Anesthesia Touch User Guide SOFTWARE REVISION 4.0. ipad Version

Transcription

1 Anesthesia Touch User Guide SOFTWARE REVISION 4.0

2 Contents About this Guide... 4 Introducing Anesthesia Touch... 4 How Anesthesia Touch Assists in the OR...5 Launching Anesthesia Touch... 5 The Appointments (Patient List) Screen... 6 Retrieving Anesthesia records...6 Information in the patient list... 7 Accessing Patient Records and Other Functions...8 Creating a New Patient Record... 8 Using Anesthesia Touch to Conduct a Preop Evaluation Height, Weight, and Demographics History Sections Allergies and Medications Allergies Information Medications Information Problems Selecting problems from within a group Selecting from a Customized List Selecting by Searching Physical Exam Airway Preoperative Baseline Vital Signs section Within Normal Limits/Other section Test Results Assessment and Plan Section Buttons on the Bottom of the Screen Revisions Note Signing and Viewing the Preop Form Previewing the Preop Document Anesthesia Consent Recording Intraop Information Top Banner Toolbar Meds and Fluids Staff Plexus Technology Group, LLC 2

3 Macro Documentation Buttons Common Elements Found on the Documentation Screens Examples of Macro Documentation Screens Medication and I/O Grid Time Frame Buttons Auto Scroll Cells in the Grid Mark and Events Physiologic Graph and Grid Tabs Graph Tab Grid Tab Manually Adding or Editing Physiologic Data Smart Buttons Tab Alerts Button Near-Real Time Monitor Previewing and Printing the Intraop Record Alerts Additional Features Accessible from the Intraop Screen Concurrency Graph Physiologics Import Physiologic Data View Remote Vitals Edit Patient Info Migrate Patient Cancel Case Delete Case Completing the Postop Evaluation/Discharge Note Index User Guide Version 1.1 for the ipad Plexus Technology Group, LLC 3

4 About this Guide This guide is intended to provide an overview of the Anesthesia Touch application. It provides a tour of the user interface and describes all the major functions. This guide covers the implementation of the Anesthesia Touch software in the ipad. Because Anesthesia Touch has been customized by Plexus Technology Group for your facility s use, your system may look and operate slightly differently than described. This book presents examples of the user interface to explain the functionality of the system and show representative software options. The way your system operates the way it looks, accepts data, and interfaces with operating room (OR) monitors, and even the way you enter information into the system -- depends on your setup. For information about customizing Anesthesia Touch, consult your implementation team. Introducing Anesthesia Touch Anesthesia Touch is an automated medical record-keeping system that streamlines the capture of real-time anesthesia data throughout the perioperative process, enabling anesthesia providers to deliver safe, effective care to patients. Anesthesia Touch comprises the following components: Anesthesia Preop Evaluation System Anesthesia Consent An intraoperative anesthesia record-keeping system Anesthesia Postop Evaluation An administration Web interface Anesthesia Touch is unrivaled in its ease of use, because of its underlying design, innovative user interfaces, and flexibility. It is integrated into your facility's registration and scheduling system, enabling the application to identify and retrieve important patient information, such as demographics, allergies, medications, and medical conditions. The user interface in Anesthesia Touch has been designed to make data entry as simple and intuitive as possible. For instance, all information in the preop examination is contained in a single screen or related pop-up dialog. Pop-ups are usually only one level deep there is no need to navigate up and down through several layers to find information. Additionally, when entering information into fields that are related, the interface will automatically tab to the next field. So for example, when entering height and weight, entering a value in the Ft, field automatically tabs to the Inches field and then to the Weight field. Plexus Technology Group, LLC 4

5 How Anesthesia Touch Assists in the OR Because the software is integrated with patient registration, scheduling, and monitoring devices and machines in the OR, Anesthesia Touch automatically records and includes various clinical data. This allows the user to focus more fully on the patient s needs, rather than on the medical record documentation. Launching Anesthesia Touch From the home screen on the ipad, tap the Anesthesia Touch icon. On the login screen, tap the Login icon and enter your user name and password. Or, if you have previously logged in on this ipad, tap the icon with your user name and then enter your password. Note: Do not give out your password, as it represents your digital signature. Plexus Technology Group, LLC 5

6 The Appointments (Patient List) Screen When you first login to the application, the Appointments screen opens. From this screen, you can search for and view a list of patients. Once you select a patient, you can then access all functionality within Anesthesia Touch. Search current and discharged patients Access to patient records and all other functionality Tap to highlight a patient, then select the patient s records using the buttons above Tap icon to display additional patient info Tap letter to jump to last names beginning with that letter Retrieving Anesthesia records By default, the Today s Cases tab displays patients scheduled for surgeries on the current day. Two other tabs allow you to Search for and view discharged patients or select a different Date, either in the past or the future. You can further limit the patient list by selecting one of the following filtering options: All cases Plexus Technology Group, LLC 6

