VSMMC ORTHO ROTATION

RESIDENTS

● Dr. Jarl Rañola - Chief

Resident
○ If he messages
to rounds, go immediately
● 1st years
○ Dr. Maki Cebedo
○ Dr. Jeric Chua
○ Dr. Graymar Ypil
 1. LOG -IN : Ortho office (near ER elevator and ED-OR)
2. Leave your belongings in Call Room (same as Neuro) (3rd floor above Neuro
ward/ward 11)
3. Get endorsements from previous shift
4. Start with paperless (you can go earlier than your shift)
5. Submit the clerks on duty that shift to “ORTHO Residents | PGIs | Interns” group
chat [subspec GC]
Example:
Good morning/afternoon/evening Doctors!
Respectfully informing you that we are the AM/PM clerks today for 03/21/23 (7AM -
7PM):

MHAM Clerks
1. Flores, Uzzhiel - 09171363259
2. Ganub, Laarni Jayne - 09603395765
3. Sinajon, Julia Ainah Marie - 09497974010

UV CLERK
Khandla Kalpesh- 09762271785 / 09477152541

CIM Clerk
1. Otadoy, Krisha Ann - 09617169248

Thank you so much!

6. Endorsement: 7:00 in Ortho Office (near ER elevator and ED-OR)

● all clerks and PGIs must attend unless you are in OR (usually lasts 2 hours)

ASSIGN- Preduty - Assist OR, Errands, Paperless

MENTS Duty - Assist OR, Errands, Paperless
Previous - Doctor’s notes/CF4 (at Philhealth office near Surg Hall)

GROUP ● Always acknowledge chats then make a "to-do list” or “reminders” in “ORTHO
CHAT CLERKS” GC
● Update in real time if possible if ongoing or done para dili magdoble
● Support each other kay daghan kayg sugo usahay

OR ● 1st Call, 2nd Call, 3rd Call and etc.

● OR Point Person /OR Chief: Assign who will scrub-in OR (MHAM assigned)
○ There is a decking sequence in “Ortho Clerks” group chat
■ Scrubbing order is CIM-UV-MHAM
■ Or it depends sa ka duty ninyo na clerks from other schools,
swerte if helpful and dili mangwenta ug tasks
○ If school to supposedly assist take long to respond, find any free clerk
○ Late respond to OR assist = IR!!
● Acknowledge resident’s message in GC:
○ “1 clerk to OR for ________”
 ■ aka runner; usually to take specimens to the lab; blood
request/blood release (make sure to bring an ice bucket and
check all infos are correct.
■ Go to OR
■ Message na ur outside the OR na or tell the nurse that you’re
the runner
■ Get container, blood availability form, and blood release order
■ Bring to blood bank
■ Get blood and bring back to OR
■ NO ABBREVIATIONS AND ERASURES (if there is, make sure
they tamla it).
○ "1 clerk to ED-OR or OR-UP or OR-DOWN scrub in/ assist"
■ If you are called to scrub in pls make sure to endorse to other
clerks of what you are doing or any pertinent info
● Scrub in:
○ Ask the resident who chatted the full name of the patient
○ Hoard xray forms before changing if you can
■ Prepare 1 xray form (½ paper siya, sometimes the OR nurses’
station sometimes they don’t, hoard lang from the radio dept)
○ Bring scrubs
○ Ask the resident who chatted if you need to prepare PNSS and how
many liters, usually
■ 2L PNSS - for ED-OR
■ 6L PNSS - for Main OR
● If so, then do paperless (http://172.16.1.12:9005/) for admitted or
tagging (BizBox HIS) if still on blotter
○ Before changing with green scrubs (if ED-OR)
○ After changing with green scrubs (Main OR
○ Changing room
■ Comfort room - for ED-OR
● You can use shoe cover found at the ED-OR near the
entrance door
■ Student Lounge in OR-DOWN - for Main OR
● You can bring food or water cause there’s a pantry
while waiting for the patient to be wheeled in
○ If extra ka, you can make a “text brigade” if the surgeon is not yet in.
PM the surgeon in messenger or his number if you have it
Good morning Doc. This is Surg Assist ___, sending updates as of
1:00 PM, 3/22/23

Patient: ___
Age/Sex:

Procedure: (if kabalo lang ka, but most of the time surprise effect ra
jud sya so pwede ra wala ra ni na part)

Patient is not yet in

 Surgeon is not yet in
SC ___ is in

Thank you Doc!

