TOPICS
In case of illness, residents are required to inform their Attending Staff member and the clinic charge nurse as soon as practically possible. If the resident is also on call, it is his responsibility to notify the Chief Resident, clinical charge nurse and appropriate staff person so that alternate arrangements may be made.
Please note that the Royal College specifies a maximum number of days of cumulative absenteeism that may occur during a resident's training. Should you find yourself in a situation where an extended leave of absence is necessary, you should discuss your situation with the Program Director to determine if additional training time will be required. If you require an extended leave of absence, clearance is required from the Head of the Department as well as the Dean of Medicine.
If a leave of absence for a psychiatric disorder is requested by a resident, or required by Faculty, an application to Postgraduate Medical Leave of Absence Committee (Associate Dean, Post-graduate, Program Director responsible, PAIRO representative and Faculty psychiatrist) will be made. The decision to return to studies will depend on the recommendation of the Leave of Absence Committee, based on the reports from the resident's attending mental health professionals and evidence of ongoing care indicated. The Committee may request a report from an independently appointed non-Faculty psychiatrist.
(Revised July 2002)
Appeals
Residents receive a copy of the handbook on Evaluation, Promotion, and Appeals. This information is also available on the Post Graduate Medical Education website at: www.queensupgme.com/.
(July 2002)
Cafeterias
The KGH cafeteria is open from 7:30 a.m. through 7:00 p.m. The HDH coffee shop is open from 7:15 a.m. to 6:00 p.m. A fridge and microwave oven are available in the Staff Lounge in the Johnson 6 Eye Centre.
(July 2002)
Chief Resident
The designated Chief Resident of the Program will be responsible for coordinating call schedules, vacations, and educational leave for meetings.
S/he will also supervise the rounds schedule and the Journal schedule to ensure that the designated resident makes all the appropriate arrangements. S/he will also be ultimately responsible for all inpatient care. It is also expected that the Chief Resident will take a leading role in instructing the junior residents in all aspects of clinical ophthalmology.
The resident will receive a stipend for these additional responsibilities. In years with two residents in their final year of training, each resident will assume the Chief Residency position for six months.
(July 1996)
CMPA
It is required that all residents in the Department of Ophthalmology have active Canadian Medical Protection Association memberships.
(July 1996)
Consent
Informed consent is required for all procedures and a written consent form is required for surgical procedures and investigative diagnostic procedures (e.g., intravenous fluorescein angiograms).
If a patient is incapable of giving consent, a substitute decision maker must be consulted under the provision of the Public Hospitals Act. Consent is not necessary where a surgeon believes that a delay in obtaining consent would endanger viability of a vital organ of the patient. In this event, the surgeon shall write in the patient's record a statement to this effect.
(July 1996)
Consults
1. Consult residents should wear Pager 368 from 8:00 a.m. - 6:00 p.m. for pager function. Respond timely to all pages.
2. All consultations should be vetted within the first 24 hours to determine how urgent the consult is.
3. Discuss/notify (pager, phone, voice mail) the most appropriate staff person.
4. All consults should be completed by the resident within 48 hours.
5. All consults should be signed off by most appropriate staff person within 72 hours.
6. Consult resident is responsible for ensuring the consult suite is orderly and working properly. Report any missing or malfunctioning equipment to Mrs. D. Shire.
7. Consult pager should be handed, in person, to oncoming resident with appropriate sign over.
8. In completing a consult, the resident should have reviewed and be able to recount: all imaging studies, laboratory reports, relevant past medical history (from hospital chart), relevant clinic data (where patient has been seen in the eye clinic); and in some cases, this may mean calling an ophthalmologist's office.
9. After consult has been signed off, follow-up may still be necessary for: results of investigations, change in patient's condition, coordinate ongoing medical care, sign over management, return to clinic/fields/photos.
10. On weekends and after hours: Resident on call should triage all incoming consults; complete any consultation where immediate medical management is affected; sign over promptly to the consult resident on Monday a.m.
