RESPONSIBILITIES AND JOB DESCRIPTION OF REGISTRAR


There are 8 registrars employed at the NCC: The registrars will spend part of the time on the postnatal wards and also in the NCC.


Shifts

In the NCC the registrars work 12 hour rotating shifts. When on the postnatal ward, the shift is usually 08:00 to 17:00 Monday to Friday.



D Day in NICU/HDU 08:00 - 21:00

D2 Day in SCN 08:00 -17:00

N1 N2 Night 20:00 - 09:00

F Fellow 08:00 - 17:00





Responsibilities for all registrars

Clinical duties

· You are responsible for the day to day management of the babies in NCC under the supervision of the fellow and attending neonatologist. You are expected to ask the Fellow or Consultant for help when needed; they are available at ALL times.

· It is necessary to appropriately inform the Fellow or Consultant whenever there are new ventilated admissions or a significant change in clinical condition of a baby.

· All new admissions in your shift must be entered into the NCC computer database.

· To attend caesarean sections and high-risk deliveries for the purpose of resuscitation and stabilisation of the newborn.

· To prescribe medications and TPN orders.

· To become competent in performing procedures of endotracheal intubation, central line insertion, intra-arterial cannulation, blood sampling, intercostal catheter insertion and central lines.

· To arrange appropriate investigations for inpatients and follow up of all results.



Documentation


· The frequency of documentation in the patients’ records should be:

o twice a day for all ventilated babies (on the day and night shifts)

o daily for non-ventilated babies with acute illnesses

o twice a week for babies in SCN and HDU.

· All procedures performed must be documented and boxed.

· Any significant changes in medical management must be noted.

· Appropriate documentation and paper work in event of death.

· Whenever you are asked to review a baby on the postnatal ward or attend a delivery, you must document in the medical notes that you have seen the baby and if necessary, what your plan of action is.



Communication: You are responsible for:

· maintaining communication with parents, notifying them of their baby’s progress and all procedures and investigations that are to be done on their baby.

· communicating with the neonatologists, nursing staff and referring physicians who will be undertaking ongoing management of the baby.

· communicating with the obstetrician. This is most important at the delivery, if the baby is transferred to another hospital or has died.

· dealing appropriately with any requests for perinatal / neonatal transfers from other hospitals to the RNSH NCC. Guidelines for NETS (Newborn Emergency Transport Service) consultation and transfer are displayed in office. If in doubt always consult with the Neonatologist on call.



Discharge summaries


· Discharge summaries must be completed before discharge. Discharge summaries for babies being transferred or discharged from the Special Care nursery are the responsibility of the D2 shift registrar during the day and the D shift registrar on nights and weekends. Discharge summaries for babies being transferred from the HDU are the responsibility of the D shift registrar, with assistance from the D2 registrar.

· When ever possible, discharges should be anticipated and discharge summaries completed 24 hours prior to discharge or transfer.

· Discharge summaries are generated from the NCC database.

· Discharge summaries should be sent to the: referring obstetrician and/or paediatrician, attending neonatologist, medical records and family general practitioner.

· Please read the discharge summary carefully before sending it out. Remember, that this is an important letter communicating the details of the baby’s neonatal course and how it is written is also a reflection of the medical staff at RNSH NCC.



Education


· To regularly attend and contribute to the Department Teaching Programme, which includes critical appraisal of scientific literature and case presentations.

· To be involved in the education of nursing staff and medical undergraduates.


Research

· To be involved in research activities within the department, as well as in the design and execution of at least one research project of sufficient merit to be presented at an appropriate national scientific meeting and to be published in a peer-reviewed scientific/medical journal. The department employs a research nurse 4 days a week to assist with research being conducted in the nursery.



Day Registrar (D)

· Responsible primarily for taking care of babies in NICU and HDU. This includes:

o the admission and stabilisation of babies.

o new admissions in your shift be entered into the NCC database.

o examination of every baby in NICU daily and HDU (twice a week) and making an entry in the medical notes.

· Responsible also for care of babies in SCN during evenings/weekends and when D2 registrar is unavailable.

· Write TPN by 09:30 and fax it to TPN pharmacy, fax number 94385050, in case of any query check with TPN pharmacist on extension 67206.

· Hand over all the important and relevant information to the Night Registrar including results pending, investigations to be carried out, discharge summaries to be completed and the specific instructions of the Neonatologist.

