Anaesthetics-LFG-Handbook-August-2016

ANAESTHETICS FACULTY HANDBOOK A GUIDE FOR POSTGRADUATE DOCTORS AND STAFF IN SURREY & SUSSEX HEALTHCARE NHS TRUST Introduction Welcome to The John Hammond Department of Anaesthesia at the Surrey and Sussex Healthcare NHS Trust This Faculty Handbook is written for you as a postgraduate doctor and all who will be working with you during your time here Its purpose is to give you information about how your programme works, and who the key people are who will be working with you Please take the time to read it as it will help you understand the Department’s and Deanery’s roles Also you will need to be familiar with the following documents to ensure you get the most out of your time with us  Curriculum CCT in Anaesthesia www.rcoa.ac.uk  Specialty School Handbook o CT 1-2 - www.kssdeanery.ac.uk o ST 3-7 – www.kssdeanery.ac.uk This handbook will be updated annually and therefore your suggestions, feedback and solutions are most welcome Aug 2016 Contents 22 23-28 29 30-35 36 37-38 39 40-41 42 43-46 47-50 51 52-53 Location of Trust/Car Parking Key people Local programme administrative arrangements Anaesthesia curriculum Duration of training How to complete the anaesthetic curriculum Mandatory competencies and certificates during training Exams Induction Your Educational Supervisor/Your Clinical Supervisor Your role as a Learner The Local Anaesthetic Faculty Trainee Representatives on the LAF Local Academic Board Your School/Your Learning Feedback Annual appraisal Learning Appeals process, Available help Emotional support MedNet Leadership, Career support Department Administrative Support On call rota Rest Facilities Study Leave Annual Leave Swapping shifts/ Other Leave Shift Handover, Hospital at Night GMC Registration/GMC Ethical Guidelines Information Governance Educational Resources Less than full time trainees For trainees interested in teaching and training Appendix A useful names and addresses List of Permanent Staff in Department Appendix B Departmental guidelines and protocols B.1 Pre-op Assessment B.2 Intensive Care B.3 Major Incident Plan B.4 Obstetric Anaesthesia B.5 Protocol for Dealing with damage to teeth B.6 Pre-operative Investigations B.7 Guidelines for acute pain relief in Children B.8 Starvation for children undergoing elective surgery B.9 Guidelines to paediatric resuscitation B.10 Policy for obtaining consent B.11 Regional Block 504/Fracture Neck of Femur Service, Emergency Bleep holders B.12 Blood Competencies B.14 Awareness 54 Appendix C Car Parking Appendix D Your Contact Details for the Department 10 12 13 14 15 16 17 18 19 20 21 Location of Trust During your time with us you will be working at East Surrey Hospital (ESH), Crawley Hospital (CH) and Redwood Elective Centre (REC) The REC is attached to the east end of the ESH The Postgraduate Centre is on the ESH site The Trust’s Website is www.surreyandsussex.nhs.uk Short cut to/from the Hospital if coming from the M25 J8 down the A217 Turn right out of the hospital up the A23 towards Redhill At the traffic lights coming down hill into Redhill turn left into Mill Street Go along here and take the 4th (ish) right into Whitepost Hill- you will then be by a big church and you need to turn right then left onto main A25 (which runs between Reigate and Redhill) Go left along here for about 100 yards then take a right turn into Wray Common Road Follow this to the end (the road does a big 90 deg bend at the start) At the end take a right onto Croydon Road and then a left turn down Raglan Road and go all the way to the end where you will meet the A217 again (Reigate Hill) You need to turn right here up the hill which may be tricky and then you will find your self back at junction This will cut of the whole of Reigate and Redhill and probably save you 10-15 journey time in the morning You can the whole thing in reverse on your way to work! The other good shortcut which you can only on your way from work is instead of turning left into Raglan Road- instead keep going a bit further and then go left (at mini roundabout) into Wray lane Follow this all the way up- it gets v narrow and will bring you out right at the top of Reigate Hill (A217)- you can’t come down this way as it’s one way Car Parking Staf car parking is available in hospital car parks (West and East) as well as on the Redhill Football Ground car park (Three Arch Road) Car parking charges were brought in during December 2011 Each member of staf will require a valid parking permit (available at the same time as the Staf ID badge) and also will need to purchase scratch cards (available from the cashier’s office and the canteen) These will cost 75p per day and are available in strips of These will need to be used for day and night staff Seasonal passes are also available http://intranet.sash.nhs.uk/_uploads/intranet/documents/car-parking/swipe-cardcar-parking- permit-application-form.pdf http://intranet.sash.nhs.uk/_uploads/intranet/documents/ebulletin/march12/applicati on-for-car- parking-season-ticket.pdf Key People There are many people who will help you during your time with