The Informal HO Guide (add-ons to the Tagging logbook brief)

Please note that this is not a formal document, but rather a supplementary guide
to the DUTY OF HOUSE OFFICERS guide found in the tagging logbook (which I
presume nobody ever reads carefully).
So please first read through the guide in the tagging logbook then read this as
additional information. Hopefully everyone will then be clear of their roles in the
respective wards.
GENERAL
1. Working hours for primary HOs are officially 6am-7pm, night shifts 6pm10am the next day. You are expected to come earlier if necessary to
complete AM reviews, and to leave later if necessary to ensure completion
of the days work.
2. Morning Prayers happen on every working day at 8am sharp. Once done
with reviews everyone should attend the MP.
3. Attendance will be taken for the MP. The attendance book should be
brought daily to MP by the ICU HO and kept by the ICU HO.
4. ICU, HDW and LR EMOT HOs are the present their patients daily. Cases and
updates should be written in the big books provided. HO leader should
obtain new books once the old one runs out.
5. After case presentations, those who have conducted procedures prior
should present their cases.
6. Pre-op HOs to stay back after MP for pre-op meetings.
7. Hospital CMEs take precedence if there are any, HO presenting cases
should present their cases and then leave for CME.
8. During your posting here, other than ward work, procedures, try to
perform as many scans as you can, as this is a necessary skill you will
need later on.
9. Text for reading in the Sarawak Labour Room Protocol. Please note that we
do not follow all of the drug dilutions in the book, we follow our own ward
protocol instead.
TAGGING
1. Tagging period lasts for 16 days (14 days of rotations plus 2 off days),
including weekends and public holidays.
2. Tagging hours are from 6am 10pm; at the end of each day you need to
get the oncall MO to sign your logbook prior to finishing the day.
3. Rotations (in no particular order):
- PAC : 3 days
- LR
: 3 days
- K1
: 3 days
- K2
: 2 days
- K4
: 3 days
4. Please read the detailed outline of the responsibilities of each ward as
listed in their sections.
During tagging period:
1. Introduce yourself to everyone (Specialists, MOs, Nursing staff). If you do
not know who they are, make it a point to find out. When you are at a
particular introduce yourself to the specialist in charge, as well as the
Sister and nurses. Do not do the introduction just to get their signature,
but be genuine about it. Be polite, it will bring you a long way.

2. Get your protocols ready, read them and practice them. If the ward
practice is different from the protocol ask the MO. Protocols pasted all over
in each location; those take precedence if there are any clashes. Note that
the drug dilutions for our hospital differs from that in the Sarawak Labour
Room Protocol.
3. Clerk as many cases as possible, first the normal cases, then the
abnormal/high risk ones. Follow up on the case. Develop your own
management plan then discuss with the MO. If the plan is wrong then
learn from it; do not discuss with them without any plan in mind.
4. In Labour Room, see the new patients, follow up until their delivery and
discharge. Your job is not merely doing discharges. Get involved in their
ongoing management, and deliver them where possible. Going to OT is an
option.
5. In the Antenatal Ward (K1), you should attempt to see both acute and nonacute cases and learn from the management. Always ask why something
is done in a certain manner; soon you will see the pattern and principles of
management.
6. Cases to pay attention to:
a. Hypertension in pregnancy: Gestational hypertension, preeclampsia, impending eclampsia, eclampsia, chronic hypertension
(superimposed with any of the above)
b. DM: GDM in diet control/insulin, pre-existing DM
c. Induction of labour: Types and contraindications (and indications)
d. Antepartum haemorrhage (APH): Placenta praevia, abruptio
placenta
e. Shoulder dystocia
f. Post-partum haemorrhage (PPH)
7. Drugs: know the protocol and dilution, dosage, contraindications
8. CTG: must know how to interpret
GOT/PPNR OT
1. GOT runs on Monday, Tuesday, Thursday, Friday, (Saturday sometimes
with Locum OT). PPNR OT runs Monday and Wednesday.
2. HO assigned should liaise with MO in charge once schedule is released.
3. HO/MO to call patient latest 2 days prior to op date. (3-4 days earlier for
Gynae-Onco patients)
4. Look for case notes. It will be either in clinic/K4/5A (less likely)/PAC (less
likely)
5. MO to do summary of cases. HO can help, but responsibility is on the MO.
6. MO to prepare OT list. HO can help, but responsibility is on the MO.
7. Once OT list confirmed, HO to help photocopy (can do at 4 th floor office,
bring empty A4 paper, can ask from ward). Total number 6 copies: Blood
Bank x 1, Ward x 1, GOT x 4
8. HO to be present during pre-op discussion (usually after MP).
9. Patients are usually admitted one day prior to op date (2 days for GynaeOnco patients). Once admitted, pre-op/ward HO to clerk patient, take preop investigations (if unsure to ask MO; may include FBC, Coag, BUSE/Cr,
LFT, GXM/GSH, ECG, CXR), trace and update. Ensure consent taken and GA
assessment done.
10.Pre-op assessment will be done by MO/specialist, HO to be present during
those times.
11.On OT day, come early to assess the patient, check consent, availability of
blood, antibiotics etc.
12.Enter OT, and assist in the cases.

