1. Anesthesia Manager Training “Events”

2. Presentation TitleDate Objectives By the end of this module the participant will be able to: Open the Events Window from the Menu command and the toolbar icon Add an Event from an Event Set Add an Event after choosing an Event Type Add an Event that is a free text comment Add a comment and change the time for an Event Use the Search tab to search for an Event Use the S.A.M. module to add supervisory data Delete an Event View the History for all additions, deletions and modifications to Events

3. Presentation TitleDate Current Anesthesia Record “Documentation” The paper record provides visual prompts to complete required information End user moves from field to field and Documents Circles Ticks all relevant information to insure a completed anesthesia record

4. Presentation TitleDate Current Anesthesia Record “Documentation” Events typically documented on the paper record: Anesthesia Start Demographic Information Procedural Information Machine/Monitor check/functionality Review of appropriate documentation Technique (GA/Regional/MAC,etc) +relevant details Airway management + relevant details IV and other invasive lines Monitors Patient position/eye status Additional Equipment Transfer/Discharge information Anesthesia Finish All other comments

5. Presentation TitleDate Elecctronic Record “Documentation” Electronic Record is a BLANK SLATE No visual prompting Potential to forget essential documentation to insure a completed anesthesia record

6. Presentation TitleDate Future Anesthesia Record “Documentation” Macro toolbar is your friend important event markers/symbols will be added to the timeline Standard event descriptors will be added to the Event Log Will act as like the visual prompter on the paper record to document required information

7. Presentation TitleDate Future Anesthesia Record “Documentation” Events will replace Written comments Check Boxes Circled Short cuts

8. Presentation TitleDate Adding Events Events can be added by: Function key F4 Using pull down menu  Insert/View-Events (F4) Selecting icon Hitting “Add” button in the “Events Log” window  (see next slide)

9. Presentation TitleDate Adding Events 2. Click on the Add Button 1. Event Log Window is OPEN

10. Presentation TitleDate Adding Events 3 options to pick: Event Sets These are custom groups created locally by the Anesthesia Workgroup This is the DEFAULT view  You will work in this view 99% of the time. All Events These are generic groups created by the software developers Keyword Events Provides search functionality

11. Presentation TitleDate Adding Events via “Event Sets” Event Sets Timeline organization Groups all events specific to a given activity Redundancy Various events can be found repeated within the same or different event sets Complete Minimal dependence to insert descriptive comments

12. Presentation TitleDate Adding Events via “All Events” All Events Consists of multiple “event types” that were created by the software vendor and listed as ANES: ……. Any new custom event entered by the Anesthesia Workgroup has to belong to one “ANES Event Type”. Every event is listed alphabetically under “All types”

13. Presentation TitleDate Adding Events via “Event Sets” “Adding an Event to the Event Log (Anesthesia Record)” 3. Double click on the “event” or click on the “forward” arrow 1. Pick the relevant “Event Set” 2. Highlight the desired “Event” 3. Double click on the “event” OR click on the > arrow

14. Presentation TitleDate Adding Events via “Event Sets” “Adding an Event to the Event Log (Anesthesia Record)” Event(s) will move over to the “Selected Events” window To document to the record, you must hit OK. Selected event now appears in the Event Log 4. Hit OK

15. Presentation TitleDate Adding Events via “Event Sets” “Adding an Event to the Event Log (Anesthesia Record)” Add multiple events simultaneously by: “Control-clicking” to select non contiguous events “Shift-clicking” to select contiguous events 1. Highlighting multiple events 2. Click on the > arrow

16. Presentation TitleDate Adding Events via “Event Sets” “Adding an Event to the Event Log (Anesthesia Record)” Selected “Events” added to event window by: (control or shift)/click/> Hit OK button 3. Hit OK

17. Presentation TitleDate Adding Events via “Event Sets” “Adding an Event to the Event Log (Anesthesia Record)” Multiple “Events” now appear in the Event Log

18. Presentation TitleDate Adding a Comment to an Event 1. From the “Selected Event” window, click on the Comment Field adjacent to the event and type your comment 2. Hit OK

19. Presentation TitleDate Changing the time of an Event 1. Adjust the time- default is current time 2. Hit OK

20. Presentation TitleDate Add/Revise a “Comment” on an existing Event From the Event Log window, double click on the Event/Comment OR Select the Event and click on the Edit button Change the time of the event if required Add or revise existing comment

21. Presentation TitleDate Deleting a “Comment” on an existing Event 1. Highlight event to be deleted 2. Hit the < arrow (this stops event from ever populating the Event Log) 3. OR highlight event from Event Log 4. Hit Delete

