1. Surgery Quality and Workflow Manager
Intraoperative Nurse Workflow

2. Learning Objectives
After instruction, students will be able to complete the following tasks:
Access and navigate Clinical Documentation through the Periop Nursing Documentation icon.
Document modules for Intraoperative Care Event
Track tissue and implants used in surgery
Add an add on case
Sign off on Care event
OPENING TASKS:
Thank participants for coming.
Introduce training team.
Ask participants to introduce themselves.
Ask participants for name, where they are from, (if class participants are from various geographical areas) experience with the VA, and what they want to get out of the training.
Inform participants about schedule, breaks, lunch, as well as the location of bathrooms, exits, food, etc.
Set Classroom Expectations (cell phones off, starting on-time, minimize distractions).
Lead participants through material on their desks.
EXPLAIN:
During the instruction, you will be given the opportunity to practice each of the tasks listed as a learning objective.
Read and discuss learning objectives.

3. Periop Nursing Documentation
TRANSITION:
Periop Nursing Documentation is where the intraoperative nursing care is documented. Selecting this icon takes you to the login screen for Clinical Documentation.

4. Access Clinical Documentation
DISCUSS:
The CPM Clinical Documentation Module is the charting module for intraop care. Nurses use this module to document all resources used on a case, including personnel, rooms, equipment, instruments, supplies, pharmacy items, implants and other items.
All of the information gathered on the case is guided by the pathway of care built and designed for a particular service or procedure in the module.

5. Search for Case DISCUSS:
After logging in to Clinical Documentation, the schedule usually defaults to today’s patients. This can be different by location. You can also limit the patients for that day by the room so that you only see the room that you are assigned for that day.
The easiest and most accurate way to find a patient is to search by the case number, which is a unique number for this particular patient and procedure.
If you use the patient name search, you see all the patients currently in the system that match the search criteria that you use. However, you should realize that the search results may display patients that are not scheduled. To search by name, enter the last name of the patient in the Patient Search text box. You can also use the first initial of the last name and the last four of the social security number to search.

6. Case Selection DISCUSS:
After entering the search criteria and selecting Find Now, patients fitting the search criteria displays. If no patients are found in the system matching the search criteria, the list is blank.
Select the correct patient from the list and the Case Information page displays.

7. Case Information DISCUSS:
The Case Information page displays with Read Only information at the top of the page and dropdown fields at the bottom. The required fields on the Case Information page are ASA Score, Anesthesia Type, and Surgery Type. Anesthesia Type and Surgery Type are usually added at time of scheduling and pull over. The VA is not using Acuity Level or Pay Class.

8. Care Events
DISCUSS:
The patient is checked into the facility during the Preperioperative Care Event. When you are choosing your patient from Case Selection, you may see the name listed twice. Please be certain that you choose the Intraoperative Care Event to document.
Because many of the same fields are available under each of the care events, it is very important that you double check to be sure that you are documenting in the Intraoperative Care Event.

9. Navigation and Toolbar
DISCUSS: Toolbars, First Group
Printer – Activates the Report Selection Dialog window
Explore Case - Accesses the Pathway Manager module
Cancel Case – Activates the Cancel or Delay Case window
Signature – Activates the Signature window user can sign off on any portion of case
Required Fields – Activates the Required Fields Selection window
Second Group:
Patient Information – Accesses the Patient Master window
Generate Charge – Generates charges for case
View Charge – allows user to view charges for case
Custom Charge – allows user to view the custom charge window
Monitor –connects to Active Monitor session
Display Quick Entry – Turns the Quick Entry Data toolbar on and off
Display Quick Entry Time Bar - Turns the Quick Entry Time toolbar on and off
Patient Identifier – Displays the Patient Identifier window
Verify Current Patient – Displays the Verify Current Patient window
Third Group:
Customizer – allows user to customize what displays on the window
Change Sites – allows user to change sites without logging out and on again
Resource Assignment – accesses Resource Assignment window
Notes Assignment – Accesses the Notes Assignment window

10. Enter Data in V-Forms EXPLAIN:
To enter data in the v-forms, certain script items, when selected, present a picklist of choices to select. Many times a default value displays, but this can be altered by selecting the field and a value from the list displayed.
Note: There are no arrows on the dropdown fields; however, a list of choices display when a field is selected.
Items for required documentation display in red font and have an asterisk next to the field. If these items are not documented when the user attempts to lock the case, they are prompted to complete the remaining required items.

