* Familiarize yourself with the local neutropenic/non-neutropenic sepsis protocol - this can be found via the oncolnet which is accessed through connect * Make sure you have a working printer fob - you may need a PUK code to activate it * Get access to the shared drive - instructions on how to do this will be in the induction pack * Go to medical staffing and make sure they e-mail the access centre to grant your security card access to the haematology department on level 3 of the lab block

As an Fy1 you will either be located on Ward D6 (+ outliers) or C10.

• C10 is the transplant unit, but many patients will also be admitted for general haematology or non-transplant haem/onc; and there are many different protocols that patients will be on, your clinical management will be based on these. The protocols are printed on pink paper. The nurses have a copy, the patient has a copy and the doctors have a copy - usually in the doctors office in the blue folder that has a label 'Doctors protocols'. You will also be able to find all protocols on EPIC under the chemotherapy tab.
• It is important to note that all allogeneic transplant patients (even if not physically on C10) will be looked after the C10 ward team.

• D6 deals with the other haematology patients and often receives the transplant patients post their procedure if they are re-admitted. The D6 team also covers outliers - mostly located on ward D9

Other Important Wards:

• C9 - the Teenage and young adult (TYA) oncology ward
• D9 - the main oncology ward
• E10 - the day unit for patients coming in for chemotherapy/ blood tests/ blood product transfusions.

In addition to the consultants/SpRs, MDT includes:

1. nutritionist (very helpful for advice about enteral feeding/PN if you're concerned)
2. physiotherapist/OT
3. microbiology/ID/virology team (attend Thursday meetingsat 14.00pm in seminar room near D10 , will often know the haematology patients well by their culture results)
4. radiologist (will be at radiology meeting on Tuesdays to go through all the scans for that has happened during the week)
5. haematology specialist nurses (transplant/lymphoma/AML/chemotherapy/trials/clotting/apheresis team - all very accessible for advice, they will often know the patients very well from their outpatient follow-up, and will be able to answer questions about their pre-hospital care)
6. senior ward sisters

This is usually who comes to the 2pm Thursday MDT meeting outside ward D10 to discuss progress/concerns of each patient - extension/bleep numbers should be available on sheets taped up in the doctors offices on C10/D6.

Radiology meeting happens at 8.15am on Wednesday mornings. Radiology consultant will go through patients that have had scans that week. FY1 will need to email the radiologists on Tuesday night with a list of the patient's names and MRN and which scans the team wish to discuss.

Two FY1s on haematology: 1 for C10, 1 for D6/outliers - should swap over about halfway through the rotation to experience both.

Annual leave is not set and you have 9 days to take. One of the SpR's (currently Dr James Russell) coordinates the junior rota (for FY1s, SHOs and the clinical fellow), and can advise you when it's possible to take annual leave, or take days for study/courses. You also have to cover the bank holidays between the 2 FY1s and SHOs and this has to be decided amongst you (you should get a lieu day for this)

The FY1 week

• Monday - 08:45 - Team meeting in the haem SpRs' office (level 3 of lab block, access via blood bank lab, or via haem dept) - weekend on-call team will run through all the patients on the list and highlight what needs to be done by the day team or who is unwell. One of the FY1 should get handover in D9 from the night team at 08:30.
• Monday - Morning meeting/ handover in registrars offices at 8.45am
  1. consultant led ward round - time set usually at the morning meeting, whenever suits the consultant
• Tuesday - 08:30 - normal day - get handover on D9 then go straight to your ward and meet with registrar/ SHO for planning of the day and then ward round.
• Tuesday evening - email the consultant radiologist with patient scans the team would like to be reviewed at wednesday morning meeting
• Wednesday 08:15 - radiology meeting - Berridge room, dept. of nuclear medicine (access via stairs in haem/onc outpatients, to level 5) - get handover beforehand (take it in turns to get handover so you can attend the radiology meeting on time)
• Thursday 08:30 - consultant ward round (again, time depends on when suits the consultant on the ward)
• Thursday 14:00 - team MDT on D10 seminar room (next to ID ward) - ensure that the list is up to date before attending the meeting.
• Friday 08:30 - normal day unless working the weekend. Handover to weekend team about 16:00 in D6 doctor's office. If you are working the weekend then you are on a long day and will be on call till 20:30 when you will go to handover to night SHO/SpR in D9 doctors office. You are only on call for Haematology, there will be a separate SHO covering the oncology evening.

Handover on weekdays will be to either a Haematology SHO/Oncology SHO who will cover the evening shift.

It is helpful to print off about 10 copies of the list for the Thursday MDT meeting and weekend handovers.

If you're on call at weekend - identify the SpR on call with you and plan which patients you'll see (often the patients on the ward you have had experience on during the week), and when/where to meet to go through the list later in the day. You may also receive calls from ward E10 on the weekends to prescribe blood products for patients in addition to any other required medications. This often needs to be done in advance of them being admitted so they can be prepared. There is a very helpful laminated guide on the nurses station which gives instructions regarding how to 'order for admission' or order outpatient TTOs.

If there is a quiet afternoon you can go to clinic - Tues and Weds afternoons are best for this and a good experience if you can get there.