22. Presentation TitleDate Adding a Free Text Event via “Memo” Default name of this type of Event is “Memo” 2. Type your memo. Maximum characters is 255. Memo/Comment now is Event Log 1.From Event Log window, click on “Memo” button 2. Type memo and hit OK

23. Presentation TitleDate Searching for an Event From the “Add Event” window, select “Keyword Search” Enter in Keyword and Find Move event to “Selected Event” window by double clicking or hitting > arrow

24. Presentation TitleDate Viewing Events on the Timeline Once an event is added, a blue rectangle appears on the timeline Run your mouse over the blue rectangle and the events entered at that time are displayed

25. Presentation TitleDate Adding Events from the Timeline Click on Timeline and the “Add Event” log opens with the current time selected

26. Presentation TitleDate Adding Events from “Basic” Event Sets Four “Basic” Event Sets have been created to contain the most common events for a typical:  GA  Spinal  MAC  Eye procedure –A separate EYE Template exists and will be covered in another presentation “Basic” Event Sets will eliminate the need to jump around to other Event Sets for the required information

27. Presentation TitleDate Event Set-”Basic GA” Reminders to include required information Reminders to include required information (Fluids) Reminder to select “Anesthesia Type” Reminder to document IV Start Reminder to document A/W Management Reminder to document Patient position, arm position,eyes Reminder to document End Activity

28. Presentation TitleDate Event Sets-”Basic Spinal”

29. Presentation TitleDate Event Sets-”Basic MAC”

30. Presentation TitleDate Timeline Based Approach Anesthesia Type (must be completed) / Preop Eval Check your machine / document milestone events Start an IV Secure an Airway (General Anesthetic Regional Anesthetic MAC Anesthetic As previously described-should account for most activities related to a basic case Event Sets-Organization

31. Presentation TitleDate Event Sets-Organization Eyes / Patient Position End Activities Invasive Lines Subspecialties Other Timeline Based Approach Anything not found under the Basic Event Sets will be found within the appropriate Event Set

32. Presentation TitleDate Adding Events via the Macro Toolbar “Documentation” Macro toolbar is your friend-Following the icons in the toolbar will help you document a COMPLETE anesthesia record Clicking on a Macro will: Add important event markers/symbols to the timeline Add Event descriptor(s) to the Event Log

33. Presentation TitleDate Adding Events via the Macro Toolbar “Anesthesia Start (S)” 1. Mouse over Macro & click 2. Agree with current time or adjust time Hit OK Event marked on Timeline with “S” 1. Mouse over Macro & click

34. Presentation TitleDate Adding Events via the Macro Toolbar “Equipment Check (C)” 2. Agree with current time or adjust time Hit OK Event marked on Timeline with “C” 1. Mouse over Macro & click

35. Presentation TitleDate Adding Events via the Macro Toolbar “Preop Assessment (CPSO Required)” 2. Agree with current time or adjust time Hit OK 1. Mouse over Macro & click

36. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” 2. Demographics Window opens 1. Mouse over Macro & click

37. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” Adm Ht/Wt/BSA/Blood Type Click on “Adm/Ht/Wt/” Fill in Weight and Height Weight and Height may auto populate if: RN has entered this information for you in the Preop Session Preop Assessment done on SAME day as Scheduled Procedure

38. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” Allergies and Precautions Click on “Allergies & Precautions” Complete using pull down menus Allergies and Precautions auto populate if: This information already exists from a current or previous encounter i.e. This information will FOLLOW a patient indefinitely Preop Assessment done on SAME day as Scheduled Procedure

39. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” Allergies and Precautions-Medication Allergies 1. Pull down menu 2. Enter name of drug into “Keyword Search” 3. Highlight desired result 4. Hit OK

40. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” Allergies and Precautions-Other Allergies (not drugs) 1. Pull down menu 2. Highlight desired result 3. Hit OK

41. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” Allergies and Precautions-Precautions 1. Pull down menu 2. Highlight desired result 3. Hit OK

42. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” ASA Click on ASA Level

43. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” ASA Pull down ASA menu, select ASA and hit “Close” button

44. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” Medical Team Select Medical Team

45. Presentation TitleDate Adding Events via the Macro Toolbar “ASA/Medical Team-Demographic Info” Medical Team Complete as appropriate See next slides

46. Presentation TitleDate Demographics “ASA/Medical Team-Demographic Info” Medical Team Main OR 1’st ELECTIVE Case of Day Scheduled Surgeon will populate from OR Manager. Do NOT make any changes/ corrections to this field Scheduled Anesthesiologist should populate from OR Manager. If information is correct, no further entries required If information NOT correct or BLANK, populate the Clinical Role /Anesthesiologist using the pull down menu 1. Pull down menu 2. Highlight name for relevant clinical role 3. Hit OK