us Their full addresses are in Appendix A where there is also a list of permanent staf within the Department This may all seem confusing due to the nomenclature changes for the training grades and also the organisation of training, but if in doubt please contact the College Tutor Dr Claire Mearns who will attempt to advise you College Tutor Director of Medical Education Medical Education Manager Programme Leads Head of School Regional Advisor KSS Administrator St George’s School of Anaesthesia Administrator Head of Academy of Anaesthesia The John Hammond Department of Anaesthesia, East Surrey Hospital Post Graduate Centre, East Surrey Hospital Post Graduate Centre, East Surrey Hospital Dr Fred Van Damme KSS Core School of Anaesthesia KSS Specialty School of Anaesthesia KSS Core School of Anaesthesia KSS School of Anaesthesia KSS Core School of Anaesthesia ST3-5 Dr Natarajan Visweswar Dr Chetan Patel CT 1-2 Dr Peter Anderson CT1-ST5 CT1-2- ST5 Dr Stellios Panayiotou Sally Maher ST 6-7 Ivy Hagan ST 6-7 Dr Peter Broderick CT 1-2 Dr Sarah Rafferty Tina Suttle-Smith Local programme administrative arrangements The administrative arrangements for the local management of your programme are managed by the College Tutor and Programme Leads and are constructed to support the RCoA Curriculum If you experience any local administrative issues your first point of contact is the College Tutor The Anaesthesia Curriculum The curriculum for Anaesthesia specialty can be found at www.rcoa.ac.uk The Local Anaesthetic Faculty which is chaired by the College Tutor and is responsible for ensuring that the Anaesthetic programme here is such that it will enable you to meet specific competences required in any given year by your speciality curriculum The local programme will be mapped to the national curriculum and includes opportunities for you to work with other health care professionals such as intensive care, outreach, pharmacy and emergency medicine doctors The aims and objectives of the Anaesthetics curriculum These are stated in the THE CCT IN ANAESTHESIA I (http://www.rcoa.ac.uk/documentstore/curriculum-cct-anaesthetics-2010): General Principles: A manual for trainees and trainers Edition 2: August 2010 states that the aims and objectives of the Anaesthetic’s curriculum and the completion of the programme is to award of a CCT in anaesthesia thus producing high quality anaesthetists with a broad range of skills who will enable them to practice as consultant anaesthetists in the United Kingdom Duration of training Indicative duration To obtain a CCT in anaesthesia a trainee has to follow a competency based, specialty training (ST) programme covering basic, intermediate and higher and/or advanced levels of training in anaesthesia, pain management and Intensive Care Medicine (ICM) The indicative duration of training is years, of which • Basic level will normally last years (CT 1-2) • Intermediate level will normally last years (ST 3-4) and • Higher and/or advanced level will normally last years (ST 5-7) The actual duration of an individual’s training will be determined by the rate at which they achieve the necessary competences Minimum duration The minimum duration of formal training is normally seven years In exceptional circumstances, if a trainee can prove that they have acquired all the necessary competences in a shorter time and have the confidence and competence to be a consultant, the College may recommend to PMETB that a CCT should be awarded after less than seven years How you complete Anaesthetics curriculum This curriculum is competency based and leads eventually to CCT in Anaesthesia You will be supported during your time at Surrey an Sussex Healthcare NHS Trust by your College Tutor Dr Claire Mearns, an allocated Educational Supervisor and Clinical Supervisors, all of whom will give you regular feedback about your progress You should never be in any doubt about your progress and what you can to improve this Stage Start of post Appraisal & Assessments Initial appraisal & Educational contract Trust’s Clinical skills evaluation KSS Deanery Form R Apply/ Check for Registration of the RCoA Meeting with Educational Supervisor Interim/mid point Interim/ mid point appraisal End of post Final appraisal Annual Appraisal and Portfolio evaluation including completed log book, assessment tools and General Annual Review of Competency (ARCP) By whom College Tutor College Tutor College Tutor College Tutor Educational supervisor Educational supervisor/Trainee Educational supervisor Educational supervisor Educational Supervisor & College Mandatory Competencies and certificates during training Full details in document ‘CCT in anaesthesia’ on the RCoA website Competency When Initial Test of Competency At 3-6 m during CT issued by both College Tutor SupervisorModule Assessment of Competency in Obstetric Duringand CT Educational issued by Obstetric Anaesthesia Director Certificates Basic Level Training Certificate End of CT issued by both College Tutor and Educational Supervisor Intermediate Level of Training End of ST issued by Regional Advisor Advanced