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Resident Orientation Manual

Produced by Galveston Shriners Burn Hospital and
The University of Texas Medical Branch Blocker Burn Unit.
Contributors:  Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD,
Patricia Edgar RN, CIC,John P Heggers PhD, David N Herndon MD,
Marsha Hildreth RD, Ray J Nichols Jr. MD



Unit Operations:

   For each shift - the inpatient units have a Resource Nurse assigned.  The Resource Nurse coordinates the units' activities.  The Resource Nurse is an experienced nurse that is available to you to assist in problem solving.  The Resource Nurse also coordinates all referral calls from other hospitals.  They will seek you to speak with referring hospitals as needed.  The Resource Nurse will attend rounds and help share information discussed in rounds.

   Lead Nurses are senior nurses on each unit.  They supervise nurses with less experience to assist in their care.  Lead Nurses serve as an identified resource for a set number of nurses.  The individual nurse in the room is responsible for the care of the patient assigned to them, however the Lead Nurse serves as a support to the assigned nurses.

   A Tub Room Team will be providing care to the patients as they go to the Tub Room.  A lead nurse is available for questions.  Patient care technicians are integral members of the nursing team.  They are usually found at the bedside helping with wound care, weights and staple removal.

   Customer Communication Clerks are responsible for the communication at the Nursing Station.  They will be entering orders and paging you for the staff as needed.  Please feel free to ask them for assistance with questions regarding x-ray's, lab, blood and ordering consults.  Please let the clerk know if you page someone and are expecting a call back so they can locate you.

General Information:

   We do not have on-line order entry.  Admission orders should be written as quickly as possible so the team can begin care of the patients.  Consents must be obtained before providing care to patients.  Please write orders ASAP on all post-op patients.  Remember that all pre-op orders are discontinued and those you wish to restart must be re-written.  Discharge orders must also be written early to facilitate the coordination of care that must take place.  Care Coordinators will assist if you have questions regarding after care.

   Verbal orders are not able to be accepted by Residents per hospital policy except from the Plastic Surgery Resident.  This will require you to come to the unit to write orders for needed changes, even in the middle of the night if you are on call.

Calculation of BSA/TBSA on Emtek
   Emtek will calculate the BSA & TBSA automatically.

1.  Log on to Emtek.
2.  At the bottom right-hand corner of the screen, click on 'admit' (F10)
3.  'Admit Patient' screen will appear.
4.  Click on the far right-side of the screen underneath the arrows to expand the screen.
5.  Type in the height and weight - the BSA will automatically calculate - then type in the % burn and amount of 3rd degree burns, the TBSA will automatically calculate.
6.  Hit cancel at the bottom of the screen and log out.

Daily Rounds:

   The entire Burn Team (Attendings, Fellows, Residents, Medical Students, Resource Nurse, Care Coordinators, Dietitians, Rehab. Therapists, Respiratory Therapists, etc.) attend rounds.  They also attend the Discharge Planning meetings.  Picture presentations by the medical staff, followed by input from the entire team occurs.  These rounds are taped and transcribed for Medical Records.  On Thursday the team will go to the 3rd floor for Recon. Teaching Rounds.  These are walking rounds where the patient is presented and the case discussed.  The resident tapes the presentation for transcription in the medical records.  Wednesday rounds will vary due to the Surgery Grand Rounds.  Weekend rounds usually occur at 9a.m., but may change depending upon the Attending On-Call's schedule.  Afternoon rounds usually occur between 2-4p.m. and are usually announced on the overhead or paged on staff beepers.


   Shriners Hospitals for Children accepts children that have been acutely burned by a physician's referral up to their 18th birthday from the United States and Mexico.  Children from other countries needing our services require special approval from the Chief of Staff and Tampa.

   The Referral form guides our interaction with the referring physician and hospital.  The Resource Nurse will assist you in communication and planning of the transport.  Remember, you are considered a representative of Shriners when you are talking with the referring hospital, your approach is key to future relationships.

   The Attending On-Call should be kept informed of the referral's progress.  They will approve the patient's admission and method of transport.  It is important that you remind the referring hospital about necessary steps on stabilization (fluids, temperature, pain management, etc.)  Many times we will transport the child.  Our flight team consists of 1 Resource Nurse and 1 Respiratory Therapist.  A second nurse may be used if the child's condition warrants.  Also, the Baylor Resident or a Shriners Attending may be included if the Attending physician believes it is necessary.  Detailed hospital policies are located on the unit for further reference.

Patient Condition Reports:

   The physician is responsible for indicating the patient's condition.  Hospital Policy #HP1A1.012 indicates that the following condition descriptions will be used:

  GOOD - vital signs are stable and within normal limits; patient is conscious and comfortable; indicators are excellent

  FAIR - vital signs are stable and within normal limits; patient is conscious, but may not be comfortable; indicators are unfavorable

  SERIOUS - vital signs are unstable and not within normal limits; patient may be unconscious; indicators are unfavorable

  CRITICAL - condition is unstable and not within normal limits; patient may be unconscious; indicators are unfavorable

The condition is usually written to allow the staff to have consistent information for release to the media, etc.


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