hematology oncology signout

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amestramgram

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Hi, does anyone have an example of a signoff in the Hematology/Oncology service written down somewhere? I am going to this rotation soon and would like to see a signout for a complicated heme/onc patient so I can follow a good example.

thank you very much!

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I did a few weeks on heme/onc service 3rd year. Sign out isn't too different. Most patients are oncology patients, there is considerably less "pure" hematological dysfunction you will encounter which is why the two were merged. If the patient has advanced oncologic pathology, you might want to sign out by system instead of by problem. These patients can have so many problems it becomes easier to group it in a systems oriented approach. It would be Neuro, CV, Resp, GI, Renal, Heme/ID, etc.

This is from the ICU, but you can modify it. Since so many patients are really sick on oncology service a lot of it applies

1.
Begin with concise relevant ID/one line brief history. including POD# or Hosp Day #
a. Ex. Mr. J is a 24 y/o man who is s/p exploratory laparotomy for a gunshot wound to the Left
Upper Quadrant.
Events:
a. Be concise. Major changes in condition, procedures done, new studies, new fevers, etc.
2.
3.
Give an integrated objective hx, with relevant vitals, labs, and meds by system:
a. Neuro:
i. Orientation: Mention if pt is alert and oriented vs somnolent and confused vs intubated
and sedated
ii.Medications: dose & route
1. Sedation: Mention meds used for sedation, including the rate of administration
(e.g. "propofol running at 53cc/hr")
2. Paralytic meds:
3. Analgesia: If on pain meds, give the dosing. Be prepared to describe how much
was administered over the last 24°
iii.
GCS and focused neuro exam if head injury: Give brief description of mental
status/gross neurologic function (e.g. "Follows commands, moving all extremities
purposefully"). Anne's Hint: the nurse is a great source of additional info on this. Ask
nurse what their exam is when they are off sedation.
b. CV
i. BP range and current BP
ii.MAP range and current
iii.
HR range and current; comment on rhythm
iv.
CVP range, current
v. Swan-Ganz catheter readings: CO, CI, SVR.
vi.
Pressors: If on pressors, name them, give the rate of administration
vii.
If on IV BP meds, name them, give dosing
viii.
Beta-blockers
c.
Respiratory:
i. Non-ventilated:
1. RR (range)
2. O2 Sat (range); give mode (e.g. 2L NC);
3. FiO2
ii.Ventilated patient: (present in this order…)
1. Ventilation mode: give type of airway support: e.g. Volume control vs. pressure
support vs SIMV, vs AC, etc.
2. FiO2 (ex. 0.35)
3. Set RR (machine rate), recent
4. Actual RR (patient rate). recent
5. Tidal volume (most recent)
6. PIP (peak inspiratory pressure), recent
7. Plateau pressure, recent
8. PEEP (positive end exp pressure), recent
9. O2 sat (range),
10. Most recent ABG; pH/pCO2/pO2/Bicarb/base deficit or excess
a. if from another date, give the corresponding FiO2 at which the ABG
was obtained
11. Respiratory meds
iii.
1.
2.
3.
4.
iv.
1.
2.
3.
4.
v. HEME/ID
1. Tmax/Tcurrent (If pt spiked a fever, ask nurse if culture was sent, then f/up)
2. CBC results
3. Coags: PT/PTT/INR
4. fibrinogen levels
5. List Abx and day number: If on Abx, state "pt is on Day 2 of 14 of
Vancomycin" and give the indication
6. List culture results
7.
vi.
ICU
1. include here any lines the patient has, their location, and when they were placed
2. List the critical care prophylaxis, e.g. GI bleed (PPI or H2 blocker); DVT
(TEDS/SCDs, Heparin, Enoxaparin, Vena Cava filter)
ASSESSMENT & PLAN
Start with a very brief assessment.
Eg. Mr. J is POD 1 s/p an exploratory laparotomy for a gunshot wound. He was hypotensive overnight due to
volume depletion. He is doing better this morning after being given a bolus of IVF.
Give your plan for each organ system, in the same order as you presented.
Neuro
CV
Pulm
FEN/GI
Renal
Heme/ID
ICU
 
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