(Revised July 1999)
C.P.R./A.C.L.S.
Advanced cardiac life support courses are given twice annually. If a resident is not qualified in ACLS training, or wishes to update his/her training in these areas, information about the next course can be obtained through the Department of Emergency Medicine.
If a resident is not qualified in ACLS training or wishes to update his/her training in these areas information about the next course may be obtained by contacting the Department of Emergency Medicine at 547-6500. The cost of the two-day update course is $200.00. The cost of the one-day course is $125.00. Courses are offered in the Fall and Spring of each year.
(July 1996)
Diagnostic Laboratories
The Eye Clinic at the Hotel Dieu Hospital has access to excellent diagnostic laboratories. To ensure that the most appropriate diagnostic information is obtained, it is vital that requisitions for ocular function testing be completed with as much clinical information as possible. Specifically, the clinical question to be answered by the diagnostic tests should be identified. Junior Residents should check with Senior Residents or Staff Members so that ocular function testing for a particular patient can be triaged appropriately. The following is a list of diagnostic laboratories available to our Department:
Ophthalmic Photography - This is located primarily in the HDH Centre, Johnson 6 and offers external eye photographs, fundus photographs, intravenous fluorescein angiograms, and indocyanine green angiograms. In addition, there is an extensive clinical kodachrome slide library.
Perimetry - Automated perimetry (Humphrey) is available in the HDH Eye Centre on Johnson 6. Goldmann perimetry is available at both sites. Automated perimetry offers a wide array of both screening and quantitative threshold testing. Residents are reminded that perimetry is not a replacement for confrontational visual field testing in the clinic.
Electrophysiology - Electroretinograms, electro-oculograms and visual-evoked potentials are available. The first two are available through the Eye Centre while visual-evoked potentials are available at KGH, Connell 7. Electrophysiological testing is extremely time-intensive. All requisitions should be signed by an Attending Staff member.
Colour Vision Testing - For patients with suspected colour vision abnormalities, the FM-100 test and the D-15 colour test are available in the HDH Eye Centre.
Orthoptics - All full range of orthoptic tests and exercises are available in the Strabismus Clinic of the Hotel Dieu Hospital. Requests for orthoptic services are normally sent to Mrs. Helen Lai.
Ultrasound - A-scan ultrasonography is performed on Johnson 6 at the HDH B-scan echography is normally reported by Dr. Sharam Danesh.
(Revised July 2003)
Dictation
The Hotel Dieu Hospital has voice activated dictation service. To access dial 5100
- enter staff I.D. number (3 digits) followed by #
- enter password (3 digits) followed by #
- work type (DCS-2, OR-1, Clinic Letter-5)
- enter 6 digit chart number followed by #
- begin dictation
- 1 play, 2 dictate, 4 pause toggle, 3 short rewind, 8 end of note, 5 end of dictation.
(Revised July 2001)
Email
Please notify the Departmental Assistant of your e-mail address. If you do not already have an e mail address and wish to set up a Queen's e-mail account, please do so by contacting ITS Accounts at 533-6741.
(Revised July 2001)
External Disaster Plan
In the event of an external disaster in Kingston or surrounding area:
1) The Ophthalmologist-on-call will be contacted by the Emergency Department physician who initiates the disaster plan.
2) The Ophthalmologist-on-call will call the Head of the Department of Ophthalmology or his/her Deputy Head and the Senior Resident on-call. The Department fan out will be instituted.
3) The staff will meet in the HDH Eye Clinic.
4) Their function there will be to provide care for ocular and facial injuries and be available as backup staff for the triage area in the Emergency Department.
(July 1996)
Eye Banking
The Eye Bank of Canada welcomes the donation of eyes of patients who die in the hospital. More than half of all donated eyes are used for sight saving corneal transplantations. Donated eyes are also used for scleral procedures as well as for medical education and research.
