anesthesia manager training basic navigation. presentation titledate objectives by the end of this...

Anesthesia Manager Training Basic Navigation

Presentation TitleDate

Objectives

By the end of this module the participant will be able to:

Use the basic terminology for all parts of the Anesthesia Manager application

Understand the :• Main Toolbar• Macro Toolbar• Navigation Menus (flowsheets/demographics)• Adjusting Resolution• Freezing the timeline• Applying Filters• Pull down menus


Contents

IntroductionLaunch/LoginThe Home ScreenMain ToolbarMain Toolbar or Navigation-DemographicsNavigation Bar-FlowsheetsMacro ToolbarViewing OptionsPull Down Menus (F)-Function Keys


What is Anesthesia Manager?

Anesthesia Manager is a charting application and data collection engine for:

1. automatically and manually collected data2. manually entered fluids and medications3. It is an application that manages, 4. integrates 5. and stores

Vital patient information at the point of care!


Where does all the data come from?

Medical devices (through drivers that Picis develops)HIS systems (Hospital Information Systems)Laboratory systems (Future Development)End usersOthers?• Calculations done by Anesthesia Manager


Clinical Data in Anesthesia Manager

Real Time Variables• Ventilator and Monitor data• MANUALLY entered clinical data

Medications

Fluids (INtake and OUTput)

Laboratory data (Future Development)

Clinical events

Demographic data


Launch and Login to Application

We are training in the TRAIN environment• User ID is your Windows Login ID• Password is Canada123 (case sensitive)• You will be prompted to change password

Will need to repeat this exercise when in the LIVE environment

OR (civic campus) Canada789


Census List

The software will open and default to:

the facility/location you are working in and list patients by OR#


Census List

1. Highlight the Patient

2. Click “Start Session” to open a new session for that

patient


Home Screen: A Good Place to Start!

Anesthesia Manager automatically opens to the “Anesthesia Summary”

flow sheet

This is our HOME screen


Ottawa Hospital Workstation

Workstations will have a 19” monitor in portrait mode• This will allow the

display of considerable data/entry fields

• Toolbar icons and macros will appear in a vertical orientation on the left and right hand sides of the screen


Home ScreenAnesthesia Summary Flowsheet

The home screen consists of four flowsheets:

Gases-Agents-Monitor DataMedicationsMed Infusions/FluidsStandard Anesthesia Monitoring




Gases-Agents-Monitor Data

Medications• Organized by subheading

of medicationMed Infusions/FluidsStandard Anesthesia Monitoring

Subheading can be turned ON (organized by type) or OFF (organized alphabetically)




Gases-Agents-Monitor DataMedications

Med Infusions/Fluids• Organized by

Fluids/Infusions “In” and

• Fluids/Infusions “Out”Standard Anesthesia Monitoring




Gases-Agents-Monitor DataMedicationsMed Infusions/Fluids

Standard Anesthesia Monitoring• Graphical recording of

typical vital sign parameters sBP, dBP, HR, Sp02, ETC02



Seclecting the “Home Screen” icon will also take you to the Home Screen (Anesthesia Summary Flowsheet).


Home ScreenPatient Banner

•Patient Name

•Sex•Weight•Height

•BSA•Medication

Allergies•Other Allergies

•Precautions/Alerts

•Incoming Lab Data beacon

(future enhancement)

•BLUE BANNER=ACTIVE Patient

•WHITE BANNER=REMOTE Patient


The Tool Bar

The Tool Bar is designed to help users easily access functions most commonly used • There are two types of toolbars: MAIN and MACRO

MAIN TOOLBAR

•Designed to assist with the workflow of the case (Start of anesthesia to Transfer/Discharge)•Will talk about the Macro Toolbar in the “Events” Tutorial

MACRO TOOLBAR


Main Toolbar”Log Off/On”

Log Off-used to stop documenting under your user name• Eg. End of case, relief, transfer of care• Real time data continues to be captured on patient• You will be asked for your credentials when you elect to logoff

Log On-used to start documenting under your user name• As above


Main Toolbar“Home”

Home• Takes you back to the “Anesthesia Summary Flowsheet


Main Toolbar“Protocols”

Protocols• Groups of standard orders (medications (single or combinations)

/infusions) that you can add to the patient chart at the SAME time.

