promptly (in less than 15 minutes) attend to all pediatric cases with due regard to logical and reasonable prioritization of activities and resources.
and monitor compliance with existing policies and standards. Under no circumstance shall patients be initially assessed and treated by an intern. Refer any case that in his/her judgment requires referral to other specialties. 23 Department of Pediatrics 99 Rev3Iss4 01-Apr-2010
. Takes and records weight. Pediatric patients for surgical clearance should be seen and examined at the pediatric ER by the surgical resident-on-duty and the Emergency Medicine Consultant. post-call.
No orders shall be made by the rotating intern. Transcribes doctor‟s orders b. knowledge. oversee their performance. All psychiatry cases are referred to the psychiatry resident after initial assessment of disposition and management. Promptly inform the attending physicians of admissions to their service and inform them if any of their patients has been seen at the ER for outpatient consultation. treatments and procedures ant changes in the patient f. Responsibilities 1. E. Assists in physical examination. Properly endorse patients for admission to the pediatric units to the receiving floor residenton-duty.
OPM No. Complete the daily ER census prior to post-call status. He/she shall make a formal report on an intern‟s performance and shall submit said report to the intern‟s monitor. make evaluations. anthropometric measurements. sudden deviations and significant e. All orders made shall be properly recorded. Completes forms to carry out doctor‟s orders for diagnostic procedures c. Referrals should be made directly to the specialty resident and never to the intern. obtain personal data and history c. pre-duty) The Pediatric ER-ROD shall directly supervise the rotating interns. Interviews patients. Critically ill patients should be endorsed directly to the senior of the service during office hours or to the senior resident-on-duty after office hours. Related to Patient Care a. Emergency Department Staff Nurses Nurses manning the pediatric ER must have the necessary skill. Acts as triage nurse ( with the necessary competence and qualifications) b. Related to Administrative Support a. Receives patient‟s valuables for safekeeping. All gynecologic referrals should be seen and initially assessed by the OB-ROD at the Pediatric Emergency Room.
Make a diagnosis or a clinical impression and decide on the management and disposition (send home/admit/observe at short stay area) of all pediatric patients. and training (including basic life support and pediatric advanced life support) to provide nursing care to children of all ages. vital signs d. Such referrals can either be to another member of the house staff or to a member of the consultant staff. Immediately/promptly reports abnormal conditions. The ER-ROD is authorized to assign duties and tasks to interns. Attend morning endorsement/teaching rounds with the ER consultant-on-deck whatever his/her duty status may be (on-duty. reviewed and signed. recommend disciplinary measures. Accompanies patients to diagnostic/treatment procedures g. Brings the patient to the unit and make the necessary endorsement to the receiving nurse 2.
Maintains ED records c. Assists in handling patient‟s complaints or inquiries g.3. ECG taking c. management and disposition of patients 2. the ER clerk has the following activities: 1. 3. the next day when their relievers shall have reported for duty.m.e. Blood extraction d. Pediatric Emergency Room Clerk Function: The pediatric ER clerk performs clerical functions necessary in an emergency room service. Apart from the activities assigned by the ER-ROD. Assists in periodic inventories of supplies. Performs patient care functions after initial assessment by the resident. instruments and equipment e. The tour-of-duty starts at 7 a. nasogastric tubes and foley catheters e. Assists in orienting new nurses. d. Pediatric ER interns go on 24-hr duty every 3 days on a monthly rotational basis. Related to General Support a. The Pediatric ER Interns Two (2) pediatric interns go on 24-hr duty at the pediatric ER. orderlies. Accomplishes charge slips when the ED clerk is not available b. Gastric lavage and catheter flushing f. a. In case of heavy patient flow at the pediatric ER. All interns assigned to the ED shall sign in and sign out in the attendance logbook. Assists the pediatric ER-ROD in the diagnosis. clerks and visitors f. the pre-duty pediatric ER interns shall be called to assist in patient care. and ends at 7 a. Reports undue incidents and problems h. Interns on duty do not leave the area at any time. 23 Department of Pediatrics 100 Rev3Iss4 01-Apr-2010
. etc.m. interns and staff nurses. The interns‟ monitor in coordination with the ER Surgery ROD will regularly check the logbook. Assists in preparing supplies such as cotton balls. History taking b. Functions: The pediatric ER intern shall 1. Monitoring of critically ill patients g. Insertion of intravenous lines. Acts as receptionist-secretary-clerk of the pediatric ER
OPM No. Attends the daily morning endorsements / chart rounds with the on-service consultant and the rotating ER residents G. Any other related activity on orders of the resident-on-duty Patient care functions are done under the direct supervision and express approval of the pediatric resident-on-duty. Assists in complying with existing policies and procedures F. i.
personnel policies and evaluation procedures. Pediatric ER residents and interns shall be oriented by the pediatric ER coordinator. tables and wheelchairs 2. Checks regularly the functional integrity of the ER equipment An orientation program is provided for new employees. 6. 5. Refills oxygen tanks and cylinders 8. Assists in physically supporting and carrying non-ambulatory patients to and from beds. Prepares deceased patients and transports them to the morgue 6. and other work areas of the ER 9. physically strenuous work and other activities requiring strength and speed. interns and staff nurses. policies and procedures. He assists in carrying out mechanical tasks. 23 Department of Pediatrics
. 3. stretchers. Changes. job orders. Apart from assignments and instructions issued by the ER-ROD. cabinets.
Takes custody and maintains ER records Prepares charges according to approved rates Maintains supply of forms and office supplies Communicates with consultants. and borrowing for proper disposition Prepares reports. Cleans and packs instruments for sterilization at the central supply room 7. Assists in all other staff activities H. the orderly performs the following activities: 1. rotating residents and interns and shall include an introduction to the overall physical setting of the pediatric emergency room as well as the whole ER complex. communications. Cleans and arranges equipment. collects and returns soiled linen 5. schedules and other written documents pertaining to ER activities 8. it‟s departmental plan and organization. Pediatric Emergency Room Orderly Function: The orderly assigned in the pediatric ER assists in providing nursing and general support in patient care for emergency patients. 7.2. stock room. 4. residents and other hospital units regarding ER activities Keeps track of purchase requisitions.
OPM No. an overview of the goals and standards of the hospital. Runs errands such as obtaining supplies from the pharmacy and other units 4. Assists nurses in all their activities 3.
No denims or flowered pants are allowed.
OPM No. No Absence: The full complement of ER staff should be fulfilled 24 hours a day.GENERAL POLICIES ON THE CONDUCT OF ER PERSONNEL 1. Professional Handling of Comments and Inquiries: All personnel should deal with comments and inquiries by patients and relatives in a professional manner. Proper Attire: All personnel should report for duty in proper attire with the identification badge properly displayed. 2. 6. 7 days a week. On Time Reporting For Duty: All personnel assigned to the pediatric ER shall report on their scheduled time of duty. No Check Out Until Relieved: At no time should personnel check out of duty until the reliever has checked in and endorsements have been made. 23 Department of Pediatrics
. Female Doctors Semi-formal outfit with the prescribed white coat bearing the hospital logo. Male Doctors Shirt and tie with appropriate colored pants and prescribed white coat with the hospital‟s logo. 3. 4. Waiving of ER Charges: No personnel can waive charges incurred by patients. Nurses Prescribed white uniforms
23 Department of Pediatrics 103 Rev3Iss4 01-Apr-2010
.PATIENT FLOW AT THE EMERGENCY DEPARTMENT Entrance of:
ER clerk for patient data and medical information
Pedia-ER Nurse Pedia-ER Nurse (Vital signs) ER Resident ER Resident/Intern
Resident for discharge Instructions
Resident for interpretation of results
With accredited Pediatrician
Walk-in (No AP or AP not accredited)
Need not be admitted
Needs admission Admitted under accredited Pediatrician Decked to walkin consultant Decked to coordinator
Back to clerk for billing
Ward clerk for admitting slip
To admitting section room assignment
Initial/Emergency medical treatment is instituted based on the patient‟s clinical condition and the resident‟s assessment. is a walk-in patient or an HMO patient.1. 6. If a patient is classified as non-urgent. the parent or the guardian fills up the medical information sheet under the guidance of the ER clerk. 7. the clerk encodes the data in the computer. If a patient is classified to be urgent or emergent. After all pertinent information is provided. 3. The nurse then endorses the chart to the ER clerk who provides an admitting slip to the parent or guardian. A signed consent for admission and diagnostic procedures (when indicated) is obtained from the parent or guardian. He then informs the parent or guardian of the need for admission then notifies the attending pediatrician. Upon entry of the patient to the ER. Meanwhile. The nurse carries out the admitting orders. the security personnel directs him to the triage area where he is classified by the triage nurse as non-emergent. The resident then facilitates admission after he writes down the admitting orders in the patient‟s chart. 2. The ER clerk determines if the patient has an accredited attending pediatrician. 23 Department of Pediatrics
. She instructs the parent or guardian to proceed to the admitting section for arrangements and room assignment. The vital signs are noted down in the ER sheet. The ER nurse calls the ER resident who performs a brief medical history and a thorough physical examination. he shall follow the pathway presented below:
OPM No. 5. 4. The patient is ready for transport to the pediatric unit after all orders for initial treatment and diagnostic examinations are carried out. urgent or emergent after his vital signs are taken. he is immediately wheeled in to the pediatric emergency room. brought to a bed and endorsed to the ER nurse.
Directed to billing section for settlement of bills Admit HOME Discharge
105 Rev3Iss4 01-Apr-2010
Resident explains lab result to parents. Clerks lets parent fill-up data sheet
Patient is directed to a cubicle at the pedia ER and waits to be attended to
Intern gets patient‟s chart Takes an initial history and Physical exam
Intern refers to Resident Resident takes history and P. charges or billing prepared (5min)
Patient waits for results (1-1.
Endorsed to nurse (5min)
Chart endorsed to clerk. pt is given a specimen cup for collection. Nurse submit specimen to lab once available.E
Lab tests needed
No lab test needed Patient for discharge
Resident orders lab tests in the chart (3rd sheet of the data sheet & endorses to nurse)(5 min max)
Resident fills up discharge instruction Writes prescription for home meds (5mins)
Nurse carries out order while clerk makes the charges for the test (5mins)
Explains home instructions and meds to parents (5min)
Phlebotomist arrives 5-10 min to get blood sample (if stool/urine sample are needed. 23 Department of Pediatrics
Triage area Security personnel directs patient
Triage nurse Takes chief complaint and vital signs.FLOW OF ER CONSULTATION (Non-Urgent. determines final disposition (10min)
ADMISSION GUIDELINES AT EMERGENCY DEPARTMENT
A. Determination of the Need for Admission 1. In the course of providing emergency care, the ER-ROD shall determine whether or not there is a medical need to admit the patient. 2. Patients refusing admission and who have been properly advised by the attending resident shall be made to sign a waiver. The attending pediatrician shall be personally notified by the resident. 3. All patients requesting admission, regardless of medical need, shall be admitted. The admitting resident shall then indicate that the patient was admitted “per request”. B. Attending Physician of Admissions 1. The patient‟s doctor is a member of the regular staff – The patient shall be admitted under the service of the regular consultant regardless of the nature of the case while proper communication is made by the admitting resident as soon as possible. The consultant will be responsible for proper interdepartmental or intradepartmental referrals. 2. The patient‟s doctor is a member of the visiting staff – The patient shall be admitted under the service of the consultant and proper communication is made as soon as possible. The visiting consultant will be responsible for proper interdepartmental or intradepartmental referrals. 3. The patient‟s doctor is not an accredited physician of the hospital – The parent or guardian shall be informed that the physician is not an accredited staff. If the parent or guardian consents, arrangements shall be made and the patient shall be considered as a walk-in patient. C. Classification of Patients 1. The patient is a walk-in patient. A walk-in patient is a patient coming to the hospital with no attending physician or whose attending physician is not an accredited member of the regular or visiting staff. The walk-in patient shall be admitted under the service of the regular consultant on deck for the day. If the consultant on deck is not available, the consultant on deck for the following day shall be designated as the attending physician. The schedule of walk-in consultants is posted at the pediatric emergency room. Whenever a patient is referred to a consultant other than the one scheduled, a notice of deviation on the prescribed form shall be sent to the consultant on deck and to the Auditing Department. 2. The patient is a member of a health maintenance organization duly accredited at The Medical City.
OPM No. 23 Department of Pediatrics
An HMO cardholder shall be admitted under the service of the HMO coordinator. The coordinator shall be responsible for interdepartmental or intradepartmental referrals. The pediatric ER ward clerk checks the validity and expiration date of the HMO ID card at all times. A Letter of Authorization is required. 3. The patient is a referral from an outside physician, a private or public agency/hospital. The preceding guidelines on assignment of attending physicians shall apply. Letters of referral from outside physicians and institutions shall be attached to the patient‟s medical record.
(For detailed procedures on handling patient admission at Emergency Department, please refer to Appendix H - OPC No. 27 – Handling of Patient Admission at Emergency Department and OPM No. 34 – Admission and Allied Services Department)
OPM No. 23 Department of Pediatrics
GENERAL GUIDELINES ON HANDLING OF EMERGENCY DEPARTMENT PEDIATRIC PATIENTS I. Policy Guidelines A. Patients under Observation 1. Patients whose initial medical assessment calls for a short period of direct observation to allow frequent reassessment by the ER resident-on-duty in terms of response to treatment shall be accommodated in the short stay or holding area. 2. Whenever possible, the ER resident shall inform the attending pediatrician that his patient is at the short stay area for observation and shall relay results of diagnostic tests and subsequent assessments to determine whether or not the patient should be admitted, referred or discharged. If the patient has no accredited attending pediatrician, all matters that concern treatment and continued care shall be brought to the attention of the walk-in consultant for the day. 3. Patients who are discharged after observation are provided a home instructions sheet. 4. Patients who are subsequently admitted are endorsed by the ER resident to the service resident-in-charge (during office hours) or to the resident-on-duty (after office hours).The attending pediatrician is informed of the admission. B. The Pediatric Trauma Patient 1. All trauma or multiply injured pediatric patients shall be seen, assessed and treated directly by the trauma service. 2. They shall be admitted under the surgery service who shall determine if a referral to the pediatric service is necessary. C. Patients Referred for Clearance Prior to Any Surgical or Diagnostic Procedure 1. Walk-in patients shall be formally referred to the regular consultant on-deck for the day. 2. Charity patients or patients for admission under the Divine Mercy program shall likewise be cleared by the regular consultant on-deck for the day. 3. Existing policies apply for patients with accredited pediatricians or patients who are members of accredited health maintenance organizations. D. Direct Admissions (Patients with Admitting Orders from their Attending Pediatricians ) 1. Patients with direct orders for admission from their attending pediatricians who pass through the pediatric emergency room shall be seen initially and assessed by the pediatric ER-ROD before endorsement to the receiving service resident or the floor resident-on-duty. 2. If the patient does not need emergent treatment, he shall be directed to the admitting section for arrangements on admission and shall be transported to the unit where he shall then be received by the corresponding service. The receiving service resident or on-duty floor resident shall be responsible for informing the attending physician of the admission and carrying out all orders made.
