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Overview

This section is designed to draw you attention to some of the common clinical processes, systems and policies at Westmead, which all new medical staff should know about.

In general, the way of doing things at Westmead should not vary enormously to what you are used to elsewhere, and we will try to draw your attention to any variation under each section.

The one section you should definitely familiarise your self with is at the top of the list: Between the flags - our Clinical Emergency Response System. You need to be aware from Day 1 of the nomenclature used at Westmead and exactly how to call for help in an emergency.

ALS & PACE - Between the Flags

Between the Flags is the statewide Clinical Emergency Response System (CERS), which sets out standard calling criteria for triggering either a "clinical review" or a "rapid response". These calling criteria align with colour coding on the state-wide standardized adult observation (SAGO) chart. A breach of the yellow zone criteria triggers a "clinical review" and a breach of the red zone criteria triggers a "Rapid Response".

In many NSW hospitals, the rapid response is known as a "MET" call, but at Westmead, a rapid response has two components: "PACE" - which is an urgent review by the specialty team registrar or, if the clinical situation is more urgent, or the patient does not improve following the PACE call - escalation to an ALS call. An ALS call will activate an emergency response by the Advanced Life Support Team.

An ALS call can be activated by the wall mounted red emergency buttons bedside each bed, or by dialing 111. Our PACE & ALS policy can be downloaded below along with other key documents relating to the deteriorating patient. Further resources can be found on the hospital intranet which can be accessed by clicking here, from inside the hospital or on the CEC website, with specific information about CERS and the Sepsis Kills program

  • Clinical Emergency Response Policy - Westmead Hospital - Please refer to the Policy section of the WSLHD intranet.
  • Clinical Emergency Response Policy - Within ED - Please refer to the Policy section of the WSLHD intranet.
  • Advanced Life Support Flowchart 
  • Using Resuscitation Plans in End of Life Decisions - NSW Health Policy - Please refer to the Policy section of the WSLHD intranet.
  • Using Resuscitation Plans in End of Life Decisions - Westmead Procedures - Please refer to the Policy section of the WSLHD intranet.
  • Inpatient Sepsis Pathway
  • Sepsis Antibiotic Guidelines
  • Code Crimson
  • Management of Acute Hypoxia Flowchart
  • Cannula Peripheral and Central

    Anti-coagulation Guidelines

    Anticoagulants are confusing, and while you can find plenty of guidelines in the literature, Westmead has maintained and updated its own comprehensive set of guidelines for many years. These represent the consensus Westmead approach to the prophylactic and therapeutic use of anticoagulants in a range of clinical different settings

  • Anti-coagulation guidelines - Please refer to the Policy section of the WSLHD intranet.
  • Child Protection

    Although you will see very few children at Westmead Hospital, you may come across a few transferred to us from the Children's Hospital, for specialized services. In addition junior medical staff may be rotated to secondment hospital with exposure to children. In short you still need to be aware of Child Protection at Westmead. The NSW summary fact sheet can be downloaded below, or you can click here for the longer NSW Health Child Protection policy document. Don't forget that Child Protection is also a mandatory e-learning module which you will find on "My Health Learning".

    NSW Child Protection Policies and Procedures Fact Sheet

    Death Certificate and Coroner

    Writing a Death Certificate is not an everyday experience so we've tried to put together a pack of information, called the D-Cert folder, which will be available on every ward. This walks you through forms and the policies you need to be aware of. Key documents from this pack are available below for your information.

    Just to emphasis a few common points of confusion:
    D-Cert Folder.JPG
    • Even if you have never seen the patient alive, you CAN write a death certificate for a hospital inpatient.
    • The person on the spot should always write the death certificate. If the patient dies after hours, do NOT leave it for the day team to do it later
    • The standard of proof for death certificates is "the balance of probabilities". You don't have to be 100% certain
    • There are a number of mandatory reasons for reporting to the coroner, and they are all are non-negotiable, even when the cause of death seems obvious and may not, to you, be suspicious. We are a Trauma hospital and almost all deaths of patients, who were admitted following trauma, need to be reported to the coroner
    • When you are reporting to the coroner you must NOT also write a death certificate - its can only ever be one or the other
    • Conversely, if the family or the hospital has arranged a non-coronial, hospital post mortem, a death certificate MUST be written beforehand
    • Reporting to the coroner is a legal requirement - the family's wishes play NO role in your decision making. Families often want to avoid a post mortem, and the coroner will often oblige - BUT only the coroner can make this decision


    Documents from the D-Cert Package
    For those who want to know more about the rules of what you should write on a Death Certificate, here are some detailed instructions from the Australian Bureau of Statistics

    Discharge Summaries

    Everything you need to know about discharge summaries at Westmead is in the attached document

    Health Care Interpreter Service and Translation

    Westmead is located in a hugely diverse part of the city and booking an interpretter is a skill which you will rapidly need to aquire when working here. We have an excellent Health Care Interpretter Service (HCIS) and they can be contacted by phone or by placing an e-order (see instructions below)

    Imaging

    Incidents & Complaints

    IIMS (Incident Information Management System) is a statewide, on line database for recording clinical incidents and adverse patient events, which is accessible from most computers in every hospital in NSW. By recording incidents as they happen, it helps to inform clinical managers about what is happening in their area, as well as providing valuable aggregate data about what is happening in our hospitals. In both instances is has a important role in helping maintain patient safety. All JMOs should be aware of this system. Anyone is able to report an incident into IIMS, and reporting can be anonymous.

    What should be reported?
    • Anything that you think went amiss or shouldn’t have happened.
    • Any situation where a reasonable patient would have been surprised or concerned about the
    • clinical outcome.
    • Any failure of equipment or clinical process.

    More information can be downloaded below

    Infection Control

    Library and CIAP

    Medical Records (HIRS)

    Pathology - ICPMR

    Patient Identification

    Patient Identification - Please refer to the Policy section of the WSLHD intranet.

    Patient Information

    Public Health

    Transfusion

    Transfusion Orientation Pack Website Image.jpgThe Australian Red Cross Blood Service has put together a useful Transfusion Orientation Pack for JMOs which you can download here.

    You will find other useful resources at transfusion.com.au including:

    and a variety of lanyard cards

    Looking for General
    Orientation information?

    See more
     

    More Info

     

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