Updated 5.29.25
Transition of Care Pharmacist
“Pharmacy – Misc Consult” order for any patients who are going home soon and may struggle with medications
Consider for: IV/SQ meds, medication weans/tapers/ titrations, keto diet, TPN, rare meds, meds needing prior authorization, family who struggles with resources, understanding, or compliance.
When you place the order, put in the details why you feel this patient needs pharmacist support and anticipated discharge.
Available M-F 8a-4p and is on Voalte.
WhiteBoards
More space - Please use daily
Use when huddling
Update daily
Sepsis Alert
-Alerts only for severe sepsis - truly sick kids
-Expectation for bedside huddle for all alerts
-Must complete risk mitigation form
Consults
OMFS Option - Dr. Doug Olson, Orthodontist - For contact info, check with Hospitalist on call or Doc of the Day
Dermatology Consults - Click here for tip sheet
New Asthma Inpatient Guidelines - Click here for flowchart
Bronchodilator Protocol with Details
Resident Admit Times and Caps
-See ADMISSIONS Tab in Guidebook
-Link to Resident Admit Times and Caps Document HERE
Direct Admissions
-Admissions direct to the floor
-Patients will be assigned to teams within timeframe of 15 min prior to arrival-arrival to floor
-Goal: Meet transport at bedside to get in-person signout
-Evaluate and admit patient as soon as possible upon arrival to floor
-If a patient arrives during Golden Hour, someone from team must eyeball patient and place general orders
-Upload images with "Import" under contains tabs, can add screen shot
Medication Shortages
IVF Shortage
Mitigation strategies include:
- Truly evaluating if IVF need to be started
- ensuring that we are appropriately stopping IVF when no longer needed
- this includes not restarting a new bag by nursing until checking with the team
- utilizing oral rehydration which includes NG tube placement
- Not routinely placing an older NPO kid on fluids overnight
- Truly calculating appropriate npo time for procedures to minimize ivf
Medical Floors - Consider Glucose 5% NS - 200kcal/L vs. 170kcal/L, cannot be run with other fluids, cannot add additives
Discharge Checklist
-Use of discharge checklist - for your hyperbili and AGE patients this week, please check in with your team/nursing on patient admission (arrival huddle or first rounds are good opportunities) to ensure the discharge checklist is filled out to help our teams focus on discharge readiness from day 1. Example checklists attached—nursing should have a paper copy already on the chart (except 5E—not participating yet). Send any comments/concerns to Dr. Britanny Wincklerdischarge_criteria_for_hyperbilirubinemia.docx
Sitter Orders
No further 1:1 sitter order, updated to 1:1 observation
Virtual RN
-Pilot on 5E at this time
-Click here for PDF
Communication Best Practices PDF
Trauma Admission Guidelines
-Consult Trauma team for all traumatic NATs
-Consult also SCAN and SW
-If Trauma team would like to be primary, follow up if they also would like Peds Consult
Heme/Onc Admissions
Hematology
Weekdays:
8a-4p – Hematology division does admission
6p-6a – Night heme/Onc NP does admission
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if a hematology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), the hematology division or night NP will do the admission when they are able. If the patient is sick and needs someone to “lay eyes” and no one is on campus, pediatric residents can help.
Weekends:
6a-6p – pediatric residents do admission. Staff with hematology fellow/ attending and receive feedback/ education
6p-6a – Night Heme/Onc NP does admissions.
*** if there is no night Heme/onc NP -> pediatric residents will do admission
Oncology:
Weekdays:
8a-4p – Oncology division does admission
6p-6a – Night heme/Onc NP does admissions
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if an oncology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), the oncology division will do the admission when they are able. If the patient is sick and needs someone to “lay eyes” and no one is on campus, pediatric residents can help.
Weekends:
8a-4p – Oncology division does admission
6p-6a – Night heme/Onc NP does admissions
*** if there is no night Heme/ Onc NP – pediatric residents will do admission
*** if an oncology patient arrives during the gaps in NP coverage (ie 6a-8a and 4p-6p), pediatric residents will do the admission and staff with Oncologist/ fellow to clarify plan and receive teaching.
Senior Reminders
1) Make sure day attending name is updated on the list
2) Keep an eye on the list. If approaching 20 patients, notify Doc of the Day for redistribution to Platinum. Identify a few patients with your day attendings which patients may be good candidates for off loading.
3) Triage your patients for rounds, round on new ones/sick patients first
4) Update attendings in AM which patients can be seen early prior to rounds for discharge. Can be on the same group text with case management and SW so everyone is aware
5) Weekend residents holding phone should keep attendings notified of new admits to prevent delayed staffing (and overflow into night shift)
6) Keep ED Covering MD boards updated
9) Admissions - Use order sets - IPR vs OPO
Additional Tips:
- For early AM admits - Seniors to eyeball/ put in orders, have a med student do admit. Ok if not fully ready to present new admit at the end of rounds
- For weekends – post call senior should sign out and leave, but expectation is that the intern can stay a few hours longer to continue to tie up loose ends. Intern to message covering senior with updates and that they are leaving. Attending also around to help support intern wherever needed.
- For weekend rounds – in an effort to improve efficiency, the expectation is that whole team will not round bedside on every patient if high census. Can “table round” on most patients and go to bedside of acute and actively changing patients. Make sure to update RNs on all plans and that attending will be by later for those not rounded at bedside.
1) Ensure logged into Voalte at start of shift. Incorporate this into your verbal sign out
2) Notify ED MD and RN for any major changes to plan of care and/or orders
3) Huddle with nursing at bedside upon arrival to floors, discuss patient plan of care using 5P's, document in Cerner Checklist
4) Discussions regarding non urgent orders with floor charge nurses
5) Use consult templates!