OPM No. 23 Department of Pediatrics 108 Rev3Iss4 01-Apr-2010
3. However, should the patient‟s condition require immediate attention and management, he shall become the responsibility of the ER-ROD and shall be admitted from the emergency room where all orders shall be carried out prior to transport to the unit. It will be the responsibility of the ER-ROD to inform and update the attending pediatrician. E. Non-Emergent Patients not For Admission 1. All patients not requiring admission or not needing laboratory work-up shall be sent home within the hour after having been seen and assessed by the ER-ROD. 2. The patient‟s out-patient record must be complete and factual and a complete physical examination shall be made by the ER-ROD. 3. If laboratory tests were requested, results shall be obtained at the soonest possible time for appropriate disposition. 4. Upon discharge from the emergency room, the patient/parent/guardian should be given explicit instructions on follow-up care. The patient/parent/guardian should provide assurance that these are clearly understood. Oral instructions should be confirmed in writing. A copy of the written instructions, signed by the patient/parent/guardian to indicate receipt, co-signed by the attending resident, preferably witnessed by the attending nurse, shall be included in the patient‟s out-patient record. 5. If the patient leaves the pediatric emergency room against medical advice the patient/parent/guardian shall sign a waiver to release the hospital and the attending doctor from all responsibility. If he/she refuses to sign the waiver, the facts shall be entered in the record and witnessed if possible. 6. The pediatric ER-ROD shall inform the attending pediatricians if any of their patients were seen in the emergency room as outpatients. F. Conduct of Emergency Room Procedures 1. All diagnostic, clinical and treatment procedures in the emergency room shall be accompanied, whenever applicable, by a written consent from the patient/parent/guardian. The consent shall be attested to by a witness. 2. If a patient/parent/guardian refuses to give consent for a procedure or treatment after adequate explanation by the attending resident of the consequences, he/she shall sign a waiver. If he/she refuses to sign the waiver, the facts should be entered in the patient‟s record and attested to by a witness. G. Do Not Resuscitate Orders in the Emergency Room 1. For the critically ill, the standard of care in any institution is to perform cardiopulmonary resuscitation (CPR). The two general situations that justify withholding CPR are: a. When CPR is judged to be of no medical benefit b. When the patient with intact decision making capacity or someone designated to make decisions for him/her when he/she lacks such capacity clearly indicates he/she does not want CPR 2. The DNR order can be entered for a child with the consent of the child‟s parent or guardian. If the child is old enough to understand or decide about CPR, the child‟s consent shall also be required for a DNR order.
OPM No. 23 Department of Pediatrics
who in this instance is the ER resident-on-duty. If a standard hospital DNR form is available. 23 Department of Pediatrics
OPM No. The DNR order shall be removed at anytime upon the request of the parent or guardian or the patient. 4. co-signed by the attending resident and attested to by a witness. The ER-ROD must inform the attending pediatrician or the walk-in consultant (for patients without attending physicians) if such a situation arises. The DNR order shall be written or co-signed by the attending ER physician.3. this shall be properly filled up and signed by the parent or guardian. 5.
Poisoning IC Bleed or increased ICP Mental status changes. Inability to provide safe environment 4. Suicidal Patient. coordinate with the National Poison Control Center (trunkline 521-84-50)
OPM No. Severe physical abuse 5. etc. Fractures. Acute Vaginal or Rectal bleeding 3. Acute Abdomen. Social emergencies (from the province. History of inappropriate sexual contact within 72 hrs.
CPU CONSULTANT ON-CALL STABILIZE REFER TO APPROPRIATE SPECIALTY
Emergency Assessment by CPU (Child Protection Unit) Consultant for the following: 1.FLOW ON HANDLING OF SUSPECTED CHILD ABUSE/CHILD NEGLECT PATIENTS
SUSPECTED CHILD ABUSE/NEGLECT PATIENT PER/OPD
INITIAL ASSESSMENT BY TRIAGE
2. police emergencies)
* For poisoning cases. 23 Department of Pediatrics 111 Rev3Iss4 01-Apr-2010
ER/TR Patient Logbook – this logbook shall contain the following information: Patient‟s name Date when seen Patient‟s record number HMO/Company ID numbers Diagnosis Medicine/Treatment given Charge Slip Number 3. 2. ER/Treatment Room Record – All cases seen at the pediatric ER-TR shall be documented in specific pre-numbered.HANDLING PEDIATRIC EMERGERGENCY ROOM RECORDS I. Policy Guidelines 1. 4. The ER-TR shall keep patient logbooks for the current and past year only. Custody of Records – The ER-TR shall keep patient records on a weekly basis only.
OPM No. Any request by surgeons or patients for copies of these records shall be coursed through the Medical Records Section. The duplicate copy and the patient‟s chart shall be kept in the ER for billing and filing purposes. Filing – All ER-TR patient records shall be filed in numerical sequence. Folders containing older records shall be sent to MID for custody and storage. Daily records shall be put in one folder. The original copy shall be forwarded to the Medical Information Department (MID). loose-leaf forms containing personal and medical information related to the care of the emergency room patient. 23 Department of Pediatrics
. The rest of the logbooks shall be forwarded to MID for custody. 5. Record of Operative Procedures in the ER-OR – this form shall be accomplished in duplicate by the surgical consultant.
Introduction The outpatient department of the Department of Pediatrics will serve as the comprehensive Ambulatory Care Section of the department. In March 2005. weekly conferences and audits. with the set up of our own OPD clinic within the ER complex. which includes the residents and interns. Aligned with the Vision of The Medical City. which is a Phase III. The Pediatric residents manned this clinic.PEDIATRIC OUTPATIENT CLINICS AND CHILD HEALTH SERVICES I. It offers complete health supervision service in an outpatient clinic setting. In preparation for this bid. particularly. This will help fulfill the requirements set by the Philippine Pediatric Society. Last March 2005. the Department of Pediatrics was finally awarded the Phase III status. 23 Department of Pediatrics
OPM No. innovations and changes were instituted in our department. the new out patient clinic of the department was opened. TMC was then further elevated to a higher level of accreditation. (PPS-HAB) to be a training hospital. this includes residents and interns in health supervision of children in the ambulatory setting. However they recommended the following improvement in our training program. From the basic Phase I. preventive pediatrics and family and patient education. The objectives of the opening of the service are: 1. (2) strong support from the central administration focused in fulfilling the department‟s short and long-term goals. The patients who availed of the services at that time were dependents of TMC employees and their relatives. Training in health supervision includes diagnostic and therapeutic management of common out patient diseases. One of these was the intensified and enhanced OPD/ER services initiated in 1999. In 2004. the Department of Pediatrics aimed for the highest accreditation of the PPS Hospital Accreditation Board. 2. Phase II a and b. and (2) increase in-hospital OPD census. II. This was in 1986. (1) increase the number of Divine Mercy patients which is being addressed with more vigor by the Central Administration and the department. (3) research and faculty development. Together with the fact that pediatric practice would involve 70-80% out patient cases. This section will also function as the teaching venue for the house staff. Inc. The strengths of the department were as follows: (1) infrastructure and facilities offered by the hospital were of high quality and of international standards. for Phase III accreditation of the Residency Training program of the hospital. This section will also function as an educational and training arm of the house staff in the form of hands on supervision by consultants. The patients were relative and dependents of TMC employees and the patients from the “recruit” program of the Department of Obstetrics and Gynecology. anticipatory guidance which includes health promotion. Inc. the PPS-HAB revisited The Medical City in its new home to reaffirm our position as a Phase III hospital. the department realized the need to intensify and improve the trainee‟s exposure in out patient care. To serve as the in-house comprehensive ambulatory care of the department in fulfillment of the PPS –HAB requirement. This service then fulfilled the minimum requirements set by the Hospital accreditation board of the Philippine Pediatric Society. Rationale The Department of Pediatrics of the Medical City has been operating an Out Patient Service section since 1974. To provide training and exposure to our house staff.
23 Department of Pediatrics
. Qualifications: Must be an accredited medical staff of The Medical City Must be a diplomate or fellow of the Philippine Pediatric Society D. Subspecialty consultants supervise the clinics in the following specialties: Pulmonology Cardiology Neurology 3. both active and visiting. Social Worker 1. function to provide direct supervision and training of residents and rotating interns 2. Residents 1. Organization A. Interns 1. Qualifications: Must be an accredited intern of The Medical City C. General pediatricians. First year resident 2. Nurse 1. Qualifications: Must be a registered nurse with a BSN degree Must be an accredited nursing staff of The Medical City
OPM No. Assigned interns to the department 2. Qualifications: Must be an accredited social worker of The Medical City Must have a degree in BS Social Work E.III. Qualifications: Must be a duly licensed physician Must be an accredited Pediatric resident of the Department B. Consultants 1. Second/Third year resident 3.
Minimum requirements to be eligible for the issuance of a White Card: Voter‟s identification number Barangay Certificate of residency in Pasig City or in the other involved municipalities for at least 6 months Combined salary of all family members residing with the pediatric patient of not more than Five Thousand Pesos (PHP 5.00) per month Accomplishment of screening form
OPM No. Target Patients 1. The Department of Pediatrics of The Medical City will accept indigent pediatric patients from the municipality of Pasig who have passed the minimum requirements for eligibility for issuance of a DSWD –White Card. a. Patients from the Divine Mercy Program approved by the hospital. 23 Department of Pediatrics
. This would include patients for follow-up after admission from the Divine Mercy ward and patients for clearance prior to any operation under the Divine Mercy Program. Patients referred by the Barangay Ugong Health Center. Well babies from the recruit program of the Department of Obstetrics and Gynecology who may avail of free consultation and OPD immunization program. 3. Elizabeth Palmero-Reyes and the Department of Social Welfare and Development head of Pasig. Francisca Delleva. 2. All patients aged 0-18 years old and 364 days can be seen in the pediatric outpatient department. and another representative from the City of Pasig. Qualified indigent pediatric patients referred by the Department of Social Welfare and Development (DSWD) of Pasig City.
A memorandum of agreement will be signed by both The Medical City through the Department of Pediatrics represented by Dr.ORGANIZATIONAL CHART Department Chair
5. Ambulatory Services
OPD Committee Head
OPD Committee Co-Head
OPD Committee Members IV. Mrs.
Immunization. The following documents must be completed by the OPD Resident: Patients‟ Chart (General Data. Others 1. DPT. The number of patients to be accepted per day will be limited to those that can be accommodated in the OPD-Pediatric Clinic and only during the clinic hours provided. Location The Outpatient Department clinic of the Department of Pediatrics is located at the Lower Ground of the Podium of The Medical City. Cardiology and Neurology) Pulmonology: Monday and Friday AM Cardiology: Wednesday and Thursday PM Neurology: Thursday AM The OPD will be closed every Saturday. OPV. 4. Mechanics A. General Pediatric Clinic: Monday to Friday: 9:00 AM to 12:00 NN Monday. The DSWD of Pasig City has the responsibility to strictly screen. 2. D. Vaccines under EPI are free as long as they are available (BCG. check and verify the indigent status of the patients referred to the OPD. V. No consultation fee will be charged. Physical Examination. Subspecialty Clinic (Pulmonology. 3. Hepatitis B. Vaccines not under the EPI may still be given as long as they are available and will be at the expense of the patient. Fees 1. Immunization Day: Wednesday. 2. B. Sunday. Clinic Hours 1.Only children of holders of the DSWD White Card can avail of the OPD program coupled with a referral letter signed by their city hospital officers addressed to the section head of the Section of Ambulatory Pediatrics. C. Legal and Special Holidays. Diagnosis and Management) Growth Charts / Nutrition Charts / Immunization Charts
OPM No. 9:00 AM to 12:00 NN 3. Wednesday and Thursday 2:00 PM to 4:00 PM 2. Past Medical History. History. Measles). 23 Department of Pediatrics 116 Rev3Iss4 01-Apr-2010
. All patients will be evaluated and managed by the resident under the supervision of the consultant on deck. Necessary laboratory work up may be done at The Medical City at the expense of the patient or any government hospital. Developmental Milestones.
those for follow up from the Divine Mercy Program and well babies from the recruitment program of the Department of Obstetrics an patients referred by the Barangay Ugong Health Center shall be seen at the TMC OPD clinic. Pediatrics consult Refer to Pedia subspecialti es
Well baby check up
Refer to other subspecial ties The Outpatient Department of The Medical City Department of Pediatrics is composed of the following:
1. Workflow for Consultation at the Pedia OPD
Patient comes in for OPD result Social worker
screens patient for eligibility Nurse triages patient Patient is assessed by the physician (resident or consultant)
Sick baby Gen.
OPM No. 4. priority will be given to children whose illness necessitates immediate attention. However. 23 Department of Pediatrics
. General Pediatrics Clinic 2. All patients will be seen on a first come first serve basis. Only eligible patients with White Cards and referral letters issued by partner municipalities. Subspecialty Clinics Cardiology Neurology Pulmonology The objectives and policies for each of the clinics will be discussed in the succeeding sections. Logbooks 3.
Patients are then referred to the intern and/or resident for initial assessment. Past Medical History f. Management 5. Wednesday Thursday: 2:00 PM to 4:00 PM 2. Diagnosis h. health education and nutrition) To provide training opportunities for residents in the care of acute and chronically-ill patients in the outpatient setting To provide the post-graduate interns the necessary exposure to common pediatric illnesses in the outpatient setting To be a venue for educating patient/ parents on primary health care To serve as screening area for patients needing referrals to pediatric subspecialty clinics or other appropriate specialty clinic/s To provide continuity of care to discharged patients from the Divine Mercy Program To deliver free health services to qualified indigent pediatric patients from selected municipalities and from Barangay Ugong Health Center and to babies from the Recruit Program of the Department of Obstetrics
II. The elements of the outpatient assessment are as follows (please refer to Attachment C): a. 3. Developmental Milestones e. Priority is given to patients who manifest with grave illness and who are weak. All pediatric patients who consult at the OPD are assessed first by the social worker or nurse. if they are eligible to avail of the OPD Program. The resident and/or intern should
OPM No. 1 intern and 1 social worker or nurse. General Policies 1. an assigned intern.SPECIFIC CLINIC GUIDELINES GENERAL PEDIATRICS CLINIC (GPC) I. A General Pediatrician is also available to provide direct supervision of the residents and interns. History c. 23 Department of Pediatrics
. 4. Immunization d.
Policy Guidelines A. Well babies from the recruit program of the Department of Obstetrics Patients referred by the Barangay Ugong Health Center Patients from the Divine Mercy Program Children of holders of the DSWD White Card with a referral letter from their Municipal Health Officer. or if unavailable. Physical Examination g. General Data b. febrile and restless. Objectives To acquire thorough knowledge and skills in the care of infants and children (immunization. Consultation Hours: Monday to Friday: 9:00 AM to 12:00 NN Monday. The OPD-General Pediatrics Clinic is manned during clinic hours by 2 residents (1 first year and 1 second or third year resident).
Patients may avail of free immunization (EPI vaccines: DPT. All cases should be seen and examined by the Pediatric Resident rotating at the General Pediatric Clinic following all the requirements set by the subspecialty clinic/s b. Obstetrics and Gynecology. shall be rescheduled depending on the clinical status of the patient. Resident to resident endorsement should be done on all referrals d. Patients who are suspected Child Abuse cases are immediately referred to the senior resident and consultant-on-deck accompanied by an intern. c. Unscheduled patients coming to the GPC shall either be seen last or. in case there are already too many patients. Patients for referral/transfer to other hospitals should be given clinical abstracts duly noted and signed by the GPC resident.
e. 3. Hepatitis B. Intervals in the follow-ups are up to discretion of the GPC resident.
