Emergency Situations 1 In emergency situations, simply ADMIT the patient into the system This allows for vital signs to be captured while you LOOK AFTER THE PATIENT Information can be entered afterwards

Emergency Situations Starting the Record 2 If you forget to “ Start Session ” when an emergency patient enters the room, you have several choices: “ Start Session ” on patient and manually enter data (using the Datex monitor as a source of information) You will need to use a series of memos q5min You cannot enter data in the (BEFORE ADMISSION) section “ Start Session ” on patient and use paper for the initial period that is not captured electronically Make a note on both records as to what has occurred. Chart entire case on paper

Two ways: 1. Add the Order again using Protocols – set earlier time 2. MOVE the order by Right-clicking on the Order Emergency Situations How do I chart BEFORE the Chevrons? 3

Emergency Situations Inserting Emergency Data SIMS system collects data on an active patient on a local workstation q30 ”. 4 Snapshot Insert Emergency Data :00 15:05

Emergency Situations Inserting Emergency Data  The emergency data will be archived electronically Intermittent data (eg. NIBP) will not print to the paper copy of the anesthesia record Beat to beat data (invasive pressures, HR, Sp02) will print to the paper copy of the anesthesia record  30 second data intervals are cleared from the local workstation on transfer/discharge Ensure you capture important data prior to transfer/discharge 5

Transfer &/or Discharge 6 Transfer ONLY Patient will be picked up/cared for on another bedside SIMS workstation PACU/SDCU Transfer & Discharge Patient will be picked up on another SIMS workstation but care will NOT continue at the bedside ICU Labor and Delivery PACU “ Start Session ” on the local machine (NOT Remote View) Document handover events on the local machine Manually enter handover vital signs into the electronic record Document “ Anesthesia Finish ” and print record Discharge the patient from SIMS (choose “ ICU ” from pull down menu if discharging to ICU) (choose “ Nursing Area ” from pull down menu if otherwise)

Transfer &/or Discharge 7 What happens if I don’t discharge my patient?? Patient is left in the transfer zone (cloud) Creates chaos when patient returns to the OR Patient WILL appear on the census list Starting Session will pull the old encounter back down from the transfer zone (cloud) and merge the encounters creating one potentially very large anesthetic record encompassing days Hopefully you will recognize problem Medications other than the default med template are apparent Fluids/infusions may continue to be running Demographic information is showing different anesthesiologists/surgeons, etc. What do I do?? Document a memo stating that patient had not been discharged DISCHARGE the patient Return to “CIVMOR-Surgery patients for Today” Census list Locate the patient and “START Session”  proper encounter should load You will have to add vitals manually You may elect to document on paper if significant time has passed.

Transfer &/or Discharge 8 Discharge ONLY Patient will be NOT be picked up on another SIMS workstation/care will NOT continue at the bedside Dental Clinic Lithotripsy Endoscopy Case MUST be finished in the OR DO NOT hit the TRANSFER icon Document handover events on the local machine (forward time) Document “ Anesthesia Finish ” and print record (forward time) Discharge the patient from SIMS Choose “ Nursing Area ” from pull down menu

Printing SIMS Preop Training Manual is a document of about 100 pages 9

Printing 10 Hitting “ All ” in the Page Range dialogue box will print >100 pages

Printing 11 If I just want to print information from Sections , I will select pages in the “ Page Range ” dialogue box  4 pages

Printing 12 Surgical Encounter is analogous to a document/book with several chapters Before Admission GA (Surgical Pre-Op) GA (Transfer) GA (Anesthesia Standard) GA (Transfer) GA (PACU Post Op) Discharge

Printing 13

Printing 14

Printing 15

Preop Manager Corridor Computer  If a patient is on the default census list (CIVMOR-Patients with Preop Started Today) The patient has NOT been seen by a RN/MD prior to TODAY The initial nursing Preop Assessment has been completed TODAY The Preop Assessment has been left UNLOCKED by the Nurse Select the appropriate patient and OPEN the Assessment  Complete the MD Assessment  Complete the Anesthesia Plan/Record Status/ +/- Addenda  Signature- Assessing Physician  Signature-Final Chart Signoff and Upload to vOACIS 16

Preop Manager 17  How do we know whether a formal MD Assessment has occurred???? vOACIS is your friend DO NOT use Preop Manager on a workstation that is ACTIVE with a different patient in Anesthesia Manager  (high potential to produce a second but blank assessment for the same surgical encounter!!)