○ Alternative:
■ Just PM:
● Good morning Doc. I am the Surg Assist for Patient
____ OR today. Patient is already at the OR lobby/ OR
Theatre. Thank you Doc!
○ Take note of the time of the following for filling up the gform for TURN
AROUND TIME : https://forms.gle/2ofdWQw7wLwX63St8
■ Time pt arrived at OR lobby
■ Time pt arrived at OR theater
■ Time surgeon arrived at OR lobby
■ Induction time
■ Cutting time
■ Closing time
○ Assist resident (retract, OS, suction)
○ Wait for resident to finish doctor’s orders
○ After OR:
■ Do paperless (see details below) for the medications ordered
by the surgeon and anes
● If system is down, make physical Rx
○ For ED-OR: ask in the ER Otho table → have
it signed by resident → insert in the chart
○ For Main OR: ask the nurse
■ If with SPECIMEN
● Fill out histopath form (usually for GS/CS and
Biopsy - separate forms)
● Tag order (see details below)
● Ask nurse to render
● AND MAKE SURE NA DI MAWALA ANG SPECIMEN
● SUBMIT DIRECTLY TO THE LAB
■ If for XRAY:
● Fill out x-ray request form
● Ask nurse to tag
■ If asked to stay with the patient at PACU
● message the residents if en route na ang patient to
X-ray from PACU
● Post-op patients need to be accompanied by a
resident at x-ray
■ Fill up TAT gform (link above)

PAPERLESS 1. Open http://172.16.1.12:9005/ik

2. Accounts: 1 person per account otherwise you will be logged out. Update gc if
you are using the account.
a. racabahug (PW: rannico13) - MHAM
 b. radira (PW: 123456) - CIM
c. sifernandez PW: RESIDENT
d. 3) heguieb (PW: hedaguieb) UV
3. Fill up the necessary details
a. NAME OF PATIENT
b. DEPARTMENT: ORTHOPEDICS
FOR OR (IF FOR PNSS)
● WARD: OR
● WARD NO. OR-UP/DOWN
● BED NO. OR1
● PRESCRIPTION TYPE:
REGULAR
● Indicate 6L (unless specified by
resident)
● Ask the OR nurse (or
admitting/blotter nurse if ED-OR)
to render order right away
● Claim sa pharmacy in
ORD-DOWN (or Pharmacy-ER if
for ED-OR)
● Place it in the designated OR
FOR WARDS PAPERLESS
FOR PACU (IF FOR MEDS)
● WARD: RECOVERY ROOM
● WARD NO: PACU
● BED NO: PACU
● PRESCRIPTION TYPE:
○ MONITORED - If
antibiotics
○ REGULAR - meds other
than antibiotics
● Take note:
○ 1 antibiotic per
prescription
○ Just place “NA” or “ - ”
for the allergies, labs if
ganahan kag paspas
○ Multiple entry if meds
other than antibiotics per
prescription
● Just tell PACU nurse you already
made the paperless
● You can also paperless again
the same meds for the patient’s
ward (Example: WARD: HRU)
so that on transfer from PACU,
the ward will have post-op meds
OF

Aug 22, 2022 PM SHIFT (2PM-10PM) NIGHT SHIFT

PLS PUT IF DONE August 22, 2022 - please (10PM-6AM) August 22
AM SHIFT (6am-2pm) if done please if done
Cut off time 9pm Cut off time 9pm CUTOFF TIME: 9AM

MHAM (racabahug) LRU - MHAM (racabahug)

Ward 2 - ANNEX A - *NICU MAIN -
Ward 3A - WARD 3B- *NICU ILI -
Ward 3B - 4A 1 (CFI) - *KMC -
Ward 4B - 4A 2 (CFI) - *ANNEX B -
Labor Room - PICU-
PHIC Male - WARD 10 ADULT (aka CIM (heguieb)
trauma & burns- VND 2nd flr) - *ND1 -
WARD 10 PEDIA - *ND2 -
UV (heguieb) CCU EXTENSION - *ND3 -
Ward 7 GF - TRAUMA AND BURN
Ward 8 - UNIT- UV (radira)
Ward 9 - VND EXTENSION *ND4 -
Ward 11 - GROUND FLOOR - *EREID-
Annex B - *NEWBORN WARD-
*VND Extension 3rd floor-
CIM (RADIRA)
SP GROUND -
SP SECOND -
SP THIRD -
ICU/CCU -
Ward 1 (HRU) -
Ward 1 LRU
NICU
PICU
ND1
ND2
ND3
ND4
CFI UP (WARD 4A)
CFI DOWN (WARD 4A)

____________________________________________
UPDATE:
 hi

👇👇👇
● Maka payperless ra sa gadgets pero use this wifi connection in the wards

SSID: VSMMCWARDWIFI
password: vsmmc_wardw1f1
● (Manually ad d a network if dili makita sa wifi networks)
● Prioritize the following wards (no rotating pharmacists):
○ SP1
○ HRU
○ Ward 4
○ Sa HRU, ask if patient has Bfluids or Aminoleban (based sa amo
patients HRU ra ang naa but maybe naa ang others)

!! DO NOT GO HOME IF MEDS FOR PAPERLESS ARE NOT YET DONE !!