Write a comprehensive pediatric/neonatal history. C. Patients may then be referred to government hospitals such as Pasig City General Hospital for admission or to TMC Divine Mercy if patient meets all requirements for admission. All patients should be seen by the resident and assigned consultant before discharge. expenses incurred for these laboratory examinations will be shouldered by the patient. Work-Ups 1. Referrals to subspecialty Pediatric clinics or other specialties like Surgery. To other Non-Pediatric OPD Clinics (Surgery.
b. Measles) on scheduled days and subject to availability of vaccines. This will provide comprehensive and immediate care for the patient without the trauma of repeated interviews. To other Pediatric Subspecialty Clinic a. Patients for pre-surgical evaluation are seen by the Senior Pediatric resident then referred to the consultant of the day. All cases should be properly endorsed to the hospital or private physician. 23 Department of Pediatrics 119 Rev3Iss4 01-Apr-2010
. perform a complete physical examination. To other hospitals/private physicians a. 2. No laboratory work-up is required prior to referral to the General Pediatric Clinic. All referrals should be seen and examined by the Pediatric Resident rotating at the General Pediatric Clinic. The referral is made by the pediatric resident to the resident of the different departments. b. Patients requiring admission should be referred to the senior resident. All laboratory examinations required by the Specialty Clinic should be done prior to their appointment with the subspecialty clinic c.
B. give an impression and outline the management for the patient. D. Residents may request for laboratory work-up if necessary. The reason for referral/transfer should be indicated. however. b. Schedule of Follow-Ups 1. d. unless the patient is for pediatric clearance prior to surgery. 2. Otolaryngology and Ophthalmology are done if deemed necessary. Ophthalmology and ENT) a. OPV.a. Referrals 1.
OPM No. Difficult or problematic cases should be referred to the consultant on deck at the subspecialty clinic 2.
The audit is held every 1st Friday of the month at 9:00 to 10:00 AM g. Attends to Pediatric Clearances of patients for surgery referred to the GPC on an outpatient basis e. the consultant should be informed by the senior resident d. Each resident has an assigned clinic hour at the OPD during the week that serve as their continuity clinic. 23 Department of Pediatrics 120 Rev3Iss4 01-Apr-2010
. Supervises the work of the post-graduate interns f. Evaluates all patients for referral to other clinics and countersigns the charts of these patients prior to the referral h. Ensures that all charts are complete i. Obtains a complete history and does a thorough physical examination of each patient at the OPD Clinic c. Should be at the GPC at 8:30 AM c. Assists the senior residents in checking and countersigning the charts of the patients seen by the interns e. Second/Third Year Residents At least one 2nd or 3rd year Pediatric Resident is assigned at the General Pediatric Clinic as scheduled by the Chief resident. Holds teaching rounds with the post-graduate interns g. Consultants a. Conduct teaching rounds for the rotating residents and interns e. Should there be any problems encountered at the GPC for the day. Refers all patients to OPD consultant for the day 3. Patients may follow-up with the resident during their specified clinic schedule. Guides and helps the first year residents f. The admitting conferences are held every Friday at 9:00 to 10:00 AM. First Year Residents At least one 1st year Pediatric Resident is assigned at the GPC as scheduled by the Chief resident. Duration of rotation is one month b. There is an assigned Consultant-of-the-day at the GPC from the pool of Pediatric Consultants. (see page 132) b. The following are their expected duties and responsibilities: a. Duration of rotation is one month b. Oversees the day to day running of the OPD Clinic d. Makes a complete assessment and formulate a diagnostic and therapeutic plan d. Checks that all charts bear their printed name and signature
OPM No. Evaluate the performance of the residents and interns using standard evaluation tools 2. Responsibilities of the Staff 1. All patients should be referred to them for proper assessment and disposition c. E. whether clinical or administrative. Accomplishes requests for laboratory examinations and gives appropriate instructions to the parents/guardians/patients g.3. Conduct weekly admitting conferences and monthly audits with the residents and interns f. The following are their expected duties and responsibilities: a.
Prepares medications and other materials for procedures 6. Endorses the patient to the intern for initial assessment h. for admission) F. Assists patients to be referred out (ex. give a logical assessment and make an appropriate management plan for the patient b. Prepares the patient‟s database and other forms that needs to be filled up by the intern and resident g. Post-Graduate Interns a. other hospitals. Nurses a. Serves as the triage officer f. Ambu-bag (2 sizes) – pediatric & neonatal Laryngoscope Endotracheal tubes Suction Machines
OPM No. Confirms eligibility of the patient based on the OPD requirements d. physician‟s license number and/or S2 number for prohibited drugs. Emergency equipment and drugs. Refers all cases seen to the resident c. for emergency situations like an anaphylactic reaction or neurogenic shock. Assesses eligibility of patients b. Should be at the GPC by 8:00 AM b.h. Gets anthropometrics and vital signs of patients e. in accordance with the Generics Law 4. Equipment and Physical Plant Requirements 1. Attends the required scheduled activities of the section 5. Makes sure that all equipments and materials needed at the clinic are in good working condition c. for laboratories. perform thorough physical and neurologic examination. Social Worker a. Charts new cases and is expected to write a complete history. Standard Equipment Weighing scale Lengthometer Thermometer Measuring tape BP apparatus with cuffs of different sizes Diagnostic set Negatoscope Equipment rolling tray Growth charts Nutrition charts Immunization charts Logbooks Reference books 2. Checks that all prescriptions have the printed name. signature. 23 Department of Pediatrics 121 Rev3Iss4 01-Apr-2010
11. 7.V. 16. syringes). 14.
Oxygen tank / O2 mask & tubings/O2 catheters I. 13. Alma Bie Dr. Gee Serafica-Diaz Dr. Cristina Bernardo Dr. Marthony Basco Dr. Elizza Senseng Dr. Anna Crucillo Dr. Epinephrine. Anne Orendain Dr. Jocelyn Echiverri Dr. Hydrocortisone. 3. etc (Such specific emergency equipment and/or drugs should be kept in readiness at the GPC)
G. 15. Fatima Gimenez Dr. 23 Department of Pediatrics
. NaHC03. 10. Josephine Dimayuga-Dela Pena Dr. 12. Josephine Bondoc Dr. 5. 6. Rotating General Pediatric Consultants 1. Sally King Dr. Dr. fluids Venosets and butterflies Emergency drugs (Extra batteries & laryngoscope. 2. 4. Xeres Luz Dr. 8. Heidi Villanueva
OPM No. Edna Morada Dr. Rosario Isada Dr. 9.
Admission Criteria 1. C. diagnosis. Service To deliver holistic care to children with cardiac problems To provide initial consultation for patients suspected with CHD. Rheumatic Fever and Rheumatic Heart Disease To provide post-graduate interns an opportunity to gather data and examine patients with cardiac disease To provide a venue for developing and reinforcing teaching potentials of the rotating cardiology residents and other personnel To recognize and practice the role of pediatricians in implementing the multidisciplinary approach in the care of chronically ill children especially those with heart disease
C. Rheumatic Fever and RHD To give specific care (advice) for children with CHD. management. Clinic Schedule & Venue 1. Unscheduled patients from the General Pediatric Clinics may be seen on a case to case basis. Patient Quota 1. The Cardiology Clinic can assess and manage a maximum of 5 patients (follow-ups and new cases) per clinic day. and rehabilitation of Congenital Heart Disease. Patients seen for the first time in the clinic should be registered and a registry form incorporated in their charts. 23 Department of Pediatrics 123 Rev3Iss4 01-Apr-2010
. Training To provide training for pediatric residents and interns in the recognition. The Cardiology Clinic is held every Mondays and Wednesdays 2:00 PM to 4:00PM at the Lower Ground of TMC. Referrals 1. D. Policy Guidelines A. B. Research To encourage research on pediatric cardiology diseases seen in the clinic
II. All patients perceived to have cardiac problems should be referred to the Cardiac Service.
OPM No. RF and RHD To monitor status of children with RHD
B.SUBSPECIALTY CLINICS CARDIOLOGY CLINIC I. Objectives A.
6. Follow-up patients are examined. ASO for patients where CHD is to be differentiated from RHD or whose presence of both is suspected such as in Lutembacher (ASD & Rheumatic MS) 3. hyper cyanotic spells. 8. Referral Protocol for all patients: a. CRP.E. For patients to be seen for the first time: History and P. including BP in all extremities CBC for cyanotic patients ECG. Results of the ECG and Chest x-ray need not be in for the patients to be seen by the Cardiology service 4. When CHD needs to be ruled out against RHD.for difficult cases.Irregular rhythm . All diagnostic procedures will be referred to Pasig General Hospital. 2. symptomatic arrhythmias and syncope on exertion are to be referred as emergency cases. They should be referred immediately to the senior resident and consultant-on-deck.Syncope . Patients with referral letters from physicians outside of TMC may go directly to the Cardiology Clinic without being seen at the General Pediatrics Clinic. Chest x-ray & Echocardiography should have been done within the last 3 months before presentation
OPM No. c. 3.2. ECG should be done immediately at the PER by the Resident in Charge Chest x-ray ESR. Chart with clinical abstract b.Murmurs . 10. Diagnostics 1. Criteria for referral to the Cardiology Service: Children suspected to have congenital heart disease with any of the following findings: . heart failure. Patients with cyanosis aged < 1 year.Abnormal cardiac findings on ECG and Chest x-ray 5. Children who have undergone close heart and open-heart surgery. as needed for the acyanotic patients Echocardiography every 12 to 18 months or earlier as needed For pre-op hemodynamics presentation: ECG. cardio-respiratory distress. evaluated and will have their names recorded in a special follow-up logbook. For follow-up patients: ECG as needed Chest X-ray as needed CBC every 6 months and as needed for cyanotic patients. 7. 23 Department of Pediatrics
. Children diagnosed elsewhere to have CHD.Cyanosis .Multiple congenital anomalies . 9. Age limit: birth to 18 years and 364 days E. Patients discharged from the Divine Mercy Program and diagnosed to have cardiac anomaly.
F. 23 Department of Pediatrics
OPM No. All patients seen at the Cardiology clinic should be continually followed up by the residents and as such. no patient will be discharged from the clinic except for patients who reach adulthood. Discharge Criteria 1.
schedule of follow-ups should be done prior to discharge of the patients. Training To provide opportunities for Residents to diagnose and manage neurologic disorders in the out-patient setting To provide a venue for postgraduate interns to acquire skills in data gathering and examination of patients with neurologic problems
C. Research To establish a database or registry of neurologic cases seen at the clinic for future studies by residents and interns
II. TMC. C. direct referral from the resident of the GPC or subspecialty clinic should be done. Patient Quota 1. All neurologic cases discharged from TMC Divine Mercy Program who will need continuity of care by the neurology service are seen at the clinic. Podium. In cases where close follow-up is necessary. 23 Department of Pediatrics
. Objectives A. In these cases. The General Neurology Clinic is held every Thursday from 9:00AM – 12:00 NN. the resident rotator should coordinate with the clinic nurses to give such patients priority in scheduling.NEUROLOGY CLINIC I. B. The clinic is held at the Lower Ground. Clinic Schedule & Venue 1. All patients seen per clinic should be previously scheduled except for emergencies or patients needing immediate referral.
Policy Guidelines A. Admission Criteria 1.
OPM No. The Neurology Clinic can assess and manage a maximum of 5 patients (follow-ups and new cases) per clinic day. 2. However. In addition. Patients who may seek admission to the clinic are as follows: Patients referred from the GPC and other subspecialty clinics needing neurologic evaluation and/or management. Service To follow-up neurology patients discharged from the TMC Divine Mercy Program who would need continuity of care To evaluate and manage patients with neurologic problems referred from the General Pediatrics Clinic (GPC) and other Specialty Clinics
B. these patients should have been previously referred to the service for evaluation.
All neurologic cases requiring clearance for a surgical procedure may be cleared at the GPC except if with seizures. Referrals from other departments may. Patients referred to Neurology Clinic should be screened first at the GPC or other Subspecialty Clinics. Diagnostics 1. G. Work-ups of patients depend on the discretion of the referring resident. Requirements prior to a referral include: Complete history. 2. treatment may be started right away even in the absence of an EEG except for questionable seizures. 23 Department of Pediatrics
. Discharge Criteria 1. E. Patients regularly seen at the Neurology clinic will have the below follow-up schedule: Thursdays at 9AM to 12NN. Follow-up Schedule of Patients 1.
OPM No. 3. 2. if the patient is co-managed by Neurology Service. However. In addition. Patients having the following specific conditions may be discharged from the Neurology clinic: Uncomplicated suppurative meningitis Simple febrile seizures GBS with return of some motor power and reflexes Viral encephalitis without complications 2. 3. be directly seen at the Neurology clinic. physical examination as well as a neurologic examination A working impression The reason for referral 4. Neurology will give the clearance. Referrals 1. Patients who are beyond 21 years old may be discharged from the clinic and referred to adult neurology clinic if further follow-up is necessary. No laboratory work-up is required prior to referral. F. however.D.
In addition. Objectives A. However. Research II. This includes in-patients as well as patients at the OPD. C. 2. rescheduling shall be done. Patient Quota 1. the resident rotator should coordinate with the clinic nurses to give such patients priority in scheduling. Unscheduled patients coming to the clinic shall either be seen last or in case there are already too many patients. To encourage research on pediatric pulmonary diseases seen in the clinic
Policy Guidelines A. these patients should have been previously referred to the service for evaluation. Unscheduled patients coming to the clinic shall be seen last. However. Training To provide opportunities for Residents to diagnose and manage pulmonary disorders in the out-patient setting To provide a venue for post-graduate interns to acquire skills in data gathering and examination of patients with pulmonary problems
C. Podium (Hospital Building). Patients who may seek admission to the clinic are as follows: Patients referred from the General Pediatric Clinic needing pulmonary evaluation and/or management All pulmonary cases discharged from the TMC Divine Mercy Program who will need continuity of care by the Pulmonary service are seen at the clinic. B. in case there are already too many patients for the day. shall be scheduled for another clinic day. schedule of follow-ups should be done prior to discharge of the patients.
OPM No. The Pulmonology Clinic is held every Tuesday at 9 to 12 noon and Thursdays at 2 to 4 PM. 23 Department of Pediatrics
. The Pulmonology Clinic can assess and manage a maximum of 5 patients (follow-ups and new cases) per clinic day. TMC. In cases where follow-up is necessary. 3.PULMONOLOGY CLINIC I. All are held at the Lower Ground. Service To render optimal care for patients with pulmonary diseases To educate parents and patients on the nature and progress of the pulmonary illness
B. Admission Criteria 1. Clinic Schedule & Venue 1. 2.
All out-patients with pulmonary problems shall initially be seen and screened at the GPC. Discharge Criteria 1. Referrals from other departments may be directly seen at the clinic.
