General Info

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Orientation Guide

Please review this orientation guide created by Dr. LaFontaine prior to your first day!  

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Important Contact Numbers:

• Nursery Director - Dr. Diana LaFontaine (email: dlafontaine@memorialcare.org). Can also contact via PerfectServ.

• Delivery phone #1: x82133 (this phone is usually carried by Dr. Cox during the weekdays, the residents hold on to it on the weekend and occasionally during the week when Dr. Cox isn't there)

• NICU Attending/Delivery phone #2: x82134 CALL IF YOU NEED ANY ASSISTANCE WITH DELIVERIES OR PATIENT CARE

• Nursery Senior: x85154

• Nursery Intern: x85166

• Family Medicine Intern: x85266

• NICU secretary: x38100 or x11000 

• Dr. Kacey Cox: x85156, Dr. Jones x85266

• Postpartum/Mother-Baby: x32761

• Labor and Delivery: x32711

• Interpreter service: x31113, pager *317825. Language Line: 800-523-1786 ID 295270; Access Code 60700

• Rapid Response: x85149
   

Map of Nursery/NICU:

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Getting to the Nursery:

Take the main elevators in the lobby up to the second floor.

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When you come out of the elevator, if you go to the left you will find the Mother-Baby unit (where you will be rounding on majority of your babies). If you go down the hall to the right, you will dead end into L&D (where you will go for deliveries). To find the Nursery where you'll pre-round every morning: make a right off the elevator, then make an immediate right again down the hallway with baby photos on the wall. You will see the NSY on the right. The current UCLA nursery work area is “Nursery Room 4.”  
 

What do I wear? 

• Please wear scrubs (any type, do not need to be OR scrubs)

• When you are in patient care areas, your arms should be bare from the elbows down

• When you go to a C-section in the OR, you are required to wear a bouffant cap and disposable scrub covers over whatever you are wearing 

• Scrubs are available when you are training in the Newborn Nursery. To access the scrub machine, you will need to punch in the N# located on your badge. Each resident will only have access during the period of their rotation. It is very important that you use the scrub machine that has been assigned in your area. Scrubs must be returned on a daily basis; a $30 fee is charged per scrub set if not returned. If you experience problems accessing the machine, please call Natalie Cano at ext. 31952. Please do not access scrubs for another trainee and do not wear scrubs home.

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Where are my babies located? 

Your patients will be in the Mother-Baby unit (rooms 201-260) or in the well baby NSY.  

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Schedule

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0700 - 0900:

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Arrival & Getting Started

1. Pick up the two phones (x85154 - Senior, x85166 - Intern) from the old NICU (see map)

   • Weekends only: You will be holding the Senior phone (x85154) and the Delivery phone. Call the Delivery phone (x82133) at 8 AM to pick it up – usually one of the NICU attendings is holding it. You do not need to pick up the intern phone.

2. Log-on to Epic (Context: MCH C76- NICU Room 276 or MCH Neonatology)

3. On your first day, add the following user SmartPhrases (as of 2/2026):​

   • H&P note: .nbhp (Kacey Cox)

   • Progress note: .nbprogress (Kacey Cox)

   • Discharge note: .nbdc (Kacey Cox)

   • Delivery quick note for mom's chart: .nbdelivery (Kacey Cox)

   • Delivery attendance note for baby's chart: .nbattenddelivery (Kacey Cox)

   • Discharge instructions (English): .dldc (Diana LaFontaine)

   • Discharge instructions (Spanish): .pedsresnsydcspan (Ozioma Obiwuru)

   • Handoff: .pedsresnsyhandoff (Ozioma Obiwuru)

   • Handoff to-dos: .pedsresnsytodos (Ozioma Obiwuru)

4. Add the following SmartPhrases found under Dr. Diana LaFontaine’s name:

   • ROS: .dlros

   • Late preterm infant: .dllpi

   • SGA: .dlsga

   • LGA: .dllga

   • GDM: .dlgdm

   • Breech baby: .dlbreech

   • Hyperbilirubinema requiring phototherapy: .dlphoto

   • Hypothermia: .dlcold

   • Hypoglycemia: .dlhypoglycemia

   • Maternal chorioamnionitis: .dlchorio

   • Declined Vitamin K: .dlvitamink

   • Declined erythromycin: .dlees

   • Declined Hepatitis B vaccine: .dlhepb

   • Declined Vitamin K, Erythro, Hep B: .dldeclineall

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Dividing Patients and Creating Your List 

1. Under "Shared Patient Lists," navigate to the "Nursery Hospitalist Rapid Response"
   (attending-only patients) and "Nursery Hospitalist Resident Team" lists.