7 By Room By Surgeon Anesthesiologist Procedure Choosing By Room, By Surgeon, or Anesthesiologist opens a selection list for that item. You can sort the patient list by Last Name, or by the Time of the surgery. The right hand column of the list displays a set of letters based on the patient last names. If there are any patients whose last name begins with a specific letter, it will display in the list. Tap the letter to jump to that point in the list. Once you find the correct patient, tap the record to highlight it. You can now retrieve the records for that patient. Information in the patient list Each patient record displays the following: DOB Age Sex Medical Record Number Operating Room # Date and Time of surgery Surgeon Checkboxes indicate the status of the documentation for Consent, Pre-op, Intra-op, and Post-op. If you begin work on a document but do not complete it by signing it, the box will be gray. Once a document is completed, the box will be blue and check marked. In the example below, Consent has been completed, and Preop has been started but not completed. An information icon: Tap it to view an additional summary of information. Plexus Technology Group, LLC 7

8 Accessing Patient Records and Other Functions The three buttons in the upper right hand corner of the screen provide access to the patient s records, as well as other functionality. From the Documents button, you can access the following: Anesthesia Preop Evaluation Anesthesia Consent Anesthesia Postop Evaluation Tapping the Intraop button opens the Intraop screen. See Recording Intraop Information for details. The Others button is configurable; following are the standard functions accessed from it: Sign Intraop Change Password About shows your version of Anesthesia Touch Additional functions can be configured for your facility Creating a New Patient Record Typically, you will access patient and surgery appointment information that is already entered in your medical records system. But in case of an unscheduled surgery or an emergency, you might have to create a record for the patient. 1. Highlight <New Patient> in the Patient List and tap Documents. Select the Anesthesia Preop or Anesthesia Consent options. Or, you can also tap Intraop. The Create Case dialog appears. Note: If you are in a situation, such as an emergency, where there is not time or it is not possible to obtain the patient s information, tap Emergency PT to create a patient record with default information. Plexus Technology Group, LLC 8

9 2. For an unscheduled surgery, enter the patient information, including medical record number, first, middle and last name, date of birth, sex, and account number. 3. Select the Demographics tab and enter the information, including address, city, state, zip code, phone number, weight, and height. 4. Tap Save. The new patient is added to the patient list and the document that you selected in step 1 opens. If you need to add or change any information after saving, you can access the Edit Info dialog, which looks identical this dialog, by select Edit Patient Info from the Others button on the Intraop screen. Plexus Technology Group, LLC 9

10 Using Anesthesia Touch to Conduct a Preop Evaluation When you select the Anesthesia Preop Evaluation option under the Documents button in the Appointments screen, the Preop document opens. Tapping on a field either opens a dialog for entering a numeric value, or a menu where you can choose from a list, or add your own entries. Once the evaluation is complete, tap Sign to authorize the form. You can view it by tapping Preview. You can search for and select allergies and medications from a list. Once selected, a second screen allows you to enter details (doses, severity, etc.). Enter Anesthesia and Surgical History here. Enter Height, Weight, and Demographics Enter Surgical and Family History here Tap here to set all the fields below to Nor (Normal) Tap on a category to select from a list. Once selected, you can enter details. Tap checkbox next to category to enter WNL. Tap checkox next to Problems to enter all categories as WNL. Tap the star to view a customized list of problems. Tap the magnifying glass to view currently selected problems and search from a list. Tap here to open the Airway dialog, which includes multiple selections. Tap WNL for Within Normal Limits. If you tap OTH, a dialog opens to let you record the abnormality. Tap anywhere in this section to open a dialog where you can enter test results. This section is used to assess the patient s food and liquids intake, indicate the ASA status, and select an Anesthetic Plan. Plexus Technology Group, LLC 10

11 The Preop evaluation is broken out into the following sections: Height, Weight, and Demographics Surgical History Anesthesia and Family History Allergies and Medications Problems Physical Exam Test Results Anesthesia Plan A Revision history, which documents any changes you make. A separate screen for additional Notes. Each of these sections is described in brief, on the following pages. Height, Weight, and Demographics Tap the height and weight fields to open a numeric keypad where you can enter the numbers. Throughout the application any fields which require numeric only entry will typically have a pop-up dialog like the following: Tap the Demo field to open a dialog with drop-down for Language, Race, and Ethnicity. Plexus Technology Group, LLC 11

