1. Surgery Quality and Workflow Manager
VASQIP Nursing Workflow

2. Learning Objectives
After instruction, students will be able to complete the following tasks:
Access and navigate windows for Surgery Clinic Census, OR Census, and VASQIP Census
Access and enter data in VASQIP forms
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), role 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.
The purpose of today’s training is to understand the functionality of the Surgery Quality and Workflow Manager tool, specifically the OR Census, Surgery Clinic Census, VASQIP Census and Pending Work Census.
READ and DISCUSS Learning Objectives.

3. SQWM Documentation Icon
EXPLAIN:
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 start by logging in to the system.

4. Access Perioperative Anesthesia
DEMONSTRATE:
After clicking the SQWM Documentation icon, enter your Login Name and Password. Click OK.
The Centricity Perioperative Anesthesia (CPA) login page allows the user to log into the Anesthesia Application and to 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 see patient data display. All screenshots and training exercises take place in a training database, and no actual personal patient data is used.
TRANSITION: Let’s look at some of the features of the system.

5. Census Selection DISCUSS:
As we work in the different areas of the software, we discuss several different censuses. A census is a list of patients or items needing attention. Different logins may have a different census, which is the list that opens automatically on log in, set as the default. This is usually established by role.
The Census options for a VASQIP Nurse are usually OR Census, Surgery Clinic Census, VASQIP Census, and Pending Work Census.
The Surgery Clinic census lists the patients scheduled for a consult in the surgery clinic.
OR Census lists patients scheduled for surgery on a particular day.
VASQIP Census lists post-surgery patients. The VASQIP Nurse gathers information for the VA’s Surgical Quality Improvement Program by collecting data from all surgical patients using the VASQIP Form.
VASQIP data is used to improve surgical outcomes for the VA.
The Pending Work Census lists the unsigned notes or other items that require attention.
TRANSITION:
Let’s look at how to search for patients.

6. Search Options EXPLAIN:
The surgery clinic, also called Surgical Consult Census, is often the default clinic for many users, and it displays on login. Patients display on the Surgery Clinic census following a consult request.
To search for patients in the Surgery Clinic select a clinic from the Unit dropdown, such as General Surgery, Orthopedics, etc. A default unit for the user can also be designated for users in the Surgery Clinic Census. The Surgery Clinic census has multi-select 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
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 now 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.

7. Census Navigation and Toolbars
Surgical Consult and VASQIP Census Toolbars
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.
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.
The New Case icon allows you to schedule a new case if you need to schedule multiple cases on the same patient.
Export allows the user to export the results of search within a 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 census 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.
Unit allows the user to designate a unit.
TRANSITION: Let’s start with the Export icon and learn how to export your search results to be able to manipulate them in a spreadsheet.

8. 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 features of the OR Census.

9. Census Navigation TRANSITION:
Nurses can also access OR Census. It defaults to display patients scheduled for surgery on the current date.
DISCUSS:
To display patients for a specific date census, select the From Date and the To Date in the date fields on which you wish to search. To retrieve all patients for a specific date, do not enter any information in the patient search text box. All patients that are scheduled for that clinic date displays.
To search for a specific patient, enter the last name in the Last Name field, and click Search. The 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. The more data entered in the search fields, the more focused the results. In order to search on the various roles (i.e. Surgeon, Anesthetist) these roles must have been assigned via the scheduling system. As users log in to the application, if they have been assigned 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: Now, let’s look at some of the features of the VASQIP Census.

10. VASQIP Documentation 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.
VASQIP forms are only used for surgical patients and documents anything that happens within 30 days after surgery.
For surgical patients, post case, a brief operative note is documented directly after surgery that eventually pulls in information based on what the nurses charted. This is done from OR Census and includes a clinic note, E-consult, or non-visit phone call. It also includes post operative follow up from the surgery clinic.
The VASQIP forms provide information that is used to calculate the surgical risk for the surgeon using the Risk Calculator in the Surgical H & P.
To display patients for a specific date census, select the From Date and the To Date in the date fields on which you wish to search. To retrieve all patients for a specific date, do not enter any information in the patient search text box. All patients that are scheduled for that clinic date displays.
To search for a specific patient, enter the last name in the Last Name field, and click Search. The 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 display area.
TRANSITION: Let’s look at the documentation available from the VASQIP Census.

