A.
VIBER ACCOUNT
I appreciate that your format of viber account name is as follows
CC-surname, first name
Clinical Clerks
*CC-Chan, Mark*
to avoid confusion
interns will have
*I-Chan, Mark*
as their format
You should be part of the 4 group chats at least 12 hours prior entering to your duty
(PAYWARD, Service / CHA ward, NICU PAY, ER for ____ 2023)
B. ATTENDANCE LOG BOOK
C. DIRECTORY OF CLERKS (8)
your assigned number is beside your name as shown in this photo
each day may number
so beside the number you write your name and fill up the following
Beside the number write your name legibly.
For the Column (left) before your number pls indicate if
P for PRE
D for DUTY
F for FROM
Next column to the (right) of your number is your post
Indicate if you are
Write the 3 letter abbreviation
PAY (for payward)
CHA (for Charity)
ER (emergency room)
NSU (nsu pay)
TI means time in
Sign beside once u time in
TO means time out
Sign beside once you sign out
yes Mag log pa rin sa attendance logbook kahit from duty status (From duty may start
logging in by 6am)
D. ATTENDANCE INDEX CARD
Kung sino kasama mo na POD or PROD , sa kanya mo ipasign ung quota mo or ung
index card. WAG WAWALAIN ANG INDEX CARD / QUOTA SHEET
E. POSTS / DURATION
PRE DUTY 8AM - 6PM
Your respective posts and duration.
No Clinical Clerk should have face to face encounter with covid patient (RT PCR
confirmed)
BUT CC may look into the chart of the covid patient in the nurses station.
Always wear mask inside hospital premises.
Then tuloy tuloy na yan Pre duty from cycle
For any questions regarding schedule, ask me. dont assume,
ON SUNDAYS, HOLIDAYS
PRE DUTY - DO NOT COME TO CGH
FROM DUTY - LEAVE AFTER 8AM ENDORSEMENT
DUTY - 6AM TO 6PM (then endorse to your PGI kasi walang CC from 6PM sunday to
6AM monday)
ON DAYS WITH SUSPENSION BECAUSE OF NATURAL CALAMITY as approved by
Dr. Alyce Gail Arejola Tan
Wait for announcements. Case to case basis.
ABSENCES
Excused absence will only be excused if with med cert or excused letter acknowledged
by dr A. Soliven for PGI (1:1)
By college physician for Clinical clerks
or else if not excusable (1:3)
For other non medical cases of reason for absence, pls PM me
F. REQUIREMENTS
a. Patient encounter log form
b. Internship skills check list - also for clerks
c. Drug list
G. FOOD
H. ER PANTRY
Note: photo not taken today
A friendly reminder to
please maintain cleanliness at all times at the ER PANTRY
(ref / table) area
Ayaw natin ung mga gantong eksena o scenes sa ER pantry
Food packs coming from the dietary dept must be CONSUMED WITHIN 4 hours.
Label your food pack (name and time) accordingly.
ER NOD (maam thez) doing inspection.
di atin ung area na yan so if may food kayu, consume within 4 hrs and discard properly.
I. THURSDAY PEDIA STAFF CONFERENCE
Different from Saturday staff conference
*EVERY THURSDAY is STAFF CONFERENCE DAY*
unless announced to be canceled
Your role as clinical clerks in every staff conference is
1. Arrive at 820 AM in proper uniform
2. Sit down in alphabetical order
3. Listen to the speaker
4. Learn
5. Be at your best behavior. Behave.
6. You may get the food provided AFTER the staff conference (if available)
7. Back to your post immediately after the conference ends and after getting your food.
ALL Clinical clerks will go up unless toxic situation in particular post
and need extra man power but please *inform me of the situation*.
FOR INTERNS
1 intern per post will be left meaning
1 intern sa nsu pay
1 intern sa charity
1 intern sa er
1 intern sa payward
Unless may toxic na patient need help, inform me na dun kayu sa toxic patient
Di naman kayu magsasalita dun sa harap. makikinig lang kayu. nothing to prepare so
please behave lang unless gusto nyu magsalita sa harapan.
Attendance will be checked.
