Everything you need to hit the ground running on the D4 paediatric ward - where to be, what the shifts look like, and the day-to-day jobs that make you useful from day one.
D4 is the paediatric ward and your home base. The neonatal and obstetric areas are nearby - you'll get called to them on evenings and nights.
Paediatrics runs 24-hour RMO cover, so you should always be able to hand jobs over rather than stay back. If you do stay late, claim your overtime.
Ward round, jobs, discharges and consults. Keep the handover sheet rolling.
Not always rostered. Take handover from the day RMO, mop up outstanding jobs and PM reviews, and make sure the day RMO gets home on time.
Just you and the reg, covering ED, D4, deliveries (K5/theatres) and SCN (K7). A great chance to step up.
All three handovers happen in the same place - the Lorraine Love Education Room (enter D4, head to the back of the ward, door on your right).
The night RMO updates and prints ~4-5 copies of the running handover sheet (PR-02 printer, front reception room - colour) and "drives" PowerChart during handover.
Consultants will want to see the BTF chart, relevant results (pathology, imaging), progress/nursing/allied-health notes, and occasionally the Advanced Growth Chart.
The day RMO updates the running sheet beforehand and prints copies for the evening team (usually fewer). Drive the computer as in the morning.
Informal handover in the doctor's room between day and night regs. Have the handover sheet updated with all expected patients included.
The bread and butter of the RMO role. When in doubt on any of these - ask your reg.
You document the morning round. Rounds can be quick, so ask if a plan isn't clear. Always note who was present (e.g. "seen with mum") and document relevant conversations.
Daisy should be stocked with tongue depressors, an otoscope and ear probes. The red ward folder holds fact sheets, Ventolin weaning plans and Asthma Action Plans.
Copy templates from previous paediatric RMOs for admission notes, ward-round notes and discharge summaries.
Turnaround is fast and there's no discharge lounge, so most parents won't wait for a summary. Nurses hand out fact sheets, Ventolin weaning plans and Asthma Action Plans (red ward folder on the COW).
Add any outstanding discharges or results-to-chase to the handover sheet.
A wealth of knowledge who prepares discharge meds in the background - often before you ask. You don't need to give her a med rec as on the adult ward, but complete one for the discharge summary as a record of dispensed meds.
CHW don't have eMR but may ask for an MRN to access imaging. Call via switch (43 → ask for Westmead Children's → say you're from Gosford paediatrics and name the team). Document clearly, including who you spoke to.
Everything is charted by weight. Double-check the patient's current weight in eMR before charting anything, and double-check dosing on AMH Children's even for drugs you've charted a hundred times.
There's a fluid-calc poster by the JMO computer in the doctor's room. The PowerPlan auto-calculates full maintenance from the latest eMR weight (and includes a TKVO line). Always sanity-check with an online calculator (e.g. RCH).
| Rule | How |
|---|---|
| 4 / 2 / 1 (mL/hr) | 4×first 10kg + 2×next 10kg + 1×rest |
| 100 / 50 / 20 (mL/day) | 100×first 10kg + 50×next 10kg + 20×rest ÷ 24 |
| Day 1 | 10% glucose |
| Days 2-28 | 0.45% NaCl + 10% glucose |
| Days 28+ | 0.9% NaCl + 5% glucose |
| 16-year-old | Counts as an adult - 0.9% NaCl is fine |
Most ward kids get glucose 5% + sodium chloride 0.9%, with rare exceptions.
Check doses on AMH Children's Dosing Companion (bookmarked, or CIAP → Medications → AMH Children's).
Every referral you send must be documented in PowerChart - these jobs often happen after discharge and are easy to lose track of.
Type PARC into eMR. For a discharged patient, be on their inpatient encounter or PARC won't receive the referral. Specify F2F or phone follow-up; put a target date in the order comments and a brief reason (e.g. "day 5 bronchiolitis - review symptoms and feeding").
Also an eMR order (search "PAU"). Generally for patients who came through Wyong ED or live closer to Wyong. For an in-person review, call PAU to let them know the patient is coming.
Email cclhd-e4paediatrics@health.nsw.gov.au.
Subspecialty referrals most often go to the Children's Hospital at Westmead (CHW), but we also refer to Sydney Children's Hospital and John Hunter Children's Hospital depending on the specialty. SCHN referrals (CHW and SCH) go online via ConsultMed - you'll need an account. Example referral letters are saved on the JMO computer. In doubt, ask your reg.
Protected teaching most weeks, on MS Teams and in the D4 handover room.
A registrar/SRMO presents a case with consultants present. Currently on hold - expected to recommence in registrar term 3.
A SRMO/registrar presents a general paediatric topic (e.g. DDH). Every second month this is replaced by the combined Paediatric/ED teaching program in ED.
Exciting education opportunities coming soon.
The everyday presentations. For the neonatal side, the rest of this hub has the pathophysiology and management in depth.
Bronchiolitis, viral-induced wheeze, asthma, pneumonia, croup. Use the Paediatric Acute Asthma Management PowerPlan (search "asthma" in eOrders) - it splits meds by severity and includes a salbutamol-stretching order.
The respiratory system is fully built out on the hub - RDS, MAS, TTN, PPHN, air leak, CDH and apnoea, with pathophysiology, clinical findings and management.
Recognise, reason and manage - the newborn, system by system, with the evidence behind it.