12 History Sections Tap on the Anes HX / Surg HX, Family HX, and Social HX fields to open a dialog where you can select from a list. You can also enter a new value by tapping the blank, sectioned area to open the keyboard. Allergies and Medications Tap the Allergies and Medications fields to open a list screen. These populate with information from the patient s medical record. To add allergies or medications tap Add to open a Search screen. As you type, the list below automatically populates. So by typing just a few characters, you can quickly find the desired value. Then tap the value to add it to the list. At this point, you can tap Add Another to start typing again, or tap Save to return to the list. Plexus Technology Group, LLC 12

13 From the original list screen, tap, the desired item to open a dialog where you can enter details about that allergy or medication. Allergies Information In this dialog, two pickers (spin dials) let you choose the Reaction and Severity. Date fields allow you to record when the patient s allergies began or ended. Tapping on the first Start field selects the year; additional fields allow you to select the month and the day (if that specificity is not known, these can be left blank). There are additional fields for selecting an end date. Finally, the blank area allows you to type any notes. Plexus Technology Group, LLC 13

14 Medications Information In this dialog, enter the Dose. Tapping Default will set a default dose, based on the parameters in the Anesthesia Touch medication database. Tap plus or minus in increase or decrease dose option. Two pickers let you choose the Unit and Route. Tap Frequency to select an amount from a drop-down, and/or tap Yes for PRN to indicate medication is taken as needed. As on the allergies dialog, you can select start and stop dates, but in addition you can enter the date of the last time the medication was taken. Finally, the blank area allows you to type any notes. Problems There are three ways to add to the list of the patient s problems. You can: Select a from within a group of related problems Select from a customized list using the Star button Search for a problem by typing part of its description using the Magnifying Glass Selecting problems from within a group The left side of the Problems section consists of multiple categories. Each category consists of a gray box with a text label, plus a white checkbox. If the patient has no problems or significant history to be recorded within that section, you can tap on the checkbox to select it. The text WNL (Within Normal Limits) will be displayed next to it. Each category contains multiple problems. You can record information for both current and resolved problems. A final Other box opens a screen where you can type any additional information. If you tap on a gray box, a dialog specific to that category opens, as shown in the following Endocrine screen: Plexus Technology Group, LLC 14

15 Any entry with a + next to it has multiple sub-entries just tap the + to expand the list: Once you select an item tap the Detail button. You can indicate whether the problem is Active or Resolved, and enter a date of the diagnosis, in the form of year, month, and day. Finally, you can add Comments. Plexus Technology Group, LLC 15

16 In the upright hand corner of the problems section are two buttons a Star and a Magnifying Glass. Selecting from a Customized List Tap the Star button to open the Custom dialog. This is a quick access list of commonly occurring problems from multiple categories. When you select a problem a Detail button appears for it and functions the same as when selecting a problem from one of the gray category buttons Selecting by Searching You can also document less common problems by searching from a more comprehensive list than is included in the gray category buttons. Tap the Magnifying Glass button to open the Problems dialog. This lists all problems that have currently been documented for the patient. If you tap the icon to the left of the problem the dash turns from horizontal to vertical and you can delete that problem. Plexus Technology Group, LLC 16

17 Tap Add to open the search dialog. Type part of the description and all matching items will display in the list. Note: Anesthesia Touch searches for the text you entered anywhere within the description, not just the starting text. When you select the desired problem and tap Save, you return to the Problems dialog. If you then tap that problem to select it, the details dialog for that problem opens, the same as when you tap Details using the other two methods. Plexus Technology Group, LLC 17

18 Physical Exam The physical exam section consists of several subsections. Airway Tap this field to open the Airway screen. Select a value for each parameter by tapping on the appropriate button. These buttons function like radio buttons selecting one value will deselect any other value for that parameter. You can completely deselect a parameter by tapping on the selected value. You can also enter notes at the bottom of the screen. Preoperative Baseline Vital Signs section Directly below the Airway section is a set of eight fields where you can enter amounts such as blood pressure, heart rate, etc. Tapping any field opens the numeric entry pad. Within Normal Limits/Other section This section consists of eight categories, each with two buttons labeled WNL (within normal limits) and OTH (Other). The Normal button next to the Physical Exam label provides a shortcut to set each category to WNL. Tap Normal if there are no issues. If you tap OTH, a dialog opens for that category, allowing you select a symptom and enter notes. Plexus Technology Group, LLC 18

