ARMMC SURGERY ENDORSEMENT

MUST KNOW!

1. Attendance at Surgery OPD (2nd floor)

2. Attend morning endorsement every 7:00am so make sure na naghihintay na
kayo sa Surgery OPD before magstart ang endorsement.
3. Change of dressing (COD) after endorsement. By TEAM po ang COD. Wag
iasa sa ibang team ang pagCOD ng patients na nakadeck sa team nyo.
● REMEMBER: Take a picture of the surgical site AFTER removing the
gauze (old) and BEFORE putting the clean (new) gauze. Send the
picture on the viber group of your respective teams with caption
(Name, BEFORE/AFTER)
● How to make Dakin's Solution: 1L PNSS + 3mL Zonrox original
4. ERRANDS by TEAM din po ito.
5. Always reply po sa VIBER GC

GS Teams
● GS1: Napay/Jopson/Unida/Verallo
● GS2: Rovillos/Sanchez/Cecogo/Piñera/Imperial
● GS3: Matundan/Rubia/Alejaga/Valeña

Duty Teams
● Green: Napay/Jopson/Rubia/Verallo/Imperial/Valeña
● Red: Rovillos/Unida/Sanchez/Cecogo/Piñera/Imperial/Valeña
● Blue: Matundan/Martin/Alejaga/Imperial/Valeña

PRE DUTY (OPD)

TASKS:
➔ Interview the patients (CC and pertinent history/pe)
➔ Prepare requests (depende sa ipapagawa ni Doc), always remember na pag gumagawa ng request dapat
laging may kasamang medical certificate for Malasakit.
◆ CP Clearance Lab Tests:
● CBC, BT, PT/PTT
● Urinalysis
● FBS, Lipid Profile, BUN, AST, ALT, Crea, Na, K
● Chest X-ray PA
● 12L ECG
➔ Prescription (see medications cheat sheet)
➔ Skills
◆ Removal of suture (ROS)
● Pwede nyo na agad unahin mga ROS tapos kayo na rin magtanggal ng suture.
● Before tanggalin lahat ng sutures dapat mag-alternate muna ng pagtanggal to make sure
na well-coaptated na talaga yung suture. If hindi pa, tell your patient to follow up again

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 after 1 week.
● If hindi kayo sure sa tatanggalin nyo, you can always ask your residents. Very
approachable naman sila.
● On the back of the patient’s chart, you can already input your Assessment and Plan on
your own tapos pacheck mo na lang kila Doc if hindi ka tiwala sa assessment mo.
○ Example:
◆ A > Lacerated wound, frontoparietal area, left
◆ P > For removal of suture
◆ Removal/change of IFC - usually every Tuesday and Thursday to kasi URO day.
◆ Tuli - tuturuan naman kayo if hindi pa kayo marunong
◆ Procedures (incision, excision, wound debridement, etc) - usually sila Doc gumagawa nyan after
matapos lahat ng patients.
➔ Assign 1 JI to do the EHR (see EHR guide below)

ORTHO OPD 1PM ONWARDS (Monday-Wednesday-Friday)

➔ Always assign 2-3 JIs for ORTHO OPD
➔ Tasks: Same lang din sa general OPD
➔ Skills: Casting (e.g. Long arm posterior mold, etc.)

BOBO-FRIENDLY EHR GUIDE

Pag di mo pa nagets ‘to ewan ko na lang

STEP 1:
● Login the EHR account of the resident-on-duty for OPD
● Accounts:
○ Username: CMOVALENO Password: abcdE123!
○ Username: TJIMPERIAL Password: Weakpr#062017

STEP 2:
● Click on ELECTRONIC HEALTH RECORDS

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STEP 3:

STEP 4:

STEP 5:
● After clicking ADD NOTE, there will be a dropdown box then
choose FOR CURRENT APPOINTMENT

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STEP 6:
● SOAP (Subjective, Objective, Assessment, Plan)

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STEP 7:
● Last na ‘to
● Discharge the patient
○ Go back to VISITS

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ADDITIONAL:
● Laging lumalabas ‘tong bwisit na ‘to. Click mo lang lagi
yung OK

CF4 AFTER OPD

Paano mag CF4 ang beshy ko?

STEP 1:
● Check nyo muna yung list kung sino pa ang di nagagawan ng CF4. Click the link below
https://docs.google.com/spreadsheets/d/1RH3NTxewJv_qoDr3O8z_6Il82kyeC7GPe6ZljKuJUFo/edit#gi
d=740972182

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STEP 2:
● Go to Hospital Information System 8 or HIS and search for the patient’s name.
● Click Claim Form 4 Processing.

STEP 3:
● Fill up the blank data on the FIRST and SECOND PAGE
● Kahit gawa gawa na lang kayo ng HPI if hindi nyo kilala yung patient basta malapit dun
sa CC and diagnosis nya or you can ask your first year residents.

