Transcript Document
SIMS FILE PUSH-OCT 2013
• File push to occur weekend of October 20 – New template to address high volume/rapid turnover – Changes to the “Anesthesia Standard” template – Refresh my memory/How to
Rapid Template
• Rapid Template designed to accommodate high volume rooms at the Riverside Campus (cysto, D&C, Litho) • Features include: – No need to complete formal Preop Assessment using Preop Manager – – Default template includes most commonly administered drugs Customized Event Sets – Customized Icons
• • •
Using the RAPID Template
Launch Anesthesia Manager Select Patient as per usual fashion
Use pull down menu on ADT screen to select the RAPID Template
• Should you accidentally launch the incorrect template, simply TRANSFER your patient back to the network and start from the beginning
RAPID Template-HOME Screen
SYSTEM Icons-NO CHANGES*
*addition of anesthesia WIKI to all templates discussed later in ppt
CUSTOM ICONS-Modified
CUSTOM ICON-PIT
This ICON will place an “O” on the timeline and add the following text to the Events: • “Oxytocin 20u/L added to IV Fluid (O)”
CUSTOM ICON-END GA
This ICON will place an “g” on the timeline and add the following text to the Events: • Oropharynx suctioned
as required
• Adequate spontaneous ventilation resumed • Opens eyes to verbal stimulation
OR exhibiting purposeful movement
•
Airway device, (ETT/LMA), if present, *removed,
ventilating well • End General (g)
Italics denote changes from “Anesthesia Standard”
CUSTOM ICON-ZZZ
This ICON will place an “g” on the timeline and add the following text to the Events: • Oropharynx suctioned
as required
• Adequate spontaneous ventilation resumed •
Airway device (ETT/LMA), if present, *left in situ Italics denote changes from “Anesthesia Standard” this icon can be used when taking a patient to the PACU who has not emerged from GA
MEDICATIONS-Default
New Medications: • Ketamine mg • Ketorolac mg • Lidocaine PF (Pain) mg/kg • Remifentanil mcg
FLUIDS-Default
New infusions: • Lidocaine 1% PF (PAIN) mg/h • Remifentanil 0-1 mcg/kg/min • Ketamine (GA) mg/h • Propofol mcg/kg/min
EVENT SETS-Modified
3 new Event Sets added: •A!01_Rapid Preop Eval •A!05_Rapid GA •A!10_Rapdi MAC •Remainder of Event Sets stripped down
•
EVENT SET A!01_RAPID Preoperative Evaluation takes the place of Preop Manager
– Review of Systems (Events) relating to procedures specific to the RAPID template – Review of Systems (Events) relating to CVS and Resp system
EVENT SET A!01_RAPID Preoperative Evaluation
•
takes the place of Preop Manager
– Review of Systems (Events) relating to GI/End/Haem system – Physical Exam (Events) related to the Airway
•
EVENT SET A!01_RAPID Preoperative Evaluation takes the place of Preop Manager
– Physical Exam (Events) related to the CVS/Resp systems – Relevant lab, Meds, Allergies, NPO status – Anesthetic Plan
•
A!05_RAPID GA Highlighted events are new
•
A!05_RAPID GA Highlighted events are new
•
A!10_RAPID MAC Highlighted events are new
Anesthesia Standard Template Changes
• • The push of the RAPID TEMPLATE has given us the opportunity to incorporate changes to the “Anesthesia Standard” template I am happy to report that we have recently established a SIMS Committee. This Committee will: – meet on a quarterly basis – Is multidisciplinary in representation (IT/Nursing/Anesthesia) • Anesthesia Reps: Zunder, Jee, Bryson, Pysyk – will facilitate improvements and upgrades in a timely fashion
“GA-Anesthesia Standard” Template Changes
General fixes to various event sets
WRONG PATIENT protocol and documentation
Preop Manager pull down for Meds/Allergies
Surgeon NOT requesting antibiotics
Addition of Albumin 5% to database/protocols
Subheadings
Originally programmed as ON by default, we realize they take up precious screen real estate New Default Setting is OFF All meds and fluids to be listed alphabetically
General Fixes-Event Sets A001_Anesthesia Type
• (M)_Monitored Anesthesia Care-Deep Sedation – added in at request of Business Groups to reflect changes to the MOHLTC Schedule of Benefits
General Fixes-Event Sets
A005_PACU-SDCU-ICU Report • Reminder by QPS Committee to submit a PSLS Report should you answer YES to: “Periop Adverse Event/Near Miss:
General Fixes-Event Sets A011_Basic GA
• Steep Trendelenberg (Position Checks q1h) – Added in at request of QPS Committee • Trend/Rev Trend Angle – Added in at request of QPS Committee • Upper arm Krauss armrest – Position in Event Set changed
General Fixes-Event Sets A012_Basic Spinal
• Please REMEMBER to chart SPINAL Drug Dosage in Medications – Added in as a reminder to document as audit committees have noted absence of spinal med doses
General Fixes-Event Sets A013_Basic MAC
• Same options added to this event set similar to – Basic GA – Basic MAC
General Fixes-Event Sets
A066_Regional Upper Limb • Local anesthetic thru needle – Typo corrected (used to say “catheter”
General Fixes-Event Sets
A150_Thoracic GA-DLETT • Eschmann Stylet (Bougie) – Position in Event Set changed
Anesthesia WIKI Displays all Educational/Update Material Relevant to SIMS http://wiki.med.uottawa.ca/display/WIKITHESIA/SIMS+Reference
Preop Manager New Med/Med Allergies “pull down” list
• • • • Will contain ~80 of the most commonly prescribed medications.
