To prepare, it is useful to have the BNF for Children app on your phone and to know the formulae to calculate fluids (although EPIC does this for you now). It is also helpful to know the alterations for paediatric life support vs. adult (although hopefully you won't need to!)

The department is spread over 4 wards:

C2 is oncology ward

D2 is general children's ward

C3 is ward for babies

F3 is for day cases (usually F2s don't go here much)

If a certain ward is short of beds then the other wards will accommodate so there may be babies on D2 now and again.

There is a resource room on C3, to the right when you enter. This is where handover happens for medical specialties (not oncology) and surgery.

In Addenbrookes Paeds is divided into general Paediatrics (who accept all of the acute non-sub specialty patients who attend A&E e.g. bronchiolitis, croup, neonatal jaundice etc.) and then various sub-specialty teams: neuro, gastro, respiratory, endocrine who deal with the very complex patients. Although there are some general Paediatric consultants, most consultants, registrars and SHOs rotate through general paediatrics as an “on-call” week. NICU is for newborns who have never left hospital. In general, if they are discharged home and require re-admission, they are admitted to C3, they almost never return to NICU. There is also a paediatric surgery team that the F2s rotate through, and is usually quite taxing.

Currently, there are 4 FY2s in each Addenbrooke's paeds rotation. This usually means that 1 will help cover general paeds, 1 will cover ED, 1 will cover general surgery and 1 will be on the specialities. Annual leave/study leave is organised via Nico and Birgit. There are no rotad on-calls, although you can opt in to do evenings and weekend days (and these are often a great opportunity to experience emergency paediatrics). When you cover any speciality apart from surgery, you will start at 8:30 and finish at 5, although handovers do frequently run over time.

Most FY2s will spend 4-8 weeks on Paeds surgery (start time 8:00, finish time 4:30).

Annual leave can be negotiated, but you are likely to have limited say over when lieu days are taken.

Study leave is possible as rota gaps permit, and there are regular ST paediatric training days which you may be able to attend if you book leave early.

Paediatric surgery starts at 08:00 in C3 Dr's office for handover. You (as an FY2) will be expected to arrive a few minutes before in order to print off the patient lists, and link the computer up with the display monitor. On Paediatric surgery your jobs include routine things such as discharge summaries, bloods, prescribing etc. You also clerk new patients in who arrive in A&E and will be bleeped to do this. You are also expected to discuss required investigations with one of the three consultant paediatric radiologists: (Dr. Pat Set, Dr. Jackie Hughes and Dr Anna Gomez). It is often best to do this in person, but finding them can be tricky. The staff at the Ultrasound department on level 3 are very helpful (go through the doors on the left just before reception to get into the ultrasound suite, and ask one of the staff at the computers there, they will tell you where the consultants are rota'd to be). Once a week (Tuesday afternoons) you will be expected to see patients in the pre-admission clinic in clinic 6. Ideally you will be joined with a Specialist Nurse (who explains the operation and post op care) and a Reg who will consent patients - although in practice the Reg is very rarely there. Your role is to take background history and basic examination and screen for potential problems (such as current/recent chest infections). There is no anaesthetist on hand, so if there are any potential issues, discuss them with the Specialist nurse and email the anesthetist. There is also an MDT on Monday mornings at 10am in the paediatrics portakabin for all the surgery inpatients, and there will be a teaching presentation.

For paediatrics, handover from the night team is at 8:30 in C3 Dr's office. The night team will print out all the patient lists. Pick up your bleep (depends on which speciality you are on) from the tin on the table. There is no oncology handover (usually if you are on oncology, go to C2 at 8:30). At 9-9:30 there is usually teaching every day, by trainees/consultants. Everyone is expected to attend this.

After teaching is the ward round, then you will do the jobs like discharge summaries, bloods, prescribing etc. You always have a senior point of contact if you need help. Find out who this is at the start of the day! You can attend theatre if you are in the Surgery weeks.

There is Oncology teaching on Friday mornings at 08:00, this is often very helpful and very interesting. There is Paeds teaching on Monday lunchtime in the J3 seminar room. There is F2 teaching on Friday 1-2pm.

Handover to the evening team is at 4:30 (or 4pm on Friday) in the C3 Dr's office. The SHO or FY2 on general paediatrics is to print the patient lists.