11. Signing V-Forms DISCUSS:
There is now an additional step when you sign your documents. After you click on “I, … have completed and reviewed this note.” The Password Required window displays.
Enter your password in the field, and then click OK.

12. Intraoperative Workflow
DISCUSS:
Once the patient leaves the Preop Holding area and enters the operating room, the Intraoperative workflow begins. To begin the Intraoperative Care Event documentation, the nurse:
Searches for case in Case Selection and selects the patient
Completes required fields in Case Information, if not already completed
Documents the providers, including themselves, on Resources & Procedures
Documents the Times for the Intraoperative care event
Documents in the Checklist for site verification and time out
Documents in the Intraop Record - This is where you document your position, prep, equipment etc.
Documents the Preoperative and Postoperative Diagnosis
Documents on Counts or check No Counts Taken
Document Implants or N/A if no implants were used
Documents as applicable:
Medications
Specimen & Cultures
Note: Remember to complete the ASA score on the Case Information screen in the Intraoperative Care Event. It is a required field that is not completed at the time of requesting surgery.

13. Resources and Procedures
EXPLAIN:
Once the relevant data has been checked and corrected on the case information window, you can begin logging data for the case. All of the information gathered on the case is guided by the pathway of care built and designed for a particular service or procedure in the module. Normally users start entering data on the Resources and Procedures page. To access, select the icon next to Resources and Procedures in the far left column. The Resources and Procedures page opens with the Multi view tab displayed.
The Multi view tab allows access to all of the fields under this heading, but there are more details available under the specific tabs, which are Staff, Procedure, Rooms, and Equipment.
The Staff tab is used to document the provider for each care event. It is also used to document the VA level of supervision. They must enter what supervisory levels are required. Add (+), Update (=), and Remove (-) icons are available on the main toolbar as well as the banner at the top of each heading. To assign people, select your choice and click Add.
If you add another procedure during the case, you need to add it on the procedures tab.

14. VistA Concurrency DISCUSS:
First highlight the existing case, make sure that Primary is selected for Type and then select VISTA Case 1 from the VistA Concurrency window. Click Update.

15. Concurrent Add On Cases
DISCUSS:
Then search for the concurrent case to be added. Type part of the new procedure using the * wild card, click Enter and select the correct procedure from the list. Select Secondary under Type. Check each of the areas to ensure they are correct and make any needed corrections.
Click VISTA Case 2 under VistA Concurrency. Click Add. You now have two cases under the grid. Be sure to go to Staff tab and add the new surgeon then come back to Procedure tab and associate them with the new procedure if it is a different surgeon.
TRANSITION: Let’s look at documenting Times.

16. Times
EXPLAIN:
After documenting the provider on the Resources and Procedures page, select the Times icon and document the beginning and end time for the patient in each care event.
A simple way to document the time as you work is to click the Current icon to enter the current time. It is important to keep track of how long the patient spends in each care event.
There are two required fields for this screen: Patient In/Out Room Start and Stop Times.

17. Quick Entry Times EXPLAIN:
A quick way to add times is to select the Quick Entry Time from the toolbar. The Times-Intraoperative window displays. You can now click on the times as you are documenting in other screens for example, just after you finished your initial count. Once you click on the Quick Entry Time, it continues to display until you close it. You can hover over each of the times to see the definition of which time it is. This also places the time in the Times screen. You have to go to the Times screen to make any adjustments to the times as this only places the current time there. The Quick Entry Time is available from the toolbar from every screen except Times, it is grayed out there.

18. Intraop Site Verification
EXPLAIN:
The checklist items grouped under Site verification indicate items that need to be in place prior to surgery. This is also where you document your time out. This is found in the Checklist documentation screen. When you select Site Verification, the Checklist-Select procedure window displays.
If there is more than one procedure, you can either select all by using control and then selecting the procedures if you are verifying them at the same time and doing the time out for all at the same time. Or you can choose them individually and complete the information pertinent to each procedure on the Site Verification tab. A new Site Verification tab displays each time that you document in the current one. After selecting the procedure(s), click OK.