19 An Other button in this section opens a screen where you can type information about any other issues that don t fit the categories. Test Results Tap anywhere in this section to open the Lab Result screen. Tap in any field to enter results for that lab. Note: If Anesthesia Touch has been integrated with your lab system, the results can be populated automatically. Assessment and Plan Section This section allows you to enter the patient s overall status, Anesthesia Plan, and any addition information that may not be covered in the preop evaluation. The checkboxes in the NPO section indicate when the patient last had food and fluids. Select the ASA level to indicate the patient s physical ASA status. Tap Plan to select the Anesthetic Technique, Airway, Pain Control, Monitoring Plans for the patient. Tap within the blank area for each plan to select an option. Plexus Technology Group, LLC 19

20 Additional comments regarding the assessment or plan can be added in the Comments box. Buttons on the Bottom of the Screen Revisions This button opens a screen that lists the names of users who have made changes, deletions, or additions to any data on the Anesthesia Preop Evaluation. Note This button opens a screen where you can enter any additional notes that do not apply to any specific section of the preop form. Signing and Viewing the Preop Form Once you have completed the Preop Evaluation, tap the Sign button in the top right hand corner of the screen. Note: The preop form is automatically saved to the Anesthesia touch database. You do not need to sign the form in order to save the data. Sending the data from the form to your facility s Medical Records System is also possible this is specific to the configuration of this software in your facility. Previewing the Preop Document Once the document is signed, tap the Preview button to view it. Note: You can preview the document at any time during the evaluation. You don t have to sign it first. From the Preview screen, you can print the preop document. Select Print or AirPrint depending on the configuration in your facility. There are configurable options for which and how many signatures are displayed. Blank Signature and Date fields are also included for facilities that allow handwritten notes on the printed form. Plexus Technology Group, LLC 20

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22 Anesthesia Consent When you select the Anesthesia Consent option under the Documents button in the Appointments screen, the Consent document opens. This form can be customized to fit the needs of your hospital or institution. Multiple version of the consent form can be made available. You can specify whether the form is being signed by the Patient, Parent or Guardian. The form is signed directly on the screen using a finger or stylus. Once the document is signed, tap Save. A dialog opens informing you the document is saved and provides the option to Print. Or, tap Preview, where you can view the final document and print it, if needed. Note: If you preview and print the document before saving, you must still save before exiting the screen. Plexus Technology Group, LLC 22

23 Recording Intraop Information When you select a patient in the Appointments screen and tap Intraop, the Choose a Room dialog opens. The transmitter will correlate to a specific anesthesia machine. Note: It is critical that the correct transmitter and room are chosen because this determines the real time streamed data is received from the correct anesthesia machine and/or physiologic monitors. Once you select a room and tap Done, the Intraop screen opens. The Intraop screen is divided into sections: The toolbar buttons at the top open different screens where you can view and record information. The purple template button allows you to choose a specific template. These templates can be configured for your facility. The gray workflow macro buttons along the left allow you to enter times, comments, and other details as you progress through the surgery. The purple button at the top selects different workflow templates, which determine which gray workflow macro buttons are displayed. The medication and I/O grid scrolls information coming in from the anesthesia machine and physiologic monitors. You can also enter information manually. The grid can be customized to display the items you need to monitor. The tabbed section at the bottom allows you to switch between a Graph and Grid view of physiologic data. The Smart tab provides a set of Smart buttons for commonly used medications relevant to the selected workflow template. These buttons open additional screens. Finally, green section in the lower right hand corner displays near-real time vital signs. This allows you to see the most recent data from the anesthesia machine and patient monitors, whereas the grid and graph areas show summarized data for current and past time intervals. These sections are described in greater detail, following the screenshot on the next page. Plexus Technology Group, LLC 23

24 Toolbar buttons open other screens This section displays basic info about the patient and surgery. The grid displays information coming in from the anesthesia machine or from manual entry. The interval button allows you to alter the rate of display. The macros allow you to record times and information for various tasks. The purple button switches between templates, which determine which macros are displayed The red triangle in the corner means there are comments for this medication For an infusion, arrows are automatically filled in to show that the fluid was running during that time interval. Display Mode allows you to switch the display between a Graph and Grid view of physiologic data. The Smart buttons option provides a set of buttons for commonly used medications. Near-real time vital signs and other information are displayed in this section Top Banner Patient and case information is displayed on the top banner, including: the patient s name, date of birth, age, sex, and allergies, the medical record number, account number, surgeon s name, and the procedure scheduled to be performed. Plexus Technology Group, LLC 24