Kakain ng pagkain AFTER ng conference. Pwde mag kape provided during conference.
✨ CGHMC Department of Pediatrics
[THURSDAY STAFF CONFERENCE]
Topic: "When the Sun is Not Enough"
Speaker: Dr. Felizardo Gatcheco
Moderator: Dr. Rowena Co-Lee
Date: AUGUST 3, 2023
Time start: 08:30 AM
Venue: 6/F Conference Rm., Bldg 1 (Main Bldg)
Thank you!
J. INTERN / CLERK IN CHARGE
Assign a clerk or intern in your subgroup who should know everything about the patient
from head to toe PE, from womb to tomb history
K. REFERENCE MATERIALS / RESOURCES
Dahil lahat tayo di kabisado ang mga dosing ng gamot kahit residente na ako
all of us, as in ALL OF US should have these materials in our phones so when we try to
compute for meds, we have this as basis… unless kabisado nyu na… eh ako nde pa
hehe
Neofax
Harriet
CPG (e.g. AGE No DHN)
“This is a file of Clinical Practice Guidelines (CPG) on AGE with no dehydration.
by the Philippine Pediatric Society
As future doctors, the CPGs (local or international) are there to guide us
on how you would manage your patient
and maybe to check if you're missing out something on your patient too
It would be your call if you would want to follow recommendations stated in the CPG or
not.
Afterall, each patient is different and individualized approach is considered.
Di po tayu dekahon na pag eto ung case ng patient mo eto ung gagawin mo
It will depend talaga sa clinical presentation of your patient.
Read on the different CPGs available on the internet and see whats applicable to your
patient”
SS of bhuttani chart harriet
SS of exchange transfusion harriet
SS of differential count Hariet
SS of vital signs for age harriet - Immediately refer if u noticed VS is not normal so we
can trouble shoot. SAVE IT in your phones.
L. CENSUS
Since clerks and interns help each other out in editing the census, here is a guide on what each
component of the census is and what it means and how you will edit.
IN EDITING THE CENSUS
Guys I want you to follow the format like how it is being done. It should be AS COMPLETE AND
AS UPDATED AS POSSIBLE
wag tayu gumawa ng sarili nating format
Ang ating census maraming short cut kasi Tayu tayu nagkakaintindihan pero sa MERX bawal
short cut
M. WHO GROWTH CHART applicable for age for every chart na non newborn.
Newborns have the 3rd page of MDS for that
N. MERX
Show SS Dr. IA abstract 101
Bawal shortcut sa MERX kasi LAY person ang magbabasa ng merx so no shortcuts.
MERX is a legal document so be careful what you enter. Also what’s not documented did
not happen so ensure completeness.
Regarding paperworks course in ward (merx) naman
1. NO SHORT CUTS when relaying labs
2. Relay ALL LAB RESULTS done for the patient on specified date in course in ward
3. Pwde naman multiple entries for one particular day (example: tatlong aug 7 entries
kung maraming naganap sa aug 7)
4. For u to be FAMILIAR and LEARN with the MEDICATIONS, relay the medications
used in the course in the wards in such a way that you will be able to relay
1. Name of meds
2. Dose of meds
MKDOSE (for non antibiotic and MKDAY (for antibiotics)
3. Route (IV, Per orem, etc.)
4. Frequency - dont write q‼️
Lay person dont know what q is
Write the word “every”
Example : ” Every 12 hours”
5. no need to specify how much milk given to baby but need to specify mode
Ex. Cup feeding started.
or OGT feeding gradually graded up
Medical abstracts are meant for LAY PERSON TO UNDERSTAND
Pansinin nyu rin kung paano mag edit ung resident nyu kung ano pinapabago at ano
ang nagbago para di paulit ulit ung pag correct
Pag NAGPAPACHECK ng course in the ward, you have to READ AND REVISE if
needed,
STARTING FROM DAY OF ADMISSION kahit d nyu pa nakikita ung patient kasi nasa
chart naman yan or kung ano ung ma endorse sayo regarding the px
Dont just revise or check ung sa last day in the hospital
This applies to PAYward and NSU PAY too
O. PATIENT DATA SHEET
For pay ward and NSU / NICU PAY patients, you are NOT ALLOWED to put anything.
