Case 10: Prioritisation and Managing Stress

A new FY1 doctor, Carla Rose, is on her first surgical on-call day shift from 8am – 8pm. The shift starts with a busy ward round with her registrar and SHO. Carla documents, on her patient list, the jobs to be completed for the overnight patient admissions. From 5pm – 8pm Carla is covering three surgical wards on call.

Carla works hard throughout the day to try and complete the post ward round tasks , as well as helping to clerk in new patients who also need new investigations organising.  Her bleep has been sounding endlessly all day.

By mid afternoon Carla is overwhelmed with multiple discharge summaries to be completed, cannulas that need inserting, a patient that has a low urine output and an angry relative. She bleeps her SHO for help but he does not answer as he is in theatres. At 3pm she calls her mum in tears, she hasn’t had lunch and feels she can’t cope.

Carla struggles on but is aware that surgical handover is looming at 8pm. She still has four cannulas to insert, three drug charts to re write, some IV fluids to prescribe and has just had two bleeps asking her to come and see an unwell patient and a patient that wants to self discharge.

Carla makes it to handover late with the jobs pending. She tells the night FY1 she will stay later to finish of the jobs from the day take. It is now 9.30pm and she is still at work completing the jobs she feels need to be done before she goes home.

photo 1Question 1: Explicitly list the tasks that Carla has left just prior to handover to in order of priority and explain your reasoning? 

Discuss now on Twitter, using the hashtag #quclms. Follow @quclms for updates. Further information and follow-up questions will appear on Twitter throughout the week.

Question setters: Dr Jessica Bilaney and Dr Beth Walker, Clinical Teaching Fellows, UCL Medical School

Further Information about Carla’s Pre Handover Tasks”

1. The Unwell Patient

After asking the nurse for more information:

Day 1 post operative (total hip replacement) 72 year old lady. No evidence of bleeding.

Vital signs were normal, urine output had been normal until 2 hours before, still has a urinary catheter in situ. Patient was complaining of supra pubic discomfort.

2. The Patient that wants to self discharge

Mr Brown, an 80 year old man, has been admitted after a fall with head injury and he wants to go home as his cat is there and hasn’t been fed.

3. IV fluids to prescribe

Two patients on two different wards. One is just starting to eat and drink and the other has severe pancreatitis and is nil by mouth.

4. Cannulas

The nurse would like two cannulas for patients who are going to theatre in the morning, a patient who is having a sliding scale and the patient with severe pancreatitis.

5. Drug charts to be re written

Two patients who are recovering from total hip replacements. The charts run out of space for the nurses to sign for prescriptions (at 6am tomorrow).

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