Junior Night Float (JNF)

Junior Night Float

Welcome to your Junior Night Float Rotation!  You will be the primary neurologist for all patients admitted to any Neurology Floor Service.  The nights can vary from busy to quiet – but you always have a senior resident and NICU fellow back up available to help you out.

 

Important Contact information:

o   Rapid Response – 72743

o   NICU Fellow – 82665 (8COOL)

o   Stroke Fellow – 80021

o   Neurology Consult Resident – 86876

 

General Logistics

Schedule

  • The rotation is Sunday night through Friday night (Sat off).
  • M-F 6pm-7am (except for nights that you act as ANF, then it is 7PM-9AM)
  • Saturday morning, the Grad NP will take signout at 8 AM.
  • Sunday come in at 5pm. Leave NO LATER THAN 8:00am on Monday mornings.

Responsibilities

  • You will receive sign-out about and cross-cover all neuro floor patients on Ward, Stroke, and Grad.
  • You may also be called to evaluate an Adult EMU patient. Sick patients from the EMU should be signed out to you ahead of time, but you will not receive full signout on all EMU patients every night.  If an EMU patient seizes, the Epilepsy fellow on-call should be the first call.
  • If there is a significant event overnight, please leave a “Neuro Event Note” in the EMR, in addition to verbally signing out to the Dayteam. This is important because other residents may rotate on, and will need to know these details. These events include:
    • Fever – do w/u including ua, ucx, bld cx, cxr, sputum cx, and EXAMINE THE PATIENT
    • Change in neurological status (exam, results from imaging that change management)
    • Desaturation – consider ABG, chest x ray, d dimer depending on clinical situation
    • Vital sign abnormalities that require action
    • Other events – family or patient outburst, Rapid response, falls
  • Admissions: from 6pm -6am, you will be responsible for all admissions to Grad (must be approved by Grad attending) and EMU (rare; must be approved by EMU attending)
  • You may be asked to see if they are any available beds for ED patients. Please help ANF/CNF see which patients can be off stepdown protocol in case a patient needs to come up urgently.

Signout

  • When you arrive, forward the JNF 82576 pager to your personal pager (daytime residents will sign over their pagers to 82576)
  • Login to Mobile Heartbeat with “JNF” as your Dynamic Role
  • Wait for signout in the 8HN Stroke Resident/Work Room
  • You should take signout from the Grad service NPs first (occasionally this list is covered by the Ward Senior from 4-6 PM when there is only one NP on Grad)

Back-up

  • If you have any questions overnight, you can ask ANF or CNF residents, or the NICU fellow.
  • You can ALWAYS call the attending for each service with questions/concerns.
  • Attendings MUST be called overnight for anything on the Trigger Protocol (see niresidents.org), including moving patients to a higher level of care.
  • If you are called on any EMU patient and have a question, page the epilepsy fellow on call (amion login = eeg)

ANF nights

  • If a PA is scheduled for JNF, you will assume the role of Admitting Night Float
  • Report to NI-1 Call Room at 7 PM to receive signout on admissions from the Consult team. Take admissions from 5 PM – 6 AM (consult or floor team will watch patients from 5-7 PM)
  • You will also be responsible for all direct admissions, NICU transfers, and OSH transfers to any of the neuro floor services (Ward, Stroke, Grad, and EMU).
  • In the morning, you will present Stroke admissions at 7:30 AM in the Stroke Conference room, and Ward admissions at 8 AM in the Ward conference room
  • See the ANF Rotation Guide for more details.

 

Other Notes/Tips

  • It is a good idea is to walk over to the NICU at some point in the evening and introduce yourself to the NICU fellow on overnight, in case you have questions at some point.
  • Make sure you are added to the “neuro-admissions” emails listserv (email Ericka Ayala). If there are direct admissions from NI-2 attendings or Neuro-onc, or floor admissions form OSH accepted by the NICU fellow, you will hear about them here.
  • Please remember to be courteous overnight to the nursing staff; even if you are fatigued, remember to act in a professional manner at all times.
  • When receiving sign-out, ask if patients in step-down beds are “off stepdown protocol”, meaning they no longer need SD-level care, but have not been physically moved. If this is the case, ask the charge nurse (and PPOC) if the patients can be moved to regular beds. This will help the admitting/consult team a lot if they need to move someone urgently from the ED to SDU.
  • In a similar vein, ask the dayteam if patients are “bumpable” from stepdown, meaning not ideal to move them from SD protocol, but you could do if you needed to.
  • 1:1s/cluster/restraints: 1. Please make sure any information on 1:1/restraint is explained.  Please touch base with each patient’s nursing aide once overnight regarding the patient’s behavior and communicate this to the day team (this is because often the day team doesn’t know what happened overnight bc the 1:1 has left). 3.  You should not have to renew these orders, this should be done by the day team.  If the orders happen to expire while you are on nights, please renew and tell the day team to DC/reorder so they no longer expire during night shifts.
  • Please also make sure you are receiving the neuro-admissions listserve emails. If there are direct admissions to grad there should be an email about them.
  • Grad/EMU admissions

Include the following in all of your admit orders:

  • name and pager of NP (Susan Kreiner 84166 as default for Grad, EMU fellow for EMU)
  • Activity order (i.e. OOB ad lib, OOB with assistance, bedrest, etc)
  • PT/OT/speech and swallow orders when appropriate
  • DVT Prophylaxis unless contraindicated
  • Please review ALL ORDERS for NICU transfers to make sure they are appropriate and that all meds show up as orders with the proper start dates (particularly important with antibiotics)!
  • Remember, no copying forward
  • Graduate patients and EMU patients do not need to be presented to an attending – just signed out to the NP (or resident if there is one on EMU)