Investigations

Endoscopy

For Inpatient requests, return all paper request forms to the Endoscopy Co‑ordinator. They will give you a time and date for the procedure. Any other questions, give them a call.

For outpatient investigations, you can just give the form to the endoscopy reception.

Rumours say you can also email them to endoscopyrequest@tst.nhs.uk

OGD (Gastroscopy)

Paper Request form
Consent form
OGD Patient Information

Flexible Sigmoidoscopy

Paper Request form
Consent form
Flexi ∑ Patient Information

Preparation:
Your patient may need a phosphate enema (Ṫ PR, Stat) beforehand.

Colonoscopy

Request Form
Consent form
Patient Information Leaflet

Preparation:
Your patient will need two bowel prep sachets beforehand, Prescribed as two stat doses of Moviprep A + B. Find out the time of the procedure.

AM Procedure: Give at 1700 previous day and 0900.
PM Procedure: Give at 0900 and 1200.

ERCP

Request Form (online)
Consent form
Patient Information Leaflet

ERCP consent should be carried out by an ERCPist due to the high risk nature of the procedure.

TODO: add information on contraindications / anticoagulation / inr/platelet requirements for all of above.
TODO: confirm bowel prep requirements

A word on consenting

Each of these procedures has a pre-populated consent form detailing the risks and benefits of each procedure.

Senior gastroenterologists in this trust are generally happy for juniors to consent patients for OGD, Sigmoidoscopy and Colonoscopy, provided they understand the risks and benefits. If you are unsure ask a senior.
Do not consent for ERCP, as the risk of harm is much higher.

▶

What is the GMC guidance on consent?

GMC guidance (Page 15, point 26) states that the doctor carrying out an intervention is responsible for discussing consent with the patient.
More pragmatically, a doctor can delegate this task to a junior who fully understands the procedure, proposed benefits, and risks in order to be able to hold this conversation and facilitate informed decision making. However, the responsibility this is done correctly remains with the doctor performing the intervention. Previously many consultant endoscopists were happy to delegate to juniors doctor for lower risk prodecures.

However, many juniors did not feel comfortable with this situation.

This has been somewhat addressed by the introduction of new two part consent forms, which are signed after two discussions, once with the ward doctor, and once in the endoscopy department. This was the practice in the first place, but is now codified in the new paperwork.

Cardiology

Echo, Tapes, etc.

Complete a Lilac Form (available on most wards).
• Inpatient Cardiac Echo requires that you go to cardiology department and get the form signed by a consultant.
Tip: Be prepared to justify the investigation, and know your patient.
• Outpatient forms can be left with the cardiology reception.

ICD or PPM interrogation

To interrogate Implantable Defibrillator or Pacemaker, call Cardiac Pacing Team (ext 3351 as of writing) and leave a voicemail with patient location and details. Like creatures of the night, they'll have come and gone before you realise.

Vascular

Doppler

Complete a Blue Form. Available on SAU and Barrington doctor's office

Respiratory

Spirometry

Call Coleridge ward and ask them to put the patient's name on the board.

Neurology

EEG and Nerve Conduction Studies

Referrals

Usually by creating an Epro note and sending the email to [specialty]redtops@tst.nhs.uk (for now you have to guess the address, but there's autocomplete so it's straighforward. this should change next year).
You should include:

• patient details
• contact details
• clinical narrative
• a clear request of what you want the person accepting the referral to do


• Do not write essays like I do.

Special Cases

Dermatology Referral
A complicated process which involves following the flowchart.
You should discuss the referral with the Derm reg at BRI first. Sometimes you will have to explain to them how their referral system works. Do not back down until they accept the referral.
Once accepted you can ask the skin cancer nurse to come and take photos.

Neurosurgical Referral
Via Refer-a-Patient.org

Medical Photography Referral and Consent Forms
When we want photos of rashes and lesions for the medical record. Complete, scan and email, or go find them next to CCU.

Repatriation
Sometimes patients from out of area are admitted, sometimes in emergencies, but mostly because Weston-Super-Mare hospital closes to new admissions at 5pm.
To repatriate, call the receiving hospital's Medical SpR, hand over the patient, then complete the form and email it to clinicalsitemanagers@tst.nhs.uk.
They will do the rest.

CARE BUNDLES

Checklists for very sick patients. Print them out and do everything on the sheet, every time.

Decompensated Cirrhosis
DKA

TODO: What others?

USEFUL GUIDELINES

Hypertensive Urgency/Emergency
Refeeding (and electrolyte replacement on last page)
MSCC (Metastatic Spinal Cord Compression - If you try to discuss with Ortho, they will tell you to FOLLOW the protocol. It helps to have it open in front of you if you need to call them out and have them come see the patient.

Search All Policies:

http://theportfolio.tst.nhs.uk/search/results.aspx?k=dka

Clinical Nurse Specialists

TODO: Add others, fill out these sections

These guys are dons. Here are some important ones.

Palliative Care Nurses

They will give good advice about effective management of patient symptoms. Sometimes they will review a your patient, but often they can give excellent advice over the phone.

IBD Nurses

Mostly help with monitoring, emotional support. Good to inform them when people come in with a flare. Very important to tell them about new diagnoses.

Hepatology

THREADS (COPD NURSES)

Patient education and inhaler technique

Oncology Nurses

Parkinson's Nurses

They like to be informed when PD patients get admitted. Also a valuable resource for advice on converting PD meds to transdermal when a patient is NBM or vomiting.

NG dietician

Alcohol and Drug Liason (SDAS)

Rob Chaggar, the alcohol and substance abuse liason. Ask patients if they would like help kicking their habit. Then send Rob chaggar an e-mail or give him a call.

Misc Jobs

Clarify Methadone Dose

Some patients take methadone. You need to call their pharmacy to confirm their dose BEFORE it gets prescribed. Otherwise your neck is on the line when they become opiate toxic because they overstated the dose.

Test Groups -
NILS Autoimmune profile Haematinics

PEARLs of wisdom

Anticoag in General:

As a general rule, consider holding anticoagulation in the following situations:

TODO: Complete this list.

• Suspicion of active bleed
• Possibility of invasive procedure (drains, LPs, but generally not for surgery)

When a patient is hyperglycemic

TODO: Clarify and simplify this advice.

Endocrine SpR say:

Rule out bad things: GCS? Ketones? Breath? Calculate osmolality (2 x K + Na) + urea

Give a stat of novorapid (not actrapid) and recheck in 20 minutes.

If they're persistently high, try upping their regular insulin dose by 3 at a time.