While eyes are of value for grafting only if the corneas are of high quality, all donated eyes should be removed. The only exception to this is if the donor is known to be HIV, Hep B or Hep C positive, or if there is a history of Jacob-Creutzfeld disease. Under these circumstances, the family is informed that their loved one is unable to be an eye donor for medical reasons.
A blood sample must be obtained from the donor that HIV and Hepatitis B and C testing can be performed. Nursing or Medical staff will draw a minimum of 10 cc of clotted blood in two red-top tubes (5 cc's in each tube) and send this to the morgue with the body. The staff who draw the blood are also required to label the tubes and include the time and date of blood sampling. If donor received blood product or colloids within 48 hours of blood sampling or crystalloids within one hour of blood sample, staff are required to send a copy of fluid intake "flow sheet" to the morgue.
Prior to enucleation, the resident should confirm that appropriate permission to remove the eyes has been obtained. The nursing/medical staff on the unit will approach the next of kin for consent and complete the Consent for Organ and/or Tissue Donation After Death. A copy for the enucleating physician is sent to the morgue with the body. If the potential donor is a coroner's case, permission must be given for eye removal from the coroner. Staff must inform the enucleating physician of this prior to eye removal and/or send a copy of the Coroner's Direction for Post Mortem Transplant form to the morgue with the body.
Hospital staff will ensure the donor eyes are moistened (acrilube), eyelids closed, and the body sent to the refrigerated morgue as soon as possible after death to preserve the corneas. Hospital staff will also ensure that the blood samples(s), copy of consent and copy of "fluid intake" flow sheet(s) [if appropriate] are placed in a large envelope and sent with the body to the morgue.
The nursing/medical staff will page the "on call" ophthalmology resident once consent is obtained so that the removal of the eyes may be performed within the required.8-10 hours following time of death. Nursing/medical staff will also notify the Admitting Department giving the name of the eye donor and the name of the on-call enucleating resident to ensure that Admitting does not release the body to the funeral home prior to completion of eye enucleation. Once eye enucleation is completed, the resident will notify the Admitting Department so that the body can be released to the funeral home without delay.
All enucleations are carried out in the Kingston General Hospital morgue. For "after hours" entry, please page security "stat" asking for entry to the morgue.
The enucleating physician will perform a physical examination of the donor, review the donor's chart, and complete the Eye Bank Donor Medical History form (located in the eye transport containers). This form is returned to the Eye Bank along with the donated eyes.
Please note that the Operating Room at Kingston General Hospital and the Stores Department at HDH both carry kits with surgical instruments for enucleations. Also note that several human eye transport containers are stored on the top shelf of the refrigerated mortuary at KGH. They are also stored in the Operating Room of KGH. These containers are sent directly from the Eye Bank in Toronto on a regular basis to ensure that they are always available for eye transport to Toronto.
The donated eyes and required blood sample(s) are packed in ice and are sent along with the completed Eye Bank Donor Medical History form, copy of consent and copy of "fluid intake" flow sheet(s) if appropriate via the eye transport container. The container is brought to the ER department. The police are alerted via the ER's direct line, and they are asked to pick up the eyes as soon as possible and take them to the bus station for the next available bus to Toronto. If the police indicate that they are unable to pick up the eyes with a reasonable time frame due to their busy schedules, the ER staff will send the eyes to the bus station using KGH taxi vouchers, available in the ER. The enucleating physician notifies the Eye Bank of all eye donations by calling 1-416-480-7465 (24-hours answering service) giving approximate arrival time in Toronto. Please note that since the bus station is not staffed at night, eyes are sent to the station between 0630 and 1830 hours only. Eyes brought to the ER Department after 1830 must stay in the ER until the following morning.
(July 1999)
Infectious Disease Precautions
Handwashing must be done before and after all patient contact. This is particularly important in the Emergency Eye Clinic. Multi-dose eye drop bottles should not be used in patients with suspected conjunctivitis.