25 Toolbar The toolbar provides access to additional screens, where you can view and enter additional information. The toolbar is configurable, and yours may contain different buttons than the ones shown in the screenshot below. Patients This returns you to the Appointments screen. Alerts This opens the Messages screen, which indicates the tasks that must be completed before the intraop document can be signed. The number in red indicates the number of uncompleted tasks, and it updates as you complete them. A number in blue may also appear. This signifies data that is waiting to be sent to the server. If blue numbers are displayed, they will normally count back down to zero and disappear as data is sent, but if your wireless connection drops, you will see this number increase. See Alerts for details on the Messages screen. Docs This opens a small menu to open patient documents, including the PreOp Evaluation and Consent. Preview This allows you to view and print the Intraop document. For details, see Previewing the Intraop Record. Meds This opens the Add Medications screen, where you can enter information about administering a medication. Once you return to the Intraop screen, that medication is added to the Medications I/O grid at the specified time frame. Fluids This opens the Fluid I/Os (Inputs and Outputs) screen, where you can enter information about fluid intake or loss. Once you return to the Intraop screen, that fluid is added to the Medications I/O grid at the specified time frame. Staff (This button may be labeled Signatures in your configuration.) This opens the Personnel screen, which allows you to document staff changes during a procedure, such as when one anesthesia provider relieves the existing one. Print/End This validates and prints the intraop record, then exits the record returning you to the patient list. All required documentation alerts must be completed before using this function. Others As mentioned above, the toolbar is configurable, so functions for which there is not enough room for a button will be found here, including shortcuts to Labs. Several administrative functions are accessed from here. This is also where you will find the screen to sign the Intraop record. For details, see Additional Functions Accessible from the Intraop Screen. Meds and Fluids The Add Medications and Fluid I/Os screens function in a similar manner. A clock shows the time and date at which the medications or fluids are administered, but you can change this if needed. When you select a medication or fluid from the list, the pickers to the right populate with appropriate choices. In many cases only a single value will show. For medications there are two pickers one for Route and one for Plexus Technology Group, LLC 25

26 Units, while for Fluids there is only a single picker. If appropriate, an Infusion field appears, and can be switched on or off. Switching it on or off automatically selects the appropriate value on the picker. For medications, buttons allow you to filter the list to show Generic, Brand, or Both. A rotary dial allows you to select the amount being administered. Or, if you tap the amount field, you can enter a specific amount using the keyboard. A Comment field allows you to add notes. Scroll through values using the rotary dial, or tap the amount field to bring up the keyboard and type a specific amount. Tap a letter to jump to that spot in the list Once you Save this screen, you return to the Intraop screen and the medication or fluid you added is added to the Medication and I/O Grid. The system automatically checks for any interactions with other drugs that have been administered. If an interaction is found, a warning dialog displays the information. If a comment was added, the grid cell will show a red tag in the corner. The comment is included on the printed record, or can be viewed on the Modify Details screen after clicking on that grid cell. Staff Use the Staff screen to document the anesthesia staff involved in the case. This screen can be configured to accommodate various approaches to anesthesia staffing as well as variations in billing-related attestation Plexus Technology Group, LLC 26

27 statements. In a care team environment, this screen includes both anesthesiologists and nurse anesthetists. It can also include residents, student anesthetists, and anesthesia assistants. Each staff is shown on a separate row, indicating the time interval of involvement in the case. Staff may work in parallel (with overlapping times) or the new clinician can take over responsibility and sign out the previous clinician. Tapping Click to Sign allows you to attest to what actions were performed in the case, such as present for induction. If more than one provider is logged in to the same procedure, those providers will all be shown in the Staff screen. The new provider taps Sign to take over responsibility. Macro Documentation Buttons The gray buttons, called macros, on the left side of the screen constitute a list of events, tasks, or actions that occur during anesthetic care. The top, purple button allows you to choose a template which determines which macros will be included in the list. These templates can be customized to the typical workflows for your institution. Examples of templates include: General C-Section Dental C/S GA MAC GI Eye Cardiac Template button Macros Plexus Technology Group, LLC 27

28 Note: In addition to determining the list of macros, the template also determines which gasses, medications, and fluids are displayed in the Medication and I/O Grid and which Smart buttons are available. Each macro button links to its own documentation screen. Each screen covers all the relevant documentation for a specific task, action, activity or workflow event. In general the screens document the work to be done in providing anesthesia care, or in capturing the data required for billing. Most of the documentation screens have similar functions. They contain a clock function to record the time and date the function was started. A Comments box allows you to add notes. And in many case, there are additional fields such as checkboxes or buttons. Once you complete a task, the macro turns green. The time the task was completed show up in light text on the button. If a macro is not completed (required documentation is missing) when you save that screen, the macro will be red. Common Elements Found on the Documentation Screens Within the documentation screens, several common UI elements may be included: Checkboxes represent independent statements or concepts. When checked, that statement will be included on the anesthesia record. Click on the white square to toggle between checked and unchecked. Radio button bars allow selection of a single statement or concept among a few possible choices. Tap the desired selection, and the chosen option will highlight and will be included on the anesthesia record. Only a single option may be selected/highlighted. If allowed, tapping an already-highlighted selection will de-select it leaving no choice selected. Plexus Technology Group, LLC 28

