PGY1 Transition to Practice

MDT Panel
Physiotherapy
● Our role
○ Respiratory, function, rehabilitation, neurological patients, equipment, discharge planning
○ Main roles
■ General medical- movement and function
■ General surgery- respiratory and mobility post operatively
○ Do not have to see every patient for discharge
■ The nurses are a great point of contact, you can even assess mobility yourself
■ Many patients improve with medical treatment alone
○ Ward based not specialty based
● Physio assistants
○ May see these on the ward- not physios so won’t be able to answer questions
General surgery
● Referrals
○ Laparotomy or other surgery cutting through abdomen regardless of surgery time
○ Any surgery more than 180 minutes in length (due to effects of general anaesthetic)
○ Patients who have had these surgeries need to walk ASAP
● What we do
○ Mobilise patients day one after surgery
■ We are not professional walkers so do not expect us to walk patients everyday until
discharge
○ Check for any respiratory compromise
■ Wide range of techniques based on what the patients issue is
■ Do not just get them to cough and deep breath (anyone can do this even you)
■ Referral for ‘chest physio’ not required if coughing and clearing independently
● Incentive spirometers
○ Not actually overly effective (feel free to tell your SMOs)
○ Actually works on inspiration not expiration
General medicine
● As I said before we have a diverse range of skills
● General medicine wards have a diverse range of patients
● Key for general medicine is that we are movement and function experts
● We mainly see acute changes in function from a mechanical cause or get a
mobility plan together for a patient (especially over weekends)
● Discharge planning is crucial in general medicine and we collaborate with the
rest of the MDT on this
What you can do to help us

● Encourage restorative care

○ Getting out in their chair, putting own clothes on, mobilising
○ Helps avoid things such as deliriums to shorten hospital stays
● Ask more questions
○ Cortex is very good at prompting to ask about social history
○ Ask about patients baseline function and if they can’t tell you then find out
○ Ask if they think they are at their baseline and if not why not
● Referrals
○ Flowview, page ward physio or come find us!
○ Be specific
○ If urgent please contact as straight away (respiratory patients and discharges)
Social Work
5 things House Officers can handover to social workers on the
Ward.
● When a patient is not able to perform the activities of daily living
independently.
● Social issues that you as a doctor do not have the skills,resources and
training to navigate. Eg Alcohol and drugs, accommodation and transport,
Grief and loss counselling, Financial stress, Family violence, Residential
care placements (Legal issues EPOA & Welfare guardianship) and
complex family issues.
● Any social issues that need sorting, that would avoid readmissions.
● If a patient needs rehab at home with CREST or Burwood they mostly
don`t need a SW referral.
● In Family meetings allow SW to deal with family issues or dx planning,
while you address the medical complexities.
The Reasons why Social work is Important
● Conducting psychosocial assessments to identify mental or emotional
Th
distress.
● Counselling those in crisis or experiencing distress.
● Connecting patients and their families with necessary resources.

“Our patients need us to be their voice when they cannot advocate for
themselves, They need us to smooth the transition between hospital
and community so they can be well at home, they need us to see the
best in them so they believe in themselves and they need us to listen
to their stories, the highs, but a lot of the times the lows, and
understand when so many other people don`t.” Catherine Hughes SW
clinical manager
What can Social workers arrange

● Community supports. Eg medication management, showering, dressing,ect.

● Respite, carer support, Day care for the elderly.
● Winz benefits, disability allowances, sickness benefits.
● Residential care, interRai`s.
● Dx planning, emergency housing,
● Drug and alcohol input
● Counselling services
● Safe accommodation for people involved in family violence and abuse.
● Educate you on what is acute and what can be dealt with by the Gp.
● Family meetings.
● Funding streams for different patients, eg life links, planning and funding,long
term chronic health
Occupational therapist
The primary goal of Occupational Therapy (O.T) is to enable people to participate
in the activities of everyday life. Occupational Therapists achieve this by working
with people to to enhance their ability to engage in the occupations they want to,
need to, or are expected to do; or by modifying the occupation or environment to
better support their occupational therapy engagement.