Consultant ward rounds are twice a week and otherwise are done as a team of juniors (you may split up or go round all together). Usually most of the morning is spent on the ward round and the afternoon spent doing jobs. Additional activities are outlined above.

You are expected to update the patient lists daily and most important to do this before the Thursday afternoon meeting and friday handover. For the transplant patients, important to update the day of transplant and neutrophil count.

Acute leukaemia- will either come as a transfer from neighbouring hospital or as an emergency admission through ED. They will need clerking, have a full set of bloods and normally a Hickmann line requested. They normally start the chemotherapy regime DA. They will be admitted under your team for at least one month.

Elective admission for chemotherapy- Will come in for 3-7 day stretch. The chemotherapy will already be prescribed but you will have to prescribe the supportive medications (i.e. anti-emetics, chlorphenamine), and also any steroid or GCSF that is needed in the chemotherapy regime. It is advisable to do there TTO on admission as most remain well during the admission.

Neutropenic fevers/sepsis- Usually a few days post chemotherapy. Will require admission, full septic screen- including serum galactomannan and viral swabs. If they continue to spike temperatures within 72 hours of admission they require a CT chest to rule out fungal chest infections or PCP, and repeat galactomannan.

Elective admission for Allograft/Autograft transplants- these patients will be admitted for 1 month or longer usually on C10. If they are an allograft patient you must remember to start their Ciclosporin or tacrolimus and to check the levels twice weekly. For each patient there is a pink printed transplant protocol which gives the clinical information, details of transplant, schedule for the transplant and medication plan. It is helpful to familiarise yourself with these and to make sure the patient's notes and drug chart match what is on the protocol. It is important to ensure that once the patient is neutropenic that they have been prescribed ciprofloxacin prophylaxis as well as aciclovir and an anti-fungal.

There are protocols for the following: neutropenic fevers, non-neutropaenic fevers, electorlyte replacement, blood product replacement, TLS prophylaxis.

There is a pro-forma for bone marrow transplant discharge summaries which you are expected to use - there is now a shortcut on EPIC for this, which is .allo or .auto depending on the type of transplant. Ask one of the SHOs to share this with you. It is important to fill this out and also to include the follow up information for the patient - this should also include any E10 appointments you have booked the patient for bloods to be checked to see whether they require any blood product support. If the team also wish for the patients tacrolimus level to be checked then you will need to request an early appointment on E10 as the blood sample has to get to the lab before 10.30am (also you should advise the patient not to take their tacrolimus tablet until after the blood test that morning).

For every Haematology patient being discharged it is good to consider: 1) Have you emailed their Specialist Nurse to let them know the reason for admission and progress? 2) Have you booked appropriate clinic follow-up? (It's best to ask the specialist nurses to arrange this). 3) Have you arranged for follow-up blood tests on E10, if appropriate? (If unsure, just ask if this is necessary).

Evening handover (from 5.30pm) is to the haem/onc SHO on-call - they carry the oncology day bleep. Night handover happens on D9 in the doctor's office.

GET THE INDUCTION APP - WILL HAVE ALMOST ALL THE UP-TO-DATE NUMBERS YOU NEED IN THE TRUST

Specialist nurse haematology: extn 6279/6771 Haematology consultants: Dr Crawley 6280, Dr Craig 6275, Dr Follows 2747, Dr Krishnamurthy 6417, Dr Uttenthal 65318, Dr Foukanelli 6240, Dr Besser 59280, Dr Baglin 3128, Dr Perry 56324

Outpatient transplant SpR - 157462 (will often know the complex post-transplant patients very well)

Blood bank 3130 Vascular access 6020 (reception) 58918 (nurses - usually better to talk to for urgent requests/complicated cases) Microbiology 57035/57055 Virology 57022 X-ray 2387 Emergency XR (out of hours) 3121 CT reporting 6817 CT coordinator 2319

Ward D6 doctors office 4680/4833 Ward C10 doctors office 3905/6489

FY1 rota - You will work some weekends, but never nights. You will also cover the friday evening of the weekends you are working. During the rotation you get a total of 9 days off, which you'll have to coordinate with your team - other FY1, SHO and SpR - to ensure adequate ward coverage. Best to arrange this as early as possible.

you'll be given copies of the haematology protocols before you start - keep them in your bag to check details - the doctors offices will have an incomplete set in a folder…

1. Worth reading through the trust guidelines for neutropenic and nonneutropenic sepsis before you start. This is very common on the wards.
2. You will frequently be ordering blood products and therefore it is useful to be aware of the indications for irradiated blood and HEV negative blood. For known patients, this should be indicated in the 'Alerts' tab on EPIC. Always check with a senior if unsure what special requirements a patient may need. When a new patient is admitted requiring new special blood product requirements, there is a form in the Doctor's office which needs to be completed and taken to the Haematology Lab.
3. Some patients need HLA matched bloods - to organise this a paper form (can get it from ward E10) needs to be faxed across - worth doing this advance of when the patient actually needs the transfusion as it can take along time for the platelets to arrive (can blue light the platelets across if very urgent).
4. get the induction app - will give you all the numbers you need