USER GUIDE Version 1.0 - Monarch Medical Technology
Contents
1. F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM Attending Enter the name of the attending physician Physician If using an ADT interface the user may be able to select the attending physician from a dropdown list or type in the physician information which adds the physician to the list Birth Date Enter Birthdate MM DD YYYY this is used to calculate and display current Age beweege engen crier Weight kg Height in 1 Enter the patient s height in Inches the system will convert to centimeters cm Room Bed Select patient physiological sex M or F Type of DM Select the patient s Diabetes Mellitus DM status from the dropdown list 0 Non DM patient has no history of diabetes or is undiagnosed 1 Type 1 patient has a diagnosis of Type 1 diabetes 2 Type 2 patient has a diagnosis of Type 2 diabetes Gestational patient has gestational pregnancy induced diabetes Unknown patient is unable to communicate and no medical history regarding diabetes is available Creatinine Enter the patient s current creatinine value mg dL HbAic Enter the last HbA1c if available optional field Patient Info Input Screen PATIENT INFORMATION SUBJECT Medical Record 9076543 Attending Physician White Carnie P Date of Birth 01 01 1970 e Age 45 Weight kg TESTEN 76 00 FEELEN Room Bed Sex eta o wen pu Creatinine mg dL HbAtc a Monarch Medical Technologies EndoTool subO User s Guide Page 13 of 362. F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 8 Total Daily Dose TDD and Basal Bolus DistribUtion ccccccccccccccccceeeeeseeeeesseeceeeeceeesssseeeeeeeeaaeens 19 8 1 Changing the TDD and Distribution ccccccccssseccceesececeeecceceesececeuseceeseeeceeseusecessuneceeseneeeetas 20 8 2 PANY ae e n CAR EL KEE 20 GN 9010 ET e Mea e E 22 9 1 Pood Glucose l EE 22 9 2 Glucose Enty STE 6 E 22 9 3 VIR ng EE 22 9 4 PS ENE Voie UNS naessstd cesses ane ec siocsinnseecnep cise daioedeseicnsaasemusioun wevacossacnaceaasoaceesaeewcenddoesaasnssednenas ser usendanec 23 dO fmm Bro ky ee ein 1616 Ee 23 WT r oe Te CITE 24 10 2 Bo l s Co rrection WS UUM xsstcecodetcienseccdsnsctuitedenteccdaoaadutasenanccdenssd ien eie iaiia 24 103 ER Meer ER gn 25 LOA Recovery Carbohydrate Treatment eisereen 25 105 Dosing ISTIC UO RL 25 T e ei ll Eden LE 26 ILI eo Te E giele We CN 27 12 OSD SONS EE 28 TZ 4 DOs Deviation RR CaS ONG ia cigeeetercarrncecesceaspecracandcinaeuspers euler aa 28 KEE nt CAE VOCS estepcc ceeds cncentaecenueidtecbtoceencesandeeas aerepadeneds E 28 A ele ER 29 E DR Tee ET EE 29 TT 30 EE FPE RKE eaa E 31 TA ON un RE 31 E O A E EE 32 Ee Ee EE 32 15 1 Patient Total Daily Dose Advisory ccccccssssessssssecconssscnnssseneoussectonssscneussressoussscuenssscneuusrense 32 ze Ee EE Uer e EE 33 ke A Gate acai gg ai ee cola E 33 18 Discontinue a Patient on Endotool EEN 34 t9 Reacuvanne a
3. F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM USER GUIDE Version 1 0 Indication for Use EndoTool SubQ is a software application for use by trained healthcare professionals to calculate and recommend an individual patient s next dose of insulin to be administered subcutaneously to manage blood glucose levels in patients with Diabetes Mellitus in both adult and pediatric patients age 2 years and above and 12 kg or more The software is designed to recommend the insulin dose s and when indicated a carbohydrate dose based on the prescribing healthcare provider s nutritional regimen insulin regimen target glucose range and patient specific characteristics The EndoTool SubQ Glucose Management System is not a substitute for clinical reasoning but an aid for trained healthcare professionals based on obtained glucose readings and entered clinical data Final dose recommendations for a patient must be made only after consideration of the full clinical status of the patient No medical decision should be made based solely upon the results provided by this software program CAUTION Federal USA law restricts this device to sale by or on the order of a physician or other licensed healthcare practitioner h Monarch Medical Technologies For assistance please contact your facility s IT department Or Monarch Medical Technologies 2137 South Blvd Suite 300 Charlotte NC 28203 1 877 FIX GLUC 1 877 349 4582 24 7 Clinical Suppor
4. Advisory Flag This alerts you to a potentially hazardous situation which if not avoided may result in minor or moderate injury It may also alert you against unsafe practices and provide guidance to avoid injury as a result of misuse Warning Flag This information alerts you to a situation which if not avoided could result in death or serious injury It may also describe potential serious adverse reactions and safety hazards This flag is also displayed when critical required information has not been entered Monarch Medical Technologies EndoTool SubQ User s Guide Page 5 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 3 Dashboard Dashboard is the main screen that displays when EndoTool SubQ is first opened All fields except Facility and Unit are locked until a user has logged in 3 1 Dashboard Login Prior to Dashboard login a Facility and Unit must be selected The last selected Facility and Unit will be stored as a defaults for the logged in user on that PC The Facility and Unit are changed by use of the dropdown menu The display will indicate the successful selection and allow for the user to login into the application The Dashboard is designed to hide PHI private healthcare information prior to login once login is complete PHI for patients on the work list is displayed ALL PATIENTS 2 STATUS LOG IN USemame Due now Due now MY PATIENTS Eeer Op 157 BG ASTBG et O