On Wednesday morning, there is a respiratory and gastro grand round. The respiratory grand round is in the portacabins next to the liaison psychiatry building and the gastro grand round is in the seminar room in the Rosie hospital - one floor beneath NICU. In the grand round, consultants/juniors/clinical nurse specialists/dietitians/SALT/clinical psychologists would be present and will often discuss both inpatients and any patients due to come in. It is important to be present so that you are familiar with the patients to ensure a full clerking is completed for those to be admitted and appropriate management plan is in place as per team discussion.

You rotate between general paediatrics, paediatric surgery, respiratory + gastroenterology, neurology, oncology and Paeds ED.

*Please note, the below information applies to normal working days only*

Most shifts have handover at 0830 in the resource room on C3 ward. Patient lists are printed by the night team by sub-speciality. Any jobs for patients will be handed over in this meeting, followed by teaching sessions which are pre-planned. Surgery is slightly different in that you prepare a surgical list for handover at 8am on C3 ward which is followed by the ward round with either the consultant or registrar. Oncology meet downstairs in the C2 MDT office at 08:30, have a list ready and one of you should attend handover on C3 briefly before this for handover.

It is advisable to make your own lists on EPIC of each sub-specialty so that you have easy access to them for the ward round.

There is an evening handover for Paediatrics at 1630 (1600 on Friday) in the same resource room where you hand over outstanding jobs or things to be aware of to the night team. For paediatric surgery handover is at 1730 with the same criteria. Between 16:30 and 20:00 there is a ward Reg and an ED Reg with an SHO covering both (primarily ward based).

The evening paeds surgery SHO starts at 17:30 by taking handover from the paeds surgery SHO. They finish by handing over to the paeds SHO at 23:30 (NB these times are potentially changing soon, so please confirm them at the start of each rotation!)

The night shift starts at 8pm with handover in the C3 resource room from 20:00 - 20:30. The evening team should print the out of hours hand list for this - which include all paediatric patients in the hospital.

The most common patients in A&E are those with poor feeding and fever. With these it is important to get a detailed feeding history of what they are being fed, how much, how often and how it has changed. For a child with diarrhoea/vomiting the first line intervention for dehydration is usually diarolyte, there is a protocol for a diarolyte challenge for dehydrated children. If they fail this they are likely to need IVF.

The NICE guidelines on fever in children include a traffic light system for assessment of severe illnesses (https://www.nice.org.uk/guidance/cg160/resources/cg160-feverish-illness-in-children-support-for-education-and-learning-educational-resource-traffic-light-table2). This is a good tool and will guide you on treatment and speed of escalation. Do not hesitate to contact a senior if the child has a high PEWS, has any red features, or if you are concerned in any other way.

In young infants the birth history is important, including any risk factors for infection - prolonged rupture of membranes, labour >24 hours, maternal sepsis/fever, positive results of any swabs at birth - especially group B strep. Any infant under 3 months with a fever will need a full septic screen, including blood cultures, urine cultures and an LP.

Patients can be admitted from clinics, ED, referrals from GPs, elective admissions or transfers from other hospitals.

Clerking for all patients should be thorough and include birth history, developmental history, immunizations, family history and social circumstances.

ANY safeguarding issues should be discussed with seniors straight away for advice, who will know when or when not to escalate. At times safeguarding concerns may have already been raised but it is always advisable to check.

Follow ups are booked through epic on the discharge section - be aware of the different acronyms for the different consultants and different teams.

For paediatric surgery OP referrals, enter 'ref 500' under the orders section of the TTO, then specify the appropriate clinic code. Below is a list of the current clinic codes:-

• ADD AA AA Mr Aslam’s General Clinic
• ADD AAGAST Mr Aslam’s Joint Gastro-Surgery Clinic
• ADD AATHOR Mr Aslam’s Joint Gastro-Thoracic Clinic
• ADD GMSURG Miss Georgina Malakounides
• ADD CRJAPSUR Ms Jackson’s Clinic
• ADD CRJAHH Ms Jackson’s Outlying Hinchingbrooke Clinic
• ADD SFASURG Mr Farrell’s general clinic
• ADD MPLW MW Mr William’s Urology Clinic
• ADD NCFUROL Mr Featherstone’s Urology Clinic
• ADD NCFHINCH Mr Featherstone’s Hinchingbrooke Urology Clinic
• ADD ARKPUROL Mr Khan’s Surgery/ Urology clinic
• ADD NCFSTONE Mr Featherstone’s Stone Clinic
• ADD ADSUROL Dr Sansome’s Urology clinic
• ADD GSUR FTOR Mr Farrell’s Joint Gastro-Surgical Clinic AND Miss Malakounides Joint Gastro-Surg Clinic Thus need to free text which surgeon
• ADD JSAREN Joint paediatric urology/ nephrology clinic
• ADD MWIH Joint DSD clinic
• ADD AJCNS NURSE Clinical Nurse Specialist Gen Surgery Clinic
• ADD AJCNSU NURSE Clinical Nurse Specialist Urology Clinic
• ADD AJCNSD NURSE Clinical Nurse Specialist Dysuria Clinic
• ADD AJCNSG NURSE Clinical Nurse Specialist Gastrostomy Clinic