13.Post-op do rounds with MO.

14.If you finish early, help out with ward work.
MOT
1.
2.
3.
4.
5.
6.

MOT runs on Monday-Friday, on working days.

HO assigned should liaise with MO in charge once schedule is released.
HO/MO to call patient latest 2 days prior to op date.
Look for case notes. It will be either in K1/PAC.
MO to prepare OT list. HO can help, but responsibility is on the MO.
Once OT list confirmed, HO to help photocopy (can do at 4 th floor office,
bring empty A4 paper, can ask from ward). Total number 5 copies: Blood
Bank x 1, Ward x 1, MOT x 3
7. Does not require pre-op presentation and discussion.
8. Patients are usually admitted one day prior to op date. Once admitted,
pre-op/ward HO to clerk patient, take pre-op investigations (mainly FBC,
GXM/GSH; extra investigations to check previous plan/ask MO), trace and
update. Ensure consent taken.
9. Pre-op assessment will be done by MO/specialist, HO to be present during
those times.
10.On OT day, come early to assess the patient, check consent, availability of
blood, antibiotics etc.
11.Enter OT with patient, before 8am, and assist in the cases.
12.Post-op do rounds with MO.
13.If you finish early, help out with ward work.
14.Special note for MOT:
a. If there are OPU cases, collect scan from Room 7 and send to MOT
before 8am.
b. If there are BTL cases, patients will usually come for pre-op at day
care one week prior to op date. On op date they come early, get it
done and go home in the evening. It is the MOs responsibility
regarding the patients for BTL, but just take note.
c. When there are OPU cases there should not be any BTL cases.
Should there be any clashes to inform MO and new date for BTL has
to be given.

PAC (Patient Assessment Centre)

1. PAC is the front door to O&G, usually the first contact point we make with
mothers. Mothers may be booked/unbooked cases coming in for
pregnancy-related or non-related problems, or for delivery.
Note: Mothers less than 22 weeks pregnant are under Gynaecologys
purview.
2. Patient will first be registered at the counter then brought in to the PAC.
3. In the PAC, you are to clerk the patient, perform assessment (general
examination, abdominal examination, VE +/- per speculum, CTG), decide
on a working diagnosis and formulate a plan of management, either to
admit to K1 or to send to LR.
4. Clerking needs to be done IN FULL, including social history, and to fill up
the RED clerking sheet as completely as you can.
5. Where indicated, take bloods and insert IV cannula.
6. Ensure all immediate tasks are carried out prior to transferring patient.
7. Prior to leaving at night, ensure all cases are appropriately handed over to
the night HO.
LR (Labour Room)

