1. Anesthesia Manager Training Basic Navigation

2. Presentation TitleDate Objectives By the end of this module the participant will be able to: Use the basic terminology for all parts of the Anesthesia Manager application Understand the : Main Toolbar Macro Toolbar Navigation Menus (flowsheets/demographics) Adjusting Resolution Freezing the timeline Applying Filters Pull down menus

3. Presentation TitleDate Contents Introduction Launch/Login The Home Screen Main Toolbar Main Toolbar or Navigation-Demographics Navigation Bar-Flowsheets Macro Toolbar Viewing Options Pull Down Menus (F)-Function Keys

4. Presentation TitleDate What is Anesthesia Manager? Anesthesia Manager is a charting application and data collection engine for: 1. automatically and manually collected data 2. manually entered fluids and medications 3. It is an application that manages, 4. integrates 5. and stores Vital patient information at the point of care!

5. Presentation TitleDate Where does all the data come from? Medical devices (through drivers that Picis develops) HIS systems (Hospital Information Systems) Laboratory systems (Future Development) End users Others? Calculations done by Anesthesia Manager

6. Presentation TitleDate Clinical Data in Anesthesia Manager Real Time Variables Ventilator and Monitor data MANUALLY entered clinical data Medications Fluids (INtake and OUTput) Laboratory data (Future Development) Clinical events Demographic data

7. Presentation TitleDate Launch and Login to Application We are training in the TRAIN environment User ID is your Windows Login ID Password is Canada123 (case sensitive) You will be prompted to change password Will need to repeat this exercise when in the LIVE environment OR (civic campus) Canada789

8. Presentation TitleDate Census List The software will open and default to: the facility/location you are working in and list patients by OR#

9. Presentation TitleDate Census List 1. Highlight the Patient 2. Click “Start Session” to open a new session for that patient

10. Presentation TitleDate Home Screen: A Good Place to Start! Anesthesia Manager automatically opens to the “Anesthesia Summary” flow sheet This is our HOME screen

11. Presentation TitleDate Ottawa Hospital Workstation Workstations will have a 19” monitor in portrait mode This will allow the display of considerable data/entry fields Toolbar icons and macros will appear in a vertical orientation on the left and right hand sides of the screen

12. Presentation TitleDate Home Screen Anesthesia Summary Flowsheet The home screen consists of four flowsheets: Gases-Agents-Monitor Data Medications Med Infusions/Fluids Standard Anesthesia Monitoring

13. Presentation TitleDate Home Screen Anesthesia Summary Flowsheet The home screen consists of four flowsheets: Gases-Agents-Monitor Data Medications Organized by subheading of medication Med Infusions/Fluids Standard Anesthesia Monitoring Subheading can be turned ON (organized by type) or OFF (organized alphabetically)

14. Presentation TitleDate Home Screen Anesthesia Summary Flowsheet The home screen consists of four flowsheets: Gases-Agents-Monitor Data Medications Med Infusions/Fluids Organized by Fluids/Infusions “In” and Fluids/Infusions “Out” Standard Anesthesia Monitoring

15. Presentation TitleDate Home Screen Anesthesia Summary Flowsheet The home screen consists of four flowsheets: Gases-Agents-Monitor Data Medications Med Infusions/Fluids Standard Anesthesia Monitoring Graphical recording of typical vital sign parameters  sBP, dBP, HR, Sp0 2, ETC0 2

16. Presentation TitleDate Home Screen Anesthesia Summary Flowsheet Seclecting the “Home Screen” icon will also take you to the Home Screen (Anesthesia Summary Flowsheet).

17. Presentation TitleDate Home Screen Patient Banner Patient Name Sex Weight Height BSA Medication Allergies Other Allergies Precautions/Alerts Incoming Lab Data beacon (future enhancement) BLUE BANNER=ACTIVE Patient WHITE BANNER=REMOTE Patient

18. Presentation TitleDate The Tool Bar The Tool Bar is designed to help users easily access functions most commonly used There are two types of toolbars: MAIN and MACRO MAIN TOOLBAR Designed to assist with the workflow of the case (Start of anesthesia to Transfer/Discharge) Will talk about the Macro Toolbar in the “Events” Tutorial MACRO TOOLBAR

19. Presentation TitleDate Main Toolbar ”Log Off/On” Log Off-used to stop documenting under your user name Eg. End of case, relief, transfer of care Real time data continues to be captured on patient You will be asked for your credentials when you elect to logoff Log On-used to start documenting under your user name As above