   • Note: the previous “Long Beach resident team” no longer exists!
      

2. Remove any patients that have been discharged (they won't have a room number)
   from either list, if applicable.
    

3. Navigate to the "Newborns and Moms" list organized by "Attending" in alphabetical order.

   • Names to look for every day are Cox, LaFontaine, Laktineh*, and Yoonessi*.

   • Thursday-Sunday: look for McCrae and Reece in addition to the above names,
     though they rarely have patients listed.

   • *Note: We rarely have Laktineh or Yoonessi babies.
      

4. Follow these steps to add all new babies to the appropriate list:

   • (a) All new babies (generally less than ~16 hours old) will have been added under
     Dr. Cox or Dr. LaFontaine as the “Attending” on the "Newborns and Moms" list.

   • (b) Distribute babies such that the “Resident Team” list has two-thirds of the
     total number of patients between Cox, LaFontaine, Laktineh, and Yoonessi
     (+/- McCrae and Reece depending on the day of the week).

   • (c) Add the remaining one-third of new babies to the “Rapid Response” team list.

   • Note: The combined total # of babies assigned to the “Resident Team” and
     “Rapid Response” lists should equal the total # of babies listed under Drs. Cox,
     LaFontaine, Laktineh, Yoonessi, and McCrae on the Newborns & Moms list.
      

5. Revisit the "Newborns and Moms" list periodically from 0700 to 1000 as new babies added during this time will need to be distributed to either team. These new babies must be seen within 24 hours of life.

   • Notify the respective attending if a new baby was added to their list via PerfectServe.
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6. Once the lists are finalized, split the "Resident Team" patients in half between the intern and the senior. You can now begin pre-rounding!

   • Patient caps: Senior cap = 10, intern cap = 8 patients.

   • If there is a Long Beach or UCI Resident, you can divide the Resident list into thirds.
     *They may leave after noon, so make sure they give you signout on their babies before they go.

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Pre-rounding

1. Use the “Newborn Nursery Rounding List” sheet (linked on this page & typically printed on the counter) to pre-round.
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2. Dr. LaFontaine requests that you wrench in the following sub-tabs under the main “Patient Summary” tab (see example above):

   • “NICU Profile”

   • "NB Data Sheet"

   • "NICU MD Care Report"

   • “MHS MD New Results Report 48 hours”

   • "Bilirubin"
     * Nearly all the information you need to pre-round is found in the "NB Data Sheet" tab, with "NICU Profile" containing the GxPx and APGAR info.
      

3. Use BiliTool to trend TcBs and TsBs. Copy and paste the graph and recommendations that the calculator produces into your note that day.
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4. Following completion of the rounding sheet, pre-round on your patients and get ready to table round with Dr. LaFontaine around 0900.

   • * If working with Dr. LaFontaine: see and examine all patients (including new patients needing an H&P) prior to rounds.

   • TIP: The boards on each hallway have asterisks next to the names of babies that the RNs anticipate are discharging that day.

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0900 - 1100:

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Rounds

Table round with Dr. LaFontaine until ~1000 - 1015, followed by in-person rounding on patients until 1100. Patients being discharged that day are prioritized during in-person rounds. Remember that any new babies delivered before 10a and assigned to our attendings will need to be added, seen, and staffed. You may be called to deliveries during this time (see Deliveries below).

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1100 - 1600:

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Afternoon Tasks

** You may be called to deliveries during this time **

• ​12pm- Residents are expected to attend noon conference

• Finish up notes.

  • Dr. LaFontaine will come by around 1230-1300 with any updates (additional exam findings, problems, etc) to be added to your note. If applicable, change your note to reflect these changes. The goal is to have notes signed by 1pm.

  • The short call resident generally leaves after this check-in (interns and seniors typically alternate days).
     

• Prepare handoffs and update to-dos:

  • Copy all the handoff one-liners and add any overnight to-do items in the sticky note column of the list. There are very rarely overnight to-dos! 

