1. Surgery Quality and Workflow Manager
Anesthesiology Workflow

2. Learning Objectives
After instruction, students will be able to complete the following tasks:
Access and navigate OR Census, Surgery Clinic Census, Misc Census, and Pending Work Census
Enter data in Preoperative Evaluation form and create a Procedure Note
Access Pending Work Census and sign note
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 are given the opportunity to practice each of the tasks listed as a learning objective.
The purpose of today’s training is to provide an understanding of the functionality of the Surgery Quality and Workflow Manager tool, specifically the OR Census, Surgery Clinic Census, Misc Census, and Pending Work Census.

3. SQWM Documentation Icon
DISCUSS:
Selecting the SQWM Documentation icon takes you to the login screen for The Centricity Perioperative Anesthesia (CPA) application, which contains the documentation screens for both the anesthesia and surgery providers.
TRANSITION:
Let’s look at how to log in.

4. Log in
DEMONSTRATE:
To log in, click the SQWM Documentation icon. Enter your Login Name and Password. Click OK.
The Centricity Perioperative Anesthesia (CPA) login window allows the user to log into the CPA Application and change the password.
EXPLAIN:
The permissions granted are based on the role of the user. Some actions demonstrated may not be performed by all users. Role specific privileges are highlighted throughout the training.
NOTE:
As we walk through the examples and practice exercises, you will see what appears to be patient data. All screenshots and training exercises take place in a training database, and no actual personal patient data is used.
TRANSITION:
Next, let’s look at the Census options available on login.

5. Census Selection DISCUSS:
As we work in the different areas of the software, we will discuss several different censuses. A census is a list of patients or items needing attention. Different logins have a different census, the list that opens automatically when they log in, as the default. This is usually established by role.
The Census options for an Anesthesiologist are OR Census, Surgery Clinic, Misc Census, and Pending Work Census.
When logging in, the Anesthesiologist often defaults to the OR Census, which is a list of patients scheduled for surgery on the current day. Anesthesiologists work in either the OR Census or the Surgery Clinics.
The Anesthesia Consult Clinic in the Surgery Clinic is for pre-admission testing to assess medical readiness for surgery. This is usually done for those who are medically unstable, with an ASA of three or four. It is not as common for those who are generally healthy.
Miscellaneous Census, which is also called the Waitlist Census, lists patients who are indicated for surgery. This is also where users can track medical readiness. Patients are placed on this census once they are indicated for surgery and remain there until the surgery is performed.
The Pending Work Census is used to access unsigned notes or other items that require attention.
TRANSITION:
First, we will discuss the Surgery Clinic Census.

6. OR Census Overview DISCUSS:
When users select OR Census, the patients assigned to them for the current day populate automatically.
To display patients for a specific date census, in the date fields, select the From Date and the To Date on which you wish to search. To retrieve all patients for a specific date, do not enter any other information in the patient search text boxes. All Patients that are scheduled for that date display.
To search for a specific patient, enter the last name in the Last Name field and click Search. Other search options include specific personnel, such as attending, resident or anesthesiologist, as well as case number or room number.
Search fields can be used to limit the results seen in the OR Census display area. In order to search on the various roles (i.e. surgeon, anesthetist) these roles need to have been assigned via the scheduling system.
As users log in to the application, if they are assigned to one of the roles in the search area, their name defaults in the initial search. If the user has not been assigned to cases, they can select Clear and Search to remove the provider criteria.
Column headings include Name, OR Scheduled, Scheduled Time, SSN, DOB, Assigned Personnel (Anesthesiologist, CRNA, Resident, Surgeon), Preop Eval, Case Number, PAT Concerns, and Clinic Location. The columns can be sorted by double clicking on the column header.
TRANSITION:
Next, let’s look at the documentation options in OR Census.

7. OR Census Documentation
EXPLAIN:
Once the patient list displays, click anywhere in the patient row to show the documentation options. The forms that display are based on security setup. For the Anesthesiologist these include the Preoperative Evaluation, the Procedure note, Preop Instructions and access to Case Manager and the VistA Anesthesia form.
Preop Patient Instructions can be documented using a form available to either the anesthesiologist or the preop nurse. To display the form, select Preop Patient Instructions from the dropdown menu from either the Surgery Clinic or OR Census. Document instructions given on the form just like the other v-forms. Then sign the form.
After signing the Preoperative Evaluation, the anesthesiologist’s next contact with the patient is likely in the OR Census on the day of surgery.
Other options for documentation include access to the PACU/Preop Record and Dictated Note Report.
TRANSITION:
Next, let’s look at how to find patients in the Surgery Clinic. .