1. HOs should know all the cases in LR (divide yourselves accordingly).

2. All HOs should know acute room patients and present cases during
specialist rounds (usually TDS)
3. EMOT HO is in charge of morning statistics: to fill up form and get the
necessary updates.
4. Reviews to be performed as scheduled (with complete documentation in
case notes), and update the board accordingly.
5. All new patients should be assessed for progress of labour, given adequate
hydration, offered analgesia.
6. Discharges should be done promptly, usually after 1 hr of delivery if no
other issues.
7. For complicated deliveries (e.g. Instrumental deliveries, discharge timing
may be up till 2 hrs, other maybe up to 6 hrs). Always discuss with MO
prior to discharge.
8. All post-delivery patients must have perineal inspection and VE to remove
clots and gauze if any, prior to discharge.
9. HDW HO is considered part of the LR force and should help out once HDW
responsibilities are settled.
K1 (Antenatal Ward)
1. Mothers above 22 weeks gestation are admitted here when indicated.
They include mothers with pregnancy-related or non-related problems, or
may simply be in latent phase of labour allowing time to take its course.
2. TDS rounds. Do rounds before MO, including PM rounds. AM rounds (and
assessments) are to be completed before MO rounds. Night rounds for
non-acute rooms to be done by AM HOs, night HO to review acute room
patients and do night rounds with oncall MO.
3. Always recheck clerking history, done in PAC, as well as investigations
taken.
4. Each ward should have a pass-over/job list book to note all the orders
given during morning rounds and to carry them out before PM rounds:
tracing investigations, reassessments, referrals, discharges. No office hour
duties should be passed over to night HO.
5. All investigations results must be counter-signed by the HO.
6. IOL pre-requisites:
a. Must be discussed with specialist and indication clearly laid out.
b. Ensure IOL plan clearly stated: method, dosage (if using prostin).
c. Check dates, if wrong to inform stat.
d. Ensure availability of FBC and GSH, IV access prior to IOL.
e. AM HOs to write on board patients due for Prostin the next morning.
f. Prostin should be taken out of the fridge 30 minutes prior to
insertion. Only take out the required amount. Prostin is quite pricey.
g. All cases of IOL that have been decided the previous night/day
should be carried out FIRST THING in the morning by the night
HO. AM HOs to help if not completed in time by post-night HO.
h. Ensure that there are no contraindications: no contraction, cephalic
lie. Do vaginal examination, document findings and stamp. IOL
assessment format can be found on the ward notice board.
i. Special circumstances:
i. If patients develop 1:10 contractions/tightening, inform the
MO before deciding on proceeding with or halting IOL.
ii. 3rd prostin insertion for MO to perform.
j. Post-IOL, ensure patient is reassessed timely.