  • Useful SmartPhrases: .pedsresnsyhandoff and .pedsresnsytodos 

  • Remember, routine items like following up TcB/TsB for guidance re: phototherapy should generally be done between 0600 and 1400. The day team can make most decisions (and this avoids giving extra work to the night team) 😊
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• Get ready to signout:

  • Include the sticky note column under “Custom” when printing the patient list for easy access. Print two copies of the list: one for the NICU fellow/attending, and another for yourself to read along as you signout.

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1600:

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Signout

Call the NICU attending at x82134 to see if they are ready for signout and, if so, where to meet them. They will usually ask you to meet them in the “new” NICU. Normal signout consists of handing over the list and reading the to-do items. Don’t forget to return the phones in the “old” NICU (where you picked them up) prior to leaving for the day!

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Getting to the "new" NICU:

From the NSY, turn right → continue down the hallway (you will pass the “old” NICU on your left) → follow the winding hallway down to the right and continue until you see the entrance to Peds Core → go through the double doors across from the Peds Core front desk → follow the hallway down across the bridge. The hallway dead ends into the “new” NICU, and you will see the conference room on your left (code is 43215#).

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Communication

* Important #s can be found under General Info (top of page)
 

Nursing:

• Please be sure to introduce yourself to the nurses at the start of your day and give them your perfect serve information and nursery phone numbers.

• First, assign yourself to patients on PerfectServe.

• You should also put your name and info into the “Communication” section in EPIC so all staff can see it.

  • Go to Patient Summary → MD Care tab → Communication Notes – Edit Comment → and insert following sentence: Between 7am-4pm, contact nursery resident *** via Perfect Serve, after 4pm please contact the NICU resident on call.

    • You may also make this a personal SmartPhrase to make things easier.

  • You can then add to the signature on your notes “please contact me via Perfect Serve and x85154 or x85166 for any issues.”

  • The RN list is posted in every nursing area if needed.

• You should be the first contact for your patients.

• Residents should respond to questions on the patients that they are rounding on. For patients under Dr. Cox that you're not rounding on, you can direct the calls to the attending you're working with that day. For patients under private pediatricians, non-urgent issues should be directed to the pediatrician and urgent issues that require immediate attention to the NICU attending (x82134). If requested by the NICU/newborn attending, please assess the patient even if you weren't rounding on the patient that day.

• All babies require an exam before 24 hours of life. In the event that the care of a patient is transferred to the resident team after this time, please document the reason and provide care as appropriate.

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Attendings:

• The best way to contact your attending is via PerfectServe.

• Consult the NSY hospitalist schedule (sent out by the chiefs and printed in the workroom) to see who your attending is that day.

• Attendings start their shifts at 8a on weekdays and 9a on weekends.

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Deliveries

Nursery Refresher - Set-up Guide Link

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**If you have ANY concerns before/during/after a delivery, call x82134! (NICU delivery phone 2)**

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• You should attend all scheduled C/S and high-risk deliveries between 7:30a - 4p. 

• The L&D Greaseboard (or L&D Manager): located at the top of Epic and can be wrenched in if not already there. This will have information on how many moms are in antepartum, L&D, and what stage of labor they're in. 

• OR Schedule: to optimize attendance, check the women's OR schedule to find approximate times for any C-sections scheduled that day by navigating to EPIC → LBM/MCH Tools → OR Surgery Schedule Women's. The color for the patient changes as she is moved into the OR.​​

• Going to deliveries: if there is a delivery to attend, Dr. Cox will call the senior phone to let you know. If it's for a C-section, head to the OR room as soon as you’re called! 

  • You normally have about 2-3 minutes to get to the OR.  

  • Put on disposable scrubs and a bouffant cap before crossing the red line.

  • Give your name to the RN when you enter the OR. The attending should be present to help get you situated.

  • Check your warmer and equipment: PEEP 5, PIP 20, Flow 10 L, suction attached. Check out the Nursery Refresher reference sheet which details how to turn on the warmers, oxygen, etc with pictures.

  • Yell "baby out!" when the whole baby is out of the uterus. Call out "15 sec" and "30 sec" for the OBs so they know when to cut the cord.

  • OBs will put the baby in the cart and you will push it to the warmer. Transfer the baby to the warmer’s bed. ​

  • Check APGARs, do your physical exam, +/- any interventions as needed

    • Don't forget to follow NRP steps! If you are worried about something or if you have to start PPV, call the NICU Attending x82134 for backup (if attending is not already present).