Tonometer tips - Applanation tonometer tips and other instrumentation used in cases of infectious disease must be appropriately cleaned before their next use.
Gloves should be worn when hands are likely to contact body substances such as mucous membranes and open lesions of the skin. Gloves are to be discarded at the completion of the procedures and hands are to be thoroughly washed.
Needles should not be recapped bent or broken. They should be discarded into a puncture resistant container, which is available in multiple locations of all Eye Clinics.
Health care workers who have themselves exudative lesions or weeping dermatitis of the hands should refrain from direct patient care.
(Revised July 1997)
Instruments
It is strongly encouraged that all residents obtain a direct ophthalmoscope, a muscle light, a 20 diopter lens, and an indirect ophthalmoscope. A 60 diopter or 78 diopter lens for slit lamp biomicroscopy is also highly recommended. Provisions will be made so that residents can properly secure their instruments to protect against theft.
(July 1996)
Intimidation, Harassment, Abuse
Residents are entitled to train in an environment free from intimidation, harassment and abuse. Any resident who feels he/she has been subject to any of these is encouraged to speak with the Program Director, Head of the Department, Associate Dean of Postgraduate Medical Education or Associate Dean of Student Affairs.
The University's grievance and appeal procedures are outlined in a supplement to Queen's Gazette, Volume XXIV, No. 9, March 16, 1992 (copy available in Program Director manual). The "Workplace Harassment Policy" is available in the Human Resources Policy Manual, Kingston General Hospital (copy also available in Program Director manual).
(July 2002)
Laboratory Coats
Two (2) laboratory coats will be issued to each resident by the Laundry Department of the Hotel Dieu Hospital. HDH provides laundry service at no charge. They do ask that all lab coats be labeled appropriately before depositing into the laundry hamper.
(Revised July 1997)
Library Facilities
Both Kingston General Hospital and Hotel Dieu Hospital have medical library facilities. The facilities include Medline and other databases on CD-ROM. Librarians will perform Medline searches for information pertaining to patient care. Each library maintains a core collection of books and journals and can obtain most other materials through inter-library loan. Library orientation and CD-ROM instruction are available. Both libraries are open through regular business hours Monday through Friday but are accessible twenty-four hours per day through the security guard at KGH and the switchboard at HDH
The Department of Ophthalmology Library offers an extensive collection of ophthalmic reference texts and journals as well as numerous videos and audiotapes. The library is unsupervised and operates on the honor system. The reference texts must not be taken out of the library. The library is accessible through a code, which can be obtained by the Departmental Secretary. Residents are asked to re-shelve texts and keep the library neat. We welcome suggestions for updates in the texts, journals, and videotapes within our budgetary limits. Please direct suggestions to the Departmental Office.
Bracken Library, located on Stuart Street, is the main medical library for the University. An OVID network password may be obtained by contacting the Departmental Office. This will allow the residents and staff to have access to the library databases via home computers.
(July 1996)
Mail
Each resident is assigned a mailbox located on Connell 6 (KGH) for PAIRO and hospital mail. Departmental mail will be sent to a mailbox location in the HDH Eye Centre on Johnson 6. It is essential that residents check both mailboxes (as well as their e-mail) frequently so that efficient communication can be maintained.
(Revised July 1997)
Medical Records
Each member of the house staff is encouraged to meet the Director of Medical Records to arrange an orientation session. Residents are reminded that the medical record is an essential component of patient care and must be legible and understandable by all who read it. This means that abbreviations must be kept to a minimum. Illegible signatures must have the name and position of the resident printed immediately below.
(Revised July 1997)
Native Patient Services
Native Patient Services facilitates the delivery of ethnoculturally sensitive health care for the Mushkegowuk Cree of James Bay. N.P.S. provides case management to all Cree patients and their caregivers referred to the Kingston Health Services Centre. This involves basic counseling, medical and cultural interpretation, patient advocacy and education. N.P.S. can be reached at the HDH extensions 3070 and 3071.