7. Any patients with abnormal liquor colour must be informed to MO

immediately.
8. Post-night HO responsibilities: Prostin insertion, blood taking, and
discharges (and helping out in whatever capacity).
K2/K3 (Postnatal Ward)
1. All post-LSCS patients to be reviewed within 2 hrs.
2. Check BMI, VTE risk scoring and preferred contraception method at the
earliest setting.
3. Ward work and reviews similar to K1. The main bulk of work would be to
review postnatal mothers and doing discharges.
4. Oncall HO is the 2nd call HO for EMOT.
5. Post-night HO to get baby updates for mothers whose babies are admitted,
and to help in ward work until shift is over.
6. HOs are allowed to:
a. Off CBD: if urine is clear and patient can ambulate
b. Off IVD: if patient is tolerating well
c. Do wound inspection as scheduled
d. STO as scheduled
7. Specific ward protocols for AUR, contraception advice, VTE risk and
prophylaxis are available on the ward notice board. Please read up.
K4 (Gynaecology Ward)
1. Patients with non-pregnancy related womanly problems, early pregnancy
problems will be admitted here.
2. Learn to perform Gynaecological scans.
3. ERPOC for missed/incomplete miscarriages can be attempted by HOs with
supervision. Septic miscarriages/molar pregnancies are out of bounds for
HOs.
4. Oncall HO is 3rd call for EMOT.
5. Post-night HO to help in morning ward work until shift is over.
Clinic
1. Clinic runs daily on working days, starting at 9am, procedures start at 2pm
(Mon-Wed in O&G clinic, Thu in Gynae-Onco clinic).
2. There will be 2-3 clinic HOs assigned each day. 1 will be the clinic
procedure HO, the other 2 will see cases in clinic. Ward HOs who are done
with ward work are expected to be at clinic to learn (and to help)
3. BP check for mothers
a. At 6am, go to level 5 Rooming-in and Cots to take blood pressure for
mothers who need BP monitoring. Divide the work among
yourselves.
b. Their names are usually written on the white board outside Room 2
of rooming-in on the opposite wall. Also ask if any mothers whose
names are not written need BP check; the JMs there know as well.
c. Fill up the BP monitoring form (usually on their chart boards or with
the mothers)
d. If 2 weeks are up and they have not been reviewed by anyone,
discuss the case with any clinic MO for further plans.
e. Any mother with issues: high BP, IE symptoms, other problems, are
to be discussed with clinic MOs (weekdays), Gynae call (weekends)
4. Clinic starts at 9am. Clerk the cases, examine and scan, discuss with MO
on further plans. They are usually very nice, so dont feel apprehensive
about asking if you have any doubts.

5. After clinic is done, HOs to proceed to either PAC/LR/K1 to help out till end
of shift hours.
6. Clinic procedure HO:
a. AM session (Mon-Fri) take blood for patient from room behind the
counter.
b. PM session
i. Mon-Wed Brief clerking and prepare consent for patients
who come for procedures (hysteroscopy or colposcopy) and
present to MO/specialists in charge. Procedures usually start
after 2pm, but patients arrive as early as 11am-12pm.
ii. Thu Colposcopy for Gynae-oncology clinic. Be there by
12pm and do the same as above. Only prepare pathology
forms after instructed by Dr Suguna.
iii. Fri sometimes LLETZ day for Gynae-oncology clinic, which
starts at 8am. Check with the clinic early, and go early to
clerk the patients.
ICU
1. ICU HO to review all patients in the morning, present the cases in MP, and
also get baby updates for ICU patients if necessary.
2. After AM reviews, proceed to Daycare (enter the door on the left
immediately after the entrance to K1).
3. At Daycare:
a. Postnight ICU HO to cover Daycare till 10am.
b. Clerk and review patients who come for ECV, BTL pre-op.
c. For ECV patients: clerk, do CTG, take FBC and GSH, then inform K1
MO
d. For BTL patients: clerk, take FBC, and inform MO in-charge
(according to op date) for consent taking.
4. Oncall ICU HO to do night reviews as well as functions as the 1 st call EMOT
HO.
5. On weekends, ICU HO to cover rooming in BP check.
5A (Onco)/Chemo/Runner
1. Primary HO to do AM and PM reviews, followed by rounds with MO.
2. Table rounds start once Dr Suguna comes up from OT/clinic, after which
are followed by ward rounds. Primary HOs are expected to stay till end of
her rounds.
3. Any orders for patients (Pre-chemo/Chemo/blood-taking/admission/other
issues) are to be written down in the Big, black diary. Orders that need to
be carried out immediately are to be noted by the Chemo boy/girl and
promptly done.
4. Runner schedule: start Mon-Fri for 2 weeks. Off on weekends. To brief next
runner prior to start of assignment.
5. Chemo 2: Starts Saturday, Off the coming Friday, In charge of Daycare.
6. Chemo 1: Continue on the next Saturday, then off the following Sat & Sun,
with an option to extend till Mon. In charge of ward chemo patients.
7. No referrals to be done by HOs. HO can help do case summaries. But
all referrals to be done by MOs only.