19. Time Out
EXPLAIN: Scroll down on the Site Verification tab to document your Time Out Process. Click in front of the items that you have completed such as, confirming the patient name and SSN. Click the Current button and adjust the time by using the arrows to document the time of the Time Out.
Each time the Site Verification tab has information entered on it, another Site Verification tab displays. If you have another procedure added on, or if you need to do multiple time outs, you have the ability to document it.

20. Intraop Assessment DISCUSS:
The Intraop Record is used to document the information related to processes followed in the Operating room, such as position, prep, dressings, etc.
Previously, when multiple procedures were performed in the operating room, either Consecutive or Simultaneous, (Simultaneous is when both surgeries are going on at the same time and Consecutive is one after the other) each surgeon wrote their own operating note and the Nurses in OR had to document twice.
In SQWM, each surgeon and procedure is added on the Resources page and there is only one Intraoperative Document that shows both procedures. This is a big change in business process.

21. Intraoperative Care Assessment
DISCUSS:
To complete the required fields, you must navigate to them. DVT Prophylaxis and Surgical Clipping are found on the Prep panel on the Intraoperative Assessment v-form. ASA status is found in the Case Selection module.
Once these are completed you can sign and lock the form.
TRANSITION: When you sign the form, there is an additional step.

22. Intraop Assessment v-form Practice
Patient A is having a laparoscopic left hernia repair with mesh. Document this in the Intraop Assessment v-form. Do not complete the DVT Prophylaxis field. Sign and lock the Intraop Assessment v-form.
ASSIST: Move around room providing assistance as necessary.
ASK: What questions do you have about the new required fields on the Intraop Assessment v-form? How do you sign and lock this v-form?
INSTRUCT: Provide directions to complete the exercise.
Open the Clinical Documentation Module through the Periop Nursing Documentation icon.
Select the patient by double-clicking.
Click Intraop Assessment.
Enter the information as indicated. Leave DVT Prophylaxis blank on the Prep panel.
Click on + in front of the Signature panel.
Click in Signature field.
Click on “I, … have completed and reviewed this note.”
The Intraop Assessment required fields window displays and states that you have not filled out the DVT Prophylaxis field.
Click on the + in front of the Prep panel.
Choose SCD Bilaterally from DVT Prophylaxis dropdown menu.
The Password Required window displays
Enter your password in the field.
Click OK.
TRANSITION: Let’s look at the VistA Concurrent Cases next.

23. Implant Tracking DISCUSS:
For the VA, implants are not considered a surgical supply. They are ordered through Order Entry and managed by prosthetics. They are not billed through the surgical event, but instead are billed by prosthetics.
In Clinical Documentation, the implant page is used as an implant log. The device description field must be populated to save a record in the grid. To search for an implant that is loaded into the system via the resource catalog, place the cursor in either the Item Number, Device Description, or Manufacturer Catalog Number text box and enter the first one or two numbers or letters. Then enter an asterisk at the end of the text box. A list of implants with those numbers or letters displays. Click the correct implant to add it, and the text boxes with that implant number automatically populates. Enter the implant details for the case as required by your hospital. Click Add to add the implant to the grid.
The search function can be used to locate implants in the Resource Catalog. Click Search. An implant search window displays. Enter the first few numbers and letters and add % or * after the entry. You can also enter an * in the serial number text box and then click Search Now. The system displays all resources that are available for implant.
If you use any medications with this implant, for example soaking mesh in antibiotic solution, you can document the medication here so that it is associated with the implant. Click in the box in front of Medications Used. The medications window displays. Document the medication by choosing the correct choices in the dropdown menus and click Add. Any medications that you document in the Medications Added field also displays in the Medications window.
Note:
A status button displays in the first column of the search grid if the resource is trackable in Clinical Documentation. To select the implant that you want to use, click any implant in the grid, then click OK. You automatically return to the main implant window and the text boxes associated with an implant populate. Enter details as required by your hospital, then click Add to add the implant to the grid.