(July 1996)
Operating Room
When booking a patient for surgery, the following information must be provided to the Operating Room Booking Clerk:
" Surname and given name of the patient.
" Age of the patient
" Name of attending surgeon.
" Preoperative diagnosis.
" Procedure to be performed and the approximate time required to complete the case.
" Patient's hospital room number.
" Indicate any special requirements (i.e., culture material, magnet, etc.)
In addition the operating room at KGH has a booking form that must be filled out by the resident including all the above information and general medical health of the patient, anesthetic requirements (eg. GA vs local). Emergency cases must be discussed with the triage nurse and the anesthetist on call.
(July 2001)
Pagers
The pagers are KGH numeric pagers. If you are not on the KGH site, dial 83 to access KGH. The pager access code is 53 followed by the pager number.
(July 2001)
Parking
For KGH, a special permit assigned by the Security department is required. You will need to complete an "application for on-call parking permit consideration" (available at the Security office) and submit it to the Security office on Dietary 1 between 0800-1600 hrs, Monday-Friday. Failure to do so may result in a parking fine of $25.00. The use of these permits during a regular scheduled shift is strictly forbidden.
Parking spaces are available for on-call physicians at:
Watkins Lot (off George Street) - 6 spaces reserved 24 hours
Connell Lot (alongside the Emergency ramp) - 6 spaces reserved 1900-0700 hrs
Main Entrance Lot (off Stuart Street) - all spaces reserved 1900-0700 hrs
For HDH after hours emergency parking is permitted in the Family Medical Centre Parking lot, but security should be notified of your car license number.
(Revised July 2002)
Payroll
Pay cheques are issued according to the PAIRO contract on a bi-weekly basis. Any discrepancies should be reported to Ann Brunet at KGH ext. 4384.
(July 1996)
Pharmacy
Pharmacists at KGH are available to answer detailed questions concerning ophthalmic medications. Special orders such as fortified antibiotics and intravitreal antibiotics should be ordered by phone well in advance of the anticipated time that the medications will be required. Please note that pharmacists do not take in-hospital calls. Therefore, after-hours intraocular surgery requires that residents contact the pharmacist-on-call well before the case goes to the Operating Room. (KGH pharmacy is open from 7:30 to 11:00 p.m. except on Saturdays and Sundays when it closes at 9 p.m. Pharmacists are available during those hours.
(Revised July 1997)
Portering
Inpatients at the Kingston General Hospital requiring assessment by Ophthalmology will need to be transported to the examination lane on Con-10. If the patient has a room on Con-10, the resident is expected to collect, escort and return the patient to his or her room. Wheelchairs will be provided for this purpose.
If the patient's room is on a floor other than Con-10, portering may be arranged to facilitate the transportation of the patient to and from the eye examination lane. To avoid excessive and unsupervised waits for the portering service to arrive, residents are asked to bring the patients to the area immediately in front of the Nursing Station on Con-10 at the conclusion of their examination. While the Con-10 nursing staff is not responsible for administering nursing care to these patients, they will be in a better position to identify and respond to situations requiring urgent attention. If is not appropriate for Ophthalmology residents to leave patients in the Ophthalmology examining lane or in the corridor immediately outside the lane unless they are in a position to take full responsibility for immediate care to these patients.
(Revised July 1999)
Post Graduate Medical Education
For information regarding out of province electives, registration and other issues pertaining to Post Graduate Medical Education, please refer to the website, www.queensupgme.com.
(Revised July 2002)
Radiology
Because of the high demand for both CT Scan and Magnetic Resonance Imaging services, it is essential that all requisitions be filled out in complete detail. This allows the radiologist triaging requests to assign the appropriate priority to the study. It also provides the radiologist with a clear idea of the clinical question. Identify the staff person to whom the report should be sent and please note that all MRI requisitions require an Attending Staff person's signature. All patients should be appropriately screened for metallic intraocular foreign bodies prior to MR Imaging.