    • There is not always an RT or an attending at every delivery. If you feel uncomfortable at any point, ask the RN to also call the attending or the NICU. You can also call x82134 for the NICU team.

• Documentation post-delivery:

  • ​1) Log into Epic → navigate to the mother's chart → click the "Delivery Summary" tab → click "NB Assessment" to add APGARs and other info → scroll down to “Physician Comments,” enter SmartPhrase “.NBDELIVERY,” and edit the note as appropriate.

  • 2) In the baby's chart, start new Procedures note.

    • ​Under “Add a Procedure,” type “Attendance at Delivery” 

    • Under "Diagnoses," add a diagnosis that starts with "Z" (most common is Z38.01 "Liveborn infant, of singleton pregnancy, born in hospital by cesarean delivery") 

    • In the note itself, use SmartPhrase “.NBATTENDDELIVERY.” Most information will be populated - sign your note once complete.

  • If the patient is coming to Dr. Cox or Dr. LaFontaine (not always the case), remember to write an H&P as well!

 

​Important updates:

• Dr. Cox typically carries the delivery phone during the week, but she may give you the delivery phone to hold when she is off. Residents carry the delivery phone on the weekends.

• For patient safety, attendings should be at (or at least aware of) every delivery – even on weekends!

• After several deliveries (and per attending discretion), you may be asked to manage MD-only deliveries on your own.

  • If you get called for a delivery with any concerning history (preterm, non-reassuring FHR, etc), call NICU delivery phone #2 (x82134) and let them know that you will be going to the delivery.​​​​​​

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Calling Codes

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• CODES - Green: STAT C-section, Crimson: Post-partum hemorrhage, White: Code blue for neonates

• If you are in a delivery and unfortunately need to call a code, there is no “Code White” button. Please ask one of the ancillary staff to call a Code White.

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Please request for a NICU attending at delivery (by calling x82134) for:

• <35 weeks gestation

• Crash/emergent C-sections (also called code Green)

• Category III tracings (sinusoidal pattern, minimal/absent variability with recurrent late decels/variable decels/bradycardia, prolonged decels)

• Major congenital anomalies with anticipated resuscitation need (CDH, TEF, CHD, etc)

• Acute perinatal event (cord prolapse/rupture, uterine rupture, maternal trauma/hemorrhage/arrest/seizures, profound bradycardia)

• Multiple gestations

• Anticipated NICU admission: BW <2000 grams, BG <25g, EOS score 3+, <35 weeks

• PPV needed in delivery room

• Any doubts, questions, or concerns

 

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Epic Tips & Documentation

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• Add the following SmartPhrases for documentation:

  • H&P note: .khhpnursery (Kalei Hosaka)

  • Progress note: .khnbprogress (Kalei Hosaka)

  • Discharge note: .khdcnursery (Kalei Hosaka)

  • Delivery quick note for mom's chart: .nbdelivery (Kacey Cox)

  • Delivery attendance note for baby's chart: .nbattenddelivery (Kacey Cox)

  • Discharge instructions (English): .gknsydcinstructions (Grace Kim)

  • Discharge instructions (Spanish): .pedsresnsydcspan (Ozioma Obiwuru)

  • Handoff: .pedsresnsyhandoff (Ozioma Obiwuru)

  • Handoff to-dos: .pedsresnsytodos (Ozioma Obiwuru)​​

• Write a H&P, progress note, or discharge summary for each patient rounded on.

• For every patient, please remember to assign a primary problem on the “problem list” (i.e. LGA, term new born vaginal, term new born C/S). This problem list should be updated as needed (ie. hypoglycemia, hyperbilirubinemia, etc). 

• Discharge summaries: Ideally, you should wait to sign discharge summaries until all screens and labs have returned. If your note is complete and just missing screens/labs, you may share the near-completed discharge summary with Dr. LaFontaine when she is on service. She will refresh and sign the note to finish it off!

• The goal is to have all notes signed by 1pm (as patient care allows).

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Discharge

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• You are expected to give “mommy talks” to parents prior to discharge. 

  • There is a nursery handbook that is given to new parents at time of discharge. The attendings will make this available for you while you are in the unit to reference for your mommy talks.

• Residents should ask families about their planned/designated outpatient pediatrician early on. Specify it in EPIC in preparation for discharge via the following method:

  • MD navigators (left-side tab) → MD Discharge → Disp & FU → select PMD based on parent preference.

