1. Welcome to the HOT Unit!

2. Purpose of these Slides  What you can expect from us.  What we can expect from you.  Pointers

3. What you can expect from us  A fun and interesting month.  Exposure to common hematology/oncology/and transplant issues.  Rounds that start and end on time (usually)! –Teaching Rounds 0830 –Patient Rounds start 0900, end 1100…. Goal is 1 hour each for Oncology and BMT.  Teaching at the bedside and at the board/computer.

4. Teaching / Learning Opportunities  0830 to 0900 Monday → Thursday –Lecture series to cover general topics –Slides will be on the website  On Rounds –topics of interest; patient-specific  Elsewhere –Ask us!

5. What we can expect from you  A fun and interesting month.  Interest in common oncology and bone marrow transplant issues (and maybe some hematology too!)  Being ready for rounds to start on time (defined as 0830).  Taking responsibility for patient care.

6. Pointers - The Computer  Sunrise has a lot of information.  Look at the “patient info” tab for many key long term issues. –Health issues  Long and short term health problems and procedures –Significant events  Consents (blood product, research/treatment protocols)  Blood product info (CMV status; premeds if needed)  Transplant info –Visit History  you can use this to find the Home Meds visit, where all the patient’s current outpatient medications are listed  Look under documents tab for dictated consults, clinic letters, H&Ps etc.

7. Pointers - The Computer: Home Med Visits  The home med visit is there for you to use at the time of admission.  It also requires that you update it at the time of discharge.  If the people in the clinic keep the home visit updated, and you do too, then it’s very easy to see what drugs a patient is on at the time you are seeing them!!  You will know when the last time it has been updated by the “home medicine updated” order date.

8. Pointers - The Computer: Home Med Visits - Admission To order the patient’s outpatient meds that are listed in the home visit into the inpatient visit:  Put the weight and height into the visit.  Click on the “orders tab”.  Click on the “order” icon (upper left) and be sure to put in the date.  Then hit “hide worksheet”  Now, click the “reorder” button on the bottom of the screen.  In the reorder/order window, use the “active held pending” filter and put in medications to get medications.  Then choose the copy from chart button and find the “home med visit”. Use select all to get all the active orders.  Do the same to get fluids/TPN by filtering for active held pending fluids/nutrition.  Make sure you hit “submit orders”  Double check your orders with parents and nurses

9. Pointers - The Computer: Home Med Visits - Discharge To update Home Meds by ordering meds that are in the inpatient visit into the home visit:  Put the weight and height into the visit.  Make sure you don’t “reorder” things that are already there.  Click on the “orders tab”.  Click on the “order” icon (upper left) and be sure to put in the date.  Then hit “hide worksheet”  Now, click the “reorder” button on the bottom of the screen.  In the reorder/order window, use the “active held pending” filter and put in ‘medications’ to get the meds.  Then choose the copy from chart button and find the “current visit”. Use ‘select all’ to get all the active orders.  Do the same to get fluids/TPN by filtering for active held pending fluids/nutrition.  Make sure you hit “submit orders ” –Double check your orders with nurses and MAR –Double check the medication start and stop dates

10. Pointers - Note Writing  The progress note is way we document and communicate information about the current status of a patient in the medical record. You should be able to tell what is going on by reading the notes!  Please do, and document, a physical exam with pertinent positives and negatives (it is our job to teach you these on rounds).  Please include an ASSESSMENT with your plans. This includes explaining why something is in your plan. Differential diagnoses, etc. can be very helpful.  For Oncology, please –use the back half of the ‘chemotherapy progress note’ if you run out of space on the front –leave the right hand margin free for the attending MD to write a progress note

11. Pointers - Rounds  Be ready for rounds. If the attendings are not there, page them!  Be prepared to present your patients using a systems oriented method.  If you are post call, ask to go first to comply with the 80/30 rules.  If you are not presenting, use the computer for order entry.  Stay interested. That will lead to more teaching and more enjoyment!

12. Pointers - Sign Outs  One of the most important jobs for a resident is a good sign out.  If an intern is on, back up must be included in sign outs.  If a patient is “ill”, bedside sign outs are best.  Ask the attending to walk around with you in the afternoon.

13. Pointers - Psychosocial  The HOT unit can be very stressful. This is because the children are often very ill, their families are very anxious, and the nurses and docs (including you) are passionate about what they do.  Together, these can put a “rotating resident” in a difficult place.  Pointers –Do not argue with a parent or nurse. Tell them you will talk to the attending, and call the attending. –Try to sit in on “big picture discussions” –Ask for “mental health” help from the attending, your peers, the Chiefs, etc. if you need it

14. Pointers - Mental Health  When you get stressed, talk with peers, staff, and the chiefs.  If one of your patients dies, if you wish, people will cover for you to go to a visitation and/or funeral.  It’s ok to be sad and depressed when your patients are ill. How you deal with those issues is an important part of your learning. Please talk with us about those issues.

16. BMT Team James Casper MD Mary Eapen MBBS MS Bill Grossman MD PhD Dave Margolis MD Julie An Talano MD Oncology Team Meghen Browning MD Bruce Camitta MD James Casper MD Sachin Jogal MD Michael Kelly MD PhD Anne Warwick MD MPH