The generic name is in brackets and follows the common trade name of the drug The list is organized alphabetically by generic name Please forward any suggestions for further additions to the list A similar “pull down” will be created for the most common Allergies
Preop Manager New Medication pull down list
Acetaminophen Tylenol with Codeine (Acetamnophen Combo) Tylenol #3 Cordarone (Amiodarone) Amitryptiline (Amitryptiline) Norvasc (Amlodipine) Atenolol (Atenolol) Lipitor (Atorvastatin) Monocor (Bisoprolol) Pulmicort Turbohaler (Budesonide) Atacand (Candesartan) Captopril (Captopril) Tegretol (Carbamazepine) Celebrex (Celecoxib) Celexa (Citalopram) Plavix (Clopidogrel) Pradaxa (Dabigatran Etexilate) Dexamethasone (Dexamethasone) Valium (Diazepam) Diclofenac (Diclofenac) Digoxin (Digoxin) Diltiazem (Diltiazem) Vasotec (Enalapril) Nexium (Esomeprazole) Pepsid (Famotidine) Fentanyl Citrate (Fentanyl) Proscar (Finasteride) Symbicort (Formorterol) Flovent Diskus (Fluticasone) Monopril (Fosinopril) Lasix (Furosemide) Glyburide (Glibenclamide) Nitro Dur (Glyceryl Trinitrate) Hydrochlorothiazide (Hydrochlorothiazide) Hydromorphone IR (Hydromorphone) Hydromorphone Contin CR CAP (Hydromorphone) Ibuprofen (Ibuprofen) Indemathacin (Indamethacin) Atrovent HFA (Ipatropium Bromide) Avapro (Irbesartan) Trandate (Labetalol) Prevacid (Lansoprazole) Synthroid (Levothyroxine Sodium) Prinivil (Lisinopril) Ativan (Lorazepam) Mevacor (Lovastatin) Metformin (Metformin) Metoprolol (Metoprolol) Morphine Sulphate (Morphine) MS Contin (Morphine) M Eslon (Morphine) Singulair (Montelukast) Naproxen (Naproxen) Trasderm Nitro (Glyceryl Trinitrate) Nortriptyline (Nortriptyline) Zyprexa (Olanzapine) PMS Oxycodone Oxycontin (Oxycodone) Dilantin (Phenytoin) Potassium Chloride Predisone (Prednisone) Seroquel (Quetiapine) Altace (Ramipril) Zantac (Ranitidine) Xarelto (Rivaroxaban) Crestor (Rosuvastatin) Ventolin (Salbutamol) Advair (Salmeterol) Serevent (Salmeterol) Zoloft (Sertraline) Zocor (Simvastatin) Flomax (Tamsulosin) Bricanyl Turbohaler……(Terbutaline) Spiriva (Tiotropium Bromide) Tridural (Tramadol) Verapamil Hydrochloride (Verapamil) Coumadin tab (Warfarin)
Artifact Rejection
• In order to prevent spurious results from being imported into SIMS, artifact rejection as described will be incorporated for – Invasive Blood Pressure – Heart Rate – Temperature
Surgeon
NOT
requesting antibiotics
• • The absence of an antibiotic dose in the SIMS database may be interpreted as failure to administer when in fact, the drug is specifically NOT requested by the surgeon during the Preop pause. In order to capture the request NOT to administer, please place a 0 for dose under Cefazolin
5% Albumin
• As a result of concerns related to HES, a request has been made to add 5% albumin to the database • “*Anes_Fluids In” protocol has been updated
Refresher Points
How can I minimize EKG artifact?