5. Patient EE 34 PO PICMG DON era E E E A 34 20 1 Report Glucose ReCO 0 EE 34 20 2 Report Discharge RecommendationS cccccccsseccccesscceceesecccceeceeseuseceeeusecessueeceessusecessugeceeseees 34 21 S ftw re S pport and Ree e E e e gn TEE 36 Monarch Medical Technologies EndoTool SubQ User s Guide Page 4 of 36 hd Monarch Medical Tec nologies ENDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 1 Accessing EndoTool SubQ To access Endotool select the desktop icon or access by a web link provided from the EMR or other system Desktop icon examples shown here LE E ai EN EA EndoT ool EndoTool EndoTool EndoT ool EndoT ool NormalColor Homestead Metallic Tangerine Unthemed 1 1 Application Log in and Security Each user must have a unique User Name and Password These are typically maintained by the Facility IS department EndoTool uses the assigned Active Directory AD account for authentication The software can use a direct authentication method and separate passwords can be maintained at the application level however for best workflow practice this is not recommended 2 Symbols and Icons Help Information Advisories and Warnings Access the On Line User Manual This is made available from the Dashboard to all users This information option provides tips or other important material that can help you better understand EndoTool it can further explain the actions you need to perform for its effective use
6. displayed Calculation time of the glucose entry Hover the mouse over any Calculation time to display the Sample time for the glucose entry The associated date is displayed at the top of the time column Today and Yesterday are labeled as such Day Month Year on the days prior to today and yesterday 14 2 History Grid Flags Flags Description amp refused glucose check 6 refused oral carbohydrates PO hold TPN hold Monarch Medical Technologies EndoTool SubQ User s Guide Page 30 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 14 3 Flags Key B Refused glucose check WW Bm Refused oral carbohydrates 14 4 History Graph View Selecting this icon A will show a graphical display of certain elements of the History Grid BG Trend sample CHO Trend or Insulin Dosing Trend 04 27 04 28 0426 04 26 04 26 04 26 04 20 LE SN 04 26 04 28 04 28 22 00 00 00 02 00 0 400 06 00 03 00 10 00 12 00 14 00 16 00 16 00 Monarch Medical Technologies EndoTool SubQ User s Guide Page 31 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 14 5 History Graph Fields Vertical axis Glucose Insulin Carbohydrate Blood glucose ranges Horizontal axis Time Date and Time in two hour intervals Changes the view from the combined graphics to the individual graphs Shifts graph backward or forward in time Green Highlight Ind
7. 49 4582 EU Version X Y Z a d c Monarc Medical Te logies Monarch Medical Technologies EndoTool SubQ User s Guide Page 2 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM Contents 1 Accessing ERGOT e SOOO EE 5 1 1 Applicaton Log inand SOC CIE EE 5 A 1 01 918 are ACON E 5 SUVA E 6 3 1 Da nDO ar TE 6 3 2 Dashboard FICIOS TTT 7 3 3 BAC OCS e Te EE 8 4 NaViZatlON ali IMTOMMIATION EEN 9 4 1 EE 9 4 2 Siet tt 9 4 3 MV ALUMS E 9 4 4 e ee TEC EE 9 4 5 EndoTooladditional INTOPMALION vesserscxesistaveurrevecocavensveatuccintese EE A 9 S AO E 10 5 1 BG DUE EE En E 10 5 2 Be Ten E 11 6 aN UN Fh VI EE 11 6 1 ADT IMR e 11 6 2 NO ADT WCU Ce 11 6 3 PROCS E E E 12 6 4 Selecting an Active Patient from the SubQ Dashboard seesesssssrsssssesressrrrssrrssrersrrrsrrererrrerrreses 12 6 5 Starting a Patient on Endotool SUDO eseeessesereressrrerereressrrerereresserersreressrrerereresserersreressererereersses 12 6 6 Patient Information Protocol and Nutrition ssssssssessessessessesserrerrsrrerrsrrsrrsresrrsresresreereererresreee 12 6 7 Bernie de ig ge DEE 12 6 8 Patientin orna TOMI les e E E uted E AE 12 6 9 PCA O BE 14 INET i FEE a E EE A 14 C VEN Pe E 15 SD E e ue e E 15 SD EC Pron ee Ee EE 15 Z RE El EEN 16 7 1 Start Restart ICONS and Fields eerste geesde ee Aender 17 Monarch Medical Technologies EndoTool SubQ User s Guide Page 3 of 36 h Monarch Medical Technologies
8. CH FIRST NAME DOB ST BG CLINICIAN td ou Dee Due now 9193933951 d Smith Test 01 01 1930 S 09 19 Medical Director Due now 9876543 Subject Patient 01 01 1970 10 09 24 Medical Director Monarch Medical Technologies EndoTool SubQ User s Guide Page 6 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 3 2 Dashboard Fields FACILITY Verify or select the facility Preselected if no other facilities are available UNIT Verify or select the unit Preselected if no other unit is available Login Logout Displays user Names after login Select User Name to Log out of Endotool Audible alert control Turns on off audible Audible default is set to on Control is user specific Barcode Initiates barcode scanning for patient selection and verification EndoTool Analytics A data reporting tool Availability is dependent upon user credentials Dashboard Navigates to the Dashboard Displays number of alerting patients Displays alerting patients in the All Active Patients list and My Patient list Monarch Medical Technologies EndoTool SubQ User s Guide Page 7 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM Patient Details Opens last patient accessed by user Help Link to this EndoTool SubQ User Guide Favorites Star Adds or removes patient s to MY PATIENTS work list Green patient is added to My Patients G