Level of Training End of ST issued by Regional Advisor Exams Exam/ part of exam Primary FRCA- MCQ (valid for 3y once passed) max attempts of Primary FRCA-OSCE & SOE (x 2) Remainder must pass both but can ‘bank’ a pass and only re-sit the failed part Final FRCA written-MCQ & SAQ (max attempts but with guidance after unsuccessful attempts) Valid for yrs MCQ questions will include 30 SBA Reminder of Final FRCA- SOEx2 which will be merged together to make pass of fail When Towards the end of CT By the end of CT By the end of ST after 30 months of training After passing written part of exam For full details http://www.rcoa.ac.uk/examinations MCQ-Multiple Choice Questions OSCE-Objective Structured clinical examination SAQ-Short Answer Questions SOE-Structured Oral Examination Induction All new doctors New CT 1-2 and ST3 Trust and The John Hammond Department of Anaesthesia KSS Anaesthesia School PGEC 3rd August 16 KSS Deanery – dates set by KSS Your Educational Supervisor – roles and responsibilities Your Educational Supervisor is responsible for overseeing your training and making sure that you are making the necessary clinical and educational progress during your time at the Trust You will have regular feedback from your Educational Supervisor For your information the responsibilities of an Educational Supervisor are given in the  Gold Guide  Standards for Training in the Foundation Programme  Operational Framework for Foundation Your Clinical Supervisor – roles and responsibilities Your Clinical Supervisor is responsible for your progress on a day to day basis eg the Consultant you are working with on that day You will have regular feedback on your clinical performance from your Clinical Supervisors The process by which information about your progress is collated by your Educational Supervisor and from your Clinical Supervisors is via your completion of assessment tools, participation in audit and teaching and feedback from Senior Staf meetings and the Local Anaesthetic Faculty-see below Your Role as a Learner You are responsible for your own learning within the programme with the support of key people as above You should ensure that you  Have regular meetings with your supervisors  Maintain your portfolio and Log Book (see Appendix D.2 re ICU and pain logbooks)  Keep up to date with assessments as required and continue to have your workplace assessments signed off  Complete the contact details in Appendix C for the Department for the Major Incident Folder The Local Anaesthetic Faculty Group (LAF(G)) This Faculty consists of Senior Staf from the Department who are actively involved in training Its remit is to  Ensure that the local Anaesthesia programme is fit for purpose and in line with curriculum requirements for the following bodies o National (eg NHS, NICE) o Professional (eg PMETB, RCoA) and o Trust (see Work Force Development site on Intranet for timetable of Trust Mandatory training on Trust Educational Half Days 14.00-15.00)  Quality control the local programme and  Ensure that trainee progression is tracked, supported and audited There are also Trainee Representatives on this committee The LAF meets at least three times a year and reports to  For CT 1-2 and ST3-5 to the Local Academic Board and ultimately the KSS Deanery  For ST 6+ to the St George’s School of Anaesthesia and ultimately the Academy of Anaesthesi a Trainee Representatives of the LAF The LAF also has representatives from the trainees to convey the views of all the trainees The representatives should meet with or contact the other trainees at least times a year to collect these views There should be representatives for  CT 1-2  ST 3-4  ST 5-7  Clinical fellows The Local Academic Board (LAB) The LAF reports to the Trust’s Local Academic Board for the trainees It oversees the whole of the Trust’s postgraduate medical trainees to ensure they receive education and training that meets local, national and professional standards The LAB undertakes the quality control of postgraduate medical training programmes It receives Annual Audit and Review Reports from Local Faculty Groups throughout the Trust including the LAF APPENDIX B.9 GUIDELINES TO PAEDIATRIC RESUSCITATION (update 2002) Introduction A child in distress will be admitted under the care of a consultant paediatrician, but its wellbeing is the duty of all staf present in the hospital The full paediatric arrest team should be called initially Avoid calling out team members individually to assist with deteriorating child All team members must be available at all times to deal with the child during its stay at East Surrey Hospital Paediatric Arrest Team i) Membership of paediatric arrest team Permanent Associate As required SpR paediatrics, team leader A&E nurse(s) Surgeon: orthopaedic, surgery SpR anaesthetics A&E SHO Paediatric consultant SHO paediatrics Anaesthetic SHO Anaesthetic consultant Outwood sister RTO X-ray technician Sister in charge/night coODP ICU staf ordinator Porter Outreach nurse ii) Duties of members of paediatric resuscitation team: SpR paediatrics-the team leader Hands of and, therefore, able