Maluoy ka sa imong pasyente walay meds for a day

TAGGING 1. Open BIZBOX HIS

2. Have the nurse log in his/her account
3. Click “Inpatient”
a. If still for blotter, click “Emergencies”
4. Type in the patient name near the apply filters
5. Click “add”
FOR LAB FOR XRAYS

1. Choose “Laboratory” 1. Choose “Radiology”

2. Search and click desired “tests” 2. Search and click desired “tests”
3. Click “Continue” 3. Click “Continue”
4. Picture “requisition no.” 4. Picture “requisition no.”
 5. Log patient’s details and tests in
the folder (Sorry I forgot the
label)

PAPER- FOR OR PROPOSAL SHEET

WORKS ● 2 copies - OR PROPOSAL
○ 1 for station
○ 1 for anes
○ Details are found in the cover page of the chart and the doctor’s order
for the proposed operation is usually written as a plan.
○ For the surgeon, you may ask the residents directly or the nurse if they
know.
● 1 copy Interdepartmental referral
○ To ANES
○ Reason - For PREOP EVAL
● Stapler the 1 copy of OR proposal and the IDR
● Bring to anes area outside OR UP
● Near entrance of OR UP is a plastic storage box and log for referrals
○ Fill in details
○ Leave papers inside the storage box

IF FOR REFERRAL
● 1 interdepartmental referral form
● Fill up necessary details
○ You may also find the details on the cover page.
○ You may find in the Doctor’s orders if the purpose for referral is pre op,
evaluation, co-management, or OR use.
● Have it signed by the resident then send it to the department involved
○ For IM, submit it sa IM dropbox near SP2, fill up logbook
○ For Rehab, find the rehab building submit and fill up logbook
● Psychiatry IDR is via text (0961-621-1771)
○ For referrals to the Department of Psychiatry, please fill up this form
and leave a separate interdepartamental referral form in the patient’s
chart. Thank you
-Name:
-AGE/Sex:
-Room Number:
-Referring Department : Ortho
- Referring physician and contact number -
-Reason for referral
-Current medical /surgical diagnosis
-Covid 19 status
Lab steps

REFERRAL TO REHAB
● Fill out interdepartmental request form
 ● Bring to Rehab Office
● Log-in details at both the ORTHO and OVERALL log sheets

GREEN FORM or BLOOD REQUEST FORM

- The details of the patient are found on the cover page
- Other details are at doctor’s orders

MEDICAL ABSTRACT FOR FINA ko NCIAL ASSISTANCE:

● 1 discharge summary/med abstract form

FOR DISCHARGE:
● 2 copies - Medical /Discharge Summary
○ Do not write on the date of discharge
■ The ward nurse will fill this up
● 1 copy - Alagang Pinoy (or Discharge Instruction)
○ Make sure not to abbreviate meds
■ E.g. cefuroxime 500 mg PO BID
● Spell it out into cefuroxime 500 mg/tab take 1 tab
orally twice a day for 10 days
● 1 copy - Interdepartmental Referral form (Referred to social worker)
○ this was what was endorsed to me but ask nalang station kay murag
the other schools don't do this na
○ Doctors will also indicate this if ever needed
● 1 white Rx with take-home meds
○ for take-home meds (Check chart if rx was already made by doctor. If
none, check doctor’s orders then make the rx)
○ Have it signed by resident
■ Can go to Ortho table at ER and have PGIs sign if wala
resident
○ Put follow-up orders sa Bottom Left part
○ If wala pa take-home meds sa doctor’s orders you can leave a blank
white Rx with patient’s name daan
● Doctor’s notes/CF4
○ Can be done at home if pa out na ka and gisugo ka sa resident just
take a pic (ayaw kaayo pa obvious) of the following:
■ Cover sheet of patient’s details (dapat makita ang barcode)
■ Hx, PE form (you need the chef complaint, HPI, PE)
● Copy what is written
■ Doctor’s orders
○ Ask for their username and pw
○ (See full details below)
● Take note of the discharged patients in your assigned ward
○ Chat them in the group chat at the end of the day
○ Fill-up the discharge census
■ https://docs.google.com/forms/d/e/1FAIpQLSe9hE-mkluVtvFsjIo89Zif2YS2bFmayh
9Hf3Pmj8zWSd3uVA/viewform?fbclid=IwAR3kjEFM-dv-YkB-_Gg3TMrbnJ0PPAzh2
dCUaJlKFDtg2XmKXT0QirUcUkM_aem_th_ARYRWgmufwgs2HD4vVosyYObc2uw
A-ISOAFhElBsMOENBBdg6f9YJqcoBxq4H0j7Ats&pli=1
■ Take note of the teams (applicable for June-July 2023)
 ● Team A: Dr. Lim/Dr. Nalo
● Team B: Dr. Dy/Dr. Yrauda/Garcia Team
● C: Dr. Dira/Ypil Team
● D: Dr. Fernandez/Dr. Cabahug Team
● E: Dr. Comaingking/Dr. Chua
● Tumor: Dr. Guieb (Team B daw)

