Working an ‘On Call’ shift means that you are working outside of the normal hours.
This usually means after 5pm on a weekday, weekends and nights. The number of on call shifts you have, varies depending on the department and your trust.
There will be junior doctors on nights in their respective specialties. For e.g., if you are in Trauma & Orthopaedics, you will have your team (1 junior doctor and 1 senior doctor), if you are in Medicine, you too will have your seniors.
However, in Surgery and Medicine, it may be that you will have to cross cover the whole of surgery or the whole of medicine irrespective of where you are currently based.
For example if you are on Gastroenterology, during an on-call shift, you will be covering all of the other medical specialties, i.e. Endocrinology, Respiratory, Elderly Care and so on. Likewise, in surgery.
Surviving On-call Shifts
Bleeps will be the main mode of contact between yourselves and the ward. You will be bleeped for all sorts of things during a night shift, much like during the day, but it is again, about prioritising your bleeps. This will help you survive your shift.
On- Call Team
Although there may be a reduced number of doctors working during an on-call shift, don’t worry, you will have support.
Aside from your team, you will also have the Critical Care Outreach Team (CCOT) who can help you with an unwell patient.
CCOT are very experienced, and they are a bridge between ITU and wards.
They see and manage unwell patients all the time and so, don’t be afraid to ask them for help if you need it! The escalation pathway is demonstrated below.
Surviving Night Shifts
Prior to starting your night shifts
- Don’t set an alarm, sleep as much as you can and wake up naturally
- Try not to have coffee or anything caffeinated throughout the day.
- Prior to your night shift, sleep and rest well.
On the last day of your night shift
- Have a nap for an hour or so when you get home
- Wake up and go about your day
- Try to sleep around your normal time so that your body clock can adjust itself
Ensure you have food/snacks and drink to keep you going
- If you can have a power nap during the shift, then do so!
- Make use of the team around “Hospital at night team”
- Prioritise your jobs/bleeps
- Ask for help
- Handover to day team clearly
Prescribing
There are many hospitals who have moved on from the traditional written prescriptions, but the basic principles of prescribing remain the same, i.e. using the correct medications for the correct patient with the correct frequency and route.
- Write the medication name clearly – make sure it is legible and in capitals
- ALWAYS check allergy status prior to prescribing medications
- Ensure correct dose (you can use the BNF), correct frequency and route (adjust to renal dose if kidney function isn’t great)
- Write a review date or end date if necessary (electrolyte replacements/antibiotics)
- Think about the contra-indications of medication/s you want to prescribe
Different hospitals in the same and in different countries have their own guidelines in prescribing for certain conditions. If you aren’t sure of what to prescribe or what the dose is, you can refer to your trust guidelines which can be found on “MICROGUIDE” or your trust’s internal website. You can also use BNF.
