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Saturday APS Shift

From April 2023 onward, Saturday APS is managed by nurse practitioners. Except during those weekends when there is no ORs running, Sat APS are then covered by residents who are on regional anesthesia rotation at Holland.

On arrival, inform the locating personnel at the switch board that you will be covering APS until further notice (otherwise s/he will keep calling APS on Bayview)
 
1) Print out 2 APS lists (one for the rounds, the other for billing) – should be able to print from any computer on a ward or our block rom (any treatment plan / note is documented on the list).
 
APS list print out instruction:
1. Log onto SunnyCare
2. Chose “Acute Pain Service – Holland” on Select a Patient List
3. Click Print right upper corner of the list
4. Choose “eSignout Nursing Report” unlike Bayview chose Physician Report
5. Print
2) Currently only 3E and occasionally 6E have post-surgical patients. There is an APS clip board to check specific patients need to be addressed (pain issues, consultation requests, etc.) – ask nursing staff if you can’t find one.
3) Same as Bayview Campus, progress notes are to be entered on Sunnycare and physician’s orders (except initial APS admission orders) are handwritten in charts.

4) The code for clinician bolus on CADD pump is 777 for both nerve block and IV PCA. Alternatively, one can give manual blous (see (6) below).

5) To change the rate of nerve block infusion or to change the range of the IV PCA bolus , write the order in the chart for nursing staff to do it.

6) If you want to give top-up via nerve block catheter manually, there is 1% ropivacaine & lidocaine, and NS in the nurse station (medication machine) on each unit (ask a nurse to override unless you bring your own stocks).

7) Continuous Adductor Canal Nerve Block (CACNB)/Femoral Nerve Block (CFNB) infusion is by default discontinued and removed at 06:00 on POD#1. When the initial APS admission order indicates 'APS to reassess,' you have to write a specific d/c date and time. If you decide to keep it longer, please write the order and d/c date & time of the catheter (ideally, 6am d/t daily Rivaroxaban is given at 10am for TKA but peripheral catheter can be pulled out anytime) as well. 


8)
You have to order the d/c date for IV PCA if not specified in the APS order sheet.  Make sure there is proper breakthrough dose ordered (e.g. hydromorphone 1-3mg PO q2hrs PRN) upon IVPCA discontinuation.

9) Bring the billing list with you and hand it to the staff anesthetist coordinator next Monday.

10) Update the APS patient list on Sunnycare (handover notes on Nursing report)
11) Usually keep continuous brachial plexus block infusion till the patient discharges home. Consider a top-up when the patient discharges home on Saturday if applicable (upper extremities only). 
12) Call home catheter patients if there are any

Let the locating person know when you are leaving so that they will contact Sunnybrook APS on-call for pain matters thereafter.
 
Email: eri.maeda@sunnybrook.ca  for any questions

 Following is the orientation manual for Holland APS (by Dr. M. Van der Vyver)