PLC Department of Anesthesia

Orientation to the Department of Anesthesia 2010
 
The department consists of a varying number of gp-anesthesiologists, plus a group of fellowship anesthesiologists who provide coverage on a rotating basis. We provide elective and emergency services for 2 OR theatres, labour epidural anesthesia, and acute pain management.
 
OR Duties and Miscellaneous Information: 
 
Elective OR’s run 0730-1530 M-F; first case start time is 0800h except for 0900h on Thursdays. On-call is from 0730-0730 M-Th; most w.e.’s are Friday a.m. to Monday a.m. Emergency cases are fit into regular hours whenever possible. Requests for obstetrical epidurals are directed to the person on call, who has the option to delegate to the person not on call if this will facilitate the completion of the elective slates.
 
Preop assessment is done with Pre-Anesthetic Information Forms (PAIF’s), collected by the OR booking clerk from health centres and doctors’ offices and placed for our review in the box outside the OR Nurse Manager’s office. Anesthesia consults are seen on an as-needed basis in the Surgical Daycare (SDC) Unit following our elective slates.
 
We are responsible for our daily machine checks. Soda lime canisters must be changed each Monday morning, and prn in between. Sharps buckets have to be shipped to Alberta so please use them only for needles and glass. No food or drink in OR theatres. Masks are obligatory and cloth hats prohibited. 
 
Glidescope is to be kept plugged in when not in use. If used after-hours the blade must be cleaned (a “recipe” is kept in the bag hanging on the scope cart).
 
 Physician Standing Orders are available for Post Neuraxial Narcotics, Multimodal Analgesia, Patient Controlled Analgesia, Post Op Epidural Anesthesia, and Obstetrical Epidural Anesthesia. To simplify routines for surgical/obstetrical nurses, whenever possible please use these PSO’s rather than devising your own.
 
The routine for dealing with epidural steroid patients is recorded in a binder in the OR booking clerk’s office. Guidelines for dose and drugs are included.
 
Arrangements must be made with Pharmacy for preparation of infusions for postop epidurals. L&D is supplied with premixed bags of bupivicaine 0.08%/fentanyl 2 mcg/ml.
Pain service patients (multimodal anesthesia, epidurals, PCA’s) should be seen daily by the on-call person until at least 48 hours post-op, when the PSO’s expire. Please record name and ward on the pain service clipboard in the OR.
 
Pre-op consults in SDC are to be shared by both anesthesiologists at the end of the elective slates.
 
Each day the OR booking clerk will provide you with a slate for recording billing data; billing codes are found in binders in the lounge.
 
 “Leftover” remifentanil must be stored in the narcotic cupboard, not the frig. Multidose vials must be dated, and discarded after one month.
 
An I Pod for procedural sedation patients is in the Nurse manager’s office and needs to be wiped down after use, and turned off and recharged before replacing in its box.
 
Long distance phone calls made from the hospital are to be strictly related to work at Stanton, or billed to a personal calling card.
 
It is recommended that patients be extubated prior to leaving the theatre, although recovery room nurses are comfortable with LMA removal. Anesthesia Department policy dictates that the anesthesiologist (including those staying at Beck Court and Nova Court) stay in the hospital until the last patient is out of Recovery Room. All ICU admissions must be approved by the internist on all.
 
Blood bank supplies are limited, and platelets aren’t stocked. If there are significant antibodies there may be a delay in obtaining cross-matched blood, so double check for a group and screen report when dealing with patients in whom transfusion is anticipated.
 
Hospital policy dictates that central venous and femoral art lines lines be inserted using strict aseptic technique including gloves, mask, gown, chlorhexidine skin prep, and head-to-toe drapes. Radial art lines to have the same except only a wrist drape.
 
Thursday mornings there is a 0900h start, allowing for anesthesia rounds and grand medical rounds. Anesthesia rounds include informal discussions of difficult cases and adverse events as well as didactic presentations on a variety of topics. They may or may not include the OR nursing staff.
 
Etomidate is available in the ER. Any physician using it must have completed a brief multiple choice “test”, and must fill in the appropriate documentation.
 
Admission to ICU must be approved by the internist on call. Ensure that it is clear who is to be the Most Responsible Physician during the ICU stay.