9. ENT CARBS 60 60 60 LANTUS BASAL NOYOLOG BOLUS 34 11 11 11 Extra calories between meals Correction Insulin for extra carbs 1 Excludes insulin for extra et TO Gene 14 1 History Grid Fields Field Name Calculation time of the glucose entry Hover the mouse over any Calculation time to display the Sample time for the glucose entry The associated date is displayed at the top of the time column Today and Yesterday are labeled as such Day Month Year on the days prior to today and yesterday Flags associated with glucose entry see below Blood Glucose entered Monarch Medical Technologies EndoTool SubQ User s Guide Page 29 of 36 wd Monarch Medica F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM Basal Insulin Name Displays basal insulin dose BOLUS Insulin Name Displays meal insulin dose Correct Correction Insulin Name Displays Correction insulin dose Oral Carbs Displays oral carbohydrates for meal intake tube feeding hypoglycemia treatment and recovery carbohydrate treatment Doses specific to hypoglycemia or recovery carbohydrate dosing are labeled DEXTROSE Displays dextrose doses for IV dextrose infusion TPN and D50 25 10 Doses specific to hypoglycemia or recovery carbohydrate dosing are labeled FREQ CLINICIAN UNIT Confirmed row Change in Insulin If at any time a change in the insulin ordered occurs a sub header will display with the previous insulin and the new insulin
10. TPN content has occurred the user must return to the Patient Information screen and update those fields Monarch Medical Technologies EndoTool SubQ User s Guide Page 26 of 36 h Monarch Medical Technologies CONFIRMATIONS AND SIGNIFICANT EVENTS Recommendation generated 09 26 Blood Glucose 1 02 INSULIN INTERMITTENT NUTRITION Ee oo Units Detemir i of meal Bolus Correction Units Aspan wi mL To make changes to the current Nutrition Plan visit the Nutriton Page CONTINUOUS NUTRITION and update according to new order siege Dextrose 5 d 20 NR mLfhr Start Titrated en Dextrose 10 mL hr Start Titrated TUBE FEED None E mi hr Start Titrated Recommendations for insulin recovery carbs hypoglycemia treatment and previously entered nutritional carbs are prepopulated The user will review all fields If the values displayed are correct the user selects the checkbox If the dose s delivered differ from displayed values the user will change the values to what was given In addition the user will update the IV fluid and Continuous Nutrition fields if any changes have occurred since the last entry The checkbox is selected attesting to the accuracy of the values displayed and the user can select either the Save and Exit option to return to the Dashboard or select the Continue option to advance to the Glucose Meal Entry screen 11 1 Confirmation Fields Held Description S Insulin If recommended at last
11. col and Insulin type input fields require the user to provide the system with the physician orders for glucose check timing and the Insulin types and frequency to be used in the determination of the dosing recommendations 6 13 Protocol Fields Glucose Checks Select from the dropdown the appropriate schedule for glucose checks Extra If ordered by a physician an additional glucose check can be selected by selecting the appropriate time BG Goal mg dL Select range of glucose control Verify against physician s orders if more than one range of control can be selected Insulin Types Select Long Acting Insulin ordered by physician Basal Frequency Select Once BID as ordered AM PM Select AM or PM when Basal insulin is ordered Once Select Short acting insulin ordered by physician Monarch Medical Technologies EndoTool SubQ User s Guide Page 15 of 36 h Monarch Medical Technologies Correction This will automatically populate with the same selected Bolus insulin Protocol Input Screen PROTOCOL Glucose Checks ha xtra K Get E 90 130 EIDA INSULIN TYPES Basal K ee Aspart Ki Comection Aspari 7 Start Restart The Start Restart dosing option allows the user to select from the options displayed additional information which will be used to determine the initial dosing model Click on the appropriate choice toi start the dosing Model You must select Yes or No for the question Has the patient revieved
12. cond confirmation Advisory screens provide additional information and are designed to highlight values outside the medical director thresholds These screens require user acknowledgement of the information verification of information accuracy or as a reminder to complete a step AA Confirm the highlighted fields which are related to the calculated kidney function 4 5 EndoTool additional Information Additional information can be accessed by clicking on the information icon O throughout the application Monarch Medical Technologies EndoTool SubQ User s Guide Page 9 of 36 hd Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 5 Alerts EndoTool provides both Visual and Audible alerts to indicate when blood glucose checks are due or are past due when the Dashboard is actively displayed 5 1 BG Due Visual Alerts e On each patient list header MY PATIENTS and ALL ACTIVE PATIENTS an Alerts area on the right side of the display shows the number of patients in that list that have a glucose due or past due e By patient row Each patient row lists the patients next expected glucose time Due at LUNCH in the Status column The row is highlighted in orange to indicate the patient has a glucose check currently due The row is highlighted in red beginning at one minute past the designated meal time frame For example If lunch typically occurs between 1100 and 1300 the row would turn red at 1 minute pa