First Page

Second Page

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STEP 4:
● Click “Course in the ward”

Course in the ward > ADD > Change the date > Input data (see CITW cheat sheet) > SAVE

COURSE IN THE WARD CHEATSHEET:

(DATE OF ADMISSION)
● PATIENT WAS ADMITTED UNDER SURGERY SERVICE. PATIENT WAS EXAMINED PHYSICALLY. CONSENT FOR MANAGEMENT AND ADMISSION WERE SECURED. NECESSARY DIAGNOSTICS
WERE DONE. GIVEN PRESENT MEDICATIONS AND REFERRED ACCORDINGLY.
(DURING HOSPITAL DAY)
● PATIENT WAS SEEN AND EXAMINED. VITAL SIGNS WERE MONITORED AND RECORDED. INPUT AND OUTPUT WERE MONITORED EVERY SHIFT. CONTINUE PRESENT MEDICATIONS. REFERRED
ACCORDINGLY.
(DATE OF DISCHARGE)
● PATIENT WAS SEEN AND EXAMINED, CONDITION IMPROVED AND WAS DEEMED FIT FOR DISCHARGE. PRESCRIBED TAKE HOME MEDICATIONS AND ADVISED FOLLOW UP.

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EXAMPLE OF CITW:
● Reminder: Start from date of admission to discharged date. Makikita nyo naman yung date of admission/discharged sa first page.

STEP 5:
● SAVE AND CLOSE

STEP 6:
● Update “EHR and CF4 Endorsement” GDoc
https://docs.google.com/document/d/17kE-QWBKvuHRcnMW2_8YJaD2XU-dIQn02aBIyWA5ExY/edi
t

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 DUTY (WARD)

TASKS:
➔ VS Monitoring
◆ Always ask from duty teams for patients for monitoring (ask din kailan last VS nila)
➔ Other errands by residents specially by seniors

FROM STATUS

TASKS:
➔ OR Proposal
◆ Step 1: Print OR proposal form.
● Look for OR Proposal na Word file sa computer sa nurse’s station (yung malapit sa
printer) then print.
◆ Step 2: Fill-up OR proposal form
● First year resi will send the OR line up for tomorrow’s OR. Ask if final na kasi minsan
nababago pa. If may go signal na, fill-up the OR proposal.
● Yung sa last column ilalagay risk strat ng patient. Check nyo na lang chart if may entry
ang IM-Cardio or Pedia about clearance sa doctor’s order.
◆ Step 3: Put the lab results at the back of the OR proposal.
● Lab tests to include (Always put the latest labs)
○ CBC (Oks lang fishbone dito)
○ PT/PTT (Ilagay ang PT, % Activity, INR, PTT)
○ BUN, Crea, Na, K
○ Chest X-ray
● Para di ka na maghanap sa chart ng patient, check mo na lang Weblis and SoliPacs.
Check nyo pinakalatest na results.

➔ Medical Records
◆ Assign 1 JI for medical records. Make sure may dalang trodat ng resi.
◆ Punta sa Med Records and ask if may for completion pa na charts under Surgery.
◆ Sign in the attendance logbook then may ipapasign sainyo na waiver for Data Privacy tapos
ipapasa sa Legal Management O ce.
◆ May iaabot na bundle ng mga charts sainyo. May mga tag na nakalagay and label kung ano need
gawin. Usually ito pinapagawa nila:
● T/S → trodat and sign.
● Lagyan ng Final Diagnosis or Operation
● Kulang na details sa OR Tech

➔ Errands

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 OR

Anyone can assist pero preferably pa rin na kung kaninong team nakadeck yung patient kaya dapat may
assigned JI na for OR. Usually sinesend naman nila kung anong OR procedure the next day.

Histopath Logbook
➔ Histopath logbook for all OR cases na may specimen for histopath. Need i accomplish yung rows as well
as ipasign sa lab afterwards. Must do this for every OR na may specimen. Logbook will always be
returned dapat sa Surg O ce para hindi tayo magkawalaan. Lab is at 3rd floor of OPD building. Picturan
nalang din natin every after entry for backup.
➔ Remember: nawalang specimen = repeat rotation

DISCHARGED PACKAGE (MGH PACKAGE)

ALWAYS REMEMBER NA 6 PAPERS ANG KAILANGAN MATAPOS MO FOR DP

1. Admission and Discharge Record

● Ito yung front page sa chart.
● Lagay niyo lang yung final diagnosis ICD code (search niyo online) and procedure done then trodat
dalawa sa harap
● Pirmahan ang attending physician ng team-in-charge

2. CF2
● Lagayan niyo yung name, date and time admitted, admitting diagnosis, discharge diagnosis and ICD
code, Procedure done and RVS code tapos trodat sa likod sa pinaka baba