• Will offer significant time savings• Protocols are an integral part of this build


Main Toolbar“Protocols”

•Custom built to allow rapid access and addition to the respective area of a flowsheet


Main Toolbar “Protocols”- Eg. Adding drugs from the **Anes Drug

Cart

For example, the “Default Medication Flowsheet” contains the main drugs from the respective medication classes used in the vast majority of cases

If an administered drug is not present, “Protocols” is a powerful and timesaving technique to add what is required

• Other options are also available and will be discussed.


Main Toolbar“Protocols”- Eg. Adding drugs from the **Anes Drug

Cart

• In this case, “*Anes-Drug Cart” brings up every drug/fluid not listed in the default protocol that can be found on our carts in the Operating Room.

• One drug/fluid or mulitple drugs/fluids can be selected simultaneously and quickly added to the flowsheet


Main Toolbar“Protocols”- Eg. Performing a Spinal Anesthetic

2. Click on Atropine and Bupivicaine to selectIf you make an error, reclick to deselect

3. Hit Add button

1. Highlight a protocol option

Atropine and Bupivicaine are NOT present on the default medication flowsheet

However, both drugs can be found on the anesthesia cart

(**Anes-Drug Cart protocol)


Main Toolbar“Protocols”- Eg. Performing a Spinal Anesthetic

OR alternatively, the drugs can be selected from the respective protocols:

*Anes_Regional Spinal (Bupivicaine) protocol• Select Bupivicaine x%

*Anes_CVS_Anticholinergicsprotocol

• Select Atropine


Main Toolbar “Protocols”- Eg. Performing a Spinal Anesthetic

Atropine and Bupivicaine now added to the Flowsheet


Main Toolbar“Protocols”-Subspecialty/Unique Events

In addition to Drug Protocols, we have created Protocols for various subspecialties and unique problems

Eg. Vascular, Neuro, Obs/Gyn, Trauma, MH, ACLS

• Click on the orders you want added to the flowsheet

• If you want all the orders in a Protocol, hit ADD without selecting an order


Main Toolbar“Event Log”

Event Log-Adding Events• This is the way you will enter in all notes related to the

procedure• Events remove the need to “free text”

• Will discuss further in upcoming lecture


Main Toolbar“Device Snapshot”

Device Snapshot• Manual capture of Real Time Data (RTD) from devices

to obtain all current values at that point in time.

Will discuss further in upcoming lecture


Main Toolbar“Emergency Data”

Insert Emergency Data

• Emergency data is a selection of data points from a temporary reserve on the local workstation that holds all data device readings received over the previous six hours.

• Will allow you to retrospectively enter Real Time Data (RTD) every 30 seconds for a defined period



Main Toolbar“Fluid Balance”

Fluid Balance• Total intake and output for fluids documented on

flowsheets are displayed graphically in the Fluid Balance window. The window also shows total volumes for all fluids.


Main Toolbar “Fluid Balance”

The Fluid Balance Window for anesthesia environments shows intake and output on a single pie chart.

An accompanying table shows values for each fluid

type.

Hit this icon to see the “Fluid Balance

Detail”

•Fluid Balance Pie

Chart

•Fluid Balance

Histogram

•Final Fluid

Balance


Main Toolbar“Medication Summary”

Medication Summary• Shows all medications that have been documented,

including those administered as drips. This window shows individual and total doses for the selected viewing period.

• Medications can be sorted alphabetically by medication or family name, or chronologically by administration time.


Main Toolbar“Medication Summary”

Total Dose administered over the current encounter

Data sorted by “Administration Time”


Main Toolbar“Supervisory Anesthesia Module”

S.A.M. (Supervisory Anesthesia Module)

• An anesthesiologist who supervises anesthesia residents/fellows may need to document certain events during the procedure. SAM allows you to log on and enter events and demographic data while another user is logged on. All of your entries will be attributed to you.

• When you have finished, the other user can continue working without having to log on again.