24. Miscellaneous Implants
DISCUSS:
If you cannot find an implant after executing the two types of searches, it is likely that the implant has not been added to the Resource Catalog. In this case you need to log the implant in Miscellaneous Implants. Click the Miscellaneous Implants tab on the main Implant page. The Miscellaneous Implant page displays.
Enter any of the details that you know about the implant used for the case. Under Implant Status, in the location list, select the location where the implant is stored. In the status list, select the status of the implant. In the temperature group, select N/A (not applicable) or enter the temperature in the space alongside.
In the Add Date / Time group, enter the date and time. You can click Current to auto update the system date and time. In the Comment text box, enter your comment, if any. Then click Add to add the implant to the grid .
Removing an implant that was entered by mistake or incorrectly on the Implants or Miscellaneous Implants tab is done by highlighting the implant in the grid area and clicking the minus sign which is the Remove icon. Once an implant has been deleted from a case, the serial number assigned to the deleted implant is available to be assigned again in Clinical Documentation.
After an implant has been added to the implant tab grid, you may need to go back and add additional information. Highlight the implant you want to update in the grid area. Enter the data that needs to be updated, and click the = which is the Update icon.
Medications used with the implant are entered the same way as with implants found from the list.

25. Miscellaneous Implant Practice
Patient B is having a laparoscopic left hernia repair with mesh. The surgeon uses a large prolene hernia system. It is not in resource catalog. Document the implant using the following information: Prolene Hernia System Size large Ethicon Catalog Number is PHSL Lot Number is Expiration Date is 07/2016
DISCUSS: How to document an implant not in resource catalog
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about documenting a miscellaneous implant?
INSTRUCT:
Provide directions to complete the exercise.
Open the Clinical Documentation Module.
Select the patient by double-clicking.
Click implants.
Click the Miscellaneous Implants tab.
Enter information as indicated.

26. Inputs from Bar Codes EXPLAIN:
Some implants carry barcode information. The bar code reading devices scans the information so it can be input into the system. Ensure that the cursor is in the correct place before entering each bar code item. If you do not move the cursor, you’ll scan information into an incorrect field.
To open a barcode entry dialogue box, click Barcode.
Under Action Type group, click Add when an implant is inserted into the body.
Click Remove when an implant is removed from the body, and click Waste when an implant is not usable.
In the Quantity text box, enter the quantity.
In the Expiration date box, select the date from the calendar.
In the Item number text box, type or scan the item number.
In the Serial Number text box, type or scan the serial number.
In the Catalog Number text box, type or scan the catalog number.
In the Size text box, type or scan the size.
In the Department list, select the department.
In the Inventory Location, select the correct location.
To save, click Close.

27. Tissue Tracking
EXPLAIN:. Allograft human tissues, such as bone, skin, and cornea need special storage care before they are implanted in a patient. Their storage conditions and usage are tracked by the tissue tracking feature. The Resource Catalog maintains an inventory of all surgical resources and is generally maintained by non OR staff. The OR nurse using the Implants Screen documents the tissue implants and documents their status.
In the left pane, click the Implants icon. In the Item Number list, select the resource number from the Resource Catalog. The status button is enabled for those items that were set as trackable in the Resource Catalog Module. In the Serial Number list, select a resource of the resource type configured as trackable in the Resource Catalog.
To record the tissue implant status, click Status. The Status button is enabled only when the resource is designated as trackable in the Resource Catalog Module. In the Status list, select the current implant status.
In the Temperature group, select N/A, or enter the temperature in the field alongside. In the Add Date field, enter the date. In the Location list, select the location where the implant was stored. Enter comments in the Comment text box. To save the status, click Add.

28. Specimen and Cultures DISCUSS:
The Intraop Specimens and Cultures page is used to track either specimens or cultures, or both, that were taken on a case and sent for analysis.
To document a specimen or culture, select the applicable option, either specimen or culture, under the Kind heading. This limits the choices in the dropdown menus for the other fields to be completed.
Click the dropdown for the Type. This is the numbering system for either specimens or cultures. Specimens use 1, 2, 3 etc. for specifying a specimen and cultures use a, b, c, etc. . Then select the specimen or culture that was taken for testing from the list. This selection determines the choices in the Tissue Code drop down menu. Select the description from the dropdown for the specimen or culture taken. Enter your source for either your specimen or culture in the Description text box.
Click Add to add the specimen or culture to the grid area. Repeat the steps if there was more than one specimen or culture taken during a case.
You can update a specimen or culture by highlighting it in the grid, updating the information and clicking the Update icon. To remove the specimen or culture, highlight in the grid and click the Remove icon.

