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UNIVERSITY OF PERPETUAL HELP - DR. JOSE G.

TAMAYO MEDICAL CENTER


STO. NIÑO, BIÑAN CITY, LAGUNA
DEPARTMENT OF SURGERY

SURGERY ROTATION GUIDELINES

Pre Duty (OPD)


1. Usually the OPD will start at 8:30AM but still you need to sign in at 7am, make sure you eat your breakfast
before going to OPD
2. Always bring your tackle box. Make sure your tackle box is full of dressing materials needed by our Jonelta
Patients. It is necessary to fill up your tackle box with the following materials, don’t empty your tackle
box.
a. Sterile Gauze/OS
b. Betadine
c. Hydrogen Peroxide
d. Clean/Surgical Gloves
e. Cotton balls
f. Instruments (2 kelly, 1 iris, 1 bandage scissors)
3. When there is an OPD OR, it means that the OR is elective/ the patient is not admitted (outpatient). It is
the pre duty clerk who will accompany the patient at the OR and assist the consultant or resident to the
procedure. It’s up to you how you will deck this among your group mates(Alphabetical or Crowd’s
favorite)
st
4. New patient (New chart-1 consult with surgery)
a. Chief complaint
b. History and PE (Surgical/Non-Surgical)
c. Picture of the lesion
d. Refer to intern/resident
5. Old patient
a. Usually they come for follow up
b. S-O-A-P (include picture of lesion/wound)
c. Refer to Intern/Resident
6. If the patient has a mass, wounds, lacerations, diabetic foot or anything that is surgical, even if it’s a
wound that needs to be dressed, it’s a must to take a picture of it (you must be able to still give a detailed
description of the wound i.e. size, character, color, smell, etc). Pictures can be sent via viber.
7. Sometimes the medical records will ask you to fill up some DOH forms, it is also the pre duty clerks who
fill up those forms.
8. There are some patients who will come to OPD for change of IFC, removal of JP drain and
Excision/Incision, make sure to prepare the necessary materials needed by the residents for the
procedure (DO NOT PERFORM ANY PROCEDURE WITHOUT A RESIDENT PRESENT UNLESS INSTRUCTED
OTHERWISE)
a. Surgical Instruments (kellies, needle holder, blade holder, scissors,retractors if available)
b. Clean/Sterile Gloves
c. Materials in your tackle box
UNIVERSITY OF PERPETUAL HELP - DR. JOSE G. TAMAYO MEDICAL CENTER
STO. NIÑO, BIÑAN CITY, LAGUNA
DEPARTMENT OF SURGERY

Duty (ER)
1. It’s the Duty people who will stay at the ER.
2. Teamwork is essential in surgery.
3. Usual cases in the ER
a. Trauma (head/chest/abdomen/extremities)
b. Fall
c. Stab wounds/gunshot sounds
d. Vehicular/industrial accidents
e. Sports injury
f. Abdominal pain (Appendicitis/cholecystitis/trauma)
g. Acute urinary retention
4. When examining a patient, especially in trauma/emergency cases
a. get the History and PE (vital signs and pertinent findings)
i. Don’t forget to include the NOI, TOI, POI and DOI
b. do wound care and take a picture of the wounds/lacerations/injury (IF UNSURE ON HOW TO
DRESS THE WOUND, INFORM THE RESIDENT AND WAIT FOR FURTHER INSTRUCTIONS)
c. Emergency cases like Stab wounds and VAs ( all clerks should wear clean gloves and attend the
needs of the patient) – REVIEW ABCDE AND AMPLE FOR TRAUMA.
5. When referring emergency cases
a. ABCDE
b. AMPLE
c. VITALS
d. GCS
6. 2clerk will be assigned to do the census each duty ( Censuser)
a. Must do his/her own chart rounds to update the census and the residents if there are new lab
results – to be double checked by yourintern on duty
b. Always present during rounds with the residents
c. Must have his/her own laptop
d. Provide 12-13 copies of census for the next duty team
i. 6 for the SROD
ii. 2 for the Interns
iii. 2 for the clerks including the next censuser
iv. 1 for Mam Lolit’s copy
v. 1 for medical records
vi. 1 for compilation

7. 2-4 people will be assigned to be the Dressing team


a. Dressing team are also present during rounds with the residents
b. Help the Censuser to gather all the charts of the patient and put the latest vital signs on the
doctors order sheet
UNIVERSITY OF PERPETUAL HELP - DR. JOSE G. TAMAYO MEDICAL CENTER
STO. NIÑO, BIÑAN CITY, LAGUNA
DEPARTMENT OF SURGERY

