We had a very good day today with the residents on
rounds. I had thought we would let them
do their work rounds and then we would teach afterward. Instead we went around together in Room 2
with the term babies. We did some
teaching during the rounds and I think it was fun with good dialog and learning
and no one becoming defensive. We will
try and do it this way again tomorrow.
We spent some time with Sister Berhane and discussed nursing
care. We will split up tomorrow and each
go with one group; also include the nurses in the discussions. Cindy and I spent some more time fiddling
with trying to get what we think will be a better CPAP circuit. We will have to cut up some tubing to see if
we can fit one together without the 3 way stopcock.
I went to lunch alone—got some dry erase markers for the
white board Sister brought in this morning.
I had thought I would use for teaching and will from time to time. It seems preferable if I can do on rounds
though. I also got a roll of aluminum
foil and we lined the sides of two cribs where babies are receiving
phototherapy. I think that should
help. I will look for any literature
evidence for this practice tonight on the internet.
After rounds I went back into Room 1. Kediyah Mohammed, the baby with the ileal perforation
looks great and her mother is mostly smiling now rather than tearful. That is very nice to see.
On the other hand, one of the babies presented at morning
report was a 7-month-old former 32 weeker admitted over the weekend with
pneumonia/respiratory failure and rickets.
He died. Very sad. One of the attendings blamed the neonatology
program and the fellows for failure to identify the baby’s rickets in the
follow up clinic. Easy to do when they
are not here to speak for themselves.
the baby's wrists showing his rickets |
He also had pneumonia and didn't respond to supportive therapy. There isn't a ventilator. |
After, we chatted with one of pediatric residents and she described the
conditions in the clinic. Sixty or more
children come and they are all together and being seen by the residents at the
same time. It sounded very hectic and
certainly seems like it would be possible to miss the diagnosis in that
setting. What system improvements might
be possible there to decrease the incidence of missed and delayed
diagnoses?
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