13. e method of treatment to be provided At Confirmation the user will be able to indicate which agent was given HYPOGLYCEMIA TREATMENT NEXT CHECK IV Treatment PO Oral Treatment 09 a 4 5 D50W Juice 10 2 09 45 09 45 OZ Give IV or PO option DO NOT GIVE BOTH If patient is unresponsive and no IV access give Glucagon 1 mg IM then obtain IV access and Give IV Dextrose recommendation Back To Dashboard 10 4 Recovery Carbohydrate Treatment Recovery Carbohydrate treatment recommendations are provided in 2 separate formats IV infusion recommendations for patients who are unable to consume oral carbohydrates and oral recommendations for those patients who are eating The medical director will determine the IV and Oral agents recommended Both IV and Oral recommendations are displayed Select only one method of treatment to be provided At Confirmation the user will be able to indicate which agent was given 10 5 Dosing Instruction Fields Basal Long Acting basal insulin recommendations as schedule by the treating physicians orders Short acting meal carbohydrate coverage for carbohydrate intake Correction Short acting corrective insulin recommended for glucose level above an expected value Monarch Medical Technologies EndoTool SubQ User s Guide Page 25 of 36 h Monarch Medica F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM Hypoglycemia Calculated recommendation of carbohydrate to increase a gl
14. el Enter the following information into the appropriate fields Total basal insulin units per day Total bolus insulin units per day Last basal dose amount date and time Last bolus dose amount and time Note This does not include Correction insulin only Basal Bolus insulin It is also acceptable to use EndoTool to Calculate when a patient is transitioning from home or other subcutaneous protocol Monarch Medical Technologies EndoTool SubQ User s Guide Page 17 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM When selecting From IV Complete the fields for Current insulin infusion rate and Last BG then Confirm a Current insulin infusion dose units per hour Fc Last previous blood glucose used to calculate the current infusion dose mg dL Note Use when patient is responding well to prior treatment When selecting From SubQ Complete the fields for Basal and Bolus dosing and Confirm ENTER THE PATIENT S TOTAL DAILY INSULIN DOSES FOR LAST 24 HR BASAL BOLUS Daily Dose El Daily Dose LAST BASAL DOSE LAST BOLUS DOSE Dose Dose Basal Type Bolus Type Date Date Time Time Monarch Medical Technologies EndoTool SubQ User s Guide Page 18 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 8 Total Daily Dose TDD and Basal Bolus Distribution The Total Daily Dose TDD and Basal Bolus Distribution screen allo
15. er the current Blood Glucose Reading The time of the Sample should accurately reflect the actual sample time but cannot be prior to 30 minutes from the current time After valid entries are made the Calculate button will become enabled select Calculate to display the dosing recommendations BLOOD GLUCOSE MEAL ENTRY Glucose 102 i shar Food Sample Time 03 24 4 Patient has started or already eaten meal Sample Date 4i Ti2015 9 1 Blood Glucose Fields Enter current point of care glucose in mg dL Sample Time Defaults to current time If the point of care reading was performed greater than 5 minutes prior to the displayed time adjust the sample time accordingly and if necessary sample date Refused Select this when a patient Refused the BG Check Your Medical director can set the maximum number consecutive times a patient may refuse the BG check After 24 hours of refusals the patient should be discontinued on EndoTool 9 2 Glucose Entry Advisories Advisory screens will display for BG or Carbohydrate Meal entries that are outisde of set thresholds 9 3 Meal Entry Meal entry is the entry of the carbohydrate content of the meal There are three methods of accounting for carbohydrate content are provided grams of carbs carb servings or of meal Itis recommended that a facility promote the use of only one method A list of diets and feeding products with their associated carbohydrate content will be maintained i