c. Do change of dressing for in patients (CONFIRM WITH SROD REGARDING WHO AND HOW TO
DRESS)
d. Ask the nurses for some dressing materials for each patient (most especially for private patients)
e. You still need the bring your tackle box during rounds
f. At the end of your duty, you will be endorsing the patients with dressing to the next duty
dressing team (HAVE THE JUNIOR SROD CHECK THIS LIST)
i. Dry dressing
ii. Fluffy dressing
iii. Wet to dry dressing
iv. Open dressing
v. CTT care (ALWAYS WITH SROD)
vi. Daikins Solution wash
g. Make sure to dress all the patient before endorsing it to the next duty
8. It will be a DUTY DECKING in surgery.
a. Things to accomplish if a patient is decked to you
i. Paperwork
1. 2 Admitting Hx
a. Clerk’s copy
b. Resident’s copy
2. Therapeutic index
3. Progress notes
4. 24 hours history
5. Discharge Summary
6. Clinical Abstract
ii. Referrals
1. Referral form (green form- you can get at the nurses’ station)
2. Progress notes
3. Therapeutic index
b. If the patient decked to you is for OR or has a scheduled procedure
i. The Clinical clerk in charge (CIC) will update the residents about the status of the patient
for OR, if its
1. Billing cleared
2. CP/ENDO/NEPHRO/PULMO cleared
ii. Should be at the OR 30mins or 1hour before the procedure and text the resident if the
patient, consultant or anesthesiologist on duty is in the OR already
iii. The CIC will scrubbed in to assist the consultant/resident on the procedure
iv. If the CIC is an International Student, a local clerk will accompany the IS inside the OR
v. Don’t let the resident to leave the OR without finishing the OR tech of the patient
1. Bring long bond papers for the OR tech
UNIVERSITY OF PERPETUAL HELP - DR. JOSE G. TAMAYO MEDICAL CENTER
STO. NIÑO, BIÑAN CITY, LAGUNA
DEPARTMENT OF SURGERY

2. There is a computer inside the OR were OR techs are typed and printed
(password: eklavush)
3. Make sure to have 4 copies
a. 2 for the patient’s chart
b. 1 OR copy
c. 1 resident’s copy ( we are the one also to compile this at the end of
the month/rotation)
vi. Make sure to have a picture of the patient Pre-Op, Intra OP and Post OP, if you are
scrubbed in, let the Intern In Charge to take the picture
vii. For the patient’s specimen
1. Take a picture of the specimen that is placed on a measuring board
2. Fill up the Histopathology form (before submitting this form to the lab, it must
be signed by the OR nurses)
3. Submit the specimen and the histopathology form to the lab
4. If you lost the specimen or misplaced it = Repeat Rotation
5. IMMEDIATELY SEND PICTURES TO RESIDENT ASSIGNED TO THE OR VIA VIBER
viii. After the procedure, the patient will be sent to Recovery Room (RR) and the CIC also will
monitor the patient post op.
1. Monitoring sheet is at the nurses’ station (Post Anesthesia Care unit form or
PACU form)
2. You will monitor until the patient is transferred out to OR
ix. Regardless of your status, if you are the CIC and the patient are for OR you will be the
one to enter and scrub in.
x. You will only be relieved in the RR by the duty people if the procedure finished beyond
your status. Example:
1. You are Pre duty/From and your patient is for OR at 4pm and approximately it
will finished at 6pm, after the procedure that is the only time you will be
relieved by the Duty people in the RR.
9. 1 clerk will be assigned to get the OR schedule for the next day and send it to all clerks and interns (SEND
OR SCHED TO JUNIOR SROD FOR CORRECTION BEFORE SENDING TO EVERYBODY ELSE)
a. There is a huge white board inside the OR where you can see the OR schedule, if nothing is
written there ask the nurses
b. Text all the OR sched to your Resident on duty (junior) ,
i. Patient’s general data (name, age, sex)
ii. Procedure and time
iii. Attending physician
iv. Resident in charge
v. Intern and clerk in charge
vi. CP/Billing cleared
c. Wait for the resident’s confirmation before sending it to all the clerks and interns (day 1 to Day 3)
UNIVERSITY OF PERPETUAL HELP - DR. JOSE G. TAMAYO MEDICAL CENTER
STO. NIÑO, BIÑAN CITY, LAGUNA
DEPARTMENT OF SURGERY

From Duty
1. There is a white board at the ER, make sure to change the decking of the consultant per day
2. Complete all the ER sheet and log it all to the ER logbook
3. Floaters
NOTE:
1. Sign in 7am and sign out 5pm at Clerks Logbook in the ER
2. Present in your ward bag or pocket (ALL CLERKS ARE REQUIRED TO CARRY BELT BAG/WARD BAG AT ALL
TIMES REGARDLESS OF STATUS)
a. Bp app, Steth, Pulse ox , Thermometer
b. Bandage scissorS and Clamps (Kelly, mosquito)
c. Micropore
3. Always bring scrub suit, face mask and OR cap REGARDLESS of your status
4. Wednesday conference 1pm at Surgery Office (ATTENDANCE IS A MUST REGARDLESS OF STATUS, FAILURE
TO ATTEND = OUT OF POST)
5. OPD is half-day on Wednesday, No OPD during Saturdays (Pre duty – Floaters) – STILL 7AM-5PM
6. Know the type of Dressing
7. Materials needed for Suturing
a. Nylon 3.0/4.0/5.0, Needle holder, Surgical gloves (2 pcs), Lidocaine, Scissors
b. Cotton balls with betadine and hydrogen peroxide, Gauze/OS
8. Always get the radiographs of the patient and take pictures of it
9. Have VIBER application on your cellphone
10. Honesty is the best policy
11. Good luck and Enjoy your Surgery Rotation
12. ALWAYS BRING YOUR COMMON SENSE WITH YOU AT ALL TIMES. REGADLESS OF STATUS.
13. Don’t be too sensitive. The residents can be high strung sometimes, but they are very nice. =)
Prepared by:

Edmund Carlo T. Briones


Kareen L. Ultra
(September-October Surgery Clerk – Class 2018)

Noted by:

Kathryn Reunilla, MD Eva Donna Ecle, MD


rd
2 year Surgery Resident Assistant Chief Resident
th
Interns Monitor 5 year Surgery Resident

Jack Echauz, MD
nd
2 year Surgery Resident
Clerks Monitor