OPM No. 3. Patients for referral to other services will be referred using the standard referral policies with an abstract and referral slip. Diagnostics 1. Requirements prior to a referral include: Complete history and physical examination A working impression The reason for the referral 5. E. 2. Referrals 1. 4. Patients referred to the Pulmonary clinic should have an initial Chest x-ray prior to the referral. 6. 4. 23 Department of Pediatrics
. Mandatory work-ups at the GPC for patients referred to the Asthma Clinic shall include: Spirometry Exercise challenge test (optional) Chest x-ray AP-L view – for moderate to severe persistent asthma 3. The following diagnostics are needed prior to pulmonary clearance: CBC Chest x-ray Spirometry (obstructive/restrictive) F. Patients from other specialty clinics may be referred directly to the Pulmonary clinic with the accompanying results of the initial laboratory work-up and the signature of the specialty clinic residents. All diagnostic procedures will be referred to the Pasig City General Hospital. 2.D. Patients for admission may be referred to Pasig City General Hospital or to TMC Divine Mercy Program. Patients will be discharged from the clinic only with the discretion of the senior resident and with the approval of the Service Consultant on a case to case basis.
exploitation or discrimination because of a physical mental disability or condition. medical clinic and similar institution. 2. neglect. Art. "Child Abuse" refers to the maltreatment. cruelty. I.D. 603. multiple fractures. 23 Department of Pediatrics
.R. Syphilis. Nursing Unit. Exploitation and Discrimination Act). 7610. A patient who during the course of evaluation at the ER for another concern has medical examination findings that indicate child abuse c.. Policy Guidelines 1. This policy as governed by Republic Act 7610: Special Protection of Children Against Child Abuse. A patient who during the course of evaluation at TMC for another concern has medical examination findings that indicate child abuse. 4. A patient seen at TMC for the purpose of management of alleged child abuse b. of the child which includes any of the following: Psychological and physical abuse. HIV or other sexually transmitted infections not perinatally acquired. A suspected child abuse patient may also include the following: a. Chlamydia. These may include but not limited to the following: Diagnosis of N. AND OUTPATIENT CLINICS I. P. A suspected child abuse patient presenting at the ER may include the following: a. Any suspected child abuse patient will be referred to the Department of Social Welfare and Development (DSWD) as required by law. Retinal hemorrhages in an infant Unexplained head trauma Suspicious child death Any disclosure of abuse by the child 5.R. and outpatient clinics will be managed according to the law (Republic Act 7610: Special Protection of Children against Child Abuse. to the DSWD within 48 hours of learning of the abuse. neglect. to wit: “The head of any public or private hospital. sexual abuse and emotional maltreatment. Suspicious child death d. fractures of different ages. 166)” 6. intracerebral hemorrhage. Pregnancy in or delivery by a child who is less than 13 years old Pregnancy in or delivery by a child with disclosure of abuse or rape Suspicious physical injuries with incompatible history such as pattern burn injuries. whether habitual or not. A patient admitted at the floors and assessed to be a suspected child abuse patient 4. Policy Statement Suspected child abuse patients who come to the Emergency Department. (R.MANAGEMENT OF SUSPECTED CHILD ABUSE PATIENT IN THE EMERENCY DEPARTMENT. etc. The suspected child abuse report (please refer to Attachment E) should be prepared by the Attending Physician and faxed to one of the following :
OPM No. II. 3.A. Exploitation and Discrimination Act defines children as follows: Persons below eighteen (18) years of age or Those over eighteen years of age but are unable to fully take care of themselves or protect themselves from abuse. NURSING UNITS. gonorrheae. cruelty. Sec. Reporting and Investigation of Child Abuse Cases. A patient brought to the ER for the purpose of examination of alleged child abuse b.
a. DSWD (Pasig City) – (02)643-5010 7. DSWD Social Protection Unit Quezon City (02) 931-9133/932-2573 d. DSWD-NCR Ugnayan Pag-asa Crisis Intervention Center Legarda. Batasan Complex. Philippines Tel. Department of Social Welfare and Development DSWD Bldg. The management of these patients with regards suspected abuse would also be referred to a child protection specialist (Regular and Visiting Staff of the Medical City Department of Pediatrics). 23 Department of Pediatrics
.C. Constitution Hills. (632)931-81-01 to 931-81-07 b.. Manila (02) 734-8617 to 18 c. Q.
PICU). provision for one whole wing/ floor for Pediatrics
The department aims for a balanced staffing of highly qualified clinicians. OPD. 1 resident for Community Pediatrics. The proposed staffing pattern until year 2010 is as follows: ACTIVE & VISITING General Pediatrics Adolescent Medicine Allergy & Immunology Ambulatory Pediatrics Cardiology Dermatology Developmental Pediatrics Endocrinology & Metabolic Gastroenterology & Nutrition Genetics Hematology Infectious Disease Intensive Care Neonatology Neurology Nephrology Oncology Pulmonology Toxicology CURRENT 62 3 3 3 6 1 3 2 (1) 2 2 4 3 2 5 2 2 4 1 2006 2 2007 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2008 2 2009 2 1 2010 2
OPM No. Proposed Staffing Pattern ANALYSIS ELEMENTS Professional Manpower Consultants SHORT TERM (2005-2007) Please see attached recruitment targets 21 27 Nurses 1:2-3 1:7 1:1 NICU(80-100 beds) and PICU (14 beds) 1:1 Pediatric Floor/Wing 1:4 LONG TERM (BY 2015) Please see recruitment targets (table below) JUSTIFICATION/REMARKS
6 residents each for 5 independent service areas (WARDS.MANPOWER PLANNING I. with at least 2 recruited general pediatricians or sub specialists in each of the 18 focus subspecialties. ER. Adolescent Clinic Aside from full NICU and 12bed PICU complement. 23 Department of Pediatrics
Strategy Action Plan STRATEGY ACTION STEPS TIME FRAME April UNIT RESPONSIBLE APB Section Head Chair
Review/ Update of Profile current manpower Medical Manpower complement Requirements (NEEDS ANALYSIS) Determine current service areas Updated Manpower Plan Determine current manpower complement per service area Determine future service areas requiring additional manpower complement and project manpower needs Determine future events requiring additional manpower (medical school and new hospital wing) and project manpower needs Determine baseline service utilization/ patient load and revenue generation of current manpower complement Project future service utilization/ patient load and revenue generation for the department and determine additional manpower required to meet projections Project manpower requirement
OPM No. 23 Department of Pediatrics
Mandaluyong. 23 Department of Pediatrics
. Quezon City. and the Rizal towns Obtain a list of pediatricians in mall based practices in the Ortigas.STRATEGY Creation and maintenance of a recruitment database Database is created and maintained
Determine database content April April Design and produce information sheet April List ten major target hospitals as source of April and every recruit January if each year thereafter Obtain list if new pediatric residency graduates from 10 major target hospitals End of April and after every PPS convention Obtain list of new each year diplomats and fellows from PPS April
UNIT RESPONSIBLE Department
Obtain a list of pediatricians from medical society of Pasig. Eastwood. Mandaluyong area Verify list and data gathered Encode database Verify current database Obtain new entries
May June January of every year January of every year
STRATEGY Tracking and recruitment of top TMC trainees
ACTION STEPS Ask all graduating residents to accomplish information sheet for database Review and verify graduate‟s database
TIME FRAME September
UNIT RESPONSIBLE Department
September Establish and maintain an e-group of TMC graduates Start an annual registration and update of database of all TMC graduates through egroup Identify top 20% of specialty and subspecialty board passers Special recruiting teams Send invitation and brochure of TMC Identify team members Meet teams to set objective and make plans June June
ID and recruitment of topnotch MDs
May (PPS) May onwards (subspecialties)
OPM No. 23 Department of Pediatrics
Entrance requirements shall be as follows: Doctor of Medicine degree from an accredited college or university Completed internship from an accredited hospital Passed the Physicians‟ Licensure Examination conducted by the Board of Medicine of the Professional Regulation Commission Satisfactorily completed pre-residency Must undergo interview by a panel designated by the Residency Training Committee C. Entrance Requirements 1. Application forms are available at the Medical Training Office at the 2nd floor of Podium Building anytime starting June until September 31. Other relevant hospital policies on admission shall also apply. Only applicants with good academic records will be admitted. 6. 5. General Policies 1. They are then interviewed by a panel of RTU members using the unified interview questionnaire formulated in 1997 by The Medical City‟s Committee on Medical Education and Professional Development under the leadership of Dr Mediadora Saniel. Policy Guidelines A. Only applicants with good moral character and who have never been convicted of any crime shall be admitted to this department. Qualified applicants undergo a one-month pre-residency training program. 4. An applicant must submit to the Medical Training Office a complete application. Applicants are required to take the qualifying written examination composed of questions submitted by the members of the RTU and selected generalists and subspecialists. Application starts every September of each year. A complete application includes: Completely accomplished application form of The Medical City Application letter addressed to the Department Chair (2) 2x2 Colored I. picture with red background (2) Letters of recommendation Resume Class ranking Transcript of Records (certified true copy) Diploma (certified true copy)
OPM No. Filipino citizens will be given priority for admission to the program.RECRUITMENT PROCESS
SELECTION OF INCOMING RESIDENTS Every year. Admission Policies 1. 23 Department of Pediatrics 136 Rev3Iss4 01-Apr-2010
. I. B.D. 7. the Residency Training Committee undergoes a tedious and thorough process of selecting applicants for the training program. Qualified applicants who are not admitted may re-apply in any succeeding academic year. Only applicants with attitudes suitable for pediatrics will be accepted. 3. 2. Foreign graduates shall only be admitted based on the rules and regulations set by the Professional Regulation Commission and The Medical City.
6. Members of the Residency training Committee will evaluate the presentation. 4. 5. At the end of the pre-residency.
OPM No. Qualified applications will be asked to take the written examination.2. applicants will be required to do a case management presentation. 7. A panel interview will be conducted by the Residency Training Committee members. The Department of Pediatrics and the Residency Training Committee reserve the right to refuse admission to any applicant for any due cause.
Certificate of Internship (certified true copy) Board Rating PRC License Card Birth Certificate Marriage Contract The Medical Training Office will forward complete applications to the Department of Pediatrics. Selected applicants will be asked to undergo pre-residency training for one month. 3. 23 Department of Pediatrics
(For Current Roster of Subspecialty Consultants. Lucia. Pasig and Congressional Avenue. located in the areas of Sta. Cainta. respectively). 23 Department of Pediatrics
. Fifty four (54) consultants belong to 17 subspecialty sections. exclusive of the sixty-three (62) general clinicians in the faculty. Sixteen (16) pediatricians have pursued masters and post doctorate studies. Fourteen (14) pediatricians belong to the Satellite clinics. most of which still continue to practice general pediatrics. General Pediatricians and Affiliate Subspecialties please refer to Attachment F) (For list of consultant development programs please refer to Attachment G)
OPM No. Fairview. Sixteen (16) other consultants were recognized as affiliate subspecialists. Antipolo.DEPARTMENT STAFF PROFILE The department hosts a staff of one hundred twelve (112) pediatricians (42 and 70 active and visiting consultants.
Discuss with the mentor his/her areas of interest (clinical and research) 4.STAFF TECHNICAL TRAINING REQUIREMENTS
DEPARTMENT OF PEDIATRICS MENTORSHIP PROGRAM To ensure that every resident receives appropriate professional and personal guidance during his/her residency training. All Consultants of the Department of Pediatrics are eligible to become mentors. Responsibilities of the Pediatric Resident/Trainee: 1. Receive a summary of evaluations from the Residency Training Unit and discuss this with the trainee quarterly. 2. Facilitate professional advancement/opportunities for continuing training/education. Duties of the mentor include but are not limited to: 1. Inform his/her mentor of all assigned formal presentations and have the mentor evaluate presentations beforehand 3. Meet with his/her mentor at least once every quarter to obtain an evaluation as well as give feedback regarding his/her training experience 2. Provide/facilitate research opportunities for the trainee. Provide/facilitate subspecialty exposure 5. each resident who enters the Department of Pediatrics is assigned to a mentor at the beginning of the training program.
OPM No. The chosen mentor remains in charge of the trainee for the entire 3 years of residency training. 7. 6. Discuss with his/her mentor any significant untoward events that may occur 5. Inform the Residency Training Unit of any commendations or special concerns regarding the trainee. Supervise/approve all formal presentations to be given by the trainee during the course of residency. 3. 4. B. 23 Department of Pediatrics
. A. Act as liaison between the Residency Training Unit and the trainee as needed. Disclose any personal issues that may interfere with his/her residency training and clinical obligations.
relationship with peers and adjustment to the residency program.
OPM No. headed by Dr. In cases where a resident is not performing at par. Paguio. It is the duty of the specific consultant adviser to counsel the resident in terms of academic growth.GUIDANCE AND COUNSELING SERVICES FOR RESIDENTS Each resident is assigned a specific consultant mentor who monitors and supervises the resident‟s performance and well being while in the department. the Residency Training Committee. 23 Department of Pediatrics
. Carlos E. coordinates with the consultant adviser so as to provide a stronger support system.
c. e. The resident-in-charge is asked to present the patient‟s history and course. The discussion should include: complete history. NICU. Should the preceptor feel that he/she is unable to evaluate a resident for a particular session. though all residents are encouraged to join in the discussion. Each preceptorial session should last no longer than 1 hour. b. Policy Guidelines 1. determine the appropriate diagnostic tests to be performed.GUIDELINES FOR PRECEPTORSHIP I. appropriate course of management including clinical practice guidelines (if any). prognosis. c. All consultants of the Department of Pediatrics. Preceptorship Assignment a. the basis of evaluation is the resident‟s ability to obtain a complete but concise and directed history. prevention. Conduct of Preceptorial Session a. Department of Pediatrics Clinical Preceptorship Program A. 2. and as often as everyday. 23 Department of Pediatrics 141 Rev3Iss4 01-Apr-2010
. Objectives: To provide a formal venue for regular clinical teaching To provide an objective basis for evaluating the pediatric residents‟ clinical skills and knowledge B. make the correct diagnosis. (See Attachment D) As indicated in the form. and identify any long-term implications of the patient‟s disease/condition. Any patient currently admitted can be chosen for discussion. 3. These patients need not be personal patients of the preceptor. One or two patients from those currently admitted in the unit/division will be selected for discussion during each preceptorial session. come up with reasonable differential diagnosis based on history and physical exam. One preceptor is assigned to each division/service every 2 weeks. ER) will have a designated group of preceptors b. discuss the pathophysiology and natural course of the disease. perform a complete targeted physical examination. formulate a discharge and follow-up plan. The session is conducted in a private area (family conference room/division conference room) to ensure patient privacy. The assigned preceptor will perform teaching rounds with all residents presently rotating in the unit/division at least once in the assigned 2-week period. anticipatory guidance and any implications on public health. Evaluation of Preceptors Each preceptor will receive an evaluation from the residents presently rotating in his/her service/division at the end of the rotation
OPM No. PICU. Each division of the Department of Pediatrics (Ward. are eligible to become clinical preceptors. It then becomes the responsibility of the resident to schedule another preceptorial session in order to obtain an evaluation. complete physical exam findings. unless otherwise indicated by the patient‟s Attending Physician. the resident should be informed. 4. discuss appropriate management. Resident‟s Evaluation Each resident who is present during the preceptorial session is to be evaluated using the Clinical Skills Evaluation form. including those whose practice is mainly out-patient based. accurately interpret test results. d. appropriate diagnostic tests and proper interpretation of results. differential diagnosis. d.
Olympia O. Aguirre (RTC representative). The consultant staff will give lectures on selected topics. The department has organized its own Research Committee. The department has adapted the policies formulated by the hospital‟s Research Committee. Rabanal. headed by Dr. At the end of the pre-residency period. The members are Drs. their manifestation. pathophysiology. To learn basic pediatric knowledge regarding: The common disease in the pediatric age group. In compliance with the PPS-HAB requirements on Research. diagnosis and management Basic pediatric skills: . Navarro and Cynthia A. 23 Department of Pediatrics
. Teresita N. conduct the research and submit a research paper before graduation from the three-year training program: The first year residents are required to develop and submit a research protocol prior to promotion to the next year level.Blood extraction in patients less than 1 year old .Intravenous insertion . Agnes Alarilla-Alba.Endotracheal intubation . Objectives 1. Lopez.
Pediatrics Research Program One of the department‟s thrusts as far as its academic growth is to encourage and contribute to research output. submit a protocol. They are expected to go on duty under the direct supervision of the first year and senior residents on duty. the department requires all its residents to formulate a research question. Cynthia B.Nasogastric tube insertion/ gastric lavage of the newborn . the applicants have to present at least one case management report. clinical course.Umbilical cannulation . with an end goal of having at least 1 published paper per year.
OPM No.II. Susanna L. Jacqueline O. the Residency Training Committee evaluates the performance of the pre-residents and chooses those will go into the regular residency program. It is the department‟s aim to produce 2-4 winning papers a year.
III. review submitted protocols and assist in the proper conduction of researches. It functions to gather research materials. Malanyaon.
Pre-Residency Training Program A.Lumbar puncture To learn how to make a concise but comprehensive clinical history and physical examination To learn the proper decorum and bedside manners toward pediatric patients To provide the Residency Training Committee an opportunity to evaluate applicants During the pre-residency period. Gomez.