16. for the search This is the top left field on the screen e You can search by any combination of name gender and date of birth If the facility is using the scanning feature for patient selection verification click the Barcode Icon and scan the patient s wristband identification number If the patient verification feature is turned on selecting a patient that is already on EndoTool SQ in your unit from the My Patients or All Active Patients list will open the barcode scanning window SEARCH AND ADD PATIENTS Medical Record Account Number Date of Birth is Sex MM dd yyyy 6 1 ADT Interface If the facility is using an Admit Discharge Transfer ADT interface and the patient is not found the patient may be activated in Endotool Manually It is not recommended to active patients manually unless it is an emergency situation as merging of patient information from improperly entered demographics is not possible 6 2 NoADT Interface If facility is not using an Admit Discharge Transfer ADT interface all patients will be entered manually Monarch Medical Technologies EndoTool SubQ User s Guide Page 11 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 6 3 Adding a Patient Select patient by clicking on the plus CJ icon When multiple patients are found select the correct patient based on the patient s unique identifiers age gender DOB etc 6 4 Selecting an Active Pa
17. glucose mealentry D50 D25 D10 as per age and medical director Oral Agent Oral glucose juice tabs get etc as per medical director Weight based dose recommendation as per medical director Hypoglycemia Treatment Populates recommended dose of Monarch Medical Technologies EndoTool SubQ User s Guide Page 27 of 36 h Monarch Medica F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM D10 TPN 12 Dose Deviations 12 1 Dose Deviation Reasons The Dose Deviation Reasons screen will appear when any recommended dose value was changed on the confirmation screen Check all reasons that apply CONFIRMATIONS AND SIGNIFICANT EVENTS Ls PRIOR RECOMMENDATIONS WERE NOT ADMINISTERED INDICATE THE REASON 3 FOR THE DEVIATION Reason for dose change _ Refused Insulin Refused Meal MD Order _ Ate Less Than Expected _ Change in IV Dextrose or Tube Feeding _ Ate More Than Expected _ Emesis _ Other Document in EMR 13 Significant Events Certain events are known to impact insulin needs Two of those events are changes in steroid dosing and the administration of antibiotics in dextrose containing solutions If one or both of these events have occurred since the last interaction with the system the user can select the correct radio button check the box or both CONFIRMATIONS AND SIGNIFICANT EVENTS ba Yes E iV Dextrose Bolus Piggyback Since Last BG Entry O No E Emesis Since Last BG Entry E Snack Since Las
18. h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 6 9 Nutrition The nutrition fields require the user to provide dietary and carbohydrate intake information including IV infusions containing dextrose Complete only those fields that apply to the patient s current orders 6 10 Nutrition Fields Intermittent Nutrition Product and frequency as ordered Continuous Nutrition Dextrose Select the D5 or D10 solution from the dropdown and then enter the administration rate administration rate TPN Provide the Dextrose of the TPN rate units of insulin in units and total volume of the TPN solution in mL When the value enter into the insulin field is greater than O the application displays a unit mL calculation as an additional safety check Nutrition Input Screen NUTRITION INTERMITTENT NUTRITION Meal Diet Plan Eolus Tube Feed SE Product mL every CONTINUOUS NUTRITION Tube Feed Product a TPN a X Dextrose units insulin in Monarch Medical Technologies EndoTool SubQ User s Guide Page 14 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 6 11 View Plan To review a comprehensive display of the patients planned nutrition select the View Plan button NUTRITION 24 Hour Nutrition Analysis BMR O Carbohydrates Day BREAKFAST LUNCH DINNER SHACK GRAME 60 60 60 A DSW Grand Total 6 12 Protocol The proto
19. he Patient Information screen and Confirm patient transfer Monarch Medical Technologies EndoTool SubQ User s Guide Page 33 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 18 Discontinue a Patient on Endotool To discontinue treatment of a patient on Endotool access the Patient Information screen and select the Discontinue button You will be prompted to confirm your selection to discontinue Select Yes to discontinue else Select No if you have inadvertently selected this option 19 Reactivating a Patient Search and add the patient using Search and Add Patient Enter all necessary information Complete Start Restart Dosing screen and Confirm These steps are the same as the initial activation of a patient 20 Patient Reports The number and type of available reports orders is unit specific A barcode can be placed on the bottom right hand corner of report This barcode can be the patient s Primary Identifier or a form number The length of the barcode is limited to 20 characters To view and print a report e Select the patient from the Dashboard e Select Patient Reports e Select the report of interest e Complete applicable fields e Select Run Report to display a printable report e Select the print icon or right click on the displayed report and select the print option 20 1 Report Glucose Record Select the report and then desired date range To include the graph selec