(July 1996)
Security
Twenty-four hour security service is available at both hospitals to open any rooms within the Eye Clinics. Security Guards may be reached by calling hospital pager 104 or office number 4218 during the day at KGH and at HDH by calling 544-3310 or 0 from an HDH internal line and asking to page security.
(July 1996)
Sexual Abuse
It is imperative that all resident physicians and other physicians should be concerned about the potential misinterpretation or misperception by patients being examined that might be construed as compromising circumstances. Any physician who has reason to believe that such a circumstance might arise (e.g. in the middle of the night in the Eye Clinic) should always have an accompanying person with him or her when examining the patient. If this is not possible it is recommended that the eye examination be carried out in the Emergency Room where ophthalmology equipment does exist.
(July 1996)
Social Work/Services
The Social Work Department has a staff of professionally qualified social workers that may intervene to assess the extent of social and emotional difficulties for patients and their families. Other services include counseling, financial assessment, discharge planning, referral to community agencies, placement, and native patient services. The Social Work Department can be reached at ext. 4109 at KGH and at ext. 2000 at H.D.H (or beeper #183).
(Revised July 2001)
Stress
Any resident having difficulty coping with the stresses of residency training is encouraged to speak with the Program Director or the Associate Dean of Postgraduate Medical Education. Residents may also contact the PAIRO Resident Well-Being Committee that has established a Help-line referral service for residents and partners: 1-866-help-doc (1-866-435-7362).
Each resident will be given a copy of the handbook, "Feeling Stressed? Do you know where to go for help?" a guide prepared by the Office of the Associate Dean.
A copy is also available from the Program Director's Office.
(July 2002)
Student Health
A list of Family Physicians and Dentists who will accept Queen's medical residents is available in the booklet mentioned above.
(July 2002)
Vacation
Vacations will be coordinated along with the call schedule by the Chief Resident. The residents should obtain a "vacation request" form from the departmental secretary. The completed form with the dates for the requested vacation will be submitted to the chief resident. The chief resident will ensure adequate clinic and OR coverage before signing the form. This will generally mean no more than 2 residents on vacation at any given time if possible. The resident will then submit the form to the departmental secretary who will keep a record of all vacation dates and the numbers of residents for the coming months. The departmental secretary will obtain the final approval from the program director. This process should be completed at least 6 weeks prior to the vacation date.
Each resident is encouraged to take one of his or her weeks of vacation at either the winter break or March break. The dates of these weeks can also be obtained from the Chief Resident or the Departmental Assistant. Residents should plan their vacation so that they do not conflict with examinations (OKAP, departmental) or important Clinical Days (e.g., the Resident Research Day or the R.M.H. Pinkerton/Alumni Meeting).
PGY1 Vacations - Requests for vacation time should be made through the service on which you are scheduled well in advance of the block of time being requested. The Ophthalmology Program Director should also be notified in writing, through the Departmental Office, of any approved vacation time.
Dept. of Medicine - If you are scheduled for at least five months in total with the Dept. of Medicine you are entitled to two weeks of holiday time while with them. Any requests should be submitted (2 months in advance or earlier if possible) to Jacoba Franks for review by the Senior Resident. Note that the Dept. of Medicine does discourage May vacation time due to staffing shortages. Special days off should be requested by the 10th day of the month before.
Dept. of Surgery - The Department of Surgery requires that you make vacation requests to the Senior Resident on the Service, the Service Chief and the Ophthalmology Program Director. Where there is no Chief Resident, in the case of Plastics, the request should go through the Senior Resident on the Orthopedics Service, and in the case of Neurosurgery, through Dr. Ross Walker. The Department of Surgery has requested that you give them at least one month notice when requesting vacation time and special days off and where possible, even more time.
See PAIRO Agreement, section on Vacations (9), page 12.
(Revised July 2003) |