8. Search Options EXPLAIN:
When patients are medically unstable or need to have additional tests run before surgery can be done, an appointment can be made for them in the Surgery Clinic as an Anesthesia Consult. This Clinic Census is handled by anesthesiologists or hospitalists to establish medical readiness and ensure that patients can get cleared for surgery. Patients display on the Surgery Clinic census following a consult request scheduled in VistA. You can use the Date Search to find patients for a particular date or search by name to find a specific patient.
To search for patients in the Surgery Clinic, first select a clinic from the Unit dropdown, such as Anesthesia Consult. Then add other search criteria, such as date, name, etc.
A default unit for the user can also be designated for users in the Surgery Clinic Census and the Misc Census. For the Anesthesiologist, this would probably be the Anesthesia Consult clinic. Surgery and Misc Census have multi-select options instead of a dropdown menu. You can select multiple units or use the multi-select option to select all units. However, if you use the Select All option, the system limits your results to the first 500.
Other search criteria, such as date, name, etc. can be added. You can enter a date range, or if looking for today’s patients only, leave it set to the default of the current date. You can search by Social Security Number, or use the Quick Search option. The quick search is the first initial of the patient's last name and the final 4 of the Social Security Number. In some areas, the Search functionality is a smart search and narrows options as you type. Other filters you can use include selecting Status, Surgeon, or PCP. The Status and Service fields also have multi- select options. Once the appropriate entries are made, click Search. The entries matching your search criteria display. Results columns can be sorted by double clicking the column header.
NOTE:
You must have a Unit selected before searching to get any results.
TRANSITION: Let’s look at the toolbar icons and what they do.

9. Census Navigation and Toolbars
Surgery Clinic Census Toolbar
OR Census Toolbar
EXPLAIN:
Many of the Toolbar icons are the same for all the Census windows:
Back takes you back to the clinic you were in before or returns to the previous page.
Log Out allows the user to log out and enables someone to log in as a different user.
The New Case icon allows you to schedule a new case if you need to schedule multiple cases on the same patient.
Census displays the dropdown of the available Census options for the current user.
Approval is located on the Surgical Clinic Census and accesses the Approval queue for surgeons to approve or reject residents’ requests for surgery.
Export allows the user to export the Census to a CSV file.
Worklist displays a list of unlocked forms or follow up items pending or needing additional attention. This is the same as the Pending Work Census.
Monitor allows the user to remotely access monitors that are used in the OR.
Print when selected on the OR Census, prints the content displayed.
Refresh provides a refresh or update of the most up-to-date data.
VistA Web provides access to the web-based CPRS notes for the patient.
TRANSITION: Let’s look at using the Export icon to export a list of your search results.

10. Export to CSV
EXPLAIN:
As seen on the previous slide, the Export icon is available on the toolbars for the OR census, Surgery Clinic and Misc Census.
The system allows patients to be exported from a search. Users with the appropriate Security rights are able to export the information to a CSV file.
For example, you can do a search for a list of patients meeting a certain criteria, then you can export that list, and pull it into Excel. Uses for an exported list include creating a patient list for the day for the surgeon or clinic, or managing and scheduling patients for surgery.
Once you select the Export icon, a dialog box displays allowing you to save the file to CSV format.
TRANSITION: Let’s look at some of the documentation options of the Surgery Clinic Census.

11. Anesthesia Consult Documentation
EXPLAIN:
After you execute the search in the Surgery Clinic Census and the patient list displays, select a patient and click to display documentation options.
Select a documentation option, and then open the form. Icons are available to access CPRS and Labs from within the Surgery Clinic Census.
The anesthesiologist’s options for documentation include the Preoperative Evaluation and the Clinic/Procedure Note, as well as Patient Preop Instructions and the Dictated Note Report.
If the Procedure Note is selected, a page displays that lists the various procedure note templates. We will look at that later in the lesson.
The Preoperative Evaluation is usually the first documentation to be completed. Once this option is selected, the Form Selection dialog box displays.
TRANSITION: First, let’s look at accessing Labs from within SQWM.