Main Toolbar“Print”

Print• Allows you to create a paper/electronic record


Main Toolbar“Remote View”

Remote View• Allows you to enter and modify any type of data for

which you have access rights on a remote workstation (i.e patient in another location)Finish/revise/review documentation on a previous patient

You are able to switch between an active patient and remote viewing on the local workstation


Main Toolbar“Remote View”

White Banner = Remote View

Blue Banner= Active Patient


Main Toolbar“OR Manager”

OR Manager• Access to the Smart track System

Can see location of patients in the system(Preop, OR, PACU, Discharged)


Main Toolbar“Demographics Flowsheet”

Demographics• Found at bottom

of Navigation Panel


Demographics“Patient Identification”

Should be coming across from OR Manager/ADT Hospital system

No need to enter any information into these fields


Demographics“Admit Ht/Wt/BSA/BMI/Blood Type”

As in Preop Manager• Enter either in metric or

imperial with automatic conversionMetric will be printed to Anesthesia Record

Blood Type can be left alone

• Hit OK


Demographics“Allergies and Precautions” (Medication

Allergies)

2. Pull down menu

3. Enter name of drug into “Keyword Search”

4. Highlight desired result 5. Hit

OK

•As in Preop Manager

1.Hit New Row if

required


Demographics“Allergies and Precautions” (Other Allergies-not

drugs)

2. Pull down menu

3. Highlight desired result

4. Hit OK


1.Hit New Row if

required


Demographics “Allergies and Precautions” (Precautions)

2. Pull down menu

3. Highlight desired result

4. Hit OK


1.Hit New Row if

required


Demographics“ASA Level”

1. Pick appropriate ASA

2. Hit OK


Demographics“Medical Team”

First Case of the DayBooked Surgeon should be automatically populated by OR Manager

• Correct information as required

Booked Anesthesiologist should be populated by OR Manager

• Correct information as required

All subsequent cases will require data entry

2. Pull down menu

3. Highlight name for relevant clinical role

4. Hit OK

1.Hit New Row if

required


Demographics“Procedure(s)”

•Booked surgical procedure should be populated by OR Manager•Revisions, changes or additions will require data entry

2. Enter keyword 3. Find now

5. Hit Add

4. Choose appropriate procedure

1. Hit ADD if require

d


Demographics TabRequired Events

Required Events (highlighted if not completed)These are events that should be entered (*if relevant) on EVERY Anesthetic record

• Anesthesia Start (S)• Anesthesia Case Finish Time (F)• QA Indicator• Anesthesia Type• Positioning• Equipment Check• Peripheral IV• Airway Intubation (if applicable)

Functions as a reminder to insure chart is complete


Navigation Panel

The Navigation Panel gives you quick access to: Flowsheets

and

Demographics (recently discussed via icon in Main Toolbar)


Gases/Monitor Data Flowsheet

Any variable captured by the Datex CPU or the 7900 ventilator will be automatically captured

Exception-Fresh Gas Flows• Aestiva has manual controls

• These numbers MUST be entered manually


Medications (All) Flowsheet

For documentation of:all medicationsall medication infusions


Med Infusions & Fluids Flowsheet

For documentation of all:Fluids In (including medication infusions)

and

Fluids Out


Lab Results (All) Flowsheet

Future development to capture lab results in real time from hospital information systems and populate the electronic anesthesia record.


Anesthesia SummaryHome Screen


Trends Flowsheet

For display of:Non invasive trending (upper graph)• Sp02• EtC02• HR• NIBP• Resp Rate (from ETC02)

Invasive trending (lower graph)• HR• Arterial Line Blood pressure• PA Catheter pressures• CVP


Invasive Monitoring Flowsheet

For display of: invasive RTD (upper) and graphical display of invasive trending(lower)• HR• Arterial Line Blood pressure• PA Catheter pressures• CVP


Vent Settings Flowsheet

For display of:

Basic ventilation parameters (upper table)

Ventilation and oxygentation trend (lower graph) • Respirations

• ETC02

• Sp02

• Pmax


Lab Results (Manual Entry) Flowsheet

Any result not automatically populated by the lab• Includes POC results


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