Mole 101:

Mole 101:

This sheet was put together in order to help those residents who are “moleing” for the first time, or who might just need a refresher on what to do when moleing. If you have suggestions, additions, or corrections, please let the chiefs know.

The mole team arrives at 6pm each evening or at 8am on Sunday. One mole team member will be designated to carry the anesthesiology scheduling phone (494-4990). This mole team member will have the following responsibilities (applies mainly to weeknights, not Sundays):

· Make sure that the day’s late stay residents and mole team members are in rooms or otherwise working.

· Ensure that post-late-stay residents are relieved, if possible; if not immediately possible, try to get any inpatient pre-ops of theirs seen. While you normally like to replace these residents with late stays or moles, in some circumstances it is appropriate to use a non-late-stay; use your judgment, and make sure you get those residents out next if that’s what you do. Keeping the resident turnover in a room at a max of 2 (with rare exception) is our goal, for good patient care.

· Find out which room will be the trauma room, and get it setup as soon as possible. This only happens once rooms are coming down, and it is usually room 2 (other rooms may be used – so please check with the charge nurse). Write the trauma room number at the top of the white board. It’s acceptable to have any free resident set up the trauma room, depending on how busy the OR is. If this is later in the evening, this is normally done by a late stay. No late stay resident is to leave prior to the trauma room being set-up.

· See which residents still working in a room have inpatient preops to see. Try to take care of non-late-stay residents’ inpatient pre-ops. Don’t let any late-stay residents leave until inpatient pre-ops are seen for all residents still in rooms. This does not include preoperative evaluations for add-on patients, which are the mole team’s responsibility. No late stay is to leave unless all non-late stay and late stay inpatient preops are seen. This is a team effort.

· Take care of add-on pre-ops once late stay [and other] pre-ops are done. These will be given to you by the charge nurse. Check with the charge nurse late in the evening for any additions. You also need to scan the next day’s OR schedule for the following:

All inpatients on the add-on list, indicated by room “A1”
All inpatients posted into rooms after the initial printing. The charge nurse will have to tell you which patients have been placed into rooms. If not too late (after 9 pm), call the resident in that room and let them know about the case.
All inpatients in the CRNAs’ or PA’s rooms (currently, Allen Tracy, Charlie Cooper, Lori Desorbo, Debbie Drake, Margaret Ford, Taja Fricker, Ellen Knudsen, Lynn Leonard, Greg McCracken, Carol Pearson, Debby Reed and Connie Welch). Don’t call them with these unless there are major issues.
No mole team member should leave until the number of remaining add-ons to be seen are reasonably few (e.g., 1-2 inpatients). It’s not appropriate to leave with 10+ pre-ops on the board so that your fellow-residents are up all night doing them.
You will also take over management of the PACU (which means frequent pages) depending on how busy things are. If you are too overloaded to manage the PACU, then do not allow that resident to check-out until you are reasonably caught-up.
Pharmacy will check-out to you at some point, usually around 23:00 or so.
Late-stays must check out with the 494-4990 holder prior to leaving.
Other mole team responsibilities:

· Your day starts at 18:00, when you arrive in the clinical office. One of you will be assigned to carry the scheduling phone and the rest will likely be assigned to relieve a resident in a room. The faculty member on call makes your assignment. Once you finish whatever case you are assigned to, check back with the team member carrying the scheduling phone. Please remember that residents are waiting in rooms for you to relieve them. It is not appropriate for you to show up @ 1800 and then relieve @1830-PLEASE BE PROMPT!

· No later than 7pm, if there is a CV resident still doing a case, they should be offered the option of being relieved. If they choose to stay and finish their case, please see their preop patients.

· There is always one resident in-house in addition to the number of rooms running. Therefore, if 2 rooms are running, #3 stays and so forth. #1 and #2 mole are ALWAYS in-house, even if no rooms are running.

· In addition to taking care of add-on pre-ops overnight, an additional [very important] responsibility is taking the “coffee cart and computer” to lecture in the morning, as well as unlocking the lecture room. The lectures are in room R5-265 in the research building Monday - Thursday, and in Room 6120 on Friday (Grand Rounds). This needs to be done by 06:45 every morning. Also, set-up the LCD projector and computer (located on the cart with key) if the lecture requires it.

· After lecture, the 494-4990 pager is passed to the AOD or other person in charge of the board for the day.

i Mole Duty #1001 – Add-on Preops / Case Preparation and Postoperative Notes:

We have been experiencing ongoing problems with the completion of add-on [and other] inpatient pre-ops by the mole team members. This handout is intended to help clarify these duties, and to serve as a reminder!

The following are all responsibilities of the mole team, and should be carried-out every night.

1) Check the printed schedule’s add-on list

These cases are booked in the room designated A1. If these cases are inpatients (“IP”), then there are to be seen by the mole team. Also, patients on this list designated as outpatients should be verified as such; this can be done by looking on HIS or calling bed control (50-BED).

2) Check the OR rooms for “late postings”

These are essentially add-ons, but will appear in a room rather than the add-on list. You will have to ask the nurse which add-on patients have already been placed in an operating room.

3) Check the CRNA and AA (Anesthesiology Assistant) cases

We have ten CRNAs and one PA/AA and one AA: Allen Tracy, Charlie Cooper, Debbie Drake, Margaret Ford, Taja Fricker, Ellen Knudsen, Greg McCracken, Carol Pearson, Debby Reed and Connie Welch. Lori Desorbo is an AA and Lynn Leonard is a PA, AA. Their inpatient pre-ops need to be seen by the mole team. We keep failing in this particular area, so make a habit of checking for their cases.

4) Do any add-ons which are posted after the schedule is printed

These are usually given to you by the charge R.N., or placed on the “add-on list” which you will sometimes see sitting on the clinical office desk. Don’t ignore it- someone put it there for a reason! Of particular importance are any transplant-related add-ons, even if the patients are scheduled later in the day. We frequently do not have personnel available during the day to see these patients. The mole team is responsible for any add-on preops posted until their duty period is completed. You are expected to complete any preop evaluations that could reasonably be completed by 8am (the end of your shift). Please coordinate any uncompleted preop evaluations with the AOD. There tends to be a flood of calls from the change nurse between 6:45-7am. Be aware of this and make sure the other preops are done.

5) Completed preops should be placed under the magnet on the whiteboard in the clinical office or filed in the filing folder on the desk. If anyone calls in sick, please set-up that room.

6) Please set up the operating rooms for any add-on cases that are scheduled to start first thing the next morning. This is especially important for the mole team on Friday night (for Saturday a.m. cases) and Sunday night (for Monday a.m. cases).

7) While the OR charge R.N. usually contacts anesthesia with add-on cases, this is inconsistent and should not be relied upon. Check with the front desk for add-ons periodically and before going to bed. Also, you should check in the morning before conference.

8) If you have any questions about a pre-op, ask your on-call attending.

9) Any postoperative notes not completed by the residents assigned to the case should be completed by the mole team prior to any mole team member leaving the hospital. Which patients need postoperative notes may be determined by the sign-off schedule sheet posted in the Clinical Office on the 2^nd Floor.

· If you have questions about these policies or other Mole policies, please contact Dr. Mahla or any of the Chiefs.

REVISED 5/30/2008 (dsb)