to oversee resuscitation episode, ensure each step has been followed, request investigations, take advice from surgeons, plan post resuscitation care with consultant paediatrician (especially planning transfer of patient), re-assess situation regularly SpR anaesthetics, SHO anaesthetics In charge of airway and ventilation, initiation of IPPV and level care (intensive care) Provide support with IV access, invasive monitoring and fuid management SHO paediatrics, SHO A&E IV access, blood tests, x-matching, infusion, drug administration, catheter, drain etc Anaesthetic and paediatric staf should liaise to provide constant medical supervision during the patient's stay at East Surrey Hospital Sister Outwood, sister in charge, night coordinator brings Broselow bag from Outwood if arrest occurs outside A&E, Outwood or theatres Organises paediatric nursing cover Nurse Outwood In charge of nursing care of patient until transfer, record of events on PICU chart The chart needs to be photocopied and sent away with the patient One copy stays in the ICU A&E nurse Record events in A&E, dispense drugs, check doses on Broselow tape if needed Porte r Will collect resuscitation trolley from ICU, if needed outside one of the main areas Inform the on-call paediatric & anaesthetic consultants as early as possible The paediatric consultant is responsible for liaison with the receiving lead centre & organisation of the child's transfer Initial resuscitation Initial resuscitation takes place on site Paediatric resuscitation kits are available in the following area-A&E, Outwood ward, ICU side room Each trolley has been issued with the equipment most relevant to its clinical area However, they all have the necessary kit for BLS and initial ALS Redwood DTC limited range according to age group treated in DSU Most extra equipment available from theatre A&E standard non Broselow lay out Outwood non Broselow layout, comprehensive IV section to suit paediatric needs ICU non Broselow layout, standard arrangement Keep Broselow tape The Broselow tape is available in each location although the colour coded system is only now used in Redwood DTC and Radiology in a simplified version with colour coded drawers Additional equipment is available on request in all clinical areas Broselow bags are available in A&E and in ICU for use in areas which not keep resuscitation equipment The capacity of these bags is limited and a porter should be sent to bring one of the arrest trolleys, possibly from ICU Level (HDU) care should be administered in the relevant clinical area, unless the child presents with a critical illness which threatens to deteriorate acutely Aug 2016 Level care Level care: stabilization, preparation for transfer and holding of the paediatric patient is carried out in the ICU side room A paediatric nurse will be seconded from Outwood ward to assist the medical team ICU nursing staf will assist where possible Level care Intubated children should be transferred to a tertiary referral centre as soon as practical, and the regional paediatric retrieval team involved as early in the child's management as possible South Thames Regional Retrieval Service - Paediatric Intensive Care - Direct line 0207 9558856 Aug 2016 Inform the on-call paediatric & anaesthetic consultants as early as possible The paediatric consultant is responsible for liaison with the receiving lead centre & organisation of the child's transfer The child remains the responsibility of the paediatric team at all stages of the resuscitation and subsequent stabilisation Paediatric resuscitation/ICU equipment available in adult ICU at East Surrey Hospital  Portable, multi-channel monitoring equipment  IVAC volumetic pump  Infusion pump  Warming blankets  Infusion warmers  Blood gas analyser  Anaesthetic & resuscitation drugs  Resuscitaire  Broselow tape  Dose and infusion guidelines on wall of side room  SIMS babypack and Veolar for bigger children  Board  All observations, treatments, procedures and decisions should be recorded on the PICU chart Emergency Drugs Atropine 20 μg/kg Adrenaline 10 μg/kg (0.1ml of 1/10,000) 100 μg/kg in sepsis, anaphylaxis or profound vasodilation Calcium 0.2 ml/kg of 10% CaCL2 (about 5mg/kg of elemental calcium) HC03 1mEq/kg (1 ml/kg of 8.4% HCO3) Glucose 0.25 - g/kg (2.5-10 ml/kg of 10% Dextrose) Amiodarone mg/kg iv bolus (up to 15 mg/kg/day) Adenosine 50 μg/kg STAT Rapid iv injection Increase by 50 μg/kg if needed Maximum 300 μg/kg PGEl 0.05 to 0.1 μg/kg/min Maintenance 0.005 to 0.02 μg/kg/min Dobutamine* 1-20 μg/kg/min Dopamine* 1-20 μg/kg/min Adrenaline* 0.1 - μg/kg/min *Dilution mg of drug/kg in 50 ml of solution: ml/h is μg/kg/min 0.3 mg of drug/kg in 50 ml of solution: ml/h is 0.1 μg/kg/min Anaesthetic agents Induction Agents Thiopentone Propofol Ketamine Sedation/analgesia Midazolam Fentanyl Morphine Muscle relaxants Suxamethonium Atracurium Mivacurium Rocuronium 3-5 mg/kg (1 ml = 25 mg) 2-3 mg/kg (1 ml = 10 mg) 1-2 mg/kg (concentration varies) 50-100 μg/kg (2 ml=10 mg) 1-2 μg/kg (1 ml = 50 μg) 0.1 mg/kg on IPPV or 50 μg/kg boluses if spontaneously breathing or