3. Discharge Summary
● Yung history makikita either sa ER admission chart or residents admitting notes
● Course in the ward kahit hindi detailed
● Final diagnosis based yan sa OR tech if naoperahan na. Yung post op diagnosis. If wala, sa admitting
chart
● Pirmahan ang attending physician ng team in charge

4. Clinical Abstract
● Yung history makikita either sa ER admission chart or residents admitting notes
● Yung abstract combine niyo yung history and course in the ward
● Yung sa meds makikita yan sa medication list. Ilagay lahat with dose
● Final diagnosis based yan sa OR tech if naoperahan na. Ito yung post op diagnosis. If wala, sa admitting
chart
● Pirmahan ang attending physician ng team in-charge

5. Prescription
● Check MGH orders sa doctor's order sheet

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6. Tagubilin
● Sa may labs and diagnostics lagyan niyo lang ng see attached, tapos take home meds then follow up
date. If ortho, Mon-Wed-Fri niyo itapat

DAILY CENSUS

Reminders:
1. All teams will input their assigned patients here sa census, regardless kung procedure, referrals, or
admission.
2. It should be done before 7PM
3. If done, ipacheck niyo sa from duty 1st year resident
4. Download a copy for that day and post it here sa group.

How to make the census:

Step 1: Make a duplicate of the census from yesterday.
Step 2: Change the color of the census the same as the color of the team on duty that day (RED vs GREEN vs
BLUE)
Step 3: Input all admissions, procedure and referrals from 8AM today up to 8AM the next day
Step 4: You may ask the 1st year residents for the patient's info.

DICOM LINK

Step 1: Kuha ng CD
● Punta sa OPD. Dun sa wooden na cabinet katabi ng minor OR at ng surgery o ce door (kung saan niyo
iniiwan bags niyo) sa lower cabinet may black na bag. Sa loob may bundle ng CDs kuha ng isa

Step 2: Punta sa Radio (Information)

● Ibigay nyo CD and sabihin na kukunin po DICOM for patient ____, kung anong test ginawa, and kung kelan.

Step 3: Make a DICOM link

● Just open the Cd In file explorer
● Right click on the DICOM folder (sometimes named A)
● Send to compressed (zipped) file *ZIP please.. NOT RAR!
● Upload zipfile to google drive
● Right click on the uploaded zip file and click "get link"
● Click on "restricted" and change to "anyone with the link"
● Click "copy link" and paste it to viber for sending

MEDICATIONS CHEAT SHEET

MOST COMMONLY PRESCRIBED MEDS:

● Cefuroxime 500 mg/tab, 1 tab BID/TID x 7 days
● Celecoxib 200 mg/cap, 1 cap BID PRN for pain
● Ciprofloxacin 500 mg/tab, 1 cap Q12 x 7 days

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 ● Clindamycin 300 mg/tab 1 tab Q6 x 7 days
● Co-amoxiclav 625 mg/tab 1 tab Q12 x 7 days
● Diosmin + Hesperidin 500mg/tab, 1 tab 3x a day for 4 days then 2x a day for 3 days
● Eperisone 50mg/tab TID x 5 days
● Faktu ointment - Apply 2-3x a day along anus
● Finasteride 5g/tab OD
● Hyoscine-N-butylbromide 10mg/tab 1 tab Q8
● Lactulose 30 mL ODHS
● Mefenamic acid 500mg/tab, 1 tab Q8 PRN Pain
● Metronidazole 500mg/tab, 1 tab TID x 7 days
● Paracetamol 500 mg/tab 1 tab Q4 PRN fever or Q6 for pain
● Paracetamol + Tramadol 325 mg/37.5 mg, 1 tab Q8 PRN for pain
● Tamsulosin 400 mcg/tab OD
● Tramadol 50 mg, 1 tab TID
● Tranexamic acid 500g TID x 3 days

STEP DOWN MEDS:

● Meropenem and Piptaz → Sultamicillin 750 mg BID
● Ceftriaxone, Cefuroxime, Cefoxitin → Cefuroxime 500 mg BID

PEDIATRIC DOSE:
● Cefuroxime
○ 30 mg/kg/dose
○ Q8 x 7 days
○ Available preparations: 250mg/5mL
● Paracetamol
○ 10-15 mg/kg/dose
○ Q4 for fever and Q6 for pain
○ Available preparations: 125mg/5mL, 250mg/5mL, 300mg/amp
● Amoxicillin
○ 30 mg/kg/dose
○ Q8 x 7 days
○ Available preparations: 125mg/5mL, 250mg/5mL
● Cloxacillin
○ 50 mg/kg/dose
○ Q6 x 7 days
○ Available preparations: 125mg/5mL, 250mg/5mL
● Co-amoxiclav
○ 30 mg/kg/dose
○ Q12 x 7 days
○ Available preparations: 312.5mg/5mL
● Ibuprofen
○ 10mg/kg/dose
○ Q6 PRN for pain
○ Available preparations: 200mg/5mL

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