· Complete discharge summaries for babies being transferred from HDU. Assist D2 registrar (if available) with discharge summaries for babies being discharged or transferred from Special Care Nursery. Ensure that discharge summaries are completed for ALL babies before transfer/discharge from nursery during your shift.

· Ensure that the receiving paediatrician is aware of all babies who are to be transferred to other hospitals. (D registrar to contact paediatrician for babies in HDU, D2 registrar (if available) to contact paediatrician for babies in SCN unless otherwise instructed.) Document in neonatal records next to transfer stamp.

· To assist the SCN (D2) registrar if they are busy.



Night Registrars

· Responsible for taking care of all the babies in NCC, attending labour floor calls and attending to infants on the postnatal ward.

· Ensure that NCC staff are aware of your location if you need to leave the NCC to attend labour floor or the postnatal ward. (If possible, babies from postnatal ward should be brought to NCC for review.)

· Present all babies on the morning handover round to the consultant and day team.

· Write fluid orders at the beginning of your shift for all the babies on IV fluids.

· Collect and dispatch all the blood specimens by 06:00.

· Chase and write the lab results ready for morning rounds.

· On Thursday night: prescribe eye-drops for eye-checks done on Friday morning.

· On Sunday night: do electrolytes and haematology investigations for those babies who need these weekly.

· Ensure that discharge summaries are complete for all babies being transferred/discharged during morning following night shift.



Special care nursery (D2)

· Responsible for managing the babies in SCN area.

· To attend all labour floor calls between 08:00 and 17:00.

· Complete discharge summaries for babies being transferred or discharge from SCN. Assist D registrar with discharge summaries for babies being transferred from HDU. Ensure that discharge summaries are completed for ALL babies before transfer/discharge from nursery during your shift.

· Ensure that the receiving paediatrician is aware of all babies who are to be transferred to other hospitals. (D2 registrar to contact paediatrician for babies in SCN, D registrar to contact paediatrician for babies in HDU, unless otherwise instructed.) Document in neonatal records next to transfer stamp.

· When ever possible, discharges should be anticipated and discharge summaries completed 24 hours prior to discharge or transfer (or in previous week if discharge is planned for Monday).

· Complete the blue book examination for all babies who are to be discharged home from RNSH.

· Examine and make an entry in the medical notes of every baby at least twice weekly.

· Assist Registrar in postnatal ward if Neonatal Fellow is unavailable.

· Assist the Day Registrar if the NICU gets busy.





When the D2 registrar is unavailable the Day registrar and fellow together are responsible for:

· Preparing discharge summaries.

· Performing clinical examination and writing in the medical notes.

· Attending to labour floor calls.




Postnatal Ward registrar: Responsible for

· management of babies on the postnatal wards.

· follow up of babies discharged from NCC, especially those on antibiotics.

· routine baby checks and documenting findings in the “Blue Book’ (Not required if a baby has a private paediatrician) If a check is done before baby is 48h old, a second cardiac check is required. This can be done by the registrar if the baby remains in hospital for more than 48 hours or the family GP.

· ensuring that the night registrar is aware of any relevant patients.

· asking the fellow, D2 registrar or neonatologists for help when necessary.

· checking the results of hip ultrasounds and other investigations (eg TFT’s) that have been organised for babies following discharge. A book is kept on the postnatal ward with the MRN of each baby that has an ultrasound or other investigation, so that the parents can be notified of the result. If further follow up is required, the baby is booked into clinic or is sent to a paediatrician.

The ”Blue Book “

The “Blue Book” or personal health record is produced by the Department of Health and is given to the parents of every baby born in NSW. Where possible explain the use and relevance of this book to parents.

The “Baby Check”

The documentation of the “baby check’’ or newborn examination in the “Blue Book” forms the discharge summary for all babies who have had an uncomplicated course in the post-natal wards. It is important that you take care in completing this and in particular include the birth and the discharge weight and examine carefully the femoral pulses, inguinal hernias and hips. If you are in doubt please call the fellow or on call neonatologist.




Neonatal Monitoring Clinic (Clinic 9)

This clinic is run by the fellow every Friday morning in the Outpatient Department on level 2 and is a very busy clinic. Could you please discuss with the fellow (or the consultant on call for the week) any baby from the postnatal ward that you want to book into the clinic. Most babies can be seen by their local GP for minor issues and this arrangement for GP review is often more suitable for the families.