29 Picker controls are similar to option buttons in that they allow selection of a single concept from a predefined set of choices. Pickers can allow for a larger list of choices, and may or may not allow a null or blank selection. The highlighted value is the one that will be saved. Date-Time selectors function like pickers, allowing you to select the day, hour, minute, and AM/PM. The configuration of events typically includes logic to help prevent illogical event times. For example, the Surgery Start time cannot occur before the Anesthesia Start time. Valid selections will appear in black, whereas invalid selections will appear grey. If you try to select a value outside of the acceptable range, the Date-Time selector will automatically spin itself to the nearest valid date-time. Dials offer a quick way to document a numeric value. Simply trace your finger clockwise around the dial to increase the value, or counter-clockwise to decrease the value. Select-Remove tab panels allow you to add or remove tabs within a panel containing multiple UI elements. Tap Select to display a pop-up menu of choices, then tap within the menu to add that tab to the panel. Tap the tab header to choose which tab s details appear in the panel. Tap Remove to delete the currently-displayed tab. Arrow controls offer a quick way to document a numeric value. Simply click the arrow to increase or decrease the value. Note that you can always type in the value directly by tapping within the white value field. Text boxes allow for written notes. Simply click in the box to enable the on-screen keyboard. Plexus Technology Group, LLC 29

30 Examples of Macro Documentation Screens Following are a couple of examples of macro documentation screens: The Anes Start screen is typical of event documentation screens, with a date-time selector and comments field: The IV action documentation screen contains no clock date-time selector, but instead a Select-Remove control, allowing you to document one or more actions, in this instance the placement of one or more invasive lines. Select the type of line to add to the tabs. You can then document relevant details for line. Plexus Technology Group, LLC 30

31 Medication and I/O Grid The medication and I/O grid scrolls information coming in from the anesthesia machine. You can also enter information manually. Adjust the time frame for each column in the grid with these buttons An amount in brackets indicates multiple deliveries, with the total amount shown in the bracket. Tap any cell in the grid to enter new information about any medication or fluid. For an infusion, arrows are automatically filled in to show that the fluid was running during that time interval. This main grid is organized by category, such as gas flow, anesthesia gasses, medications, and fluids. The prepopulated items can be customized. As mentioned in previous sections, the rows in the grid are populated with specific items based on the template you have chosen. In addition, if you access a screen to add an item such as a medication, it will be automatically added to the grid. Some cells allow only a single value (monitor data) whereas other cells allow multiple values (drug deliveries). Multiple entries will be summed and displayed within square brackets. For example, two drug deliveries of 50 and 100 will display as [150] if they occur in the same time-interval cell. Time Frame Buttons The time frame buttons along the top change the time period covered for each grid, so you can zoom in or zoom out as needed. The values shown for each item display the average during the time period. So, for example, if N2O % varied within a five minute period between a 96 and 100, the value shown in the five minute cell would be 98. Auto Scroll The grid will automatically scroll as time goes by, unless you turn Auto Scroll off. You can see that Auto Scroll is on when the button is green. Plexus Technology Group, LLC 31

32 Cells in the Grid If you tap an empty cell in the grid, a screen will open allowing you to enter information about that medication or fluid. If you tap a cell in row with a medication or fluid already listed, the Medication or Fluid I/Os dialog for that particular medication will open, as show in the following example. The time will default to the time associated with the cell that you tapped, but can be changed. Enter the amount of medication or fluids by using the dial or typing in the exact amount. These screens can also be configured to include a Comments field. If a comment was added, the grid cell will show a red tag in the corner. If you tap on a cell in a row that is blank (no medication or fluid listed in the first column), the Add Medications screen will open, where you can search for and select a medication. This is similar to the screen opened by tapping the Meds icon at the top of the screen. (See Meds and Fluids.) Touch and hold in the grid area to display a set of blue lines; these allow you to select more precisely. Simply drag your finger until the blue lines indicate the desired row and column, then lift your finger to open the dialog for that cell. If you tap on a cell that has physiologic monitor data in it, the numeric keypad opens and you can modify the number. If you tap on a cell that has fluid or medication data in it, a Modify dialog opens. Plexus Technology Group, LLC 32