47. Presentation TitleDate Demographics “ASA/Medical Team-Demographic Info” Medical Team Main OR-ALL Other Cases Main OR-Emergency List Scheduled Surgeon will populate from OR Manager. Do NOT make any changes/ corrections to this field. Scheduled Anesthesiologist will NOT populate from OR Manager. Populate the Clinical Role /Anesthesiologist using the pull down menu 1. Pull down menu 2. Highlight name for relevant clinical role 3. Hit OK

48. Presentation TitleDate Demographics “ASA/Medical Team-Demographic Info” Medical Team OUTSIDE MAIN OR ALL CASES Scheduled Surgeon will NOT populate from OR Manager. Populate the Clinical Role/Primary Surgeon using the pull down menu Scheduled Anesthesiologist will NOT populate from OR Manager. Populate the Clinical Role /Anesthesiologist using the pull down menu 1. Pull down menu 2. Highlight name for relevant clinical role 3. Hit OK

49. Presentation TitleDate 2. Agree with current time OR adjust time Hit OK Event marked on Timeline with “R” This Macro does NOT indicate the Anesthesia Type. It simply puts a placeholder on the timeline for reference purposes/charting purposes 1. Mouse over Macro & click

50. Presentation TitleDate Adding Events via the Macro Toolbar “General Anesthesia Start (G)” 2. Agree with current time OR adjust time Hit OK Event marked on Timeline with “G” This Macro does NOT indicate the Anesthesia Type. It simply puts a placeholder on the timeline for reference purposes/charting purposes 1. Mouse over Macro & click

51. Presentation TitleDate Adding Events via the Macro Toolbar “MAC Start (M)” 2. Agree with current time OR adjust time Hit OK Event marked on Timeline with “M” This Macro does NOT indicate the Anesthesia Type. It simply puts a placeholder on the timeline for reference purposes/charting purposes 1. Mouse over Macro & click

52. Presentation TitleDate Macro ToolBar “End Surgery” 1. Hit the “End Surgery” icon 2. Adjust the time as required

53. Presentation TitleDate Macro Toolbar “End Surgery” Places an “E” under the timeline Running cursor over the letter “E” will bring up the event descriptor Adds event descriptor to the “Event Log” All Required Events to insure adequate CHART completion are listed. If font colour is black, the required event has been satisfied If font colour is RED, the required event has NOT been satisfied. In this example, all INTRAOPERATIVE events have been satisfied. Anesthesia case finish time (F) and ANES: QA Indicator are completed in PACU/ SDCU/ICU 3. Demographic box launches

54. Presentation TitleDate Procedures done anywhere outside the Main OR will NOT have a procedure pre-populated. Please insure this field is COMPLETE. All satellite areas should have cheat sheets with the most common procedures performed in the respective area 1. Hit Add Button 2. Enter text into keyword search 3. Hit “Find Now” button 4. Highlight appropriate procedure Hit OK button Adding Events via the Macro Toolbar “End Surgery/Confirm Procedure (“E”)

55. Presentation TitleDate Macro Toolbar “Bag Level” This icon launches the “Fluid Balance” for the Encounter. Remember to do “Bag Levels” on all fluids at the end of the case. Otherwise, fluid balance will NOT be accurate Clicking ton the icon will launch details of fluid administration Clicking on the icon will launch details of fluid administration

56. Presentation TitleDate MACRO TOOLBAR “ End GA” 1. Hit the “End GA” icon 2. Adjust the time as required

57. Presentation TitleDate MACRO TOOLBAR “ End GA” Places an “g” under the timeline Running cursor over the letter “g” will bring up the event descriptor Adds event descriptor to the “Event Log”

58. Presentation TitleDate MACRO TOOLBAR “ ZZZz” 1. Hit the “ZZZz” icon 2. Adjust the time as required Adds Event Descriptors to the Event Log Nothing is added to the Timeline

59. Presentation TitleDate Macro Toolbar “End GA” vs “ZZZz” Pay attention to which icon is hit when ending a GA-ONLY 1 icon is intended to be selected. Remember NOT to use either icon if procedure done under MAC/regional only. “End GA” will list in the Event Set that the patient is waking up and an airway device has been removed “ZZZz” will list in the Event Set that the patient is breathing spontaneously but the airway device has NOT been removed

60. Presentation TitleDate MACRO TOOLBAR “ Transfer to PACU/SDCU/ICU” 1. Hit the “PACU/SDCU/ICU” icon 2. Adjust the time as required