20. iV or Oral steroids in the past 24 Hours before you can Confirm and continue START RESTART DOSING SELECT A METHOD TO BEGIN DOSING at BON L00 RIKO From From From CALCULATE LAST SubQ ENTRY Other IV Other SubQ S 3 5 Monarch Medical Technologies EndoTool SubQ User s Guide Page 16 of 36 h Monarch Medica F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 7 1 Start Restart Icons and Fields EndoTool to EndoTool SubQ determines the dosing model based on the patient information Calculate protocol and expected carbohydrate intake provided From Last Restarts insulin therapy based on previous dosing model at the time EndoTool SubQ SubQ Entry was last active for the patient This is used when the patient has been temporarily removed from EndoTool Note This option is available for only 72 hours after the last BG Carbohydrate entry when a patient has transferred units or was discontinued on Endotool From IV Determines the starting model based on the previous glucose reading and current Insulin drip rate Use when a patient is transitioning from an IV insulin infusion Enter the following information Current Insulin infusion rate and Last previous BG Check used to set rate It is also acceptable to use EndoTool to Calculate when a patient is transitioning to EndoTool SubQ from a different IV insulin protocol Uses the patient s TOTAL scheduled subcutaneous Basal Bolus dosing orders to calculate the initial mod
21. icates the BG Goal Range Yellow Blood Glucose Light Blue Insulin Carbohydrates 15 Advisories Advisories are provided to help the user avoid errors and to aid in decision support Endotool will show recommendations for resolution of specific situations Some advisories may provide directions such as contact physician or alternate therapies These messages are approved by the Medical Director and are configurable for the facility and Review the information provided in the Advisory then select Confirm to acknowledge and advance to the next screen Advisories are intended to ensure that the clinician is making an informed decision 15 1 Patient Total Daily Dose Advisory When the systems internal math model determines that the dose recommendations should increase an advisory is displayed This is intended to keep the user informed of increases in Insulin doses and require acknowledgement by the user by selecting Confirm The user at their own discretion or at the direction of the physician can elect to Confirm Delay or Change the increase in dose recommendations by the application Monarch Medical Technologies EndoTool SubQ User s Guide Page 32 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 16 Deleting a Glucose Entry In the event that an incorrect information was entered on a patient the last blood glucose entry can be deleted from the record if allowed by the Unit Administra
22. n the medical directors table When a specified diet is selected that diet is associated with the medical director values For example if 60 grams of carbohydrate is set per meal then the application associates 100 of a meal with 60 grams of carbohydrate or 4 carb servings Monarch Medical Technologies EndoTool SubQ User s Guide Page 22 of 36 h Monarch Medical Technologies 9 4 Meal Entry Fields Field Description o Provide carbohydrate meal value Grams Carb Servings meal_ Indicates if Food value entered is in grams of carbs carb servings or O of the meal A predetermined meal value is set in the medical director parameters Example if meals are a set value of 60 grams then 100 of a meal is 60 grams or 4 Carb Servings Bolus Tube Feed Provide the volume in mL of the bolus tube feed A list of tube feeding products and their carbohydrate content is provided in the medical director table The system calculates the carbohydrate content based product type and the mLs of feeding entered Patient has started eating the IF the patient has already started consuming the meal check this box Meal to indicate that the patient is already eating as this will be used in determining the model accuracy vs a fasting BG entry 10 Dose Recommendations The Dosing Instructions screen displays multiple types of dosing recommendations these may vary according to Medical Director Facility or Unit Each recommendation will have a s
23. pecific location and associated color DOSING RECOMMENDATION Blood Glucose 144 mg dL Goal Range 110 mg dL 140 mg dL Meal or Bolus Feed 60 Grams Bolus Novolog NEXT CHECK LUNCH 11 00 14 00 Monarch Medical Technologies EndoTool SubQ User s Guide Page 23 of 36 h Monarch Medica 10 1 Basal Insulin Basal Insulin dose recommendations are displayed in the upper left quadrant in green font 10 2 Bolus Correction Insulin Bolus Insulin dose recommendations are displayed in the upper middle quadrant in Orange font IF Correction insulin is recommended it is added to the Bolus amount and indicated by showing a breakdown below the recommended dose as shown here DOSING RECOMMENDATION Blood Glucose 145 mgidL Goal Range 90 mg dL 130 mg dL Meal or Bolus Feed 60 Grams Subcutaneous Bolus 5 Units Correction 1 Unit NEXT CHECK BEDTIME 21 00 23 00 Monarch Medical Technologies EndoTool SubQ User s Guide Page 24 of 36 h Monarch Medica 10 3 Hypoglycemia Treatment Hypoglycemia treatment recommendations are provided in 3 separate formats IV recommendations for patients who are unable to consume oral carbohydrates oral recommendations and glucagon for those patient s requiring IV treatment but cannot be provided IV access in a timely manner The medical director will determine the IV and Oral agents recommended Both IV and Oral recommendations are displayed Select only on