The Medical City also has a full complement Ethics Review Board which approves researches involving patients. subspecialty for a) of research papers both locally and internationally
OPM No. relevant and ethical research those benefits The Medical City‟s pediatric patients.g.I. such as interdepartmental. IV. concluded last February 2004 at the MSD Office in Philam Towers.
The department has been receiving full support from The Medical City.R.T) as well as pediatric societies‟ research presentation. Pediatrics Research Division A. Provide opportunities for consultants and residents to engage in research related training and activities.R. 2. professional staff and communities it serves engaging the department‟s strategic partners who share the department‟s vision and passion. F. Included in its program of activities is participation in a series of research for a held at various months of the year.I. Identify venues/ journals for publishing research papers and obtaining requirements for these 5. Identify potential sources of funding both locally and internationally and outline processes and requirements for a funding/grant application 4. 23 Department of Pediatrics
.S. manage and sustain relationship with research grantors C. Mission Promotion. the hospital‟s Committee on Research organized an annual research workshop on Evidence-based Medicine & Protocol Development. First year residents from all departments participated in this. the department and the F.S. organizing research workshops facilitated by distinguished members of the Committee on Medical Education and Professional Development. publication and utilization of quality.and interhospital research paper contests (e. For 2005. Researches submitted annually are first entered in the intradepartmental research paper presentation. Cash grants provided by the hospital.g.
The second year residents are required to perform the actual research. Strategies 1. intra. Coordinate with the hospital‟s research committee regarding research training. 3.T are available and awarded to deserving protocols. Identify venue for presentations(e. Objectives To motivate and train consultants and residents to do research To guide consultants and residents in the conduct of the research To advocate for research publication and utilization To generate funding for research To establish. the department sponsored a protocol development workshop in January for the second year residents which the first year residents also attended. In its desire to stimulate a positive attitude and develop the skills in research utilization and development among the residents. Winning papers are later submitted in several other for a. Makati City. present it in department research contest and submit a completed research paper before they are promoted to third year residency The third year residents are expected to make final revisions on their research papers. scheduled during the last quarter of the training year. B.
analysis and presentation of research before the end of the second year as a prerequisite for promotion to the 3 rd year of residency. 17. All researches would be reviewed and approved by the department‟s technical review board (TRB). Once protocols are made. the Hospital‟s Institutional Review Board (IRB) will also review the paper. 8. The revised written paper would be submitted to the Research Division for review by the Research Publications Unit. a grant application would be submitted to the hospital‟s research committee 5. The second year resident must complete the conduction. The co-authors are to sign the completed written research paper before submission to PPS as part of the pediatric diplomat exam requirement. 7. 4. The third year resident will revise and fine tune written manuscripts for submission to PPS and international and regional journals. Writing scientific paper d. The first year residents will receive training through the hospital‟s research committee on the following topics: a. F. All researches shall be guided by the policies of the Hospital‟s Research Committee as stated in The Medical City Operations and Procedures Manual No. The second year resident should conduct. Likewise they have 5. 4. The conduct of research would be done from January to July of the second year level. The resident with their respective co-authors will present the research protocol to the ERB.D. analyze data of his/her research 3. If funding would be requested. hospital‟s institutional review board (IRB) and the ethics review board (ERB). The author together with the Research Publications Unit would assist the researcher in finding the appropriate venue/journal for its publication or the appropriate subspecialty forum where it could be presented. Economic Analysis 2. Metaanalysis f. Research methodology b. Sample size and stat analysis c. The 2nd year resident should have been issued a certificate of participation in the annual research presentation/ contest E. they are submitted to the department of pediatrics‟ technical review board (TRB) and the Hospital‟s Ethics Review Board (ERB). 6. one of whom is a member of the research division. The data analysis and paper writing would be done on August and September and presented in appropriate for a on October onwards. 23 Department of Pediatrics
. Evidence-based medicine e. Procedures 1.
OPM No. 7. Budget The resident upon submission of research protocol must indicate budget or expenses for said research and may apply for support from a research funding body. Policies 1. 3. Each resident will have consultant co-author/s. The first year resident should have a research protocol co-authored by a pediatric board certified consultant of the TMC 2. to comply with the TMC Pediatric Department Research Policies 6. If needed.
B. This gigantic task is being shared with the government. the consultants and residents of the department have continued to serve the health needs of the children in the community. Attachment K for the List of Research Papers and OPM No. The Medical City‟s Interdepartmental Research Contest 4. Vision and Mission VISION To be an exemplary Phase III Community Health Program (CHP) geared towards improving the child health status of communities and empowering these through the collaborative partnership of the Department of Pediatrics of The Medical City and other socially-responsible agencies. the Department of Pediatrics of The Medical City embarked on a regular community program. Department‟s Annual Scientific Paper Presentation 2. hospital‟s IRB and ERB using the research proposal checklist (please refer to Attachment H) and the evaluation used for judging papers (please refer to Attachment I). The children are growing up to adulthood. MISSION The Department of Pediatrics of The Medical City is committed to developing more appropriate responsive CHP that will: 1. 23 Department of Pediatrics
. Community Pediatrics A. two years after the inception of its training program in 1980. The FIRST annual research paper contest 3.
OPM No. non-government. Promote child survival and well-being in the identified community. Venue for Research presentation 1. Evaluation Research is evaluated through several ways: 1. This was later moved to Ugong Health Center. and socio-civic organizations. However. It has been a fertile ground for achieving the desired census for the department‟s well baby/well child clinics. If for publication then the research is submitted to appropriate journals as guided by journal requirements for authors H. PPS and subspecialty society for a and regional and international conventions (Please refer to Attachment J – Sample Unit Work Plan. In June 2003 the Community Health Program (CHP) was conceptualized wherein partner agencies have been invited to participate in the child‟s well-being and health. 17 – Research Office for the detailed policies and procedures) V.G. Rationale of Community Pediatrics With the Philippine Pediatric Society (PPS)-Hospital Accreditation Board (HAB) thrust of community exposure and development for all accredited hospitals. Pariancillo Health Center in Pasig City was the pioneer site for such an activity. Pasig City. these goals cannot be the single responsibility of the health care providers alone. Several years have passed. Health maintenance and disease prevention remain to be the goals of community pediatrics. Since then. Through the department‟s TRB. a site that is easily accessible to the hospital. 2. The TIPPS research contest 5.
create documentation system. Enhance social awareness and learning opportunities for the pediatric residents and other trainees. reasearcher. clinician. materials. 4. One resident rotator is assigned to the community for two successive months. transportation. Consultant‟s Job Description 1. orients residents to community program / work. and educator during his stay at the community. Work together with other advocacy groups that will hasten the development and empowerment of the community towards self-reliance and self-sufficiency. link to involving subspecialties as community generalist consultant. He is expected to be at the community from 9:00 AM to 3:00 PM. communication (meetings) like setting up venue. social mobilizer. 6. 3. Preparation of logistic support. He is required to have at least one mini-paper/project during his rotation. Involvement of subspecialties in COMPEDS – referrals (setting up referral system). Subcommittee on LIAISON Setting meetings with partner agencies Resources Meeting with residency training committee Coordinate projects / programs with partner agencies D.. etc. 23 Department of Pediatrics
. 2. activity secretariat. Resident‟s Job Description 1.
OPM No. 3. Subcommittee on PROGRAMS Community organization / coordination of working groups Operations review Responsible for the activities Map out plans / job description of interns. materials needed such as laptop. He becomes manager. He is expected to finish paper works from 3:00 PM onwards when he is back in the hospital. C. scheduling of residents / consultants. He holds health education encounters with the community. etc. Documentation of all activities (pre. archiving Budget preparation / tracking Financing Internal and external evaluations and monitoring – to assign another person / group Hiring of social worker who can act as administrative officer Set up the system – hire staff. integrates program to be part of the residents‟ training program. LCD. data base costing. 5. beliefs. equipment. 3. etc. actual and post-activity). residents and consultants Development of modules Monitoring and evaluation function of program / activities Weekly lectures – didactic and activity workshops Community integration / social integration – identifies person in the community whom TMC people go to.2. their way of living. Subcommittee on OPERATIONS Human resource planning. 2.
M. Nutrition Health Education (BHW) Health Education (Mothers & Caregivers) Sick Child Clinic Health Education (BHW)
P. Health Education (School) XXXXX** Individual Project Implementation Health Education (School) XXXXX**
* Monday to Friday
9:00 – 3:00 P.M. (Not in community) – Department Mini-audit and Grand audit (1st and 2nd Fridays) F. (Not in community) – FIRST Activity Friday P. Resident Rotation in Community Pediatrics WEEKLY SCHEDULE Monday Tuesday Wednesday Thursday Friday
A.M.E. 23 Department of Pediatrics
.M.M. – Community Work 3:00 – 5:00 P.M. – Back in hospital doing integration of data / paperwork
** Tuesday P. Community Health Program YEAR PLANNER Theme for the Month (In cooperation with DOH thrust) JANUARY Orientation to residents Orientation to consultants (members of Community Pediatrics committee) IMCI Dental Health BHW Survey Injury Prevention Nutrition Nutrition Physical Fitness (Annual physical check-up in Francisco Legaspi Memorial Elementary School)
MARCH APRIL MAY JUNE
Surrounded by large factories and industrial buildings. is the adopted community of the Department of Pediatrics.00 2 805 Barangay Ugong Population Total Percent Casa Verde 889 889 3. Barangay Ugong . 791 (year 2003). with a total population of 24.73 2 1535 3 1511 4 1325 5 1326 6 639 Valle Verde 1 2450 10143 40. (Purok 1-6). with an Internal Revenue Allocation of Php34 million.91 Total 24791 24791 100.86 Kaimitoville 970 970 3. 1974. 557 signed on September 21. On the north side is part of Quezon City (Barangay Ugong North) and Valle Verde occupies the western side of the community. The Medical City. Table 1 Estimated Population per community in Barangay Ugong Pasig City (2003) Barangay Ugong Population Total Percent Purok 1 2025 8361 33. Barangay Ugong (Purok 1-6) has a total land area of 394 hectares. 23 Department of Pediatrics 148 Rev3Iss4 01-Apr-2010
. It is located at the bank of the Marikina River.00
OPM No.91 2 1750 3 980 4 595 5 2982 6 1386 Landmark 1 434 1239 5.JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER G. which also borders the barangay‟s South-Southeastern margin. Barangay Ugong is divided into 6 smaller communities (Table 1). The present Barangay was created by virtue of Presidential Decree No.59 Las Villas 3189 3189 12. Introduction
Dengue Awareness Tuberculosis EPI Food Safety Awareness Substance Abuse IMCI
Barangay Ugong is one major community that makes up the City of Pasig. Community Diagnosis 1.
Sixteen percent (16%) of the population in Barangay Ugong belong to the under 6years of age bracket.2. Purok 4 contributes to 25% of the total population. Purok 4 contributes to 27% of the eligible children for schooling. Table 2 Age-Gender distribution Barangay Ugong (Nov. 2003)
Purok 5 16% Purok 4 16%
Purok 6 7% Purok 1 25%
Purok 3 18%
Purok 2 18%
The majority (60%) of the eligible working force of the Barangay (ages 18-59) belongs to Purok 4 (23%). The least populated purok is Purok 6 contributing to only 5% of the total population of the Barangay. Purok 1 (23%) and Purok 2 (21%). Barangay Ugong has a male: female ratio of 1:1 in all ages. Population per Area. Bgy. Demography of Barangay Ugong: Puroks 1-6 Among the six puroks. Ugong Puroks 1-6 (Nov. 2003) 0-2 3-6 7-17 18-59 >60 total M F M F M F M F M F Purok 1 68 46 87 75 170 167 501 550 49 47 1760 2 40 64 69 86 136 119 466 487 28 38 1533 3 30 32 52 49 74 62 237 248 32 34 850 4 59 66 75 79 191 188 499 530 37 55 1779 5 34 35 50 55 109 121 373 362 26 21 1186 6 15 10 16 16 46 37 127 129 6 5 407 Total 246 253 349 360 726 694 2203 2306 178 200 7515
OPM No. and Purok 1 has 24% of these children. Purok 2 (21%) and Purok 1 (19%). In contrast with the country‟s 67% of children in secondary school. Majority of this age group is found in Purok 4 (23%). only 18% of the population in Barangay Ugong was eligible for schooling. followed by Purok 1 with 23%. 23 Department of Pediatrics
. Figure 1.
There are also sharers of rooms (boarders) that comprise 14% of the total and majority of these types are found in Purok 1 (27%). More than half of the families (61%) have an average of 4 household members and only 8% of the total families registered have more than 7 households. 2003)
>60 18-59 7-17 3-6 0-2
-2500 -2000 -1500 -1000 -500 0 500 1000 1500 2000 2500 Female Male
3. made of concrete. Ugong (Nov. Table 3 Family Size per area Barangay Ugong (2003) Purok 1 2 3 4 5 6 Total 1-4 306 284 155 247 218 68 1278 Number of Households 5-6 >7 123 41 125 20 160 48 116 23 87 26 29 8 640 166
Total 470 434 363 386 331 105 2084
Houses in Barangay Ugong are of mixed materials. wood and steel.
OPM No. 23 Department of Pediatrics
. Barangay Ugong has a registered household of 2084 families. As of the type of ownership.Figure 2. Purok 3 (23%) and Purok 2 (22%). Purok 5 (21%) and Purok 2 (19%). 22% of which are residing at Purok 1. and most of these houses are found in Purok 1 (22%). Purok 2 (22%) and Purok 4 (21%). Bgy. 21% at Purok 2 and 18% in Purok 4. 55% of the houses are privately owned. Age-Gender Distribution. Almost one third of the houses in the Barangay are being rented by its inhabitants and majority of these types are found in Purok 1 (22%). Majority of families with more than 7 households are found in Purok 3 (29%). Socio-Economic Characteristics of Barangay Ugong As of 2003.
Purok 3 (18%) and Purok 4 (18%). 18% are found to be unemployed and 4% are underemployed. Manufacturing and Industrial type of work are the major types of employment (35%). Table 5 Distribution of Water Supply. 100% of the houses in Barangay Ugong have access to water.Table 4 Distribution of Families by Type of Housing. Despite the high proportion of working class.
OPM No. Barangay Ugong (2003)
Purok 1 2 3 4 5 6 Total Type 1 Type 3 Total 470 470 434 434 363 363 373 13 386 328 328 34 70 104 2002 83 2085
Majority of the eligible population in Barangay Ugong are employed. Barangay Ugong (2003) Purok 1 2 3 4 5 6 Total Owned 249 220 169 199 244 57470 1138 Rented 139 140 124 131 67 32 633 Caretaker 1 1 0 1 3 1 7 Sharer 81 68 70 55 14 14 302 Total 470 429 363 386 328 104 2080
With regards to water supply. Unemployment is high in Purok 2 (37%). 23 Department of Pediatrics
. Ninety-six percent (96%) are type 3 and majority of this type is found in Purok 1 (23%) and Purok 2 (22%). The remaining four percent (4%) of the community have access to deep well and this type is found in Purok 6 (84%) and Purok 4 (16%). Majority of the employed class are found in Purok 1 (25%) and Purok 2 (17%).