61. Presentation TitleDate MACRO TOOLBAR “ Transfer to PACU/SDCU/ICU” All Required Events to insure adequate CHART completion are listed. If font colour is black, the required event has been satisfied If font colour is RED, the required event has NOT been satisfied. In this example, all INTRAOPERATIVE events have been satisfied. Anesthesia case finish time (F) and ANES: QA Indicator are completed in PACU/ SDCU/ICU 3. Hit “Close”

62. Presentation TitleDate MACRO TOOLBAR “ Transfer to PACU/SDCU/ICU” Hitting “Close” in the Demographics box will launch the “Quality Measures” screen. You will NOT be able to TRANSFER unless “Required Fields” are completed. RED text = NOT COMPLETED You will have to hit “Cancel” and satisfy the “Required Fields” 4. You will have to hit “Cancel” and satisfy the “Required Fields”

63. Presentation TitleDate MACRO TOOLBAR “ Transfer to PACU/SDCU/ICU” If “Required Fields” are completed (BLACK text), the TRANSFER button will activate. 4. Hit “Transfer”

64. Presentation TitleDate Macro Toolbar ”PACU-SDCU-ICU Report” 1. Hit the “Report” icon 2. Insure you complete “=>Periop Adverse Near Miss Event”, NO or YES 3. Insure you complete handover events

65. Presentation TitleDate Macro Toolbar- ”Finish” 1. Hit the “Finish” icon 2. Adjust the time as required

66. Presentation TitleDate Macro Toolbar- ”Finish” Places an “E” under the timeline Running cursor over the letter “E” will bring up the event descriptor Adds event descriptor to the “Event Log” Launches the Printout Loader

67. Presentation TitleDate MACRO TOOLBAR “Discharge” 1. Hit the “Discharge” icon 2. Adjust the time as required Used when transferring a patient to an area where SIMS is NOT used: Labor and Delivery ICU NOA Dental Clinic GI Suite (and not transferring to PACU/SDCU/ICU)

68. Presentation TitleDate MACRO TOOLBAR “Discharge” All Required Events to insure adequate CHART completion are listed. If font colour is black, the required event has been satisfied If font colour is RED, the required event has NOT been satisfied. In this example, all INTRAOPERATIVE events have been satisfied. Anesthesia case finish time (F) and ANES: QA Indicator are completed in PACU/ SDCU/ICU 3. Hit “Close”

69. Presentation TitleDate MACRO TOOLBAR “ Discharge” Hitting “Close” in the Demographics box will launch the “Quality Measures” screen. You will NOT be able to TRANSFER unless “Required Fields” are completed. RED text = NOT COMPLETED You will have to hit “Cancel” and satisfy the “Required Fields” 4. You will have to hit “Cancel” and satisfy the “Required Fields”

70. Presentation TitleDate MACRO TOOLBAR “ Discharge” 4. Select “Discharge” location 5. Hit “Discharge” 5. Fluids will be terminated so complete “Bag Level” and hit “OK”

71. Presentation TitleDate Adding a Supervisory Anesthesia Event via SAM Supervisory Anesthesia Module” You must have rights to open the SAM module Click on the Insert/View Menu/S.A.M. OR Click on the Icon in the Toolbar Enter your user log in As an anesthesiologist who supervises fellows and anesthesia residents, you may need to document certain events during the procedure. The Supervisory Anesthesia Module (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.

72. Presentation TitleDate Adding a Supervisory Anesthesia Event via SAM You will be presented with all relevant “Supervisory Events” 1. Select events relative to the situation and hit “OK”

73. Presentation TitleDate Adding a Supervisory Anesthesia Event via SAM At this point, you will see a complete audit of all events entered into the system You can select any event and edit/delete as required

74. Presentation TitleDate Adding a Supervisory Anesthesia Event via SAM 2. Exit S.A.M. to return to Home screen

75. Presentation TitleDate SAM Window Functions From the SAM window you can: Open the Demographics window to complete other required documentation Review the Events Add events Edit events Delete events. Log Out Log Out to return to Home Screen

76. Presentation TitleDate Viewing the Event Log History You can now see who has added, modified, or deleted an Event and at what time. Click on the “Audit Trail”

77. Presentation TitleDate Events in Anesthesia Manager: Exercise Open the Events window, look through the different “Event Sets”. Look through the different Event Sets and add part or all of one Event Set. Search for all Events with the word “intubation” in them. Change the time stamp and add a comment to an Event. Add a group of Events via a Macro Button Delete one of your Events. Add a S.A.M. Supervisory Anesthesia Event Open the Event History and observe the Audit Trail for the changes you made.

78. Presentation TitleDate Questions