12. Lab Interface EXPLAIN:
The Labs icon on the Forms toolbar provides access to labs ordered for the patient. This screen is also available on the Documentation dropdown in OR Census, Surgery Clinic Census, Misc Census and VASQIP Census. Labs can be searched for by selecting groups, time frames, and priorities. 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 dropdown 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.
TRANSITION: In addition to accessing Labs, you can also access previous SQWM notes.

13. Access CPRS from within SQWM
EXPLAIN:
After you execute a search and the patient list displays, select a patient and click to display documentation options, as seen on the previous slide.
Select the CPRS link to access a patient’s CPRS record.
TRANSITION: Next, let’s look at how to access forms.

14. Form Selection EXPLAIN:
The form selection dialog box displays information showing the Date and Time the form is being launched. It defaults to current date and time but this can be altered prior to opening the form.
The form presented for the anesthesiologist to document is the Preoperative Evaluation, which is also the Anesthesia History & Physical.
The Datacopy option is the default. It is recommended to leave this option checked so that information pre-populates or flows into the forms. This allows any information documented in the Preop Evaluation to flow into any additional assessments.

15. Anesthesia Preop Evaluation
EXPLAIN:
When you open a form, it displays with the panels collapsed. This means that the only data you see, if data has been charted, are the pertinent positive or negative findings and a list of the parameters that have not yet been charted. If a Preoperative Evaluation has been completed previously, No Change (NC) is an option on the form to document findings that have not changed, otherwise they only see the Within Normal Limits (WNL) option.
The form contains:
Toolbar – Access different features/functions without returning to the OR Census.
Patient Banner – Quick view of patient demographic and important clinical information.
Form Header – Identifies the form, date initiated and user who initiated. The T on the far right of the header is used to change the template to another related template. For example, if the wrong form was selected inadvertently, the T can be selected and all documented information is saved and transferred to the new selected template.
Form body – Assessment forms are made up of panels which group similar assessment information.
Status bar – When hovering on a documentation object, the audit information is displayed in the status bar.
A form can also contain information that has been charted somewhere else. In some cases the information flows from one form to another and can be changed on a different form. For example, information charted on this Preop Evaluation flows to the evaluation done on the day of surgery and can be updated from there.
TRANSITION:
Let’s look at how to document using forms. First, we will look at the information contained in the form banner.

16. Patient Banner EXPLAIN:
The patient banner that displays at the top of the form contains important information on the selected patient so that it can be seen with higher visibility.
Information is populated from documentation within the form or from scheduled case information. The Refresh icon must be selected for documented information on the form to display on the banner after charting.
Information displayed can include: Name, Date of birth, Gender, MRN, Scheduled Procedure, and Allergies.
Additional banner information displays by clicking the red box at the far right of the banner.
The form header displays the form name, date and time when the form was initiated, and the name of the user who launched the form.
With the form for new consult, the top of the banner indicates who opened the form. If information has been entered by someone else, you see who and when.
TRANSITION: Let’s look at the Forms toolbar and what each icon does.

17. Forms Toolbar EXPLAIN:
The toolbar icons for the various forms include:
Back is used to return to the previous page displayed.
Logout is used to change users without exiting the application.
The Labs icon provides access to labs ordered for the patient.
Conversion is a conversion tool that can be used to convert between units of measure such as weight, temperatures and length.
Procedures launches the folders for the Procedure Note templates.
Census returns the user to the census from the current page.
WorkList displays a list of unlocked forms or follow up items pending or needing additional attention. This is the same as the Pending Work Census.
Risk Calc is a risk calculator available that calculates the risks from surgery for the patient.
Transmit transmits the form to CPRS.
Edit controls whether a form can be viewed or edited. If you have edit privileges, it defaults to Edit mode.
Print prints the form contents of the form displayed.
Refresh provides a refresh or update of the most up-to-date data.
The Expand icon opens all panels within the form displayed.
Collapse returns the panels to their closed positions.
New Form allows the user to select a new form to complete.
Click the down arrow at the end of the toolbar to display additional toolbar icons.
Add Variable allows you to add additional parameters to a form.
Open Form opens the form for editing.
Modify allows someone with edit privileges to modify data that was entered incorrectly.
Delete removes information if it was entered in the wrong place, for example.
TRANSITION: Next we will look at documenting the form itself.