Barangay Ugong (2003)
Total 4 33 37 4 159 259 534 529 342 76 1977
26 10 29 63 26 154
4% 18% 78%
employed unemployed underemployed
The eligible population of school children (age 7-17 years) in Barangay Ugong is 1420.Table 6 Source of Income. Figure 4 Educational Attainment Per area and Level. Majority of school children (54%) are in the elementary level. Barangay Ugong (2003)
Purok 1 2 3 4 5 6 Total
Elem in 243 120 83 205 200 55 906
out 11 4 2 1 2 6 26
HS in 104 84 55 102 98 36 479
out 42 11 5 1 4 16 79
College in 71 59 51 50 44 9 284
Graduate Vocational out 50 18 16 30 4 118 33 4 18 34 31 7 94 10 7 50
OPM No. 23 Department of Pediatrics
. 29% in high school and 17% in college. Barangay Ugong (2003) Livelihood 1 2 3 4 5 Agriculture 4 Livestock 7 6 2 14 4 Food processing 8 Cottage Industry 4 Trade & Commerce 31 18 8 28 48 Services 87 70 40 52 Industrial 198 56 76 74 101 Others 43 114 126 75 108 Unemployed 27 126 62 62 39 Underemployed 65 2 9 Total 470 392 314 309 309 Figure 3 Employment. Ninety-seven percent (97%) of this group is presently enrolled in schools. the remaining 3% are out of school. The majority of out of school children can be found in Purok 1 (50%) while Purok 6 contributes to 30% of the group.
the leading causes of mortality in the Barangay are mainly due to lifestyle related diseases (58%). Barangay Ugong (2003) Cases Cardio respiratory arrest Pneumonia Hypertensive Vascular Disease Acute Myocardial Infarction Tuberculosis Birth Injury Infant death Cancer Diabetes mellitus Total cases Total Population Number 9 7 5 5 4 3 3 2 2 40 24791 Rate (per 10. however. in contrast to the national level of 7.6 1.6 2. Barangay Ugong (2003) Total Population Total Registered Births Crude Birth Rate Total Registered Deaths Crude Death Rate Registered Infant Deaths Infant Mortality Rate 24791 505 20.6/1000 population. Like the general trend in developing countries.8 2.37 (per 1000 population) 40 1. 23 Department of Pediatrics
. though most of the deliveries (69%) were conducted in hospitals and attended by doctors.21/1000 population. case finding.13
OPM No.9 (per 1000 live births)
Table 4 Leading Causes of Mortality (all ages).
Table 3.2 1.0 2. treatment and referrals. Infant morbidity (age 0-2 years) in Barangay Ugong was 25.8 16.2 0. Selected Vital Indices. Majority of the cases are communicable in nature. Acute Upper Respiratory tract infections ranked first among the leading causes of morbidity in Barangay Ugong.6 (per 1000 population) 3 5.9/1000 live births. It is noteworthy. that the infant mortality rate (IMR) in Barangay Ugong was registered at 5. Health Status of Barangay Ugong The crude death rate (CDR) in Barangay Ugong is 1.4. It is noticeable that majority of cases have subsequent programs on health for prevention.8 0.000) 3.0/1000.0 1.
08 0.96 4.44 198.20 0.Table 5 Leading Causes of Morbidity (all ages).82 6. Barangay Ugong (2003)
Figure 6 Percent Distribution of Deliveries by Attendance.38 2.08 0.68 4.57 7.08 15. Barangay Ugong (2003)
Table 6 Infant Morbidity (0-2 years). 23 Department of Pediatrics
.11 (per 1000) 19.57 1.21
Figure 5 Percent Distribution of Place of Delivery. Barangay Ugong (2003) Cases Acute Upper Respiratory tract infection Bronchitis Hypertension Pneumonia Dermatitis Diarrhea Diabetes Parasitism Arthritis Infected wound Total Number 2917 473 388 287 194 173 135 123 116 110 4916 Rate 106.44 4. Barangay Ugong (2003) Cases Acute Upper Respiratory tract infection Diarrhea Pneumonia Bronchitis Dermatitis Bronchial Asthma Infected wound Impetigo Influenza Otitis Media Roseola Infantum Total cases Number 421 59 55 39 33 5 4 3 2 2 2 625 Rate 16.12 0.33 0.98 5.65 11.98 (per 1000) 2.16 0.22 1.08 25.
1 dentist. 23 Department of Pediatrics
. Barangay Ugong Health Center schedule of medical and dental services are as follows:
MEDICAL SERVICES Sick baby Feeding program National TB program Outreach (Purok 6) Immunization Post-partum check up Feeding program Prenatal check up DENTAL SERVICES Adult Outreach (Purok 6) Pres-schoolers School Children Pregnant Women 6. 1 nutritionist. The Barangay Ugong Health Center Barangay Ugong is provided with a local health center attended by 1 physician. 1 midwife and 30 health workers.31% 69%
5. 1 nurse. The facility has 2 rooms for consultation and a dental clinic. Existing Health Programs in Ugong Health Center
The Program demands of each intern time and participation to make full use of the opportunities and willingness and enthusiasm to adhere and utilize the structure provided. Physical fitness program 2. and where disputes may be amicably settled VI. maintain public order. d. programs. administer the operation of the Katarungang Pambarangay. enforce all laws and ordinances. projects and activities in the community. Using a combination of patient care duties delegated by consultants and residents. Salt testing for Iodine j. 23 Department of Pediatrics
. crystallized and considered. The Program provides principally two elements for training the intern. Public grade school. f. and the structure under which discipline and insight can be acquired or inculcated. enforce laws and regulations relating to pollution control and protection and assist the city council in the performance of their duties and functions. namely: the opportunity to encounter a variety of patients and a variety of diagnostic and treatment methods. kinder. National TB Program 7. day care pupils 4. clinical conferences and didactic sessions. Internship Training Program The Internship Training Program (ITP) of The Medical City is a program accredited by the Association of Philippine Medical Colleges (APMC) according to the guidelines by the Board of Medical Education. b. c. values and techniques necessary in the professional practice of medicine. plans. bedside teaching in daily rounds. effective and economical governance. the Program seeks to make interns familiar with the thinking habits. Medical clearance for Public School teachers 3. Free Physical Therapy h. e.
OPM No. Botika sa Barangay i. Barangay and Public School participants g.
Vision Statement To be the model political unit that will serve as the primary planning and implementing unit of government policies. and as a forum wherein the collective views of the people may be expressed.
Blood sugar screening Blood cholesterol screening ECG Bone scanning 24 hour rescue and ambulance service Physical examination 1.a. Political Profile: The Barangay Ugong Council Mission Statement To make efficient. Garantisadong Pambata k.
B. Outpatient Department To monitor growth and development of all patients seen using standard growth charts To assess the nutritional status of all patients using Waterlow classification To advise mothers on proper feeding and nutrition of infants and children To determine a complete immunization schedule for infants and children To know the proper management of common pediatric conditions in an outpatient setting To accomplish completely and accurately the outpatient records of all patients seen C. the intern should be able to acquire the basic knowledge. Specific Objectives 1. please refer to Attachment L) D. 4. attitude and skills necessary in the recognition and management of common pediatric conditions encountered in general practice. 23 Department of Pediatrics 157 Rev3Iss4 01-Apr-2010
. The intern must attend and actively participate in the following activities:
OPM No. Ward To diagnose correctly common pediatric conditions based on a complete and accurate history and physical examination To select appropriate diagnostic work-ups based on initial diagnosis To interpret results of common diagnostic work-ups and correlate with clinical findings To know the management of common pediatric conditions including emergency care To refer uncommon and complicated pediatric conditions To interact with patients and co-workers showing respect for human values To perform accurately basic skills necessary in patient care To develop interest in continuing medical education 2. Newborn Services Division To obtain a comprehensive and accurate newborn history including maternal history To perform complete and accurate physical examination of the newborn including APGAR score and Dubowitz maturity testing To know the proper steps in newborn resuscitation in an uncomplicated labor and delivery To render routine care to normal newborns To know the management of common newborn problems To refer uncommon and complicated newborn problems To perform accurately basic pediatric skills necessary in neonatal care To work harmoniously with colleagues and other paramedical personnel as well as relatives of patients while rendering neonatal care To accomplish accurate and concise newborn records 3. Training Program Profile (For the list of training staff. Teaching – Learning Activities 1.A. General Objective At the end of the 8-week rotation. Emergency Room To know the proper management of common emergency pediatric conditions To know the correct indications and dosages of emergency drugs To perform accurately basic emergency procedures like CPR To interact harmoniously with colleagues and other paramedical personnel as well as relatives of patients while rendering emergency care To show genuine concern and compassion for patients and their relatives.
Histories and P.E. referrals to the service excluding those for CP clearance).M.) b.M.R. especially those whom they admitted on their duty. Journal Club e. and P. Teaching rounds with Consultants c. or ER-OPD c.) 2.C..12:00 nn Mon-Fri 5:00 pm . Developmental history as well as Nutritional Status. It is the task of the intern to do admitting histories and P. Ward interns are encouraged to accompany residents during their daily rounds as well as to accompany the consultants during their rounds.R. On exceptional occasions.E.I. and make the necessary corrections. holidays and after regular working hours. He endorses assigned patients to the incoming intern-on-duty. Interns‟ Hour (every Wednesday 1-3 P. the intern-on-duty assumes the role of the Ward. Interns rotate for the duration of eight (8) weeks in the Department of Pediatrics. Duties of Interns 1.a. and direct admissions. Each intern goes on a 24-hour duty every 3 days. Ward Rotation 1. Oral Revalida (last week of rotation) e. Grand Rounds (last Wednesday of rotation) (Please refer to Attachment M – Intern Grand Rounds Evaluation Form) E. Feeding.S. N. 3. b. Inter-departmental conferences/lectures d. Daily endorsements (A. he may be required to go on a 24-hour duty every other day.7:00 am Saturday 12:00 nn . (Please refer to Attachment B . They are also tasked to read the patients‟ charts.5:00 pm Saturday 7:00 am . Teaching rounds with the Interns‟ Monitor d. Regular non-duty hours: Mon-Fri 7:00 am . Monthly audits f.T. During Sundays.U. Inter-hospital conferences (F. Immunization. All interns will rotate in the following areas: Ward. must be accurate and complete and must include the Birth.E. The Interns‟ Monitor must check and countersign all admitting histories and P.I. 2.M. c. All interns MUST sign –in their attendance logbook daily and must state their posts and duty. endorsements) b. All admitting data bases must be inserted in the chart not later than 24 hours for those not critically-ill and not later than 6 hours for critically-ill patients. General Duties a. The interns have the following specific activities: a. 3. 24-Hour Duty a. on all patients admitted to the ward (E. b.Patient Data Base Form) 2.7:00 am d. 23 Department of Pediatrics
. Duties in Each Rotation a. The following are the skills allowed of a ward intern: Duty hours as follows:
OPM No. NICU and ER intern and shall perform the tasks specified for each area. Requests for exchange of duties must be duly approved by the Intern‟s Monitor and a typewritten request must be filed at least three (3) days from the duty date. Intra-departmental conferences c.7:00 am Sun/Holidays 8:00 am .
Endotracheal tube intubation .Venostomy . All insertions must be with the assistance of the nurse-in-charge. and differential diagnosis on all pediatric cases directly admitted to the ward.g.Subdural puncture . he will be in charge of all ward calls namely: IV insertion for patients >2 years old IV push with permission from the service resident-in-charge Skin test interpretation Tourniquet test HGT monitoring NGT/Catheter insertion (under supervision of the resident)
7. Pediatric interns make daily ward rounds with consultants and service residents-on-duty.Closed chest massage .Rumple-Leede (tourniquet) test .
4.Infections .Peak expiratory flow rate determination . This should be incorporated in the chart within 24 hours after admission or within 6 hours for critically-ill patients.Nasotracheal intubation The ward intern obtains a complete history.g Medicard) will be accomplished by the pediatric ward intern as stated in section B1. ENT and Ophthalmology) for cardiopulmonary clearance purposes will be done by the referring service. 8.Abdominal paracentesis .Nasogastric/ orogastric tube insertion .
IV insertion = for those patients 2 years old.Transillumination . Data bases of patients referred to the pediatric service through HMOs (e. after which such task will be referred to the PROD/Service resident.Exchange transfusion .Gastric lavage .Blood pressure measurement . 23 Department of Pediatrics
. Surgery.Collection of blood specimen . Data bases of patients referred to the pediatric Service (e. only two (2) attempts are allowed. During non-duty working hours.Needling . NGT/OGT insertion) Catheter insertion) under the supervision of the resident IV medication push) Skin test interpretation = if results are doubtful. prompt referral to the resident As described in the Pediatric Manual for Undergraduate education the following are the procedures that an INTERN must know at the end of the pediatric rotation: .
6.Urine collection . performs physical examination.Umbilical catheterization .Thoracentesis . gives admitting diagnosis.Infusion of fluids .
It is the task of the intern to do admitting histories and PE on all patients admitted in the ward (ER and OPD). 10. NICU Duties a. d. the NICU intern is on call for all procedures to be done under the supervision of the residents. j. b. and well-functioning at the OR-DR. laboratory results. c. 4. Under the resident‟s supervision. He checks the completeness of the chart (presence of data bases. monitoring) on all ward patients.9. He accompanies ward patients for transfer to other hospitals via ambulance conduction (excluding critically-ill patients). wearing scrub suits and strict infection control). He endorses all pending ward work to the incoming intern-on-duty after the afternoon endorsements by the residents. available. He makes the necessary clinical abstracts and referral papers for some designated patients. g. He is aware of all potential deliveries for the day in the OR-DR and must make the NICU resident/s aware of such. 11. the intern does the initial appraisal of the newborn and makes the admitting orders. He makes sure that the necessary equipment and resuscitation kit for the impending delivery are complete. During non-duty hours.g. He follows up all pertinent laboratory exams and relays them promptly to the resident-in-charge. ER/OPD Duties a. 13. h.
OPM No. i. He accompanies NICU patients to other hospitals for diagnostic purposes and for transfer to other hospitals (excluding critically-ill patients). He assists the resident/s in the assessment and resuscitation of the newborn. and relays promptly to the NICU resident/s for proper disposition. 12. He secures a good OB-Maternal history on all deliveries. He must perform cord dressing (at least 10/rotation) of the newborn under supervision of the residents. He abides by the existing rules and regulations of NICU upon entry (e. He makes daily rounds on all normal patients and reports any untoward problems to the resident. e. f. laboratory exam) 5. He checks the completeness of the charts (admitting orders. 23 Department of Pediatrics
or Grand Audit/ Morbidity & Mortality Business Meeting Case Management / Grand Rounds Conference Endorsement Service Rounds
1:00 – 2:00 pm
Nelson‟s Club FIRST Conference
CORE PEDIATRIC lectures (Modular Lectures in General Pediatrics and/or Subspecialties)
2:00 – 4:00 pm
4:00 – 5:00 pm
I.Grand Audit – every second Friday of the month Business Meeting Subspecialty Hour/ Pharmacology Series – twice a week. as scheduled NICU Modules – twice a month. as scheduled Case Management/Grand Rounds – every third and fourth Friday of the month Audit.Chief/ Senior Resident‟s . as scheduled NICU audit – every 2nd Wednesday of the month Intern‟s Hour – every Wednesday afternoon
OPM No. Regular Activities Evidence-based Medicine (Journal Club) – weekly. as scheduled . 23 Department of Pediatrics
.Mini-/ Service Audit – every first Friday of the month . Mortality and Morbidity Conferences . as scheduled Modular lectures on General Pediatrics – every Wednesday/ Thursday afternoons ER Modules/ Chart Rounds – daily.DEPARTMENT ACTIVITIES
MONDAY Endorsement Evidencebased Medicine (Journal Club) Service Rounds 9:00 – 12:00nn TMC-OPD Clinic TUESDAY Endorsement WEDNESDAY Endorsement UGONG/ THURSDAY Endorsement FRIDAY Endorsement SATURDAY Endorsement NICU Module
7:30 – 9:00 am
Service Rounds TMC-OPD Clinic
Service Rounds Intern‟s Hour TMC-OPD Clinic
Service Rounds ER Module/ Chart Rounds TMC-OPD Clinic CORE PEDIATRIC (Modular Lectures in General Pediatrics and/or Subspecialties Subspecialty Clinic Chief Resident/ Senior‟s Rounds Endorsement
Service Rounds TMC-OPD Clinic Monthly Mini.Consultant‟s endorsement (walk-in) – weekly.
