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SIMS FILE PUSH-OCT 2013

File push to occur weekend of October 20 New template to address high volume/rapid turnover (RAPID TEMPLATE) “GA-Anesthesia Standard” template changes Refresh my memory. SIMS FILE PUSH-OCT 2013. Rapid Template.

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SIMS FILE PUSH-OCT 2013

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  1. File push to occur weekend of October 20 New template to address high volume/rapid turnover (RAPID TEMPLATE) “GA-Anesthesia Standard” template changes Refresh my memory SIMS FILE PUSH-OCT 2013

  2. Rapid Template • Rapid Template designed to accommodate high volume rooms at the Riverside Campus (cysto, D&C, Litho) ONLY • Features include: • No need to complete formal Preop Assessment using Preop Manager • Default template includes most commonly administered drugs • Customized Event Sets • Customized Icons

  3. Using the RAPID Template Launch Anesthesia Manager Select Patient as per usual fashion Use pull down menu on ADT screen to select the RAPID Template Should you accidentally launch the incorrect template, simply TRANSFER your patient back to the network and start from the beginning

  4. RAPID Template-HOME Screen

  5. SYSTEM Icons-NO CHANGES* *addition of anesthesia WIKI to all templates discussed later in ppt

  6. CUSTOM ICONS-Modified

  7. CUSTOM ICON-PIT This ICON will place an “O” on the timeline and add the following text to the Events: “Oxytocin 20u/L added to IV Fluid (O)”

  8. CUSTOM ICON-END GA This ICON will place an “g” on the timeline and add the following text to the Events: Oropharynx suctioned as required Adequate spontaneous ventilation resumed Opens eyes to verbal stimulation OR exhibiting purposeful movement Airway device, (ETT/LMA), if present, *removed, ventilating well End General (g) Italics denote changes from “Anesthesia Standard”

  9. CUSTOM ICON-ZZZ This ICON will place an “g” on the timeline and add the following text to the Events: Oropharynx suctioned as required Adequate spontaneous ventilation resumed Airway device (ETT/LMA), if present, *left in situ Italics denote changes from “Anesthesia Standard” this icon can be used when taking a patient to the PACU who has not emerged from GA

  10. MEDICATIONS-Default New Medications: Ketamine mg Ketorolac mg Lidocaine PF (Pain) mg/kg Remifentanil mcg

  11. FLUIDS-Default New infusions: Lidocaine 1% PF (PAIN) mg/h Remifentanil 0-1 mcg/kg/min Ketamine (GA) mg/h Propofol mcg/kg/min

  12. EVENT SETS-Modified • 3 new Event Sets added: • A!01_Rapid Preop Eval • A!05_Rapid GA • A!10_Rapid MAC • Remainder of Event Sets stripped down

  13. EVENT SET A!01_RAPID Preoperative Evaluation takes the place of Preop Manager Review of Systems (Events) relating to procedures specific to the RAPID template Review of Systems (Events) relating to CVS and Resp system

  14. EVENT SET A!01_RAPID Preoperative Evaluation takes the place of Preop Manager Review of Systems (Events) relating to GI/End/Haem system Physical Exam (Events) related to the Airway

  15. EVENT SET A!01_RAPID Preoperative Evaluation takes the place of Preop Manager Physical Exam (Events) related to the CVS/Resp systems Relevant lab, Meds, Allergies, NPO status Anesthetic Plan

  16. A!05_RAPID GA Highlighted events are new

  17. A!05_RAPID GA Highlighted events are new

  18. A!10_RAPID MAC Highlighted events are new

  19. Anesthesia Standard Template Changes • The push of the RAPID TEMPLATE has given us the opportunity to incorporate changes to the “Anesthesia Standard” template • I am happy to report that we have recently established a SIMS Committee. This Committee will: • meet on a quarterly basis • Is multidisciplinary in representation (IT/Nursing/Anesthesia) • Anesthesia Reps: Zunder, Jee, Bryson, Pysyk • will facilitate improvements and upgrades in a timely fashion

  20. “GA-Anesthesia Standard” Template Changes • Eliminating subheadings • General fixes to various event sets • Anesthesia WIKI • WRONG PATIENT protocol and documentation • Preop Manager pull down for Meds/Allergies • Preop Manager-addition of “HER” pathway to Alerts • Artifact Rejection • Surgeon NOT requesting antibiotics • Addition of Albumin 5% to database/protocols • Documenting on the INCORRECT patient

  21. Subheadings Originally programmed as ON by default, we realize they take up precious screen real estate New Default Setting is OFF All meds and fluids to be listed alphabetically

  22. General Fixes-Event SetsA001_Anesthesia Type • (M)_Monitored Anesthesia Care-Deep Sedation • added in at request of Business Groups to reflect changes to the MOHLTC Schedule of Benefits

  23. General Fixes-Event SetsA005_PACU-SDCU-ICU Report • Reminder by QPS Committee to submit a PSLS Report should you answer YES to: “Periop Adverse Event/Near Miss:

  24. General Fixes-Event SetsA011_Basic GA • Steep Trendelenberg (Position Checks q1h) • Added at request of QPS Committee • Trend/Rev Trend Angle • Added in at request of QPS Committee • Upper arm Krauss armrest • Position in Event Set changed

  25. General Fixes-Event Sets A012_Basic Spinal • Please REMEMBER to chart SPINAL Drug Dosage in Medications • Added in as a reminder to document as audit committees have noted absence of spinal med doses

  26. General Fixes-Event SetsA013_Basic MAC • Same options added to this event set similar to • Basic GA • Basic MAC

  27. General Fixes-Event SetsA066_Regional Upper Limb • Local anesthetic thru needle • Typo corrected (used to say “catheter”

  28. General Fixes-Event SetsA150_Thoracic GA-DLETT • Eschmann Stylet (Bougie) • Position in Event Set changed

  29. Anesthesia WIKIDisplays all Educational/Update Material Relevant to SIMS http://wiki.med.uottawa.ca/display/WIKITHESIA/SIMS+Reference

  30. Preop ManagerNew Med/Med Allergies “pull down” list • Will contain ~80 of the most commonly prescribed medications. • The generic name is in brackets and follows the common trade name of the drug • The list is organized alphabetically by generic name • Please forward any suggestions for further additions to the list A similar “pull down” will be created for the most common Allergies. Hopefully, this will facilitate creation of a more comprehensive consult rather than having to look at Med Rec sheets (paper or electronic). We have no control over Nursing who will continue to use the “Med Rec” solution. However, residents should be encouraged to use the “drop down” menu for their “in patient” consultations. Staff/Residents/Fellows should be encouraged to use the “drop down” menu for Preop Assessments completed on the day of surgery.

  31. Preop ManagerNew Medication pull down list

  32. Preop ManagerAddition of HER Pathway • Added at request of PAU to reflect patients that may be eligible for “HER”

  33. Artifact Rejection • In order to prevent spurious results from being imported into SIMS, artifact rejection as described will be incorporated for • Invasive Blood Pressure • Heart Rate • Temperature

  34. Surgeon NOT requesting antibiotics • The absence of an antibiotic dose in the SIMS database may be interpreted as failure to administer when in fact, the drug is specifically NOT requested by the surgeon during the Preop pause. • In order to capture the request NOT to administer, please place a 0 for dose under Cefazolin

  35. 5% Albumin • As a result of concerns related to HES, a request has been made to add 5% albumin to the database • “*Anes_Fluids In” protocol has been updated

  36. Documenting on WRONG PATIENT protocol • In order to prevent confusion, we’ve come up with ONLY two options. The appropriate choice will be determined by two main factors: • How long have you been documenting on the INCORRECT patient? • Is there ample time to document on the CORRECT patient? • We have created a new event set titled, “A235_Incorrect Patient”. Please follow the steps and complete the required fields for the option that has been chosen. • Please refer to the Anesthesia WIKI (Troubleshooting) for more detailed information

  37. Documenting on WRONG PATIENT protocol

  38. NO MORE PAPER • No more paper PAU Pre-assessments accompanying chart • use hallway PC’s and launch either • vOACIS • Preop Manager

  39. Refresher Points • How can I minimize EKG artifact? • How can I eliminate white space on the monitor • Documentation of Demographics in Satellite areas • Printout Start/Stop times • Remote View • IV tips • OR Corridor computers to access Preop Manager/vOACIS

  40. SIMS obtains HR information from the EKG. Interference creates multiple artifacts that are recorded EKG artifact

  41. To eliminate artifact, change the HR source from AUTO to Pleth EKG artifact

  42. EKG artifact Atrial Fib-HR Source AUTO PDF in vOACIS

  43. EKG artifact Atrial Fib-HR Source PLETH PDF in vOACIS

  44. Eliminating blank spaces

  45. Eliminating blank spaces Right click anywhere in the “Real Time Variables”

  46. Eliminating blank spaces Highlight the variables (Ctrl-Click) that you do not wish to display and hit <<Remove

  47. Eliminating blank spaces Blanks spaces have now disappeared. NB. All MEASURED variables are CAPTURED, PRINTED and ARCHIVED. What you see on the screen is ONLY what you choose to VIEW.

  48. Documenting DEMOGRAPHICS in satellite areas In Satellite areas, it is OUR responsibility to add in the Medical Team (surgeon is not populated as in the Main OR) and the Procedure (not populated as in the Main OR). There should be a cheat sheet in these various areas which lists the most popular procedures and the keywords used to find them.

  49. Documenting DEMOGRAPHICS in satellite areas Cheat Sheet-Labor and Delivery Cheat Sheet-Diagnostic Imaging

  50. Documenting DEMOGRAPHICS in satellite areas Cheat Sheet-Ultrasound Cheat Sheet-Endoscopy Suite

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