18. Access Previous SQWM Notes
EXPLAIN:
Any notes previously entered in SQWM can be accessed by selecting the Open Form icon.
A dialog box displays with a list of any previously documented forms. Select the appropriate form to open and view previously documented information.
TRANSITION:
Let’s look at the different ways to enter information into the forms.

19. Document Form EXPLAIN:
Once the form is chosen, the empty form displays with all the panels collapsed, ready to be opened and documented.
Forms may contain different information, but they all contain similar elements, which are described in the upcoming slides.
The T on the far right of the header is used to change the template to another related template. (Point out red box) For example, if the wrong form was selected inadvertently, the T can be selected and all documented information is saved and transferred to the new selected template.
This is not the same as the new form icon since it continues on the same form and does not open a new instance of the form.
TRANSITION:
Let’s look at accessing notes previously entered in SQWM.

20. Enter Data in the Form EXPLAIN:
Each form is made up of panels. The panels group assessment information. The Patient Information panel reflects information that was captured through the scheduling process and automatically populates the form when launched. Any updates made to that information outside the form would not update a form that is already launched.
You can expand or collapse a panel by clicking the plus (+) or minus (-) sign. You can also use the expand and collapse icon in the toolbar.
The forms also allow you to select from a list of common data, shortening the amount of time you spend documenting and standardizing the documentation. To enter data using the lists, click the parameter to be assessed. The list of items for this parameter display. Select the appropriate item from the list. If the choice you want is not available, you can enter free text data.
Within Normal Limits (WNL) is configured for each panel where applicable. When selected, the WNL button charts the appropriate verbiage to indicate a normal assessment for that section. The data for an individual entry can be changed once WNL has been documented.
No Change (NC) displays next to the WNL button only when more than one form has been documented. The No Change feature is used to pull information from like forms. To document, select the + sign in front of the panel description to expose the objects available for charting. The objects may allow for a single selection of answers or multiple selections, date/time formatting or free text fields.
Some objects may group several related objects. The user may chart a portion or all components in the grouping. Other objects have a waterfall effect, and once the first selection is made subsequent details are requested.
TRANSITION: Let’s look at how to add new parameters to document in a form.

21. Add Variable
EXPLAIN:
The different forms available for documentation function in the same way, but the information documented may vary. When you want to document information not shown on the form, you can add a variable by clicking Add Variable on the toolbar.
Add Variable lets you add a space on the form for additional information. To add a variable, click Add Variable and select from the new parameter list for the information you want to document.
Click Close to hide the New Parameter List window.
TRANSITION: Let’s look at how to sign and complete the form.

22. Sign Form
EXPLAIN:
To sign the form, expand the Sign and Lock area, then click in the area where it states you have reviewed the note.
Clicking within this field and then clicking Done completes the signing process for the form.
One additional step is required, and that is to verify your signature by entering a password.
A Password Required prompt displays. The user can certify the document or cancel out if more information needs to be charted.
Then click OK to finish the process.
TRANSITION: Now let’s practice what we learned.

23. Preoperative Evaluation Practice
Patient A needs a Preoperative Evaluation to be completed prior to surgery. Find the patient in the OR Census and highlight and access the Preoperative Evaluation form. The patient presents for a Partial Colectomy with Anastastomosis.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about the Preoperative Evaluation?
INSTRUCT:
Provide directions to complete the exercise.
Make sure OR Census is selected. If not, click Census and select OR Census.
Enter the date range, if needed.
Click the Patient’s Name.
Select the Preop Evaluation from dropdown.
Select Anesthesia- Preop Evaluation.
Click OK.
Click Expand to expand all fields.
Enter the information in the form as indicated or with WNL.
Click Preop Provider Signature in the Faculty Sign area and then click in the I have reviewed form area.
Click Done.
Enter Password and click OK.
Click Back to return to the Surgery Clinic.

24. Review So far we have covered the following topics:
Log in and select census
Navigate Census
Select and Document Forms
DISCUSS:
We have learned how log in to the SQWM Documentation, how to navigate the Census windows, and how to search for patients. What questions do you have about any of these processes?
TRANSITION:
Next, we will look at how to access and complete the Patient Preop Instructions.

25. Patient Preop Instructions
EXPLAIN:
Patient Preop Instructions can be documented using a form available to either the anesthesiologist or the preop nurse.
To display the form, select Patient Preop Instructions option from the dropdown menu from either the Surgery Clinic or OR Census.
Document instructions given on the form just like the other forms. Then sign the form.