  • Dr. Cox recommends parents call their insurance company to find out which provider(s) the baby is covered under. 

  • If not known or parents are unsure of a provider, please refer the patient to The Children's Clinic (455 E. Columbia St.) near the hospital.

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Miscellaneous

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• Alternative workflows: The workflow may look different when Dr. LaFontaine is not present, including on the weekends. Some attendings are OK with seeing patients together, while others would like you to see patients on your own. PerfectServe your attending to ask what their preference is – see NSY attending schedule for more details (chief will email to the teams).

• Post-hospitalization bilirubin orders: as of 5/21/24, you can order these labs as an “Orders Only” encounter.

  • Click “EPIC” on the top left, click “patient care,” then click “Orders Only” → select the correct patient and type in the order (bottom left corner) → add a diagnosis and associate it with your order (in most cases, the diagnosis will be “hyperbilirubinemia”) → sign!

• Circumcisions: Touch base with your NSY attending if you are interested in observing a circumcision for more information.

• Food/Drink: No food is allowed in the patient care areas. Water and closed drinks are ok.

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Lactation Clinic

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MLK Lactation Clinic information:

Patients will receive a full breastfeeding assessment including weight and bili checks for the infant. Feeding concerns will be addressed and parent will be provided a feeding plan as well as records of the visit to take to their pediatrician or family physician. Follow up appointments can be made as needed/requested. Virtual/telephone appointments are also available.

 

Address:  Wilmington Clinic (MLK)

                 12021 Wilmington Ave

                 Los Angeles Ca 90059

 

Hours:  Monday – Friday 11am-2pm 

 

Clinic Call Center: (424) 529-6755

Clinic Care Coordinators: (424) 296-3809

Email for questions: lactation@mlkch.org

 

To Schedule an Appointment:

You or your hospital/office staff can call on behalf of the patient or you can provide the patient with the clinic contact info to call. You may also provide a “lactation clinic referral” prescription on an Rx pad. There is a standard referral form we can provide if interested, but it is not necessary to make appointments. The call center or care coordinator will help book the appointment. 

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Teaching

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• You will have didactic teaching 1-2x/week from the NICU attendings/neo hospitalists. 

• You are expected to read up on patient-related topics during down time. 

• Choose one topic to present to your attending and the group of trainees on service by end of the rotation. This presentation should be 15-20 minutes long and the format is up to you (PowerPoint, chalk talk, etc)!

• Residents are expected to shadow Lactation one morning during the NSY block. The NICU/NSY attendings should set this up for you. Please remember to ask if it is not offered!

• The RTs will try and do a teaching session early in your 2-week block as a refresher for returning residents and an intro for new interns.

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Clinical Tips

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• See the following guide for a sample presentation.

• EOS calculator: For Long Beach area, EOS sepsis risk should be 1/1000 when submitting it to EOS calculator. The calculator should auto-populate into your note.

• See document 19. UCLA Newborn Guidelines (in google drive folder) for further guidelines on discharge & tidbits from Dr. Chu 

• Of note, ophthalmoscopes are in every pod. Be sure to return them when done :)

 

NSY Attending FAQ:

• Red Reflex: Performed to pick-up on congenital glaucoma and retinoblastoma (rare)

• ABO Compatibility: 

  • If Mother is O+/- or Rh-, baby's cord blood will automatically be tested for blood type and Coombs

  • → If ABO incompatible, initial hemolysis labs are released at 12 HOL (hematocrit, retic panel, and early TsB). If concerning, can follow-up with smear. 

  • FYI if mom is O and baby is B, the hemolytic disease can even affect platelets

• Developmental Dysplasia of the Hip (DDH): 

  • Screen with serial hip exams (at birth, and outpatient) → hip US if persistent

  • AAP guidelines from 2016: If a patient is high risk (female, breech, family history, etc) you CAN recommend hip US between 6 weeks and 6 months, but not absolutely necessary.  

• Hypoglycemia: 

  • Goal BG: 

    • 0-24 hrs > 40

    • 24-48 hrs > 50

    • more than 48 hrs > 60 

  • High risk infants (preterm, SGA, LGA, IDM) will automatically receive q3h glucose checks per protocol for at least 12 hrs

 

Resources: 

• AAP Hospital Stay for Healthy Term Newborn Infants

• AAFP Exam Guide

• Stanford Exam Guide 

• Stanford Newborn Skin Findings

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Last Updated: June 2024​​​