Preop Manager vOACIS as a Starting Point 18 If you see this, you do NOT have to open Preop Manager

Preop Manager Patient only seen by an RN before the date of Surgery 19 NO MD Assessment

Preop Manager Patient only seen by an RN before the date of Surgery Logical thing to do would be to open this previous assessment and complete the MD fields YOU CAN’T -The record has been LOCKED 20

Preop Manager Patient only seen by an RN before the date of Surgery  You must open a NEW Preoperative Assessment (Will be linked to correct date of surgery and Encounter number), Complete the usual fields  Signature-assessing physician  Signature-Final Chart Signoff  upload to Voacis  YES, there will now be 2 Preoperative Assessments on vOACIS 21

Preop Manager Preop Anesthesia Assessment Complete The events in this Event Set (A010) are to be used to provide proof that the physician has reviewed a formal Preoperative Assessment/Consult Previously done in Preoperative Manager-viewed in vOACIS) It does NOT replace a formal Preoperative Assessment 22

Preop Manager Inside the OR 23 Launch Anesthesia Manager

Preop Manager Inside the OR  Preop Manager should find the ACTIVE patient (same Encounter # and date as Anesthesia Manager)  Open the Preoperative Assessment  Complete ALL fields as previously described 24

Preop Manager Final Chart Signoff If you are the last person to interact with the patient in a preoperative setting, you must do a “FINAL CHART SIGNOFF” Upload to vOACIS 25

Preop Manager Inside the OR 26

Preop Manager Patient only seen by an RN before the date of Surgery 27

Copy Forward Wonderful time saving tool Allows previous MEDICAL assessments to populate the current assessment 28

Copy Forward  In this example, there are 2 previous assessments in the SIMS database The most recent assessment loads automatically  The MD Assessment of June 27, 2011 is seen in the window 29

Copy Forward If this assessment is satisfactory and closely resembles the current medical history, check the MD assessment box and hit OK Hit MD Assessment and OK

Copy Forward 31 Hit Close

Copy Forward  It is your responsibility to insure the information displayed in the new assessment is accurate This assessment is current and NOT locked If necessary, edit the information (add/revise/delete) Complete the usual fields  Signature-assessing physician  Signature-Final Chart Signoff  upload to Voacis 32

Copy Forward  In this example, there are 2 previous assessments in the SIMS database  The MD Assessment of Sept. 29, 2010 is selected In order to see the contents of the assessment, hit the LOAD button  the assessment of Sept. 29 does NOT have a MD Assessment Notice how the Copy Forward is greyed out  Do NOT carry forward a Nursing Assessment You are not a nurse 33

Consults-Residents 34 Inpatient Consult Complete Current Suggestion to choose “Ready for Surgery” Final Chart Signoff  upload to vOACIS If follow-up required, then use Addenda Changing to: Anesthesia Consult Complete

PACU/ICU 35 Handing over difficult cases Consider printing out the Preop Assessment from vOACIS to accompany the anesthetic record Default printer location in the OR is the respective corridor printer I’m called to re-intubate a patient How difficult was it during the recent GA? I don’t have time to look it up in vOacis... You can use the Nursing computer on an active patient to scroll back through the entire patient encounter (different template) You are able to hit the Event icon (F4) to see a complete description of what occurred intraoperatively.

SIMS Help 36 FUNCTIONAL ISSUES-Super Users (working hours only) Civic Campus Zunder Bryson Charapov General Campus Elliott Gagne Szeto TECHNICAL ISSUE-HelpDesk (14136) Password resets Network connectivity Printing problems Computer related issues