Instructional Activities A. as scheduled Teaching Rounds .weekly.Every Thursday Service Consultant‟s Teaching Rounds . Intradepartmental 1.
Residents‟ Organization 6. Perinatology Conference – joint lecture with the Department of Obstetrics and Gynecology 3. Interdepartmental 1.T. To perform a complete and appropriate for age physical examination on all pediatric age groups
II. Philippine Pediatric Society (PPS) Grand Echo of selected topics/ scientific lectures Terminal Competencies of Residents (Second and Third) After the Two-Month Rotation in the Outpatient Clinics A.L. the Newborn Services Division of the Department of Pediatrics regularly conducts “Parent‟s Class”.A. The Integrated Pediatric Program Secretariat (T.I. Lectures 2. F. Our Lady of Lourdes Hospital and Victor R. comprehensive and accurate pediatric history 2.
Nelson‟s Club – every first Monday of the month Interesting Case Presentation – Newborn Services – once a month ER Audit – 1st Thursday of the month
B. To elicit a complete.S.I.S.A. Potenciano Medical Center Lectures – 2 Tuesday afternoon/ month Grand rounds – 1 Tuesday afternoon/month Clinicopathologic Conference – 1 Tuesday afternoon / month N. The Medical City‟s Center for Patient Education is officially promoting this lay forum. Consultants from the Department of Anesthesia and Psychiatry likewise contribute by giving lectures on Lamaze or anesthesia and postpartum blues. Therapeutics Committee Meeting (every 3rd Thursday of the month) 5.P. by offering it as a half-day course entitled „Parenting 101. 23 Department of Pediatrics
. Competencies on Basic Pediatric Primary Care 1.S. C.L. Parent‟s Class This is held every third Saturday of each month to provide a venue where expectant or new mothers and fathers can learn more about the techniques and advantages of breastfeeding from the medical experts (consultants and residents from the Department of Pediatrics and Obstetrics & Gynecology) and from testimonials of celebrities and guests.) Grand Echo of selected topics from the American Academy of Pediatrics Annual Convention 3.P. respectively. In collaboration with the Department of Obstetrics and Gynecology. Topics discussed range from prenatal and postnatal maternal and newborn care.S. – Pediatric Advanced Life Support Course Post Graduate Courses/ Research Workshop 2.R. Inter-hospital 1. Tumor Board Conference/ Lecture (every 2nd Thursday of the month) 4. component hospitals – Cardinal Santos Medical Center.
OPM No. –Neonatal Advanced Life Support Course P. who have breastfed their own children.
family history of hearing loss.3. chronic ear problems. adolescent). 23 Department of Pediatrics
. Screen for common pediatric illness. Screen for common renal pediatric illness. These should include the following concerns: a. Screen for common developmental disorders/lags by evaluating the developmental status at all visits. Dental health d. To be trained to detect signs and symptoms of non-medical problems like child abuse. h. 5. To know when to refer cases to the subspecialty clinics and other ancillary services 4. To measure all the necessary anthropometric parameters accurately and how to use these data to asses the nutritional status and growth and development patterns of the patients 4. Newborn metabolic disorders (if the patient was delivered outside of The Medical City) b. preventive medicine in all dialogues with the caretakers/ mothers of all patients of all age groups (newborn. Importance of follow – up and continuity of care 2. To formulate and institute therapeutic plans for common pediatric conditions 3. Accident and injury prevention h. B. Sex education/ substance abuse/alcohol j. Routine screening for anemia and iron deficiency. To judicially screen all patients in the following aspects: a. Feeding problems f. bacterial CNS infections. non-urgent. Immunizations g. Subjective visual testing for all visits and objective visual testing at age 3-4 years f. optimally from 12 months to 24 months of age e. infancy.g. To implement the recommended immunization schedule 6. behavioral problems. (e. including differential diagnosis and cost effective diagnostic plans 2. To be able to distinguish urgent. Nutrition and proper diet c. g. To create a logical algorithm for common pediatric signs and symptoms. toddler. low APGAR scores). Competencies on Health Education/Preventive Medicine 1. language delay. school problems. 7. Subjective hearing tests at all visits and objective hearing tests and/or audiology referrals when certain problems are perceived. i. marked prematurity. Routine screening for TB for all patients via tuberculin test d. child. Hygiene e. Competencies on Pediatrics Diagnosis and Management 1. and emergent cases (to prioritize patients and send to the Emergency Department those who warrant Emergency care) C. To provide anticipatory guidance and counseling for caretakers. for all age groups. Disease prevention and transmission i. Routine screening for hypertension at age three c. Parenting b. To include health maintenance. To develop an effective manner of establishing rapport and communication with the caretakers (parents or guardian) of the patients
To maintain complete. 9. concise manner as a model for the interns and clerks rotating at the OPD 3. 6. To be able to utilize the OPD pool of patients and data for research purposes E.g. 2. Teacher and Researcher 1. 3. 10. 23 Department of Pediatrics
. e. accurate and comprehensive medical records for each consultation 2. The Resident as a Manager. 4. To be able to present cases in a logical. 8. 7. 5. E-game) Screening test for hearing and speech problems
OPM No. Anthropometric measurements Tourniquet test Skin tests for drugs. Basic Procedures the Resident Should Master at the End of the OPD Rotation 1.D. Penicillin Administration of the immunizations/Mantoux test Minor wound care Neurologic exam of all patients Sexual maturity rating and pelvic exam of adolescent Developmental evaluation (behavioral and fine motor skills) Screening for eye problems (Snellen‟s chart. To serve as preceptors for the clerks and interns rotating at the OPD 4.
Interpret and correlate gathered data and formulate a primary diagnosis and differential diagnosis c. vitamin K prophylaxis.Transient hypoglycemia: SGA. rooming-in) Must be skilled in peripheral vascular access insertion and umbilical cannulation Must be able to Identify components of newborn screening and its interpretation Must recognize deviations from normal intrauterine growth Must be able to recognize disorders of the newborn not usually requiring intensive care (not all inclusive) . Interpret and correlate basic laboratory results with clinical diagnosis including ABGs. IDM . congenital sepsis. gastric lavage in cases of abnormal developments As teacher / discussant is able to:
OPM No. the first year resident is able to: a.g. Recognize and manage the following problems: common respiratory disorders of the newborn. First Year Resident Duration of Rotation: Minimum of 2 months 1. common congenital malformations or anomalies f. umbilical cannulation. urinary catheterization. Elicit a complete and appropriate clinical history (maternal and perinatal history) and to perform a thorough physical examination b. Terminal competencies Expected Clinical Skills At the end of their rotation. Prioritize appropriate diagnostic studies e. 23 Department of Pediatrics 165 Rev3Iss4 01-Apr-2010
. e.Uncomplicated prematurity .Hyperbilirubinemia/ anemia not requiring exchange transfusion . x-rays d. Entry knowledge and skills Must know the components of complete maternal and newborn history Must able to identify perinatal/antenatal conditions associated with high risk deliveries Must be able to render delivery room management (preparation of equipment for and sequence of basic neonatal resuscitation) Must be able to provide general care of the newborn (temperature regulation.Transient respiratory distress . umbilical cord care. Perform the following procedures under the supervision of the senior resident or consultant.Minor infections . blood extractions. endotracheal intubation.NEWBORN SERVICES DIVISION RESIDENCY LEARNING OBJECTIVES A.Infant of substance abusing mother
2.R/O sepsis – short term antibiotic administration . breastfeeding. lumbar tap.Malformations and common birth injuries not requiring intensive care .
c. hepatitis B vaccinations as done per month as part of data collection b. the second year resident is able to: a. Evaluation: Written and oral examinations at the end of each rotation will be given.g. 23 Department of Pediatrics 166 Rev3Iss4 01-Apr-2010
. Discuss basic diagnosis and management of patients among interns c. B. retinopathy. d.a. Do ventilator management beyond initiation stage. Perform diagnostic and therapeutic management to a neonate with:
OPM No. Should be able to recognize the need to intervene with Oxygen Bag and mask ventilation Intubation Chest compressions Initiation of IV fluids Management of meconium deliveries NG/OG tube placement Umbilical cannula placement Evaluation of progress of resuscitation b. Second Year Resident Duration of Rotation: Minimum of 2 months 1. eg: Respiratory distress Neonatal sepsis Common congenital malformation Apnea of prematurity Anemia Infections Nutrition and growth in the premature infant Chronic lung disease Post-operative congenital heart disease GI problems that affect growth and nutrition Screening issues (e. Obtain a concise history and thorough physical examination b. Make correct decisions surrounding delivery room management. Terminal competencies Expected Clinical Skills At the end of their rotation. is able to: a. Should be knowledgeable with moderate to serious neonatal problem. Present / write a case report d. Conduct basic lectures for interns As Researcher. Critically appraise literature c. Prepare the monthly census of normal newborns and records hearing screening test. ICH) Developmental follow-up and early intervention 2. Entry knowledge and skills: The second year resident should have the expected terminal skills of a first year resident and: a. Formulate a research question 3. Present clinical data of patient during rounds / conferences b. hearing.
Present lectures / case discussions on assigned topics / patients c. 23 Department of Pediatrics
. Extremely low birth weight Respiratory distress Suspected congenital heart disease Possible “inborn error of metabolism” Surgical problem Hyperbilirubinemia requiring an exchange transfusion Suspected neurological injury or condition. Entry knowledge and skills: The third year resident should have the expected terminal skills of a second year resident and is able to: a. Formulate a research proposal to be approved by the Research Committee b. endotracheal intubation. Interpret arterial blood gas result and give appropriate management c. urinary catheterization. Manage more specific “NICU” diseases RDS/TTNB/Pneumonia/Aspiration syndromes Pulmonary hypertension Patent ductus arteriosus BPD or CLD and associated problems Necrotizing enterocolitis Sepsis and shock Intra-uterine and perinatal asphyxia and consequences Various congenital anomalies Congenital heart defects Inborn errors of metabolism f. Recognize respiratory failure and apply the basic principles of assisted ventilation and its appropriate intervention b. gastric lavage) As a Teacher is able to: a. C. Evaluation. Have increasing leadership responsibilities. Teach / supervise first year residents and interns b. lumbar puncture. Prepare monthly census for: sick and problematic babies congenital disorders surveillance for nosocomial infections 3. exchange transfusion. Third Year Resident Duration of rotation: Minimum of 2 months 1.
OPM No. needling. Present monthly morbidity and mortality census As a Researcher is able to a. Perform special procedures (umbilical cannulation.written examinations and skills performance evaluation will be given. e.
Guide the 1st and 2nd year in their research 3. Care for the post-operative cardiac patient As Teacher / Manager is able to: a. Conduct daily teaching and chart rounds to nurses. Obtain concise and organized clinical data (complete history and physical examination) b. Formulate preventive care g. Ensure that data collection by 1st and 2nd year is done accurately and is up to date b. Terminal competencies Expected Clinical Skills At the end of their rotation. Evaluate the 1st and 2nd year rotators of their skills and knowledge d. Act as a preceptor or trainer for first and second year as future medical students b. Correlate clinical and laboratory findings f. the third year resident is able to: a. 23 Department of Pediatrics
OPM No. Evaluation – a written examination and performance evaluation will be given. interns and junior residents As a Researcher is able to: a. Present monthly morbidity and mortality if there is no 2nd year resident c.2. Formulate an assessment / diagnosis based on clinical data c. Carry out special procedures e. Formulate a diagnostic and therapeutic management plan for each patient d.
Other member hospitals include Cardinal Santos Medical Center.I. Our Lady of Lourdes Hospital and Victor R. (Please refer to Attachment N – Grand Rounds Evaluation Form)
First Integrated Residency Training (F. Germana Gregorio Dr. Victor Doctor TMC Dr. An annual research contest is also held.I. The member hospitals have weekly CME activities which include the following: lectures or updates.T)
The Medical City is one of the member-hospitals of FIRST.S. In addition. Dyspepsia & related diseases
TMC Dr. Joel Elises OLLH TMC CSMC
Infectious GIT Diseases Renal Failure
17 20 27 April & May June 5 12 19 26
Lecture 6 Grand rounds CPC Grand rounds
Grand rounds Lecture 7 MID YEAR EXAM CPC
ERD. Potenciano Medical Center. the residents of the four hospitals take 2 examinations per year (midyear and year-end). 23 Department of Pediatrics
.S.) PEDIATRIC PROGRAM INC. grand rounds or clinico-pathologic conferences. Agnes Alarilla-Alba CSMC Carol Hernandez
Basic Pediatric Nutrition
Acute Abdomen Nephritis
Dr. THE MEDICAL CITY Secretariat 2007
DATE January 9 16 23 30 February 6 13 20 27 March 6
ACTIVITY Lecture 1 Grand rounds Lecture 2 CANCELLED Lecture 3 Grand rounds Lecture 4 Grand rounds Lecture 5 UTI
HOSPITAL Dr. Mary Jean Guno
169 Rev3Iss4 01-Apr-2010
OPM No. Delfin Cuajunco VRPMC Dr.T.R. the coverage of which include the topics discussed during the FIRST conferences.FIRST INTEGRATED PEDIATRIC RESIDENCY TRAINING PROGRAM (F.R.
Vincent Alba VRPMC Dr. Stella Guerrero-Manalo
Research Paper Presentation YEAR END EXAM Endorsements
OPM No. Eileen AlikpalaCuajunco OLLH Dr.July 3 10 17 24 31 August 7 14 21 28 September 4 14 18 25 October 2 9 16 23 30 November 6 13 27
Lecture 8 Grand rounds Lecture 9 Grand rounds Lecture 10
Obesity Newborn screening Diabetes Mellitus
Dr. Sylvia CapistranoEstrada Dr. 23 Department of Pediatrics
. Eva Maria CutiongcoDelaPaz VRPMC Dr. Carmela Kasala CSMC
Lecture 11 Grandrounds Lecture 12 CPC Lecture 13 Grandrounds Lecture 14 CPC Lecture 15 Grandrounds Lecture 16 Grandrounds Lecture 17
Genetic & Dysmorphic Child Treatment & Diagnosis of Atopic Diseases
Food Intolerance vs Food Allergy Adverse drug reactions and anaphylaxis
Dr. Carmencita Padilla TMC Dr. Sioksoan Cua CSMC Dr. Maria Beatriz Gepte OLLH Dr. Michelle DeVera VRPMC
Anemias Blood components: use and abuse Child Abuse & Medicolegal Issues
23 Department of Pediatrics
172 Rev3Iss4 01-Apr-2010
OPM No. under the supervision of an intensivist. and indications for emergent intervention. timely. Medical Ethics and Legal Issues Become familiar with ethical and medical-legal considerations in the care of critically ill children. particularly airway management and resuscitative pharmacology Describe the common causes of acute deterioration in the previously stable PICU patient. and be able to describe the physiologic basis for therapies. further evaluation. Rapidly recognize the sign or symptom as heralding the onset of disease or injury and perform a directed pertinent history and physical examination Formulate an age-appropriate differential diagnosis Discuss indications for admission to and discharge from the PICU. Goals Resuscitation and Stabilization Understand how to rapidly resuscitate and stabilize the critically ill child in the PICU setting. including when to transfer to an intensive care setting. Function appropriately in codes and resuscitations as part of the PICU team. Devise a plan for stabilization. Monitoring and Therapeutic Modalities Understand the application of physiologic monitoring and special technology and treatment in the PICU setting. PICU Medical Records
Understand how to maintain accurate. Skills / Competencies At the end of the rotation in the PICU. Management and Decision Making Develop case management skills for complex multi-problem patients under high stress situations. and definitive management. Common Conditions Understand how to manage certain common diagnoses (reasonably expected of general pediatricians) in the PICU setting. Patient Support and Advocacy Understand how to provide comprehensive and supportive care to the PICU patient and his family. Teamwork and Consultation Understand how to function effectively as a team member in the PICU.TRAINING PROGRAM FOR RESIDENTS (PICU) A. and legally appropriate medical records on complex and critically ill children. the resident must be able to: Explain and perform steps in resuscitation and stabilization. as well as procedures for stabilization prior to transport to the PICU. Common Signs and Symptoms Understand how to evaluate and manage common signs and symptoms seen in critically ill children. Diagnostic Testing Understand how to use and interpret laboratory and imaging studies in the PICU which can be reasonably expected of general pediatricians. 23 Department of Pediatrics
. Financial Issues and Cost Control Understand key aspects of cost control in the PICU. using principles of decision-making and problem solving and understanding one‟s own limits.
and skill in dealing with death and dying with the child. Describe hospital policy on “Do Not Resuscitate” orders. among others). integrate understanding of physiology and pathogenesis to determine the appropriate use of therapy and how to monitor its effect and describe its potential complications: . skills. consultants. Recognize the limits of one‟s knowledge. Provide pediatric consultation to surgeons and other specialists who manage children in the PICU. Communicate well with children and families. and tolerance for stress level. refer families for social services support as needed. and be able to evaluate prognosis.. withdrawal and withholding of care.enteral and parenteral nutrition .