11. VASQIP Form Choices EXPLAIN:
The form selection dialog box displays. The Date and Time defaults to the date and time the form is launched. This can be altered prior to opening the form.
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 previous forms to flow into the current form if they are similar.
TRANSITION:
Next, let’s look at how to document forms.

12. VASQIP Forms
DISCUSS:
Once the form has been opened, information from forms previously documented populates the form.
The nurse can also make more lines by using the Add Variable icon or by adding free text with the pencil icon.
TRANSITION: Let’s look at accessing Labs directly from SQWM.

13. Patient Banner EXPLAIN:
The patient banner that displays at the top of the form contains important information on the selected patient that can be seen with higher visibility.
Information is populated from documentation within the form or from scheduled case information. After charting, click the Refresh icon to display the information documented on the form in the banner.
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.
TRANSITION:
Let’s look at the form toolbar and the function of each icon.

14. 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 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: Let’s look at accessing Labs directly from SQWM.

15. 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 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.

16. 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 how to enter data in a form.

17. Enter Data in the Form EXPLAIN:
The 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 do not update a form that is already launched.
You can expand a panel by clicking the + on the left side of the page. You can collapse a panel by clicking the -. You can also use the expand and collapse icons 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. The WNL button when selected charts the appropriate verbiage to indicate a normal assessment for that section. The data 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 where once the first selection is made subsequent details are requested.

18. Sign Form with Password
EXPLAIN:
When a user finishes documenting a form, to lock it and allow for it to be transmitted, the user clicks Sign Off.
A Password Required prompt displays. The user can certify the document or cancel out if more information needs to be charted.
TRANSITION:
Now let’s look at how to send the form.

19. Send Form
EXPLAIN:
To Send the form, open the Send or Hold Form area. Click the line that says Complete Send Form and then Done to send the form. You can also save the form and return to complete it at a later time by clicking Hold Form Not Complete.
VA policy dictates that the form has to be sent within 30 or 90 days. Once sent, it goes out in the evening as a batch file.
TRANSITION:
Now let’s practice what we learned.

20. Practice – VASQIP Form
Last month, knee surgery was performed on Patient B. The surgical procedure was 29883, Arthroscopy, Knee, Surgical w/ Meniscus Repair Medial & Lateral, right laterality. The patient was healthy overall and denied smoking and using alcohol. Surgery proceeded normally and there were no postoperative complications. The patient was discharged as planned. Access the VASQIP form using the VASQIP census and document this surgery and follow up.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about the VASQIP forms?
INSTRUCT:
Directions to complete the exercise.
Log in to SQWM Documentation.
Select VASQIP Census.
Click Patient B.
Click VASQIP Standard.
Enter the relevant data.
Click in the Sign area and then in “I have reviewed form.”
Enter password.
Click in the Complete Send form area.
Click Done.
Click Back to go back to the census.

21. Review We have covered the following topics:
Access and navigate OR Census and VASQIP Census
Access and enter data in VASQIP forms
REVIEW:
In this section, we learned how to access OR Census, Surgery Clinic Census and the VASQIP Census.
We discussed how to search for patients and how to complete and send the VASQIP forms.
What questions do you have about any of those processes?

22. Real World Scenario
Patient C presents for left shoulder arthroscopy with subacromial decompression and is going to have an infraclavicular brachial plexus block with continuous catheter placement in holding. You gave 3 mg of Versed for the block. Use the information on your handout to document the following form for this patient: the VASQIP form.
ASSIST:
Move around room providing assistance as necessary.
ASK:
What questions do you have about entering a Preop phone call note?
INSTRUCT:
Directions to complete the exercise.
Log in to SQWM Documentation.
Select the VASQIP Census.
Find the Patient.
Click the VASQIP Standard form.
Enter relevant data.
Click in the Sign area and then in “I have reviewed form.”
Enter password.
Click Send Form.

23. Questions? Session Wrap-Up ASK: How do you access VASQIP forms?
What two censuses are typically used?
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.

24. 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 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.

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