26. Procedure Note EXPLAIN:
Whenever surgeons or residents perform procedures outside of the operating room, they must create a procedure note to document them. Procedure notes are also used as progress notes for patients. The Anesthesia application includes a procedure documentation function that gives users the ability to document information online in a standardized template format, using the standardized procedure templates available.
The Procedure Note is patient specific and must be in a proper format. To access the procedure templates, highlight the patient and click to access the documentation dropdown or click the Procedures icon on the toolbar to open the template selections.
When the Procedure Documentation window displays, select the folder showing a procedure group and then select the specific procedure that you want to document.
TRANSITION:
Let’s look at how to document a procedure note.

27. Document Procedures EXPLAIN:
Verify that the date and default information is correct, or make changes if needed. In the Time text box, enter the time in hh:mm (24 hr clock) format.
Select the Attending text box and enter the name of the attending physician. The Physician’s name displays in the text box. Select the Location performed text box and enter the location. If you are logged in as the attending, you can note that you were physically present during the procedure by selecting the Attending Physically Present check box.
The software provides short cuts for the verbiage used in the note. When you click View Note, the text pre-populates. You can add to or edit this verbiage.
Procedure notes are available for 7 days. To search for a previous note, enter the date range and click Search. The procedure notes for the specified date range display in the grid in the upper part of the page.
TRANSITION:
Next let’s look at a completed procedure note.

28. Procedure Note EXPLAIN:
Clicking Sign saves the note. You can save the note by signing and then go back and review the procedure note at a later time. It displays on the Pending Work Census until it is properly signed and locked.
To access the note, search for the patient in OR Census, select Procedure Note from the dropdown and then access the unlocked note and complete the sign and lock process.
You must use Sign and Lock to transmit the note to CPRS.
NOTE:
It is important to get in the habit of documenting as you do procedures to keep the records accurate and current.
TRANSITION:
Next, let’s practice documenting a procedure note in SQWM.

29. Procedure Note Practice
For patient A, create a Procedure Note for an arterial line placement. Document that the procedure was performed in the operating room and that the informed consent was obtained. Verify (and correct if desired) the catheter size, insertion site and any complications.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about creating a Procedure Note?
INSTRUCT:
Provide directions to complete the exercise.
Click OR Census, if it is not displayed.
Enter From Date and To Date as indicated.
Select Patient’s Name.
Click to display dropdown menu and then select Operative/Procedure Note.
Click the Procedure Templates folder.
Click the Access folder.
Select Arterial line as the Procedure from the list.
Enter the information in the form as indicated.
Click View Note.
Click Sign. (This places the procedure on the Pending Work Census)
Click Back to return to OR Census.
Debrief the exercise by reinforcing the purpose of the exercise, asking questions to check understanding and linking this exercise to previous knowledge.

30. Review So far we have covered the following topics:
Enter data in Preoperative Evaluation form
Use the WNL or NC feature
Create a Procedure Note
REVIEW:
In this session, we learned how to enter data in the Preoperative Evaluation form and how to create a procedure note. We also discussed how to enter data and use the WNL and NC feature. What questions do you have about any of those processes?
ASK:
What kind of procedures do you typically perform?
DISCUSS:
Next we will look at how to sign or cosign documentation that has not yet been completed or signed and transmitted.

31. SQWM Documentation Script Choices
EXPLAIN:
The different care events are listed in tree format, usually with the Anesthesia option expanded. Click on the ( – ) beside Anesthesia to close that option and click on the ( + ) in front of the care event that you wish to document.
PREOP opens to one choice (Case Cancellation is not an option) and PACU opens to four options: PACU Phase II, PACU-Standard for those facilities not using device capture with their ARK system, PACU-Standard with ARK for those that are and PCA, an additional script for patients with a PCA pump.
Choose the desired script by clicking on it.
TRANSITION: We will look at the information that displays in the scripts.

32. Scripts in SQWM Documentation
DISCUSS:
When the script opens, you see a banner with the patient information and the clock showing the amount of time since you clicked PreOp or PACU start, designating the beginning of their time in that care event.
Just below this is a standard toolbar for all the scripts. The format of the scripts and the way you document in them are the same no matter which care event you are in.
TRANSITION: We will look at the script toolbar next.