Occupational Therapists in the acute hospital setting are primarily concerned with
a patient’s functional ability, and will assess any patient that has had a change in
function due to injury/illness. Our aim is to facilitate patient independence while
maintaining their safety.
O.T Intervention can include:
● Issuing adaptive equipment
● Arranging for an O.T home visit
● Assessing cognition
● Providing advice/education to facilitate coping
● Organising home based support packages for ACC patients
● Assisting in the decision making process around appropriate discharge
destination for patients
How to refer:
➔ Floview
➔ Pager
➔ MDT meeting
➔ Verbal Referrals

Hours: 8am - 4.30pm Monday - Friday

Weekend Service for discharging patients only: referrals accepted between

9am and 3pm Saturday and Sunday.
Dietitian
Dietitians role is enhancing, and facilitating the nutritional needs of inpatients and
outpatients through the assessment, intervention, and education of both paediatric
and adult patients and their whanau with nutrition related conditions.

● Malnutrition (MST score >3 or more)

● Refeeding syndrome
● Initiating nutrition support - EN or PN, t/f from ICU, supplements at home, EEN
● Medical and surgical conditions e.g. burns >10%, cancer side effects impacting
nutrition, CRF, GI disorders, PIs

HHP ‘Acute Adult Nutrition and Dietitian Assessment’ page, as well as exclusion criteria
(weight loss, lifestyle change).
Referrals:

- Fax
- Phone call
- Verbals: ward meetings/face-to-face

Hours: 8am - 4.30pm Monday - Friday

Weekend On-Call Service for urgent patients only e.g. NBM requiring IV feeding or
tube feeding, referrals accepted between 9am and 3pm Saturday and Sunday.
Things to note:

● Discharge home on new TPN or EN takes time.

● Referral to dietitian for low albumin not accepted.

Albumin is affected by inflammation, infection, overhydration, redistribution of fluid,

increased losses and catabolism. A nutrition marker which in isolation does not always
indicate nutrition.

● Oral Nutrition Supplements e.g. Fortisip or Ensure Plus require a special authority.

How to help:

● Document malnutrition
● Refer early
● If unsure, give us a call
Speech and Language Therapy
What we do:

● Adult Team

Provide assessment and management of communication and swallowing disorders with

varied etiology. Adult team SLTs work across a wide range of specialties including
stroke, neurology/neurosurgery, ENT, general medicine, general surgery and ICU.

● Paediatric Team

Provide assessment and management of feeding and swallowing disorders. Paediatric

SLTs work across a range of specialties and have a significant role in establishing
feeding in the neonatal population.
How you can help!

● Provide support to explain medical consequences of aspiration to patients

who are identified to be at risk.
● Discuss cough reflex testing and instrumental assessment with us.

Things to know:

● If your patient has unexplained and recurrent pneumonia, consider referral to

SLT.
● Thickened fluids and modified food textures are not for everyone!
● There is an important difference between oropharyngeal dysphagia and
oesophageal dysphagia.
How to refer:

● We accept:

Paper referrals via fax

Acute Stroke Swallow Screens (completed by Stroke RN) via email

Service:

● Monday-Friday 0800 - 1630

● No weekend SLT service

● Provision of essential service on public holidays

 Pharmacist:
1. What happens when a patient brings in a prescription?
2. Prescribing non-controlled & controlled drugs
3. Discharge process
1
 💊💉
Legal check
Clinical check
2
 Doctor’s name (NZMC)
Address: Christchurch hospital
Contact:
Patient’s name
Address:
Contact:

Drug, strength
Instructions
Quantity (3 months or 6 months for an oral contraceptive)
*
Sign: Date:
*Special authority numbers (funding $$$)
 😅
When the doctor really doesn’t want you to get
pregnant…
And the winner is…….
 CONTROLLED DRUGS
Class A & B e.g. morphine, fentanyl, oxycodone
Differences to regular prescriptions:

● Triplicate form
● Quantity: 1 month
● MUST be in the doctor’s own handwriting
● DOB < 12 years

Common difficulties: Legibility e.g. 15ml (FIFTEEN ml) every 2 hours prn for
pain helps us! Forgetting to applying/expired special authority numbers!
3
DISCHARGE PROCESS
● Blister pack example;
ADVICE...
● Clear discharge summary: stopped/started/changed/continued
● Write prescriptions for EVERYTHING (started/changed medicines
AND continued medications) so they can go home with
everything!
● Special authority where applicable

EASY!
Bonus: The patient now has their correct medicines over the
weekend!
Thanks for listening!
😀