1. Presentation TitleDate Anesthesia Manager Training Adding and Documenting Medications

2. Presentation TitleDate Objectives By the end of this module the participant will be able to: Be familiar with the Medications (All) flowsheet Be able to add a dose to a default medication Be able to add non default medications to the flowsheet Be able to modify, delete a dose of medication Be familiar with the medication summary

3. Presentation TitleDate Medications (All) Default Flowsheet Default List of Medications can be found on: Anesthesia Summary Flowsheet Medications (All) Flowsheet Can be organized by: Subheading Alphabetical List is a compromise with nursing all meds will carry over into the postoperative period unless cancelled/discontinued Organized by Subheadings

4. Presentation TitleDate Medications (All) Flowsheet Organized alphabetically

5. Presentation TitleDate Adding a Dose for a Default Medication 1. Click cursor at desired time-Document Window opens 2. Enter dose 3. Adjust time if required 4. Change route if required 5. Hit check mark

6. Presentation TitleDate Adding a Dose for a Default Medication

7. Presentation TitleDate Adding Additional Medications to the Flowsheet Standard Option 1. Mouse turns to hand when placed over the “Medications” title bar 2. Can choose “All Families” or a “Specific Family” List of drugs appears “All Families” will list ALL drugs in the database alphabetically.

8. Presentation TitleDate Adding Additional Medications to the Flowsheet Standard Option Selecting a family will list ONLY the drugs specific to that family in alphabetical order

9. Presentation TitleDate Adding Additional Medications to the Flowsheet Standard Option Mouse turns to hand when placed over a specific Medication subheading Only medications specific to that family will be listed alphabetically

10. Presentation TitleDate Adding Additional Medications to the Flowsheet Standard Option Regardless of option used to add a new medication, you can now: “Add and Document” Brings up “document window” prior to order appearing on the flowsheet  Can adjust time  Can adjust volume  Can enter additives  Can set pump rate  Can adjust site “Add” Enters new order onto the flowsheet User must now click on desired time on the timeline to open the “Document Window” and enter information

11. Presentation TitleDate Adding Additional Medications to the Flowsheet Protocol Option Protocols are groups of standard orders that you can add to the patient chart in part or in whole Anesthesia Manager has been configured with multiple drug protocols which classify medications by families or other logical means

12. Presentation TitleDate Adding Additional Medications to the Flowsheet Protocol Option Selecting any of the medication protocols will list: Drugs/drug combinations or infusions specific to that family rather than just single drugs as per previous methods Drugs/drug combinations or infusions that are commonplace in anesthetic practice rather than ALL drugs as per previous methods

13. Presentation TitleDate Adding Additional Medications to the Flowsheet Protocol Option Eg: Selecting the *Anes_Analgesics protocol will list all common analgesics/analgesic infusions and drug combination analgesic infusions

14. Presentation TitleDate Adding Additional Medications to the Flowsheet Protocol Option 1. Click to select one drug or multiple drugs (*no need to hold down shift/control) 2. Hit “Add” button to include selected medications in flowsheet Hit the “Add” button to select ALL drugs/infusions/combinations Option 1 Option 2

15. Presentation TitleDate Adding Additional Medications to the Flowsheet CAUTION DO NOT USE THE EDIT KEY WHILE IN PROTOCOLS YOU CAN CAUSE REPROGRAMMING OF THE DATABASE (version bug)

16. Presentation TitleDate Let me BE CLEAR DO NOT USE THE EDIT KEY WHILE IN PROTOCOLS YOU CAN CAUSE REPROGRAMMING OF THE DATABASE (version bug)

17. Presentation TitleDate Documenting a Second Dose of Medication (same time block) 1. Click on previous dose- Document Window opens 2. Click on “Add Dose” 3. Enter additional dose (default will be previous value) 4. Hit check box

18. Presentation TitleDate Documenting a Second Dose of Medication (same time block) Total dose is preceded by an = sign to indicate divided dosing In real time, you must wait at least 1 minute before attempting to add an additional dose to the initial dose (above example shows 50 mcg at 21:08:10 and 50 mcg at 21:09:40) Display of Doses given

19. Presentation TitleDate Modifying a Dose 1. Click on dose that you want to change- Document Window opens 2. Check the time of dose that you want to modify 3. Modify the dose 4. Hit OK

20. Presentation TitleDate Modifying a Dose 5. Agree to the modification Modified Dose appears on flowsheet

21. Presentation TitleDate Deleting a Dose 1. Click on dose that you want to undo/delete- Document Window opens 2. Check the time of dose that you want to undo/delete 3. Hit “Undo” 4. Agree to the modification Dose removed from the flowsheet

22. Presentation TitleDate Adding a Combined Medication (Bolus) Combined Medications are found under “Protocols” and can be: IV bolus and infusion - Simple (2 drugs) IV bolus and infusion - Complex (more than 2 drugs) Epidural bolus and infusion allows for documentation in one document window rather than multiple document windows Represented by a “pill bottle” icon  We can’t do anything about the cost prefix

23. Presentation TitleDate Adding a Combined Medication (Bolus) 1. Click at desired time of administration- Document window opens 2. Populate dose fields of the respective meds. 3. Hit check mark

24. Presentation TitleDate Adding a Combined Medication (Infusion)

25. Presentation TitleDate Adding a Combined Medication (Infusion) 1. Click at desired time of administration- Document window opens Bolus infusion represented by absolute units of measurement only  (eg. mg) Continuous Infusion Represented by units of measurement/+- weight/+- time  (eg. mg/kg/hr)

26. Presentation TitleDate Adding a Combined Medication (Infusion) Building the Combo 1. Add the drug masses to your combo 2. Default fluid volume=20mL. Adjust if required 3. Enter weight if required Build your combo med as if you are filling a syringe with the different amounts of the respective drugs-entering doses at this point will result in FAILURE.

27. Presentation TitleDate Adding a Combined Medication (Infusion) Building the Combo 5. Either enter in the dose of: a. ONE of the combo meds OR b. the desired Pump Rate. All other fields will populate automatically. 4. Either enter in the dose of: a. ONE of the combo meds OR b. the desired Pump Rate. All other fields will populate automatically. 5. Hit “OK”

28. Presentation TitleDate Adding a Combined Medication (Infusion) Building the Combo Combination Medication appears in both: - Medications (All) flowsheet -Med Infusions & Fluids (All) flowsheet

29. Presentation TitleDate Adding a Combined Medication (Infusion) Adjusting the Combo 1. Click at desired time of administration- Document window opens 2. ONLY OPTION -adjust the flow rate

30. Presentation TitleDate Adding a Combined Medication (Infusion) Adjusting the Combo Reducing the pump rate by 50% reduces the infusion rate by the same amount

31. Presentation TitleDate Medication Summary Total Dose administered over the current encounter Data sorted by “Administration Time” OR alphabetically OR by family Access by pull down menu OR Medication Summary icon

32. Presentation TitleDate Adding and Documenting Medications: Exercise Add a few doses of various default medications Add new Medications to the flowsheet via: List of medications belonging to a specific family Using protocols Add a second dose of a medication Modify a medication dose Review the medications administered in the Medications Summary

33. Presentation TitleDate Questions And Answers