24. rey Not selected 3 3 Barcode Scanning Barcode Initiates barcode scanning for patient verification This feature can be used to select your patient or add a new patient to the system Monarch Medical Technologies EndoTool SubQ User s Guide Page 8 of 36 h Monarch Medical Technologies ENDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 4 Navigation and Information 4 1 Buttons e Selecting the appropriate Button for the desired action after confirming information entering necessary information or completing an actions Some buttons will only be active when the required information or conditions have been entered and or completed o Cancel Back Returns user to the previous screen or Dashboard Accordion Headers Accordions are collapsible sections within the application which can be opened or closed vertically 4 2 Scrolling Depending on PC and screen settings scrolling up or down may be necessary to navigate to a desired section within the application 4 3 Warnings Highlighted Red warning bands appear in the input boxes when mandatory fields are left blank or when the entry has not met or has exceeded a threshold or an entry requires a secondary confirmation A warning banner will also appear to assure safe use and or the accuracy of the data being entered A You must provide a value for the following field s Weight 4 4 Advisory Screens Highlighted Yellow warning bands appear when the data is requires a se
25. s experiencing a downtime Resolution Verify the use of the correct identifying number Error can occur by searching without using leading zeroes etc Alternative searches include but are not limited to patient last name patient first name etc Contact your IT department concerning ADT feed downtime Audible Alert not working Symptom Client cannot hear Alerts Cause Disabled sound in windows or speaker volume is muted Resolution Verify audible alert icon is set to on workstation is not muted and adjust external speaker volume as necessary If this does not resolve the problem contact your IT department Unable to Print Reports Symptom Unable to print Cause Printer definition on the PC is not correct Resolution Contact your IT department to configure the printer in the operating system on the PC Monarch Medical Technologies EndoTool SubQ User s Guide Page 36 of 36 hd Monarch Medical Technologies
26. st the time lunch end 0 if a meal glucose entry has not occurred MY PATIENTS 2 POB LAST EG LASTBG CLINICIAN STATUS MEDICAL RECORD de enge H mg dL Time Due now 9196983961 i 01 01 1960 111 09 19 Medical Director Due now 96763435 subject Patient 01 01 1970 102 09 24 Medical Director The Dashboard Icon displays the number of patients with active alerts and is dependent on how patient lists are set up by an individual user e f the My Patients list is populated the alerts will display on the Dashboard icon for only those patients e If the My Patients list is empty the Dashboard icon will display alerts for all active patients in the unit Monarch Medical Technologies EndoTool SubQ User s Guide Page 10 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 5 2 Audible Alerts Audible alerts sound when a patient s BG is due in approximately 5 minutes or less depending on the facility unit settings Audible alerts stop when blood glucose entry is completed In order for audible alerts to be active EndoTool SubQ must be open on a computer with functional non muted speakers and volume control set appropriately 6 Search and Add Patient 1 Select Search and Add Patients from the Dashboard 2 Enter search criteria e The preferred method is patient s primary identifier account number medical record number etc When searching by this method no other fields may be used
27. t F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM Introduction The EndoTool SubQ Glucose Management system includes security features software and technical support features Each user has an individual User Identification ID and Password in order to access portions of the application EndoTool SubQ is designed to safeguard the confidentiality integrity and availability of electronic protected health information of patients according to the Health Insurance Portability and Accountability Act HIPAA privacy rules EndoTool SubQ is packaged in a user friendly stand alone program The application is installed on Windows Server 2008 R2 or newer The end user should access the application using Internet Explorer 8 or higher The application was developed for use on Personal Computers PCs network servers and terminal server environments As EndoTool data is time sensitive it is also imperative that all PCs and servers be set with the correct date and time using UTC EndoTool SubQ can utilize barcode scanning in Code 39 format also known as Alpha39 Code 3 of 9 Code 3 9 Type 39 USS Code 39 or USD 3 for patient identification verification 9 ENDOTOOL INFORMATION For technical issues while running EndoTool passwords network connectivity hardware etc please contact your IT department For clinical or application issues about the EndoTool software please contact Monarch Medical Technologies at 1 877 FIX GLUC 1 877 3
