Monday, October 29, 2012

Back to business--Monday at TA


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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