33. Script Toolbar DISCUSS: This is the standard toolbar:
Scripts returns you to the primary script after selecting additional information to document from toolbar.
Find (magnifying glass icon) in Menu allows you to search for additional documentation options. Select Find and the search field opens. Options display under the banner as search is typed.
Other in Menu allows you to enter comment.
Time can be adjusted as in Script documentation.
Meds is where you find the medications to document. Select the desired medication and then in the window that displays document the amount, route and time.
Infusion is where you find your drips to document, aminophylline, dopamine for example.
Fluids is where you document any IV fluids
Output is where you document any output.
Blood is where you document any blood products given.
Sites is where you document IV starts.
Select Mark from menu to place a timestamp for critical event documentation if needed.
Select Preop Start/Stop from menu to document beginning/end of preop care event.
Alerts allows you to name, set and edit a timer.
Select Patient Information (Pat Info icon) to add information to Patient Manager. Information includes ht, wt, ASA Status, Procedure and Allergies.
Select Chart from menu to see same menu options as when clicking on patient in OR Census.
Edit is not active at this time.
Select Sign In (Sign-In and Sign-Out icon) from menu, and then click Search for additional staff, break and relief staff to log in.
Select Logout from menu to lock workstation or exit module.
Close returns you to OR Census.
TRANSITION: We will next learn about how to add additional patient information.

34. Adding Patient Information
EXPLAIN:
You can add additional information in Patient Manager so that it shows in the banner.
Height and weight can be added here either in metric or English.
ASA can be added if known at this point.
Allergies pull over from CPRS and additions and changes must be done there. The additions then flow to SQWM.
TRANSITION: Nursing staff must sign in to their script. We will learn how next.

35. Signing In
DISCUSS:
Staff must sign in for their care event. Click Sign In in the toolbar.
You can either enter your last name, choose your role, and then click Search, or you can choose the appropriate role, then choose the name from the dropdown menu.
Then click on your name in the grid to highlight it, and then click Sign In. You are now logged into the case.
TRANSITION: Next we will learn how to document in scripts.

36. Editing in Scripts EXPLAIN:
To document in the scripts you click on the desired documentation.
You can edit the documentation, for example to adjust the time.
Click the … first, make the adjustments, then click on desired documentation.
After you click on the desired documentation, another window may display for further details.
These windows may contain fields to type in text or dropdown menus to choose from.
After the documentation is completed, it then moves to the Event History window at the bottom right of the screen.
TRANSITION: Let’s look at Event History next.

37. Event History in Scripts
DISCUSS:
The Event History shows at the bottom right of the screen. Everything that has been documented in this care event’s script displays here.
TRANSITION: Let’s learn how to edit in Event History.

38. Editing Event History in Scripts
DISCUSS:
You can still edit or delete the documentation even after it is in Event History. Click in the Event History window.
The Notes/Events During Case window displays.
You can edit or delete documentation just as you did in the script. Click … . Click the desired edit.
TRANSITION: Next we will take a look at additional documentation options.

39. Additional Documentation Toolbar
DISCUSS:
Additional scripts are available to use for documenting in the toolbar.
Select your desired category for additional documentation from the action menu. Choices include: Meds, Infusion, Fluids, Output, Blood, and Sites.
Banner changes to name of additional documentation chosen with Search field to right of name. Selections for this script change as search is typed.
Documentation is same as in PreOp script.
Other in Menu allows you to enter comment.
Time can be adjusted as in Script documentation.
Find (magnifying glass icon) in Menu allows you to search for additional documentation options. Select Find and the search field opens. Options display under the banner as search is typed.
Select Mark from menu to place a timestamp for critical event documentation if needed.
Select Preop Stop from menu to document end of preop care event.
Select Patient Information (Pat Info icon) to add information to Patient Manager. Information includes ht, wt, ASA Status, Procedure and Allergies.
Select Chart from menu to see same menu options as when clicking on patient in OR Census.
Select Sign In (Sign-In and Sign-Out icon) from menu, and then click Search for additional staff, break and relief staff to log in.
Select Logout from menu to lock workstation or exit module.
TRANSITION: Let’s learn about Device Capture.

40. Start Device Capture DISCUSS:
For facilities that are using device capture, GE will work directly with you as it is being set-up.
Click Start vital signs capture and alarm limits set.
TRANSITION: Let’s continue with the device capture steps.