29. Print Pathology Request
DISCUSS:
A Pathology Request may need to be printed to send with the specimens. Click the Printer icon in the upper left of the toolbar. Choose Pathology (Clindoc) from the Reports dropdown menu. Choose the appropriate printer from the Printer dropdown menu. Click Add.
If there are more than this report in the string grid, highlight the Pathology (Clindoc) report and either click Preview to view the report before printing and then click the Printer icon or click Print.
Some facilities are utilizing the slip that prints from CPRS and are not printing from SQWM.

30. Intraop Medications EXPLAIN:
Medications that are given by a nurse to a patient during the Intraoperative Care Event are documented in the Medications window. If the patient receives medications from a nurse, click the down arrow at the end of the Medications text box and select the medication that a patient received. Only one medication can be recorded at a time.
Click the down arrow at the end of the Route text box and select the route used to administer the medicine.
Enter the numerical value of the Dosage in the text box.
Click the down arrow in the end of the Unit of Measure text box and select the unit of measure that the medication was given to the patient.
In the Time text box, enter the date and time that the medication was administered.
Enter any comments concerning the medication in the Comments text box.
Click the Add icon located on the toolbar to add the record to the grid.
Click the green C, Clear Edit Boxes, (point to red box) located at the top left portion of the window to remove the entries before you start over for entering the next record if needed. This helps to prevent errors with previous information being included in the new medication.
Repeat these steps if another medication needs to be added. The Medications text box is required to save a record.

31. Intraop Counts DISCUSS:
The Counts screen must be visited on each case even if no counts were conducted. If no counts are performed, click the box in front of N/A. The Counts page has two tabs: Counts and Actions Taken. The Counts tab is used to actually log the physical counts taken.
Most hospitals take it least three counts during the course of the intra-operative phase of care: initial, closing, and final. Based on hospital policy, more than these three counts can be taken. For each count taken, a separate record must be added to the grid area of the Counts page..
To do this, click the down arrow at the end of the Count Classification text box. A drop down listing displays. Click the name of the count being taken. Click the down arrow at the end of the Employee 1 text box.
Click the name of the employee who will sign off on the Counts page. Click the down arrow at the end of the Employee 2 text box. Click the name of the employee who assists in the Counts process.
Click the type of count being taken, such as instruments, sharps, sponges, in the Count Types text box. You can choose more than one item being counted by holding down the control key and selecting what has been counted
Click the drop down at the end of the Status text box, and select the appropriate correct or incorrect option.
In Procedure, select the desired procedure. Click the + on the toolbar to add the record to the grid.
Click the green C to Clear Edit Boxes to remove the entries for the previous record before you start the process for entering the next counts record, if needed.

32. Counts Action Taken EXPLAIN:
The Actions Taken tab is only used if there is an incorrect count or missing items. It is used to document whatever action was taken when items are missing from the count. If you document that a count was incorrect, it give you a warning that you need to document on the Actions Taken tab and takes you directly to it.
Note: Do not use the add, update or remove buttons when documenting on the Actions Taken tab. They are associated with the Counts tab and make the changes there, not in the Actions Taken tab. If you click any of them while documenting in the Actions Taken tab, it will affect the Counts screen.

33. Lab Access
DISCUSS:
Labs is one of the choices on the left hand side menu when you are documenting in the Intraoperative Care Event. Click Labs and the Labs module displays.
The different parameters available when you view Labs include Groups, Priority, Time Span, Time Compression and Microbiology.
Groups: Use the dropdown menu under Groups to change the type of lab that you are viewing.
Priority: Choose from All, Typical or Critical.
Time Span: When you view the labs, the time span defaults to three days. You can choose a different time span by clicking on the dropbox under Time Span. Your choices range from today to No Limit.
Time Compression: You can choose None, Day, or Week from the Time Compression dropdown menu.
If you wish to also see Microbiology, click the box underneath Microbiology. A checkmark displays and Microbiology is included in the labs.
There are also Defaults and Search buttons
Defaults: Click the Defaults icon to return the choices to default, which are Default, Typical, Three Days, None and no Microbiology.
Search: Allows to search for a specific result.