How can I eliminate white space on the monitor
Documentation of Demographics in Satellite areas
Documenting on the WRONG patient OR Corridor computers to access Preop Manager/vOACIS
EKG artifact
• • SIMS obtains HR information from the EKG. Interference creates multiple artifacts that are recorded
EKG artifact
• To eliminate artifact, change the HR source from AUTO to Pleth
EKG artifact
Atrial Fib-HR Source AUTO PDF in vOACIS
EKG artifact
Atrial Fib-HR Source PLETH PDF in vOACIS
Eliminating blank spaces
Eliminating blank spaces
Right click anywhere in the “Real Time Variables”
Eliminating blank spaces
Highlight the variables (Ctrl-Click) that you do not wish to display and hit < Blanks spaces have now disappeared. NB. All MEASURED variables are CAPTURED, PRINTED and ARCHIVED. What you see on the screen is ONLY what you choose to VIEW. Documenting DEMOGRAPHICS in satellite areas In Satellite areas, it is OUR responsibility to add in the Medical Team (surgeon is not populated as in the Main OR) and the Procedure (not populated as in the Main OR). There should be a cheat sheet in these various areas which lists the most popular procedures and the keywords used to find them. Documenting DEMOGRAPHICS in satellite areas Cheat Sheet-Labor and Delivery Cheat Sheet-Diagnostic Imaging Documenting DEMOGRAPHICS in satellite areas Cheat Sheet-Ultrasound Cheat Sheet-Endoscopy Suite Documenting DEMOGRAPHICS in satellite areas Cheat Sheet-Dental Clinic In the above list of “Events”, notice how the “Anesthesia Case Start (S) is at 07:30 and the next documented anesthesia event-”GE Health Care Aestiva machine #:” is at 07:39 1 1. Start time in print spool changed to 08:00 ? All descriptors entered before 08:00- preoperative events and machine check are not printed to the pdf Anesthesia Start Time at 07:30 is time stamped on the record regardless of the start time in the print spool First event other than anesthesia start is recorded at 07:39 2 1 3 4 1. Hitting the printer icon will bring up the print spool so you can adjust time 2. Enter in the first anesthesia event 3. Enter in the last anesthesia event 4. Upload to vOACIS Notice how 07:30 anesthesia stamp is included even though the print spool was set to 07:39 Notice how the all events relative to the Preoperative Evaluation and Equipment check are now included Check in on ANY patient in the SIMS system •last patient on your list now in the PACU •electronic record from a previous surgical procedure(s) 1 3 2 1. Pull down Census Type to pick “Surgery patients-Today” 2. Find your patient from the OR list 3. Hit Remote View 1 2 2 1. You are now looking at a patient in “Remote View” (notice white banner at top) 2. Timeline shows patient in the GA (PACU) Postop and GA (Surgical Post-op) sessions Scan to see how your patient is doing with regard to pain, nausea/vomiting, etc. Click on “fluid order” Notice default is IV Use slider to choose IV Site Roll mouse over order location of IV is now identified Patient arrives with IV (less than full bag) Patient arrives to Operating room with an IV running-only 350 ml. left in bag Bag is completed and you go to hang a new bag. The system assumes the NEW bag is similar in volume to the previous bag-350 ml. Patient arrives with IV (less than full bag) You need to change the volume to reflect what is in the new bag, typically 1000 ml. You recognize that you intended to start a 1L bag rather than a 350 ml bag. You click on the “350” dialogue box appears Hit “Undo” and you get the following message Reason for “error” message is because there has been activity on the 350 NS (in this case, a bag level) In order to eliminate the fluid order, you will need to “Undo” all changes made to the order from current time back to start time. Notice how the “bag level” is now gone. Now, click on the start of the order and UNDO The fluid order has now been deleted Documenting on WRONG PATIENT protocol • • Show the event set. Link to the WIKI for a more detailed explanation • No more paper PAU records accompanying chart-use hallway PC’sEliminating blank spaces
Printout Start/Stop times
Printout Start/Stop times
Printout Start/Stop times
Printout Start/Stop times
Printout Start/Stop times
Printout Start/Stop times
Remote View
Remote View-Nursing assessments
IV tips Multiple IV’s-same fluid
IV tips Multiple IV’s-same fluid
IV tips
IV tips
IV tips-”Undoing” an IV Fluid
IV tips-”Undoing” an IV Fluid
IV tips-”Undoing” an IV Fluid
IV tips-”Undoing” an IV Fluid