41. Device Capture DISCUSS:
The Device Manager window displays. Choose your session’s parameters.
Information that is entered via device capture flows to VistA as an image.
TRANSITION: Now we have completed learning how scripts work. Let’s take a look at documenting forms in SQWM documentation.

42. Forms in SQWM Documentation
DISCUSS:
Some scripts have forms included as part of the documentation. Click on the form and the v-form displays. Continue to document as you normally do in v-forms.
TRANSITION: And last, we will practice scripts.

43. Script Practice
Patient A is having a laparoscopic left hernia repair with mesh and has just had his IV started in the Preop area. Document the IV start.
ASSIST: Move around room providing assistance as necessary.
ASK: What questions do you have about the new places to document your care event? How do you access it?
INSTRUCT: Provide directions to complete the exercise.
Log into SQWM Documentation.
Locate the patient and click on them to bring up menu.
Click Preop/PACU Record.
Click Preop script
Click on Peripheral IV.
Document in window that displays.
TRANSITION: Let’s look at the pending work census.

44. Pending Work Census Options
EXPLAIN:
The Pending Work Census shows unlocked forms and notes that need signatures. It can also be accessed by clicking WorkList.
To access the Pending Work Census and co-sign a note, click Census and select Pending Work Census. Click in any column for the patient.
The unsigned procedure note or unsigned form opens allowing you to continue documenting and sign the form.

45. Practice – Pending Work
You notice that the Pending Work Census indicates that the note you completed earlier is unlocked. First view the note, and then sign and lock the note.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about the Pending Work Census?
INSTRUCT:
Provide directions to complete the exercise.
Log in to SQWM Documentation.
Click Census and select Pending Work Census.
Select the unsigned form.
Select Sign and Lock area.
Click in the I have reviewed form area to sign.
Click Done.
Enter Password and click OK.

46. Miscellaneous Census EXPLAIN:
The Misc Census is also referred to as the Waitlist Census. A patient is placed on the Miscellaneous/Waitlist Census when indicated for surgery and stays there until the surgery is performed and the out of room time is entered for the OR in the Nursing Documentation module.
Two important columns on this census are Status and DOL. DOL refers to Days on List, which starts with zero and shows how long the patient waited to have surgery. Days on List is counted from the time surgery is indicated until the patient is marked out of room in Periop Nursing Documentation. The status changes to Completed at this point, and drops off the Misc Census.
The Status column displays patient statuses such as Surgery Indicated, Pending Request, and Pending Medical Clearance. If the surgery is delayed as a result of the patient not being medically ready the status is Pending Medical Clearance. Although Completed cases are no longer displayed on the Misc Census, they can be searched for and viewed.
Other columns include patient’s Name, DOB, Gender, SSN, which all populate from ADT.
Once the patient list displays, click the patient to display the dropdown options for that patient.
Options available include the Surgical Readiness Status Form and links to Labs and CPRS, which are available from the Census dropdowns.
TRANSITION: Let’s look at search options for the Misc Census.

47. Misc Census Search Options
EXPLAIN:
The search options for the Misc Census are the same as those for the Surgery Clinic Census. To see patients for a specific date, select the clinic under Unit.
You can select multiple units or use the multi-select option to select all units. A default unit can also be designated in Security setup.
Enter a date range, or if looking for today’s patients only, leave it at the default of the current date.
Click Search. The entries matching your search criteria display. The columns can be sorted by double clicking the column header.
As with the Surgery Clinic Census, you can export this list if you have the correct privileges.
TRANSITION: Now, let’s look at some of the Status categories and what they mean.

48. Status Options EXPLAIN: Patients can be searched for by status:
Acton Required - Items required for clearance for surgery display on the Misc Census under the Actions column. Use the Update link to update the case. Days on List continues.
Canceled - Stops counting Days on List. Cancelled status comes from Clinical Documentation or Scheduler.
Canceled Pending Reschedule - When a case is cancelled in Scheduler, and Return to Misc Census is selected from the cancel case window. This option is used to mark a patient for further workup.
Clinic - all consults have an initial status of Clinic.
Completed - Cases fall off the Misc Census but can be searched for when needed
Deceased comes across from ADT.
Discharged from service status displays when the patient is dismissed by the surgeon.
Surgery Indicated shows whenever surgery is approved. Procedure Requests can be listed as Pending Approval, Approved Or Rejected.
TRANSITION: Let’s look at how to put a case back on the Misc census if it needs to be cancelled.