34. Sign off on a Care Event EXPLAIN:
At the end of the Intraoperative Care Event, you need to sign off on that portion of the documentation. To do that, select the Sign icon in the toolbar. choose Intraoperative from the Select dropdown menu. Or select Signature from the menu dropdown under Case in the menu bar.
A dialog box displays allowing you to select the forms or the Care Events that you wish to sign. Select All. Once selected, click Next, and a new dialog box displays asking for your password to continue the sign off process. If you have missed any required fields, a warning displays stating the first field that you missed. Then you go back and enter the required fields and go through the signing process again.

35. Required Field Wizard
EXPLAIN: Another tool that you can use to check whether you have completed all the required fields is the Required Field Wizard. Select the Required Field Wizard from the toolbar. The Required Fields Screen Selection window displays. Click Select All and then Next. The Required Field Wizard takes you to each of the screens that has required information left blank. Continue selecting Next until all screens have been completed. Click Close. You can now proceed to sign your record.

36. Scheduling an Add-On Case
EXPLAIN:
When necessary, a user can schedule an add-on or emergency case through the Clinical Documentation Module.
DISCUSS:
Once you are in the Clinical Documentation Module, click the Add-On Case icon located under the Case Selection group of the Case Selection Screen.

37. Schedule Emergency Case Screen
EXPLAIN:
The Schedule Emergency Case screen displays. To schedule a case, enter as much information as possible.
DISCUSS:
You must enter at least the Procedure Code, Procedure Description, Physician, and Operating Room text boxes, which are required fields. All other text boxes are optional, but the more information that you have available to enter is better.
Note: The Procedure Description and Procedure Code fields are linked to each other. When one of them is populated, the system auto-populates the other field.
The estimated time for the case defaults to 60 minutes. If more time is needed, you need to adjust the number of minutes.
When you complete the screen, click OK.

38. Adding the Patient’s Name
EXPLAIN:
A warning message displays.
DISCUSS:
Based on the patient record status, click one of the three buttons as follows:
Select Patient - If the patient record exists in the system. This displays the Patient Search dialog for linking to a patient.
Add Patient - If the patient record does not exist in the system. This displays the Add Patient dialog for entering the patient details and linking.
Proceed - This leaves the added case without a patient linked.
The case information displays in the grid area of the Case Selection screen and is available to be documented on. It also shows on the OR Scheduler and on Tracker.
Note: Cases scheduled using the add-on feature can only be viewed in OR Scheduler. When the information is updated in the Clinical Documentation Module, the changes are visible in the OR Scheduler Module.

39. Estimated Patient Age EXPLAIN:
When entering a case for the first time, the system may display an Estimated Patient Age screen before it allows you access to the Case Information screen. You can ignore the Estimated Patient Age screen and click OK or Cancel and proceed to the Case Information screen. Or you can enter approximate data for the patient on the case and click OK. This information displays in the Case Information screen.
Note: When either the date of birth or estimated age is not provided, the system displays the Estimated Patient Age dialog box each time the case is opened.

40. Add-On Case Practice
You are called in for a case to treat an elderly man who fell post left total hip and dislocated his left hip. You need to schedule a closed treatment, post hip arthroplasty dislocation; with anesthesia, procedure code for the left side by Dr. Holly Alderson in OR Room 2. The patient appears to be around 87. Patient had his total hip here at your facility.
DISCUSS: How to document add an add-on patient.
ASSIST:
Move around room providing assistance as necessary.
\ASK:
What questions do you have about adding an add-on or emergency patient?
INSTRUCT:
Provide directions to complete the exercise.
Open the Clinical Documentation Module through the Periop Nursing Documentation icon.
Click Add-On Case.
Complete all required fields.
Click OK.
Click Select Patient and search for patient as when scheduling a case through OR Scheduler.
The case information will display in the grid area of the Case Selection screen.
Double-click the case in the grid area.
Enter the patient’s approximate age of 87 in the Patient Age window, if the patient was not found in Patient Manager.

41. Review We have covered the following topics:
Log in and log out of Clinical Documentation
Access and navigate windows
Access and navigate the documentation for Intraop Care Event
Access Implant and Tissue Tracking and enter information
Sign off on care event
REVIEW:
In this section, we learned how to Log in, access and navigate in Clinical Documentation Intraoperative Care. We discussed how to search for and select patients, and document the Intraoperative Care Event, including tracking implants, cultures and specimens, and vitals. What questions do you have about any of those processes?
ASK: What is the standard workflow in Intraop and what windows would you use to document it?