FOR DOCTOR’S ORDERS

● Residents sometimes ask you to write their doctor’s orders.
● Comply lang then have it stamped and signed by that resident.

FOR ● Ask the nurse for 1 copy of Swab form (Version 9 - 3 pages) and 1 copy of
NPS/OPS Annex E form (1 page)
● Fill out details
● Have the patient sign
● Tag RT-PCR in BizBox (check tagging for details)
○ If down ang system, make manual lab request and have the resident
sign.
● Have the resident stamp and sign the swab form (all 3 pages)
○ Can go to Ortho table at ER and have PGIs sign if wala resident
● Get swabbing kit from the main lab
● Swab patient
● Label specimen
○ Name, age, gender, ward, date & time collected, NPS/OPS
● Submit specimen to main lab
○ make sure na tag na before going to the lab. Ikaw ra gihapon mahasol
mag balik2

Not sure with this: it’s a

- Get patients info (name, ward, reason for swab, dr of patient, last swab date)
before you go to ICC. (you don’t need to go to icc if the form is in the chart)
- Fill out icc log sheet. Fill in patient details.
- Ask for Annex E form at nurse station where patient is admitted.
- Have patient or SO sign Annex E.
- Return forms to the ward and attach to the patient chart and inform the nurse.

Swab form
 Ni

Annex E

DECKING ● The PGI will message in the “Clerks + PGI \ Ortho” GC that there is an IDR
IDR from ___ dept. in ____ (ward).
● If assigned ang CIM ana na ward, acknowledge and deck
● S and O (but prepared na lang pud A & P in case i ask)
● Send to resident on duty (if wala mo kabalo, ask the PGI)

OTHERS ● ABG
● FBC INSERTION
● WOUND DRESSING
○ Get materials from station (usually saline, os, and elastic bandage; can
be prontosan for some patients but naa ra ni bedside most of the time)
○ Make sure to take a gross pic before and after you clean the wound
■ Background should be white (get underpad or diaper from
station)
 ■ picture from above and from side (if applicable), make sure to
include joint above and below
○ send gross pic to resident
● SWAB FOR GSCS WOUND
○ Get wound swab kit from Lab
○ Swab patients wound
○ Have nurse tag it
■ Tag should be 2 - gram stain & Culture and Sensitivity,
WOUND
○ Bring back to lab
● REQUEST FOR MATERIALS (e.g. Prontosan , ITE)
○ Ask nurse for the request / procurement form
○ Fill out and pasign sa resident
● ASKED FOR LATEST LAB RESULTS
○ Open WEBLIS
● MATERIALS TO BE REQUESTED FROM CENTRAL SUPPLY
○ Get requisition slip (make sure dili katong pang implant na request)
○ Write details and orders
○ Have it signed by resident
○ Give it to the nurse
○ Note: If moingon ang nurse na kamo pakuhaon, ingna nga dili mo
allow ang taga CSR kai dapat sila jud mukuha ana. Kamo ra gihapon
mahago if adtuon ninyo.