49. Surgical Readiness Status Form
EXPLAIN:
The person assigned to monitor the surgical waitlist usually also fills out the Surgical Readiness Status Form. Patient wait times begin being calculated when surgery is indicated. In order to prevent excessive wait times, it is important to monitor the issues preventing surgery and keep it on schedule.
The Surgical Readiness Status Form can be used to track tests that need to be completed, or other issues that are impacting surgery.
Wait times can be placed in suspense from any patient decision not to have or to delay surgery. The patient can have up to three instances where the surgery is placed into suspense, after that the surgery is rescheduled.
The surgeon documents routine items through Routine Tests/Studies Needed on the H & P. These items flow to the Surgical Readiness Status form and do NOT display on the Misc census.
Items required for clearance for surgery are documented under the variable: Required for Clearance. These items DO display on the Misc Census under the Actions column.
TRANSITION:
Next, let’s look at the features of the VASQIP Risk Assessment.

50. VASQIP Risk Assessment
DISCUSS:
The VA’s Surgical Quality Improvement Program gathers information from all surgical patients and uses that information to assess and improve surgical outcomes for the VA. The Risk Calc icon in the toolbar accesses the VASQIP Risk form, which can be used to calculate the VASQIP risk assessment.
This accumulated information provides the information used to calculate surgical risk for the surgeon using the Risk Calculator.
To use the risk calculator form, fill in the data just like any other v-form that we have already seen, and then select Calculate Risk.
TRANSITION:
Does anyone have questions?

51. Questions? Session Wrap-Up ASK:
What kind of procedure notes do you most commonly create?
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?
TRANSITION:
Next let’s look at some features of the Tracker program that can help users follow the status of a patient having surgery.

52. 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 this information is based upon 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.

53. Tracker Icons Operative Consent IV in Place Staff Note Complete NPO
H&P Complete
Bed Available
Isolation Status
Blood Consent
IV in Place
NPO
Labs/Tests
EKG
Site Physically Marked
Staff Surgeon Visit Complete
DISCUSS:
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.
TRANSITION:
Let’s look at the additional information available in the Case Label drill down.

54. 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.
TRANSITION:
Let’s look at the additional information available in the Case Labels.

55. 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
TRANSITION:
Let’s practice what we learned.

56. Anesthesia Real World Scenario
Patient C presents for a left shoulder arthroscopy with subacromial decompression and will need an infraclavicular brachial plexus block with continuous catheter placement for post op pain control. Find Patient C and use the information in your handout to document the preoperative evaluation. Next, you complete the procedure note for the block, but you are called away to start a case before you are able to sign the note. Finally, you access the pending work census and sign the procedure note.
ASSIST: Move around room providing assistance as necessary.
ASK: What questions do you have about the Preoperative Evaluation?
INSTRUCT: Provide directions to complete the exercise.
Make sure OR Census is selected. If not, click Census and select it.
Click the Patient’s Name.
Select the Preop Evaluation from dropdown.
Select Anesthesia- Preop Evaluation.
Click OK.
Click Expand to expand all fields and enter the information in the form as indicated.
Click Preop Provider Signature in the Faculty Sign area and then click in the I have reviewed form area.
Click Done.
Click the back arrow to return to OR Census.
Highlight the patient and select Operative /Procedure Note from the dropdown.
Open the folder under Anesthesia.
Select infraclavicular brachial plexus block.
Document the block and save but do not sign the note.
Click Census and select Pending Work Census.
Select the unsigned note to open.
Expand the Sign and Lock area, then click the statement saying that you have reviewed the note.
Enter Password and click OK.

57. Questions? Session Wrap-Up ASK: How do you search for a case?
Where is the PACU Phase II script?
What are the fields that you typically chart, and where would you click to access those areas?
Ask for any questions on the exercises. Are there any steps or processes that are unclear?
DISCUSS:
Any outstanding questions from the parking lot?
TRANSITION: Let’s look at how to enter a service request.

58. Help Desk and References
Two methods of entering a service request
eService - low priority ticket
Phone – critical, high, medium, low priorities
Press 4 for Surgery Quality and Workflow Management, 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.
Additional training information can be found at the SQWM Training SharePoint Site:
TRANSITION: We would like to have your feedback.

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