20. Presentation TitleDate Main Toolbar “Home” Home Takes you back to the “Anesthesia Summary Flowsheet

21. Presentation TitleDate Main Toolbar “Protocols” Protocols Groups of standard orders (medications (single or combinations) /infusions) that you can add to the patient chart at the SAME time. Will offer significant time savings Protocols are an integral part of this build

22. Presentation TitleDate Main Toolbar “Protocols” Custom built to allow rapid access and addition to the respective area of a flowsheet

23. Presentation TitleDate Main Toolbar “Protocols”- Eg. Adding drugs from the **Anes Drug Cart For example, the “Default Medication Flowsheet” contains the main drugs from the respective medication classes used in the vast majority of cases If an administered drug is not present, “Protocols” is a powerful and timesaving technique to add what is required Other options are also available and will be discussed.

24. Presentation TitleDate Main Toolbar “Protocols”- Eg. Adding drugs from the **Anes Drug Cart In this case, “*Anes-Drug Cart” brings up every drug/fluid not listed in the default protocol that can be found on our carts in the Operating Room. One drug/fluid or mulitple drugs/fluids can be selected simultaneously and quickly added to the flowsheet

25. Presentation TitleDate Main Toolbar “Protocols”- Eg. Performing a Spinal Anesthetic 2. Click on Atropine and Bupivicaine to select If you make an error, reclick to deselect 3. Hit Add button 1. Highlight a protocol option Atropine and Bupivicaine are NOT present on the default medication flowsheet However, both drugs can be found on the anesthesia cart (**Anes-Drug Cart protocol)

26. Presentation TitleDate Main Toolbar “Protocols”- Eg. Performing a Spinal Anesthetic OR alternatively, the drugs can be selected from the respective protocols: *Anes_Regional Spinal (Bupivicaine) protocol Select Bupivicaine x% *Anes_CVS_Anticholinergics protocol Select Atropine

27. Presentation TitleDate Main Toolbar “Protocols”- Eg. Performing a Spinal Anesthetic Atropine and Bupivicaine now added to the Flowsheet

28. Presentation TitleDate Main Toolbar “Protocols”-Subspecialty/Unique Events In addition to Drug Protocols, we have created Protocols for various subspecialties and unique problems Eg. Vascular, Neuro, Obs/Gyn, Trauma, MH, ACLS Click on the orders you want added to the flowsheet If you want all the orders in a Protocol, hit ADD without selecting an order

29. Presentation TitleDate Main Toolbar “Event Log” Event Log-Adding Events This is the way you will enter in all notes related to the procedure Events remove the need to “free text” Will discuss further in upcoming lecture

30. Presentation TitleDate Main Toolbar “Device Snapshot” Device Snapshot Manual capture of Real Time Data (RTD) from devices to obtain all current values at that point in time.  Will discuss further in upcoming lecture

31. Presentation TitleDate Main Toolbar “Emergency Data” Insert Emergency Data Emergency data is a selection of data points from a temporary reserve on the local workstation that holds all data device readings received over the previous six hours. Will allow you to retrospectively enter Real Time Data (RTD) every 30 seconds for a defined period  Will discuss further in upcoming lecture

32. Presentation TitleDate Main Toolbar “Fluid Balance” Fluid Balance Total intake and output for fluids documented on flowsheets are displayed graphically in the Fluid Balance window. The window also shows total volumes for all fluids.

33. Presentation TitleDate Main Toolbar “Fluid Balance” The Fluid Balance Window for anesthesia environments shows intake and output on a single pie chart. An accompanying table shows values for each fluid type. Hit this icon to see the “Fluid Balance Detail” Fluid Balance Pie Chart Fluid Balance Histogram Final Fluid Balance

34. Presentation TitleDate Main Toolbar “Medication Summary” Medication Summary Shows all medications that have been documented, including those administered as drips. This window shows individual and total doses for the selected viewing period. Medications can be sorted alphabetically by medication or family name, or chronologically by administration time.

