ABC’s OF HOUSE JOB IN UCH, IBADAN

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E.O Ugwu¹, K.I Egbuchulem², I.S Eseile³, N.U Olagunju³, V.O Onyenokwe⁴, R.O Balogun⁵, S.A Adebayo⁵, A.B Obasi⁶, O. Okeme⁷, D. Ibitokun⁸, S.J Ige⁸, V.O Olalusi⁵, B.K Suleman⁷, A. Adeyemi⁹, E.G Sunday¹⁰, I.E Iwuagwu¹⁰, M. Alli¹¹, E.C Elumelu¹¹, O.T Ojediran², O.M Farinre¹², A.T Salaudeen⁸, O.W Osaghae⁸, A. Oyakire⁸, F. Ezema⁸, P. Mordi⁸, K. Okpo⁸, C. Egenti⁸, M. Emesobum⁸, N. Umunna⁸

1. Department of Plastic, Reconstructive & Aesthetic Surgery, University College Hospital, Ibadan.
2. Division of Paediatric Surgery, Department of Surgery, University College Hospital, Ibadan.
3. Department of Surgery, University College Hospital, Ibadan.
4. Department of Internal Medicine, University College Hospital, Ibadan.
5. Department of Obstetrics & Gynaecology, University College Hospital, Ibadan.
6. Department of Paediatrics, University College Hospital, Ibadan.
7. Department of Oral & Maxillofacial Surgery, University College Hospital, Ibadan.
8. House Officers’ (2021/2022), University College Hospital, Ibadan.
9. Department of Surgery (Division of Cardiovascular & Thoracic Surgery), University College Hospital, Ibadan.
10. Department of Neurological Surgery, University College Hospital, Ibadan.
11. Department of Orthopaedics & Trauma, University College Hospital, Ibadan.
12. Department of Surgery (Division of Urological Surgery), University College Hospital, Ibadan

Introduction

General Roles of a House Officer: Rtation Pattern Surgery => Medicine => Obstetrics & Gynaecology => Paediatrics =>
Usually on medical rotation then a surgical rotation and vice versa.

Ward Rounds
You are often required to document in the case notes during ward rounds. It is helpful if you have continuation sheets in your pocket along with some investigation forms.

The documentation usually follows the following sequence. (SOAP): –
Subjective: The patient’s complaint(s)
Objective: Vital signs and relevant physical examination
Assessment: Diagnosis
Plan: What to do next

Consultant Ward Round (CWR): Every Unit has a day(s) assigned for CWR. On this day(s), the consultant(s) would be on the ward to physically see in- patients. You are expected to write a CWR Summary the night before the CWR. This
summary would detail the patient’s history from

admission to care given so far and current medications as well as most recent plan. Some units assign the HOto present the patients during the CWR. Therefore, it is advised to do your CWR summary judiciously and effectively. Since it is a weekly summary, the care given so far from the last CWR to the present one (i.e., what has changed in the patients’ status or care since the consultant saw them last week) should be carefully
detailed.

Post Rounds

The “Plan” column will guide you in your post-round work. This is where you are to write out forms for
investigations, what sample needs to be taken and what medication dosage needs to be updated or added to the TREATMENT SHEET (more on this below)

Some details of the post round work below. =Filling investigation forms: You are to ensure the requested investigation forms are filled and given to patients’ relatives. If these investigations require you to take a blood sample, then always check back on the status of the form you have given, whether it is yet tobe paid for or pending at the laboratory. This feedback =will be required from you by your superiors at any time about any investigations, so it is important to be in the know. You can kindly ask the nurses to call you
on the HO call phone to inform you when a sample bottle or test result has arrived.

=Creating and Updating treatment sheets: You are also responsible for writing up and updating a TREATMENT SHEET. This contains the medications (Tablets, IV, IM, SC, NG Tube feeding) the patient is on, their dosage and duration so that the nurses can administer accordingly. This needs to be written for any new admission on the ward as well as to be updated at regular intervals for patients that have been on admission on the ward for some time.

=Drug Chart: Draw up a table for all IV drugs with the hours to be administered for each patient. This makes it easier for you to keep up with patients’ drug administration. You can chart it in a way that some drugs are given together and others far apart (a staggered system) for effective time management. The nurses also have their own drug charts showing the times all other medications prescribed (apart from IV) were given or if they are not available. Ensure the patient is taking ALL medications from both drug charts regularly as it is something you will be asked during ward rounds or even after work hours. The nurses also keep a VITAL SIGNS and INPUT/ OUTPUT chart. It is important to go over these as they help you to have a holistic knowledge of the multidisciplinary care given to the patient and enable you to update your superiors if they call after work hours without trudging back to the wards.