Only the CONSULTANT and the CONSULTANT only should write here
For charity NSU patients, you may write here ung sinusulat sa 4th page ng MDS kung ok
sa PROD kaya ipapa counter check nyu ahhh.
Pls write LEGIBLY and
COMPLETELY.
NO Short cuts
Sa Charity ward wag muna.
P. DEMERIT SYSTEM by DMER
Q. Relaying lab results in Viber
Sa pag relay ng laboratories katulad ng cbc sa viber ,
dito tayu mag e-effort na lang... meaning
1. dont shortcut (dont put S, L, M, E, B.. spell out segmenter, lymphocyte, monocyte)
2. BANDS is part of your differential count !!
(These are your very young neutrophils na pag elevated may signify bacterial infection
BUT must be correlated with patient clinical picture)
3. Also include NRBC in relaying the CBC result if present
4. always include PREVIOUS VALUES
because this is one of the many parameters we can use or judge if your management is
effective or not
for example... febrile patient ATP, Segmenter at 90 Lymphocyte 10, then started on
antibiotics then 4 days later no fever, repeat cbc showed Segmenter 50 Lymphocyte 50
sso... we know that effective ung antibiotic na binigay rin na control sepsis. may
significance ung reporting nyuu ng values ng cbc
Relay using CONVENTIONAL units
R. Relaying orders in Viber
Regarding sa pag post ng "new orders" ng picture katulad ng sample sa picture
Caption nyu lang ung Full name of the patient. enough na yun.
dont type everything in the order
(UNLESS specified by your PROD/POD to type it all).
Tipid energy for all.
Tapos ung picture nyu BUONG sheet
meaning kasama ung name ng patient sa taas na naka arrow until sa end of the paper
wag na crop crop tumatagal kasi.
let's work efficiently.
For example…
S. NEWBORN DELIVERY - “BABY OUT”
FORMAT
To ALL NICU rotators:
This is the sample of patient OUTCOME.
Good day po Dr. (Pediatrician). Respectfully informing you of new baby from Dr. (Ob)
Baby Boy of Thea
DOB: 8/12/23
TOB: 5:25 pm
Live, Term, Baby boy delivered via NSD, APGAR Score 8,9 , 40 weeks by Pediatric
Aging, BW 2.53kg BL 46cm, Small for Gestational Age, THINLY stained amniotic fluid
Born to a 28 y/o
Maternal Hx: u/r
Prenatal History
1st to 3rd trimester - unremarkable
OGTT screening: not done
FBS: normal
Hep B screening: negative
HIV : nonreactive
VDRL: nonreactive
Congenital Scan: no gross anomaly
COVID Vaccine:
Primary: Sinovac x2 (2021)
Booster: Pfizer (2022)
------
Latest VS:
T: 36.8
HR: 155
RR: 43
CCHD
LU 98%
RU 99%
LL 99%
RL 98%
On PE, patient was noted to be pinkish, with good tone,good suck and good cry, no alar
flaring, good air entry, no retractions, clear breath sounds, no murmur, soft,
nondistended abdomen, full pulses
EINC done
Suction done small to moderate amount (light green)
HGT one hour of life: 64mg/dl
Status: Patient is roomed in with mom at room 1327C
Thank you po Doctor.
____________________________
Paalala : MORTAL SIN
ang ma baby out na walang resident
Charity man or pay ung patient
UNLESS marunong kayu mag perform ng newborn resuscitation
Also ENSURE COMPLETENESS of TACKLE BOX AT ALL TIMES
Kung may nagamit na bagay, ipaTAG agad sa nurses kung ano ang nagamit at kanino
nagamit para nde kayu ung magbabayad jan
Your role whether clerk or intern is to INFORM your senior by the following modalities:
1. Initially MDS w/ Status of IE and Plans on mother via Viber grp chat
2. Relay OR/DR board with changes in the IE (and inform resident if your mesage ws not
yet acknowledge becuz busy bee)
Note:
DO NOT SOLELY RELY ON OB INTERN or CLERK for updates on mothers‼️
Nabubusy din sila. It is also your job to check status of mother IE
Note:
Steth and all materials set up but O2 hose is not needed to be opened automatically
unless expected bad outcome due to something detected intrafetally. May ask PROD
🔹 if plan for CS (Charity or pay)
a. Relay at group chat when transport to OR, induction, inducted, prepping, then
b. CELLULAR CALL if CUTTING then relay at viber grp chat
Make sure your resident acknowledges your call or is informed na cutting na
C. There may be times na walang resident on duty sa charity so once nalaman nyo na si
mommy ay for CS, please ENDORSE to NSU PAY POD / PROD of such plan, not the
ER POD.