35. Presentation TitleDate Main Toolbar “Medication Summary” Total Dose administered over the current encounter Data sorted by “Administration Time”

36. Presentation TitleDate Main Toolbar “ Supervisory Anesthesia Module” S.A.M. (Supervisory Anesthesia Module) An anesthesiologist who supervises anesthesia residents/fellows may need to document certain events during the procedure. SAM allows you to log on and enter events and demographic data while another user is logged on. All of your entries will be attributed to you. When you have finished, the other user can continue working without having to log on again.  Will discuss further in upcoming lecture

37. Presentation TitleDate Main Toolbar “Print” Print Allows you to create a paper/electronic record

38. Presentation TitleDate Main Toolbar “Remote View” Remote View Allows you to enter and modify any type of data for which you have access rights on a remote workstation (i.e patient in another location)  Finish/revise/review documentation on a previous patient  You are able to switch between an active patient and remote viewing on the local workstation

39. Presentation TitleDate Main Toolbar “Remote View” White Banner = Remote View Blue Banner= Active Patient

40. Presentation TitleDate Main Toolbar “OR Manager” OR Manager Access to the Smart track System  Can see location of patients in the system (Preop, OR, PACU, Discharged)

41. Presentation TitleDate Main Toolbar “Demographics Flowsheet” Demographics Found at bottom of Navigation Panel

42. Presentation TitleDate Demographics “Patient Identification” Should be coming across from OR Manager/ADT Hospital system No need to enter any information into these fields

43. Presentation TitleDate Demographics “Admit Ht/Wt/BSA/BMI/Blood Type” As in Preop Manager Enter either in metric or imperial with automatic conversion  Metric will be printed to Anesthesia Record  Blood Type can be left alone Hit OK

44. Presentation TitleDate Demographics “ Allergies and Precautions” (Medication Allergies) 2. Pull down menu 3. Enter name of drug into “Keyword Search” 4. Highlight desired result 5. Hit OK As in Preop Manager 1.Hit New Row if required

45. Presentation TitleDate Demographics “Allergies and Precautions” (Other Allergies-not drugs) 2. Pull down menu 3. Highlight desired result 4. Hit OK As in Preop Manager 1.Hit New Row if required

46. Presentation TitleDate Demographics “Allergies and Precautions” (Precautions) 2. Pull down menu 3. Highlight desired result 4. Hit OK As in Preop Manager 1.Hit New Row if required

47. Presentation TitleDate Demographics “ASA Level” 1. Pick appropriate ASA 2. Hit OK

48. Presentation TitleDate Demographics “Medical Team” First Case of the Day Booked Surgeon should be automatically populated by OR Manager Correct information as required Booked Anesthesiologist should be populated by OR Manager Correct information as required All subsequent cases will require data entry 2. Pull down menu 3. Highlight name for relevant clinical role 4. Hit OK 1.Hit New Row if required

49. Presentation TitleDate Demographics “Procedure(s)” Booked surgical procedure should be populated by OR Manager Revisions, changes or additions will require data entry 2. Enter keyword 3. Find now 5. Hit Add 4. Choose appropriate procedure 1. Hit ADD if required

50. Presentation TitleDate Demographics Tab Required Events Required Events (highlighted if not completed) These are events that should be entered (*if relevant) on EVERY Anesthetic record Anesthesia Start (S) Anesthesia Case Finish Time (F) QA Indicator Anesthesia Type Positioning Equipment Check Peripheral IV Airway Intubation (if applicable) Functions as a reminder to insure chart is complete

51. Presentation TitleDate Navigation Panel The Navigation Panel gives you quick access to: Flowsheets and Demographics (recently discussed via icon in Main Toolbar)

52. Presentation TitleDate Gases/Monitor Data Flowsheet Any variable captured by the Datex CPU or the 7900 ventilator will be automatically captured Exception -Fresh Gas Flows Aestiva has manual controls These numbers MUST be entered manually

53. Presentation TitleDate Medications (All) Flowsheet For documentation of: all medications all medication infusions

54. Presentation TitleDate Med Infusions & Fluids Flowsheet For documentation of all: Fluids In (including medication infusions) and Fluids Out

55. Presentation TitleDate Lab Results (All) Flowsheet Future development to capture lab results in real time from hospital information systems and populate the electronic anesthesia record.

56. Presentation TitleDate Anesthesia Summary Home Screen

57. Presentation TitleDate Trends Flowsheet For display of: Non invasive trending (upper graph) Sp02 EtC02 HR NIBP Resp Rate (from ETC02) Invasive trending (lower graph) HR Arterial Line Blood pressure PA Catheter pressures CVP

58. Presentation TitleDate Invasive Monitoring Flowsheet For display of: invasive RTD (upper) and graphical display of invasive trending(lower) HR Arterial Line Blood pressure PA Catheter pressures CVP

59. Presentation TitleDate Vent Settings Flowsheet For display of: Basic ventilation parameters (upper table) Ventilation and oxygentation trend (lower graph) Respirations ETC0 2 Sp0 2 Pmax

60. Presentation TitleDate Lab Results (Manual Entry) Flowsheet Any result not automatically populated by the lab Includes POC results

61. Presentation TitleDate Click Box to Continue to second half of Presentation