33 Tap on the Modify text to open the Medication or Fluid I/Os dialog and change the dosage or date-time values. Tap Add New to open the same dialog where you can add a new value which will display as a separate dosage. Tap the icon on the left to turn the dash from horizontal to vertical; you can then delete that dosage. If you add a new dosage in the same time frame, the total amount from the multiple entries will be displayed in the grid in brackets. Mark and Events The Mark and Events buttons allow you to mark a specific point in time and enter comments. When you tap Mark, a marker is placed at the current point in time (at the red line). You can also tap anywhere in the blank area between the two buttons and a marker will be placed at that location. Tap Events to open the Comments screen. Then tap within the blue box to type a comment for that marker. You can also create a marker and enter comments from within this screen. Tap in the white area to type your comments. Then tap ->. A marker is created for the current time. If needed, you can place the marker at a different time point by adjusting the time pickers. Plexus Technology Group, LLC 33

34 Physiologic Graph and Grid Tabs The physiologic graph and grid records live data from various instruments in the OR. Typically, blood pressures and heart rate are displayed as a graph, and the remaining data is displayed numerically on the grid. Graph Tab The graph tab displays information coming from the physiologic monitors, over the course of time. The blue + and buttons expand and contract the scale of the graph. Tap to enable an NIBP icon, then press, hold, and drag in a column to modify the value. The SBP, DBP, HR, and Erase icons in the upright hand corner of this section allow you to edit or delete the noninvasive blood pressure values (systolic blood pressure, diastolic blood pressure, and heart rate) in the graph. If you tap the icon, it becomes orange. At that point, if you press and hold a cell in the graph, a number is displayed showing the value where you have touched. Drag your finger to the value you want and let go. The original value for that cell is replaced by the new value. The next icon is then enabled automatically. So for example, if you enable SBP and change the value, once you release your finger the DBP is enabled. (This only applies to SBP, DBP, and HR Erase is never enabled automatically.). If you enable the Erase icon and then press and hold in a column, all three of the blood pressure values will be removed from that column. Grid Tab The Grid tab displays physiologic information coming from the various instruments in the OR over a time frame. You can scroll through the time frame, the same as with the Medication I/O grid. The grid can display many more parameters than the real time display to the right of the graph. Use your finger to scroll the list up and down to see all the parameters. Plexus Technology Group, LLC 34

35 Manually Adding or Editing Physiologic Data If a specific device does not output data (for example, ECG rhythm and body temperature), you can manually enter this information by entering the data displayed in the physiologic grid. Tap on the appropriate cell. If the value is numeric only, the standard numeric keypad is displayed. If the value is alphanumeric, the keyboard is displayed. You can also edit the values in cells that are automatically populated, if needed. Smart Buttons Tab The Smart Buttons tab provides quick and easy access to commonly used medications. This is customized for your institution. A button can represent a group of medications or an individual one. If you tap a button for an individual medication, a medication dialog opens. This is the similar to the dialog opened by tapping an empty cell in a labeled row in the Medication I/O grid, but these screens can be customized to display buttons that select standard dosages, as shown below. Plexus Technology Group, LLC 35

36 If you tap one of the medication group buttons (for example, Preop Meds), the screen opens, displaying medications that fall into that group. You can select a standard dosage by tapping the appropriate button or tap the amount field to enter using the keyboard or the dial. Note: The dial is not active until tap the value field for a specific medication. Plexus Technology Group, LLC 36

37 In the example shown above some medication buttons (Lidocaine 20 through Propofol 10) are displayed below the tab. These function in a different manner, automatically adding a specific amount to the Medication and I/O grid. This function can be customized for your institution. Alerts Button A yellow Alerts button may appear above the vitals box. The Alerts are dynamic notifications of case relevant messages. For example new labs, concurrency violations, and difficult airway can trigger the appearance of this button. This button is only shown when an alert is available. Note: The alerts accessed from this button are not the same as the Alerts accessed from the Alerts button in the toolbar. Near-Real Time Monitor The monitor displays near-real time vital signs. This allows you to see the most recent data from the anesthesia machine and patient monitors. A flashing blue or red dot indicates when data is being received. If you tap the area which indicates the OR that is being monitored, a Switch Room dialog opens, allowing you to change the OR that you are monitoring. Previewing and Printing the Intraop Record At any time you can preview the Intraop Record, by tapping the Preview icon. This contains all of the information entered within the Intraop screen, including all the timed entries within the grid. Tap Print, Print/End or AirPrint (depending on your printing configuration) to print the document. You cannot print the document until all required information has been entered. If you attempt to print before the required information has been entered, a warning message will appear Once you cancel out of the preview, tap Alerts on the toolbar to view what is incomplete. See the following section Plexus Technology Group, LLC 37