DOCTOR’S ● Previous status are assigned to do this

NOTES/ CF4 ● Go to PHILHEALTH OFFICE near Surg Hall and Ward 4, Ground Floor
● MUST HAVES: Laptop, tablet or basta naay keyboard!! The PCs in philhealth
are as ancient as the medrecs in cvgh
● Inform staff you are going to do CF4 for Ortho Dept

○
● Log in to this website https://vsmmconline.doh.gov.ph:8259/#/patients
○ Use the account of the resident in-charge:
 ○
● For a complete instruction view this file:
https://drive.google.com/file/d/1arHoZOyciLqvw7UG_lRestV1vqlAfkXq/view?us
p=sharing
● Once done update sheet:
https://docs.google.com/spreadsheets/d/1mlCVR9j7MWTo6J6cM6rq
Rel5m2XDvfwcVRluSUENzv8/edit?fbclid=IwAR0kgE1WszCJ0AkM8
5v6cS9y3R0ODd2jIWOQPa4ZEn4xfL2U34tyCvd1rRM#gid=0
● Once done with the shift, ask for the logbook from the staff in-charge of the
CF4 and have it signed by the resident.

CASE ● As of May 2023

PRESENT- ● CASE PRESENTATION IS: EVERY TUESDAY (so yes find a case as early as
ATION monday morning)
● Sample: CIM Ortho Case Pre
● Questions are usually focused on:
○ ANATOMY!! Know all the clinical signs, how to assess if fractured,
blood vessels, innervations, basically anatomy 101
○ Not very particular with management, doc emphasizes on the basics
○ Remember: Primary survey first!! Why? Identify immediately life
threatening conditions if trauma patient
 ● Coordinate with other schools so you wont have the same patient
● Dapat very good gd ang presentation kay the residents will really scrutinize
your pagkacim

GRAND ● Usually every Sunday @ 7 or 8 AM

ROUNDS ● Clerks on duty should join unless assisting in the OR
● Prepare gloves, OS, plaster
● Prepare charts every sulod ug ward
● ER → Phic male → HRU → SP 1,2,3 → VND 1,2,3
● Take note of the paperworks na i accomplish after the rounds
○ Chart rounds na lang after if wala kaapas sa instructions

TIPS ● ALWAYS have while accompanying rounds or at the or before scrubbing in, or
doing ward work
○ Surgical tape
○ Bandage Scissors
○ Clean OS (you can steal from ER or wards)
○ Adhesive bandages
○ IV catheters
○ Tourniquet

NEW AS OF ● Assignments update

MAY 2023 ○ For previous: go to philhealth after endorsements to do CF4, after
doing CF4, you need to take 3 pictures, these being:
■ be sure to update the spread sheet
(https://docs.google.com/spreadsheets/d/1mlCVR9j7MWTo6J6
cM6rqRel5m2XDvfwcVRluSUENzv8/edit#gid=0)
■ Ask the lady dapit sa Ortho cf4 box on where is the folder for
ortho, then write all the patients you did CF4 for and be sure to
tamla. Take a picture
■ On a small paper, write all the current previous interns /
preferably just tamla with sign. Label: PREVIOUS <DATE>,
tamla of clerks and proceed to ER, look for any ortho RIC to
sign. (Everyone needs to be present), take a pic of the paper.
■ Once you have all 3 pictures, send to DR. HEINZ GUIEB and
inform him you are the previous clerks with the attached pics.
● CF4 spreadsheet with names
● Folder with names and tamla
● Small attendance paper with tamla of clerks and
resident
● Progress for ALL assigned patients in wards, please do chart rounds in all
wards. GREEN = Ortho, or if with HALF GREEN = check DO if naay ortho
resident ni tamla.
○ Use the other medical stuff progress paper, COMPLETE DATE/TIME
AND TAMLA with your signature
○ DEADLINE is next day 7AM. Ex: BY 7AM 5/24/23, all patients should
have progress for 5/23/24
○ Template for progress: BE CONCISE and BONE focus
 ■ S > only write present complaints, no need any associated
symptoms, diet, bowel movements etc.
■ O > only note if vitals stable or not, include important
extremities, presence of cast or pins, tenderness, ROM etc.
■ A > Write <Diagnosis>, Clinically stable or unstable
■ P > For OR, For scheduling OR, or latest DO

● Discharge orders and CF4

○ In previous text it was only for diagnosis, now you have to CF4 from
history, PE, course in the wards (day of admission to discharge)
○ You have to accomplish the same ra, so 2 discharge summary, 1
alagang pinoy, 1 prescription, or any IDR as needed
● Paperless
○ Please paperless all wards but you can omit wards that have rotating
pharmacists (see previous post). (Mandatory paperless: SP ground,
HRU, Ward 4A up and down, LRU, Annex A)
○ Specifically for WEDNESDAY and SATURDAY, you have to paperless
ALL assigned CIM wards
● Case presentation updated.