Bed availability is always tight due to a high volume of admissions. Inform the bed manager of possible admissions to see if it is actually feasible or there is a bed space for them.

When patients are discharged there are often outstanding results which need to be chased up. For this there are folders in the 'My System List' part of Epic, one for ED patients and one for ward patients. When you discharge a patient who has outstanding results of investigations, please make it very clear in the discharge note what these are and place the patient in the appropriate list. If you are covering ED it is your responsibility to go through the ED patient list and chase any outstanding results, if you are covering General Paediatrics you will be responsible for the ward patient list. You will need to look up the results and inform the parents of the patient, including documenting the discussion as a telephone call on Epic, and then deleting them from the list. If you think the result changes the management of the patient, or you are unsure about its significance, discuss it with a senior prior to contacting the parents. Sometimes it is not clear why the patient is on the list, if so ask the person who discharged them, or bring it up in handover to see if anyone knows.

as with all other specialties you are the first port of call unless there is an emergency in which they will go directly to the registrar or consultant.

escalating concerns or worries should be done earlier rather than later, even if it turns out to be something you weren't familiar with and was very simple or not worrying.

handover is important and you should ready for it. It allows appropriate continuity of care but also ensures that unwell patients are highlighted to the evening / night team and jobs are completed as required for patients care.

Paed SpR on call 156 0002 Paed SHO on call 156 0003

Paed General SpR 157 261 Paed General SHO 157 664 Paed Resp SpR 156 0335 Paed Neuro SpR 154 609 Paed Neuro SHO 157 488 Paed Gastro SpR 157 767 Gastro CNS 4757/bleeps 154 702/154 701 Paed Oncology SpR 152 512 Paed Cardiologist Dr Kelsall and Dr Singh 6687/156 2303

Paed Surgery SpR 07623620868 Paed Surgery SHO 157 202 Theatre coordinator 3408/152 355

ENT SpR 156 2253 ENT SHO 157 573 Ortho SHO 156 0621

Currently all of the FY2s are unbanded, but there are opportunities to do the evening and weekend day shift on-calls - just talk to Nico/Birgit/Dr Bailie!

Paeds surgery days are longer that the 'average' week and so you get some time off in lieu, this varies depending on number of weeks done - discuss with rota coordinator.

Oncolnet is invaluable if you are working on Oncology, as a lot of the protocols and guidelines are available through that. The pink folder (kept on the C2 notes trolleys) also has a list of the protocols which is very helpful. In general everyone is super friendly and happy to help or point you in the right direction, just ask.

The oxford handbook of Paediatrics is a simple way of knowing the basics about common presentations and a great guide to help your reviews and managements of patients.

if you are struggling with a cannula or bloods - paeds ED have a “vein finder” which can be used to locate veins to help with this. PA's are only available till 1530 and can only help in paediatrics if available.

When doing blood gases for heel or toe pricks - rub the heel or toe for 1 minute or apply a glove full of warm water to the area. Apply a small amount of vaseline so the blood forms drops when you squeeze the foot. Use a tenderfoot (found in ED or D2) to obtain the blood sample. Squeeze the area using as much of your hand as possible and then press hard with the tenderfoot before releasing the lancet. Catch drops of blood using the capillary tube. Avoid bubbles in the tube (or the sample won't run) by angling the tube slightly upwards. Allow the area to refill and then squeeze again. A full tube allows you to measure all parameters on the gas machine, but beware the samples do clot quickly so if you're struggling just get enough for what you really need. One segment corresponds to one line on the gas machine. If you have had to squeeze hard, the potassium and lactate may be raised. Blood gas machines are located on PICU, F3 and ED. Blood samples for FBC and U+E, drug levels etc can be obtained using this technique - use the small paediatric bottles.