MAGDALENA CASAGRANDE

2014

SMH Psychiatry:Intro to Call, Notes & Orders

SMH Psychiatry

Introductions

Attendings and rotations

Safety

Panic buttons on units

Ekahau tags in ER

Nursing/Security to be present when entering security room

Psych Call

4 evening calls & 1 weekend call

Your attending & resident will be in house with you Exchange cell phone numbers / pagers

Weekdays 5pm - 11pm (in-house)

Weekends 8 or 9 am until the work is done (in-house)

Your responsibility to ensure coverage – can switch with same level for same type of call

Psych Call

Weekday call = new assessments

Weekend call = new assessments & follow ups

Assessments = admit or not

Do not see patients on your own before first discussing with your staff

Safety – MCFD, driving, work

Present patient to attending

Inpatient

Units: 4E, 4W & PAU

Team rounds vary depending on attending Usually in morning, once weekly Room across from Pat McColgan’s office

Nursing staff, SW, Pharmacist, Neuropsychologist, Occupational therapy

Inpatient

Daily assessments Review nursing notes Review use of prn medications S/R over last 24 hours Any messages on psychiatrist clip-board?

SOAP notes See example

Dictations

Dictation systems & codes 1-855-666-3240 Personal dictation ID Facility code = 17 Work type = 104 (consult), 107 (discharge)

Outpatient: d/w Dr. Smit

Inpatient: discharges

Psych ER: consultation & discharges

Dictation Headings: Consultation

Identification

Chief complaint

HPI

Past psych hx 1st contact Hospitalizations

Past medical hx TBI / seizures / thyroid

Meds / All

Family psych hx

Substance use hx

Forensic hx

Personal / social hx

Investigations

MSE

Impression

Plan Certifiable or not Further investigations /

assessments

Dictation Headings: Discharge Summary

Discharge dx

Discharge meds

Identification

HPI “For details, refer to

consultation by Dr. X, dated July 4, 2014”

Presenting MSE

Past history Check with attending

Course in hospital Behaviour on unit Any issues, passes Medication changes

MSE on discharge

Discharge plan Accommodations/

housing Psych & GP f/u Medications & Rx Special instructions

(driving, work)

Orders

Admitting orders Psych ER Orders sheet AD-DAVID Don’t forget nicotine replacement therapy Consulting other services

On unit Levels of observation Day passes – specify accompanied or not Overnight or weekend passes – write “with meds” Consult SW / OT etc. – write reason for consultation in

orders

Expectations

Know & utilize Meditech

Utilize various sources of collateral information Family, police (ER) GP or community psychiatrist Prior consultations

Professionalism

Check with Attendings/residents

Remind them of your scheduled teachings, half-days

Teaching Schedule

Monday, Wednesday, Friday 8am MSI teaching various topics

Friday 9 – 10 am Journal club 1st week Psychopharmacology rounds 2nd week Grand rounds 3rd week

Friday 11:45am OSCE rounds

Jeopardy August 8th

MSI Teaching

Mon / Wed / Fri 8 – 9 am: core psychiatry lectures1. Psychiatric assessment & MSE2. Emergency psychiatry3. Psychotic disorders & mood disorders including ECT4. Personality disorders, anxiety & sleep disorders5. Crash courses x 2 in psychopharmacology6. Geriatric psychiatry including dementia & delirium7. EPS & AIMS assessment demo8. Various child psychiatry topics (week 4)9. Addiction psychiatry10. CL psychiatry11. CRE practice, feedback, Q&A