UBC DIVISION OF PLASTIC SURGERY

Here are some helpful tips for surviving your surgical rotations. You can also download a quick reference guide by clicking here.

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Seeing a consult

 

• Fill out a consult form for all consults.

• Be sure to document the referring service physician, the plastic surgeon on call, and the date of the consultation. 

  • At SPH and BCCH, the plastic surgeon on call is the surgeon of the day​

  • At UBC, the plastic surgeon on call is the VGH Call 1

  • At VGH, the plastic surgeon on call is the VGH Call 1 for out-patients, Trauma 2 for in-patients.

• Review with senior/staff before informing the patient of the plan.

• Sign your name legibly

 

After the plan is decided:

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• Update your consult with the plan.

• Include "Discussed with" and put your senior resident's name and the plastic surgeon who reviewed the consult.

• Make a copy of your consult to dictate from, the original should stay with the chart

• Dictate, and CC the staff plastic surgeon, the patients GP, and any other relevant services or WorkSafe BC, if applicable.

 

If the patient is being admitted, booked for surgery, or enrolled in FastTrack:

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• Update the list (a resident will show you how and where this is done). 

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Admitting a Patient

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• Consult form

• Allergy status

• Consent form if indicated

• Admission orders

• Orders sheet

  • ADDAVIIDD format

  • A: Admit to: location, MRP

  • D: Diagnosis

  • D: Diet (NPO, soft, diabetic/renal etc.)

  • A: Activity (i.e. Bedrest, AAT, etc.)

  • V: Vitals frequency vs. continuous monitoring

  • I: IV fluids – type, amount

  • I: Ins/outs – if you want a foley/urine output measured

  • D: Diagnostics – what other testing you require, such as daily BW

  • D: Drugs: other medications – think of the “P’s” (Pain meds, Poop meds/bowel protocol, Pus meds/antibiotics)

  • DVT/GI prophylaxis if indicated

 

• If patient is a BURN patient, all of the above as well as:

  • Fill out burn admission orders instead of Order sheet with ADDAVID (can find them on the wall in the trauma bay)

  • At VGH, Parkland formula has been changed to use 3cc/kg instead of 4cc

  • Complete burn diagram– also on wall of trauma bay

• Phone admitting to admit patient (or, talk to the Emerg charge nurse at other hospitals)

  • They will request staff name, MRN, name, what type of bed you want (i.e. High acuity vs. ward) and if patient has any precautions (i.e. contact precautions)

• Add patient to the list.

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Writing progress notes​

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• Date, title (plastics)

• POD#, reason for admission

• How they feel they’ve been doing/concerns

• Pain

• Vitals, drain/urine output if monitored

• Labs for the day, imaging for the day, follow up on tests PRN 

• Plan

• Sign note with name, training level

 

Writing Orders

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• date, time

• title: Plastic Surgery

• Orders

• Sign, write your name/pager, and your level of training. if you are an MSI you’ll need to discuss all orders with a resident, so write “Discussed with ____” under your signature as well. 

• There are many pre-printed order forms available on the VCH website that will help with admitting complex patients, or writing post-operative orders. 

 

Submitting orders

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• Pull out red tag labeled “Doctor’s orders” and bring chart to unit clerk

• On Treatment side of ER: place chart and orders into wire rack labeled “Orders” at ER physician station

• On Acute side: Leave chart and orders in it’s slot marked with the bed #, and flag orders with a red peg 

 

Post-op Note: (remember PPP SAFE DISC2 from surgical recall)

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• P - Pre-op Dx (what we thought it was before the operation)

• P - Post-op Dx (what we thought it was after the operation, often the same as the pre-op dx)

• P - Procedure (Describe what was done)

• S - Surgeons (Including assistants)

• A - Anaesthesia (Anesthetist and type, e.g., general, local, regional block)

• F - Fluids (Crystalloid, Colloid, Blood etc. and how much)

• E - Estimated Blood Loss (ask the anesthetist)

• D - Drains (location and type)

• I - Intra-operative findings (remark on anything interesting)

• S - Specimens (what they were and if they were sent to Pathology)

• C - Complications (if there were any note them and what was done about it)

• C - Condition (How the patient was at the end of the case, where they were going, and the plan. e.g.: "Stable, extubated,to Post Anesthesia Recovery, Plan for discharge in the morning")

 

Post-op Orders: (remember A-D-DAVI3D3)​

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• A - Admit to: (Dr. Soandso, unit)

• D - Diagnosis (what procedure they just had)

• D - Diet (ex: NPO, CF, FF, DAT, Cardiac diet, Diabetic diet etc)

• A - Activity (When do you want them to move the affected area? Is there any location you don't want them placing pressure?)

• V - Vitals (What to check and how often? Do you need flap checks?)

• I - IV (Which fluid and at what rate)

• I - Ins & Outs (If you want fluid status to be monitored, not always necessary)

• I - Investigations (any imaging or blood work)

• D - Drugs (for drugs cover the 6 P's)

• P - Pain - (Tylenol, T3's, Dilauded are our most common ones, the "POPS" team (perioperative pain service) will follow most inpatients postoperatively as well)

• P - Puke (Prevention of post op nausea and vomiting, use Gravol, Maxeran, Ondansetron etc)

• P - Poop ("The hand that prescribes the narcotic prescribes the laxative". Vascular surgery bowel protocol is the least aggressive, we put most people on the surigcal protocol)

• P - PE (Does this patient need DVT prophylaxis?)

• P - Prevent Infection (Does this patient need antibiotics?)

• P - Previous medications (What meds were they on at home? Fill out the MAR)

• D - Drains (When to remove? Day surgery patients may require a home care referral)

• D - Dressings (What type of dressing and how often to change it?)

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