TTD 2

TTD 2: Documenting pediatric specific orders

Key Features

  • This EPA focuses on written documentation of orders for assessment and management of any patient, after discussing the case with supervisor or a senior resident.
  • This includes taking into account patient characteristics to adapt the assessment plan and/or dosing, and using the appropriate order structure and local order entry system.
  • This EPA includes ordering diagnostic tests as well as treatments, such as intravenous fluids, medications, and diet/nutrition.
  • This EPA may be observed in simulation.

Assessment Plan

Review of clinical documentation by supervisor or senior resident

Use form 1. Form collects information on:

  • Age: neonate; infant; preschool; school age; adolescent
  • Clinical setting: inpatient; outpatient; emergency department; community; simulation
  • Type of orders: medication/prescription; intravenous fluids; diet/nutrition; diagnostic tests; other (please specify)

Collect 6 observations of achievement.

  • A variety of age groups
  • At least 1 neonate/infant
  • At least 1 child/adolescent
  • At least 1 medication/prescription order
  • At least 1 intravenous fluids order
  • At least 1 diet/nutrition order
  • At least 3 observations by supervisor

CanMEDS milestones

  1. COM 5.1 Document patient care orders
  2. ME 2.4 Adjust medication dosing for patient age, size and/or other relevant factors
  3. COM 5.1 Organize information in appropriate sections
  4. ME 2.1 Recognize situations requiring direct communication of orders to the appropriate team member
  5. P 1.1 Complete assigned responsibilities in a timely fashion
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