🔹if plan for NSD (CHA)
a. Update IE status of mother
b. CALL CHARITY PHONE if POOR APGAR so resident can go there to assess
c. If APGAR is ok, relay baby out time then facilitate einc
🔹if plan for NSD- PAY
a. Relay MDS w/ Update IE status of mother (or dr board) in grp chat
b. Know that if Higher gravida score estimate na mas mabilis ung labor curve (e.g. G4
mom 5cm ngayon after 30mins 10cm na) if thats the case medjo bantay bantay na
c. CALL PROD if lalabas na baby - crowning. Bawal baby out na walang resident
Baka minsan sa narnia dadaan resident
Always ask your resident
Kung anong set up gusto nya
Baka need nyu ihanda ng gown ung resident sa narnia pwde din
Ask nyu ung kasama nyu na PROD kung anong set up ung best
Maghati hati kayu
1 clerk or intern per mother
PIOD or pCCOD per mom? Depende basta may naka assign sa inyu
Internal arrangement nyu na yan
Kayo naman ang nakaabang sa naglelabor na mother so you should know if the fetal
monitoring is normal or abnormal? Nag decel ba, pangit ba FHT, nag tachy ba kaya na
CS?
Abnormal labor ba? Prolonged ba kaya nag CS??
Meconium stained ba???
Syempre kayo ung kasama ng mother from labor to delivery alam nyo naman kung nag
epid or spinal or local anesthesia? Nag oobserve naman kayo doon habang nag aantay
U can always ask or confirm with OB counterparts. Or review sa charts. Diskarte nyo
lang yan
If hindi kayo ang nakaabang sa mother at kayo lang ang nagcatch ng baby, it should be
part of the endorsements ng awaiting mothers between you and your kapalitan na etong
nanay na to kagabi pa to nandito 3 cm pa din, ito sabi ng OB failure of descent na, ito
nag dedecel ung baby kaya i-CCS. Para alam mo what to fill up sa MDS.
FOR CHARITY Attending pediatrician is ALWAYS
DR JHANNELLE SILVANO
Reminders to ALL:
1. HISTORY
> Rehistory all patients admitted from the ER. DO NOT copy paste the history na ginawa
ng ER sa HPI na nasa census natin. Dapat makita kong iba ang history na nakalagay sa
census sa history ng ER intern, this will be a way for us to check if nag rehistory nga
kayo.
> All patients 2yo and below should have maternal and birth history
> All patients 12yo and above should have HEADSSS
❗️Review ALL HPIs of ALL patients currently admitted (admitted lang starting august
1)
- EDIT the HPIs of patients 2yo below (include maternal and birth hx) and 12yo above
(include HEADSSS)
- EDIT HPIs na need ng mkday and mkdose ang meds
2. ENDORSEMENTS
You are expected to be at the office for endorsements before 8AM. DO NOT let your
seniors wait.
WAG NYU NA HINTAYIN NA ilang beses pa kayo tawagin before kayo maupo for the
endorsements. Bakit? Dapat nauuna kayong nakaupo sa office before them.
3. WRITE your names in the HPI forms and SIGN.
Gamitin ang sariling merx
You are advised.
LAST MESSAGE
Work out your group dynamics and enjoy!
but you can open up here whatever questions or concerns you have
You can ask here or you can PM me anytime anything
I wont judge.
There is no silly question.
I understand you are in training and we are here as a team so tulungan tayu