Discuss the pathophysiologic basis of the disease or injury. Develop and maintain a detailed problem list with accurate prioritization. nurses. Prepare appropriate and timely discharge and transfer notes.basic ventilator management . even outside the scope of this ICU admission. mask. appropriately intervene or refer (i.oxygen administration by cannula. Maintain daily. Demonstrate awareness of cost of PICU care and its impact on families. 23 Department of Pediatrics
.analgesics. importance of anticipatory guidance in teaching parents about the early signs and symptoms of serious. hood . sedatives and paralytics . Explain potential acute and long-term consequences and complication of the disease and treatment.e. PCWP. Recognize and evaluate the psychosocial need of acutely ill children and their families. sensitivity.blood and blood product transfusions . the family. Know how to assist referring physicians in preparing a patient for transport to the PICU. Demonstrate respect. Describe the indications and general technique and appropriately interpret the results of invasive procedures performed in the PICU (CVP. PAP. Define brain death and describe criteria for organ donation. and other health care professionals. ask for help when needed. timed notes.positive pressure ventilation . Identify problems and risk factors in the child and family. Use consultants and resources appropriately. both during the immediate illness and during recovery.vasoactive drugs (pressors and inotropes) Coordinate orderly transfer of care to another provider when intensive care is no longer needed. injury prevention. Coordinate with multiple consultants involved in the care of the patient. ancillary staff and referring physicians.
Three second or third year residents rotate at the PICU for 2 months with each resident going on 24hr duty every 3 days. Tour of duty starts at 7:30 am and ends at 7:30 am the next day. intracranial monitoring. clearly documenting the patient‟s progress and details of the ongoing evaluation and plan. Communicate well and work effectively with fellow residents. For the common therapies listed.
OPM No. Discuss concepts of futility. life-threatening disease). with update as necessary. Consistently act responsibly and adhere to professional standards for ethical and legal behavior.
Attendance is logged. No resident shall be allowed to go on leave during the intensive care rotation. The on-call PICU resident is primarily responsible for all the patients during her tour of duty. Time off may also be spent for research or reports. All rotating residents are required to attend morning endorsements. She shall be responsible for transporting patients for diagnostic procedures. EVALUATION written exam presentation during rounds with the consultant presentation during the grand audit evaluation form
OPM No. The patients‟ charts are reviewed prior to bedside endorsements. The post-call resident after endorsements will be given the day off to rest and complete required documentations. Regular Activities (Venue: ICU conference room) First Friday of the month Second Fridays Third Fridays Fourth Fridays Every 2 weeks End of Rotation Audit Case Management Journal Report Lecture (PICU consultant or PICU rotator) Radiology Rounds Written Exam Consultant‟s Evaluation
Rotating residents shall present the ICU census at the department grand audit. She is never to leave the ICU for any reason without endorsing the patients to the pre-call resident who shall take over patient care. The pre-call PICU resident shall assist the on-call resident in patient care during office hours.Endorsements from the post-call ICU resident starts promptly at 7:30 am. She shall accompany patients who are for transfer to other institutions. 23 Department of Pediatrics
Their tour starts from 7 a. anesthesia. emergency room consultants. The pediatric emergency care rotation is designed for the resident to develop the ability and skills to triage. Pre-duty ER residents shall be called as backup in situations of heavy patient flow at the pediatric ER. In the afternoon they shall go to their designated areas of assignment in the pediatric floors or report back to the ER as backup in situations of heavy patient flow. psychiatry). until 7 a. B. Certification is updated every 3 years. pediatric attending. Two second year residents go on 24-hr duty every 3 days. Develop skills in the performance of pediatric emergency procedures. subspecialists. Overview The second year pediatric resident rotates at the ED for 4 weeks for a total of 3 months.m. Continue to develop an understanding of health delivery in the emergency room setting. they shall go to their designated areas of assignment in the pediatric floors. evaluate and manage children aged 0 to 18 years and 364 days presenting at the ED with a variety of medical as well as surgical problems. Post-call ER Residents shall be given the morning off after they have completed the daily logs and documentations and after the morning endorsement rounds with the ER consultants. with the rotating intern in attendance whenever possible. residents from other specialties (surgery.
1. Duties & Responsibilities Residents go on monthly rotation at the Pediatric Emergency Room and are under the direct supervision of the Pediatric ER Committee and the Pediatric Consultant staff. Goals and Objectives of the ER rotation: Develop competence in the assessment and care of the pediatric patient especially in determining the need for emergent or urgent evaluation.m. Rotating residents will work closely with other team members including other pediatric residents.PEDIATRIC EMERGENCY ROOM RESIDENT ROTATION A. Concentrate on the foundation of basic medical science and clinical knowledge integral to pediatric disease.
OPM No. Continue to develop methods of scientific investigation and critical review of scientific literature. of the next day when their relievers shall have reported for duty and after the morning endorsement rounds with the on-service ER consultant. knowledge. Otherwise. and training to provide emergency evaluation and treatment of children of all ages. 23 Department of Pediatrics 175 Rev3Iss4 01-Apr-2010
. Rotating Pediatric Residents: Qualifications Second year pediatric residents who have the necessary skill. obstetrics & gynecology. nurses and support staff to triage and care for these patients. ENT. He shall take a concise and accurate clinical history and perform a complete physical examination on all pediatric patients consulting at the ED. ophthalmology. Continue to develop interpersonal as well as communication skills as a member of the medical team with emphasis on physician-patient and physician-parent relationships. Certified in neonatal resuscitation and pediatric basic and advanced life support. He shall promptly (in less than 15 minutes) attend to all pediatric cases with due regard to logical and reasonable prioritization of activities and resources.
clinical histories may be completed within 4 hours for critically ill patients and within 12 hours for those who are not critically ill. He shall refer any case that in his/her judgment requires referral to other specialties. He/she shall make a formal report on an intern‟s performance and shall submit said report to the intern‟s monitor. . post-call. reviewed and signed. Such referrals can either be to another member of the house staff or to a member of the consultant staff. medical knowledge. practice-based learning and improvement.Pediatric patients for surgical clearance should be seen and examined at the pediatric ER by the surgical resident-on-duty and the Emergency Medicine Consultant.-
For admitted patients. All orders made shall be properly recorded. in circumstances of high patient load at the ER. the procedure log is reviewed as part of the evaluation. professionalism and systems-based practice. make evaluations. He shall document procedures in the patient chart and in his personal procedure logbook. However. Competencies At the end of the rotation. the ER-ROD‟s admitting history should accompany the patient‟s record upon transport from the emergency room to the unit. interpersonal and communication skills. He shall make the daily ER census and complete all patient charts/documentations prior to post-call status. The Pediatric ER-ROD shall directly supervise the rotating interns. . The ER-ROD is authorized to assign duties and tasks to interns. He shall properly endorse patients for admission to the pediatric units to the receiving floor resident-on-duty. 1. Patient Care a. . residents will be assessed based on the following competencies: patient care. No orders shall be made by the rotating intern. preduty).All gynecologic referrals should be seen and initially assessed by the OB-ROD at the Pediatric Emergency Room. Attendance to morning endorsement/teaching rounds/chart rounds with the ER consultant-ondeck is mandatory whatever an ER resident‟s duty status may be (on-duty. Referrals should be made directly to the specialty resident and never to the intern. He shall attend the monthly ER mini audit and all meetings set by the committee when resident attendance is specified.All psychiatry cases are referred to the psychiatry resident after initial assessment of disposition and management. Critically ill patients should be endorsed directly to the senior of the service during office hours or to the senior resident-on-duty after office hours. The procedure log is filled out after a procedure is successfully performed and should be signed by the supervising consultant.
C. He shall promptly inform the attending physicians of admissions to their service and inform them if any of their patients has been seen at the ER for outpatient consultation. 23 Department of Pediatrics 176 Rev3Iss4 01-Apr-2010
. At the end of the ER rotation. and monitor compliance with existing policies and standards. Competence in triaging and the rapid assessment of urgent / emergent patients
OPM No. Under no circumstance shall patients be initially assessed and treated by an intern. recommend disciplinary measures. oversee their performance. He is required to attend the monthly mini-audit and is expected to be adequately prepared for it. He shall make a diagnosis or a clinical impression and decide on the management and disposition (send home/admit/observe at short stay area) of all pediatric patients.
g. Competence in determining need for admission or readiness to discharge after thoughtful review and accurate interpretation of diagnostic results and reassessment of the patient during interventions. Procedures will include arterial punctures bladder catheterization / suprapubic aspiration endotracheal intubation intraosseous line placement intravenous catheter placement lumbar puncture nasogastric tube placement gastric lavage umbilical cannulation procedural sedation and pain management venipuncture urethral catheterization burn debridement suturing and wound care d. All procedures will be documented in the patient‟s chart and in the resident‟s individual procedure logbooks. Ability to manage patients diagnosed with Fever Cardiac arrest Sepsis Dehydration & electrolyte imbalance Fractures Burns Seizures Respiratory distress/failure
Suicidal ideation/attempts Toxic ingestions/poisoning Trauma Near drowning Bites and stings Shock / anaphylaxis
OPM No. Ability to demonstrate knowledge on basic sciences and clinical principles that are important in the practice of pediatrics. Competence in planning and performing appropriate diagnostic and therapeutic interventions in consultation with the emergency room consultant or the primary attending and after obtaining informed consent from the patient. Demonstrate investigatory as well as analytic thinking in the approach to clinical situations 3. e. Competence in acute pediatric care including cardiopulmonary resuscitation. initial stabilization and resuscitation of the critically ill. D. Competence in the performance of a problem-based pediatric history and physical examination and in the formulation of a differential diagnosis after initial evaluation of the patient c. 2. parents or the primary caregiver.b. management of shock f. Competence in the logistics of transporting a critically ill or wounded pediatric patient. 4. 23 Department of Pediatrics
. Demonstrate competence in research skills and methods of scientific design and investigation through ongoing research and completion of faculty monitored research program. Ability to provide compassionate. Medical Knowledge 1. developmentally / age-appropriate and effective familycentered care and encourage proactive involvement in medical management through counseling and education. Ability to work closely with a multidisciplinary team in the immediate stabilization of the multiply injured pediatric patient h.
Competence in using evidence-based medicine in patient care practices and in the improvement of patient care practices. informed consent. 2. Clinical competence ( history taking and physical examination. Practice-based Learning and Improvement 1. etc. H. Professionalism 1. 3.) as well as a commitment to excellence and ongoing professional development 3. 2. Feedback is given about strengths and weaknesses. J. Supervision Pediatric emergency room residents are directly supervised by the ER coordinator and members of the ER committee. Ability to demonstrate professional attitude and behavior in dealing with superiors and peers. professional attitudes and behavior. the junior ER consultants. Ability to use information technology to manage information. Ability to rally for quality patient care and assist patients in dealing with system complexities. End of rotation written examinations ( passing score = 75 )
OPM No. provision or withholding of care. Ability to establish rapport with patients and relatives. Evaluation 1. Systems-based practice 1. the attending pediatricians as well as the senior pediatric residents. Ability to work effectively with others as a member of the team. Ability to demonstrate a commitment to high legal and ethical principles (patient confidentiality. compassion and integrity in dealing with patients. Facilitate the learning of other members of the health care team (interns. Formative evaluation Observed history taking and physical examination skills by the members of the ER committee during their weekly supervision schedule. I. moral and ethical behavior) Residents are evaluated by the ER coordinator and the members of the ER committee on these components of clinical competence at the end of the rotation. Ability to create and sustain a therapeutic and ethically sound relationship with patients and their families 3. access on-line medical information and further their own education and learning 3. nurses. 2. 23 Department of Pediatrics
.E. 2. Ability to practice high quality but cost-effective health care and resource allocation 2. technical skills. Interpersonal & Communication Skills 1. auxiliary staff) F. clinical judgment. G. Competence in demonstrating respect.
3. History taking / Physical Examination b. the next day when their relievers shall have reported for duty.m. Gastric lavage and catheter flushing f. management and disposition of patients 4. and ends at 7 a. Insertion of intravenous lines. Interns shall assist the pediatric ER-ROD in the diagnosis. Perform patient care functions after initial assessment by the resident. In case of heavy patient flow at the pediatric ER. a. 23 Department of Pediatrics
. i. All interns assigned to the ED shall sign in and sign out in the attendance logbook. ECG taking c. 2. Interns on duty do not leave the area at any time. Attend the daily morning endorsements / chart rounds with the on-service consultant and the rotating ER residents
OPM No. Monitoring of critically ill patients g. Pediatric ER interns go on 24-hr duty every 3 days on a monthly rotational basis.e. Any other related activity on orders of the resident-on-duty Patient care functions are done under the direct supervision and express approval of the pediatric resident-on-duty. Qualification: He shall have fulfilled the requirements of the internship program Duties & Responsibilities: 1. Two (2) pediatric interns go on 24-hr duty at the pediatric ER. nasogastric tubes and foley catheters e. Blood extraction d.m. The interns monitor in coordination with the ER Surgery ROD will regularly check the logbook. the pre-duty pediatric ER interns shall be called to assist in patient care.ROTATING INTERNS A. The tour-of-duty starts at 7 a.
Each KPI are detailed in the Balance Scorecard and shall be reported on an annual basis to the department chairman and the head of Medical Quality Improvement Office. 23 Department of Pediatrics
. (Please refer to Attachment O for the Balance Scorecard Matrix)
OPM No.PERFORMANCE QUALITY MONITORING
The sections heads shall identify and monitor the key performance indicators of each section.
data and materials received or created by the Section in connection with the operation of its services.List of Documents for Disposition and Appendix I .Guidelines in Accomplishing List of Documents for Disposition)
OPM No. maintained and properly discarded when the retention period exceeded. This policy also to ensure that all record and documents are adequately safe kept. 23 Department of Pediatrics
. Purpose This policy provides for the systematic retention of documents.RETENTION OF RECORD A. (To identify the retention periods and manner of disposal of records and documents please refer to Attachment P .