42. Track Surgery EXPLAIN:
The Tracker Module allows users to better manage resources during the day of surgery. Tracker shows where patients are in their surgical experience. Time updates are all real time and feed in from the clinical documentation packages for more accurate logging.

43. Track Surgery EXPLAIN:
The Tracker module allows users to better manage resources during the day of surgery. Tracker not only tracks where patients are in their Pathway (pre-op, intra- op, post-op), it also tracks any resource for real time conflict checking. (e.g. Instrument sets, equipment and staffing).
This module also allows you to set up your staffing needs. The routing of information is based on the staff that is available and the routing can be configured by the end- user.
Room changes, staff changes and time updates are all real time and feed in from the clinical documentation packages for more accurate logging.
TRANSITION:
Let’s look at the meaning of the Tracker icons.

44. Case Label
EXPLAIN:
After selecting a date, the cases scheduled for that date display in Case Grid View. In Management view, the Case Label displays the surgeon, patient, procedure and age of the patient. To view additional information on each case, right click the case label. The options to Show Patient Drill Down and View Case Label Values display.
Case Labels are color coded based on their status. The status designations include Add On, Emergency, Scheduled, In Facility, Holding/Preop, In OR , Incision (only displays in Management View), Surgery Started (only displays in Ancillary and Family views), Surgery Ended, in PACU and Discharge. As the case is logged in the Clinical Documentation module, the color of the case changes in all views of the Tracker module.
The case label boundaries are driven by the times that the patient is actually in the operating room as entered in the clinical documentation module.
NOTE: If the case is too short for all of the information normally on the case label to be easily visible, hover your mouse over the ellipses ( ... ) to view the option to display the rest of the information

45. Case Label – Show Patient Drill Down
EXPLAIN:
If you choose the Show Patient Drill Down option, the Patient and Case Details window displays, which includes Scheduled Start Date/Time, Scheduled Duration, Service Area, Patient Demographics, Case Information, Allergies, Case Comments and Tracker Times.

46. Tracker Icons Operative Consent Staff Note Complete H&P Complete
Bed Available
Isolation Status
Blood Consent
IV in Place
NPO
Labs/Tests
EKG
Site Physically Marked
Staff Surgeon Visit Complete
DISCUSS:
This is a close-up of additional Tracker icons that are available to help users know the status of tasks needed to for a patient waiting for surgery.
Icons display at the top of the label to indicate items that have been completed and/or are outstanding.
Hover over the icons to display the icon description and if the item is complete or incomplete.

47. Questions? Session Wrap-up ASK: How do you search for a case?
Are all implants tracked by the system? Why not?
What are the steps to sign off on a care event?
Ask for any questions on the practice exercises. Are there any steps or processes that are unclear?
DISCUSS:
Any outstanding questions from the parking lot?

48. Real World Scenario
Patient C presents for left shoulder arthroscopy with subacromial decompression procedure today by Dr. Holly Alderson. The patient has had an infraclavicular brachial plexus block for post op pain control in the holding room. The patient received 2 gms of Ancef on the way to the OR and the surgeon used mitek anchors during the surgery. The counts were incorrect and an xray was completed. Log in to Clinical Documentation, search for and select Patient C in Case Selection and document the Intraop Care event.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about the Intraop Documentation?
INSTRUCT:
Provide directions to complete the exercise.
Open the Clinical Documentation Module.
Select the patient by double-clicking.
Click Resources.
Enter information as indicated.
Click Times.
Click Checklist and then site verification tab.
Enter information as indicated, including time out.
Click Intraop Record.
Click Implants.
Click Medications.
Click Counts.
Sign Care Event.

49. Help Desk and References
Two methods of entering a service request
eService - low priority ticket
Phone – critical, high, medium, low priorities
Press 4 for SQWM, then
Press 4 to speak to technical support
SQWM Training SharePoint Site:
EXPLAIN
There are two methods to of entering a service request, eService and by phone.
The SQWM Training SharePoint Site is

50. Course Evaluation EXPLAIN:
Your input and feedback is greatly appreciated.
Direct students to End of Course Evaluation location.