38 Alerts Tap the Alerts button on the toolbar to open the Messages screen. This displays what is missing from the Intraop Record. If an item appears with a box around it, tap that box to open the appropriate screen and enter the missing information. For some items, there may be more than one possible way to enter the missing information; as such these may not link to any specific screen. Additional Features Accessible from the Intraop Screen If you tap the Others icon at the top of the Intraop screen, a menu provides access to the following features: Logout This instantly logs you out of Anesthesia Touch Concurrency Graph This shows staff coverage across multiple rooms and times and is helpful in billing regulations. Physiologics Allows you to add a physiologic parameter to the Grid tab at the bottom of the Intraop screen Import Physiologic Allows you to populate the intraop record with data from the server for a specified location and time interval. This is useful if you are late starting the electronic record, as might occur in an emergency surgery. View Remote Vitals Allows you to view real time vital signs from multiple ORs on the same screen. Edit Patient Info Allows you to modify basic patient and demographic information Migrate Patient Use this function to migrate your anesthesia documentation if it was accidently documented for the incorrect patient, or for an emergency patient. Cancel Case This option cancels the case. It does not remove it from the schedule. This is used to document that a case was canceled. Delete Case This is used to remove the anesthesia record from the surgical case. Signature This is used for a supervisor to sign on to a case for coverage while the application is logged on under his or her supervisee/provider. Plexus Technology Group, LLC 38

39 Concurrency Graph This shows staff coverage across multiple rooms and times and is helpful in billing regulations. Physiologics This screen allows you to add one or more physiologic parameters to the Grid tab on the Intraop screen. Highlight one or more items from the list, then tap Add. You return to the Intraop screen and your items will be found at the bottom of the rows in the Grid tab. Plexus Technology Group, LLC 39

40 Import Physiologic Data This screen allows you to populate the intraop record with data from the server for a specified location and time interval. This is useful if you are late starting the electronic record, as might occur in an emergency surgery. View Remote Vitals This feature allows you to view real time vital signs from multiple ORs. Plexus Technology Group, LLC 40

41 Edit Patient Info In this screen, you can edit basic patient information shown on the anesthesia record. Ther are two tabs within this screen Patient and Demographics. Migrate Patient This function opens the Switch Patient screen, which looks similar to the Appointments screen, but without sorting, filtering and buttons at the top. Instead there is a Switch button in the top right hand corner. Use this function to migrate your anesthesia documentation if it was accidently documented for the incorrect patient, or for an emergency patient. Cancel Case This screen cancels the case. It does not remove it from the schedule. This is used to document that a case was canceled. You can specify whether the person was Cancelled by the anesthesiologist or surgeon, and the Reason for cancellation. You can also provide Comments for further explanation. Plexus Technology Group, LLC 41

42 Delete Case When you select this option, a dialog asks if you want to permanently delete the case. If you answer yes, you are returned to the Appointments screen. This is used to remove the anesthesia record from the surgical case. Completing the Postop Evaluation/Discharge Note From the Appointments screen, select Anesthesia Postop Evaluation by tapping the Documents icon. The Discharge Note screen opens. This consists of a series of statements that you can either affirm, with a Yes or None answer, or select See Comments and enter the comments in the box below. Note: The name of the Post Op Evaluation can be changed depending on your facilities configurations. Once complete, you can either select Save to sign the record and exit back to the Appointments screen, or you can select Preview, which automatically saves the document and opens the Preview/Print screen. Plexus Technology Group, LLC 42

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44 Index add medication, 32, 35 add medications, 25 additional information icon, 7 airway, 18 alerts, 25, 37, 38 allergies, 12 anesthesia plan, 19 Appointments screen, 6 A C cancel case, 41 common user interace elements, 28 commonly occurring problems, 16 concurrency graph, 39 consent form, 22 delete case, 42 edit patient information, 41 emergency patient record, 8 fluid inputs and outputs, 25 importing physiologic data into intraop record, 40 intraop screen additional features, 38 fluids, 25 medication and i/o grid, 31 medications, 25 overview, 23 printing, 37 toolbar, 25 D E F I lab results, 19 L M mark a point in time, 33 medication and I/O grid, 31 medications preop evaluation, 12 migrate intraop documentation to another patient, 41 modify dosage, 32 new patient record, 8 N P patient history, 12 patient information, 7 editing, 41 patient intraop documentation migrate, 41 patient list, 6 patient problems preop, 14 patient record for emergencies, 8 physical exam, 18 physiologic data importing into intraop record, 40 manual entry, 35 physiologic graph and grid, 34 postop evaluation, 42 preop evaluation allergies, 12 height and weight, 11 history, 12 lab results, 19 medications, 12 overview, 10 physical exam, 18 print the preop doc, 20 problems, 14 printing intraop record, 37 Plexus Technology Group, LLC 44

45 preop document, 20 select operating room, 23 smart tab, 35 S sort and filter the patient list, 6 view vitals from multiple operating rooms, 40 V Plexus Technology Group, LLC 45