Emergency Situations

1

In emergency situations, simply ADMIT the patient into the systemThis allows for vital signs to be captured while you

LOOK AFTER THE PATIENTInformation can be entered afterwards

Emergency SituationsStarting the Record

2

If you forget to “Start Session” when an emergency patient enters the room, you have several choices: “Start Session” on patient and manually enter data (using the

Datex monitor as a source of information) You will need to use a series of memos q5min

You cannot enter data in the (BEFORE ADMISSION) section

“Start Session” on patient and use paper for the initial period that is not captured electronically Make a note on both records as to what has occurred.

Chart entire case on paper

Two ways:

1. Add the Order again using Protocols – set earlier time

2. MOVE the order by Right-clicking on the Order

Emergency SituationsHow do I chart BEFORE the Chevrons?

3

Emergency SituationsInserting Emergency Data

SIMS system collects data on an active patient on a local workstation q30”.

4

Snapshot

Insert Emergency Data

2011-09-15

2011-09-15

15:00

15:05

Emergency SituationsInserting Emergency Data

The emergency data will be archived electronically Intermittent data (eg. NIBP) will

not print to the paper copy of the anesthesia record

Beat to beat data (invasive pressures, HR, Sp02) will print to the paper copy of the anesthesia record

30 second data intervals are cleared from the local workstation on transfer/discharge Ensure you capture important

data prior to transfer/discharge

5

Transfer &/or Discharge

6

Transfer ONLY Patient will be picked up/cared for on another bedside SIMS workstation

PACU/SDCU

Transfer & Discharge Patient will be picked up on another SIMS workstation but care will NOT

continue at the bedside ICU Labor and Delivery PACU

“Start Session” on the local machine (NOT Remote View) Document handover events on the local machine Manually enter handover vital signs into the electronic record

Document “Anesthesia Finish” and print record

Discharge the patient from SIMS (choose “ICU”from pull down menu if discharging to ICU) (choose “Nursing Area” from pull down menu if otherwise)

Transfer &/or Discharge

7

What happens if I don’t discharge my patient?? Patient is left in the transfer zone (cloud) Creates chaos when patient returns to the OR

Patient WILL appear on the census list Starting Session will pull the old encounter back down from the

transfer zone (cloud) and merge the encounters creating one potentially very large anesthetic record encompassing days Hopefully you will recognize problem

Medications other than the default med template are apparent Fluids/infusions may continue to be running Demographic information is showing different anesthesiologists/surgeons,

etc. What do I do??

Document a memo stating that patient had not been discharged DISCHARGE the patient Return to “CIVMOR-Surgery patients for Today” Census list Locate the patient and “START Session”proper encounter should load

You will have to add vitals manually You may elect to document on paper if significant time has passed.

Transfer &/or Discharge

8

Discharge ONLYPatient will be NOT be picked up on another SIMS workstation/care

will NOT continue at the bedside Dental Clinic Lithotripsy Endoscopy

Case MUST be finished in the ORDO NOT hit the TRANSFER icon

Document handover events on the local machine (forward time)Document “Anesthesia Finish” and print record (forward time)

Discharge the patient from SIMS Choose “Nursing Area” from pull down menu

Printing

12

•Surgical Encounter is analogous to a document/book with several chapters

•Before Admission•GA (Surgical Pre-Op)•GA (Transfer)•GA (Anesthesia Standard)•GA (Transfer)•GA (PACU Post Op)•Discharge

Printing

13

Printing

14

Printing

15

Preop Manager

17

How do we know whether a formal MD Assessment has occurred????

vOACIS is your friendDO NOT use Preop Manager on a workstation that is

ACTIVE with a different patient in Anesthesia Manager (high potential to produce a second but blank assessment

for the same surgical encounter!!)

Preop ManagervOACIS as a Starting Point

18 •If you see this, you do NOT have to open Preop Manager

Preop ManagerPatient only seen by an RN before the date of Surgery

19

NO MD A

ssess

ment

Preop ManagerPatient only seen by an RN before the date of Surgery

Logical thing to do would be to open this previous assessment and complete the MD fields

YOU CAN’T-The record has been LOCKED20

Preop ManagerPatient only seen by an RN before the date of Surgery

You must open a NEW Preoperative Assessment (Will be linked to correct date of surgery and Encounter number), Complete the usual fields

Signature-assessing physician Signature-Final Chart Signoffupload to Voacis

YES, there will now be 2 Preoperative Assessments on vOACIS 21

Preop ManagerInside the OR

23 Launch Anesthesia Manager

Preop ManagerInside the OR

Preop Manager should find the ACTIVE patient (same Encounter # and date as Anesthesia Manager)

Open the Preoperative Assessment

Complete ALL fields as previously described

24

Preop ManagerFinal Chart Signoff

If you are the last person to interact with the patient in a preoperative setting, you must do a

“FINAL CHART SIGNOFF”

Upload to vOACIS

25

Preop ManagerInside the OR

26

Copy Forward

Wonderful time saving tool Allows previous MEDICAL assessments to populate the current

assessment28

Copy Forward In this example, there are 2

previous assessments in the SIMS databaseThe most recent assessment

loads automatically

The MD Assessment of June 27, 2011 is seen in the window

29

Copy Forward If this assessment is

satisfactory and closely resembles the current medical history, check the MD assessment box and hit OK.

30

1. Hit MD Assessment and

OK

1. Hit MD Assessment and

OK

Copy Forward

31

Hit Close

Copy Forward

It is your responsibility to insure the information displayed in the new assessment is accurate This assessment is current and NOT locked If necessary, edit the information (add/revise/delete) Complete the usual fields

Signature-assessing physician Signature-Final Chart Signoffupload to Voacis

32

Copy Forward In this example, there are 2

previous assessments in the SIMS database

The MD Assessment of Sept. 29, 2010 is selected In order to see the contents of

the assessment, hit the LOAD button

the assessment of Sept. 29 does NOT have a MD Assessment Notice how the Copy Forward is

greyed out

Do NOT carry forward a Nursing Assessment You are not a nurse

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Consults-Residents

34

Inpatient Consult Complete

Current

•Suggestion to choose “Ready for Surgery”•Final Chart Signoffupload to vOACIS•If follow-up required, then use Addenda

Changing to:

Anesthesia Consult Complete

PACU/ICU

35

Handing over difficult cases Consider printing out the Preop Assessment from vOACIS to

accompany the anesthetic record Default printer location in the OR is the respective corridor printer

I’m called to re-intubate a patient How difficult was it during the recent GA?I don’t have time to look it up in vOacis...

You can use the Nursing computer on an active patient to scroll back through the entire patient encounter (different template)

You are able to hit the Event icon (F4) to see a complete description of what occurred intraoperatively.

SIMS Help

36

FUNCTIONAL ISSUES-Super Users (working hours only)Civic Campus

Zunder Bryson Charapov

General Campus Elliott Gagne Szeto

TECHNICAL ISSUE-HelpDesk (14136)Password resetsNetwork connectivityPrinting problemsComputer related issues