28. t BG Entry NOT Covered By Insulin IE Family Provided Food Monarch Medical Technologies EndoTool SubQ User s Guide Page 28 of 36 h Monarch Medical Technologies 14 History Glucose entry and dosing information for a patient is displayed in the History screen and can be reviewed at any time Entries that have been deleted will be displayed with a strike through Only the last 72 hours of history will be displayed in the History screen To view the entire history go to the Patient Reports section Selecting the Grid ICON E opens thed Hlstory Grid BREAKFAST SUPPER BEDTIME 51 BASAL NEW TDD CONFIRMATION PENDING TODAY 01 09 2015 6 59 TDD 67 units TIME 0725 1145 GLUCOSE 113 i 135 CONTINUOUS CARBS i S INTERMITTENT CARBS 60 60 LANTUS BASAL 34 i TODAY S RECOMMENDATION TDD 67 UNITS BASAL 51 NovoLo BOLUS 11 11 Values Displayed Carbs in Grams Glucose in mg dL Insulin in units BREAKFAST l LUNCH SUPPER i BEDTIME TIME 0725 1145 1714 2205 GLUCOSE 127 l 145 130 CONTINUOUS CARBS INTERMITTENT CARBS 60 60 60 LANTUS BASAL 34 3 BOLUS 11 11 11 FLAGS 1 EMESIS 2 REFUSED INSULIN 3 EXTRA CARBS 4 Low BG SYMPTOMS 5 MD ORDER 6 Low BG F U BREAKFAST l LUNCH SUPPER BEDTIME 2 DAYS AGO 01 07 2015 6 59 TDD 67 uNiTs 51 BASAL TIME i 736 1135 i 1701 GLUCOSE LETA 140 134 CONTINUOUS CARBS INTERMITT
29. t Include Graphics checkbox This will print the entire Blood Glucose Record showing all confirmed doses and administered carbohydrates When indicated the flags for significant events will appear on the Glucose Record 20 2 Report Discharge Recommendations Selecting the Discharge recommendations will show the currently calculated TDD with Basal and Bolus distribution This can be used to maintain the patient euglycemia when their diet is tightly monitored Monarch Medical Technologies EndoTool SubQ User s Guide Page 34 of 36 hd Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM and reported PATIENT REPORTS The patient s BG history Detailed discharge notes from Hospital eum 07 15 2014 Wit 07 16 2014 im Monarch Medical Technologies EndoTool SubQ User s Guide Page 35 of 36 h Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 21 Software Support and Troubleshooting For technical issues while running EndoTool SubQ passwords network connectivity hardware etc please contact your facility s IT department For clinical and application issues regarding the application assistance is available 24 hours a day 7 days a week Call 1 877 FIX GLUC 1 877 349 4582 to reach Monarch Medical Technologies Support Personnel Cannot Find Patient Symptom Unable to locate patient when searching Cause Incorrect patient identifying number is entered or ADT feed i
30. tient from the SubQ Dashboard Log in and select the patient by clicking the LJ to the right of the patient name or by double clicking the patient row 6 5 Starting a Patient on Endotool SubQ 6 6 Patient Information Protocol and Nutrition To start a patient on EndoTool SubQ the user must complete all required Patient Information fields Nutrition and Protocol selections that apply and confirm the input data 6 7 Patient Information Some fields will be pre populated if facility is using an ADT interface Ensure that data is correct If a discrepancy exists contact your facility patient registration or IT department for assistance A name Alert will appear when patients with similar names are identified on the Dashboard Warnings and or Advisories may appear if required fields are blank or if the entry is outside of expected ranges 6 8 Patient Information Fields Medical Record The medical record number will be pre populated from the Search for Patient screen This field may be labeled differently if applicable at your facility i e Medical Record PTID FIN or Visit ID Account Number Enter the patient s account number if applicable This field may be labeled differently at your facility i e FIN or Visit ID or may not display at all Enter the patient s last name FirstName Enter the patient s first name Monarch Medical Technologies EndoTool SubQ User s Guide Page 12 of 36 h Monarch Medical Technologies
31. tor If the patient has NOT been given the recommended insulin Dose the user may delete the previous BG reading and enter the current corrected blood glucose value If the patient has been given insulin based on the recommendations using an incorrect blood glucose value do not delete the entry Check the patient s blood glucose immediately and enter the current blood glucose value to obtain new recommendations Contact the patient s physician when applicable to your policy as additional glucose checks may be indicated Follow all facility polices regarding medication errors EndoTool is not designed as a medication tracking system To delete an entry select Delete Last Entry from the History screen then confirm deletion on the deletion screen A deleted entry will display on the History with a strike through HISTORY Ee BASAL BOLUS CORRECTION i LANTUS WNOVOLOG NOVOLOG ORAL CARBS W DEXTROSE NEXT BG CHECK CLINICIAN UNIT mgidLl Unit Unit Umit grams grams HH MM 17 Transferring a Patient There are 2 methods for patient transfer e Unit receiving patient Search and add the patient using SEARCH AND ADD PATIENTS Enter the patient s new room number into the Patient Information screen and Confirm patient transfer e Unit transferring patient Select the unit from the Dashboard to which the patient is being transferred Search and add the patient using SEARCH AND ADD PATIENTS Enter the patient s new room number into t
32. ucose Treatment level lower the medical director setting for hypoglycemic treatment IV Dextrose D 10 25 50 as indicated for age and weight or Oral Agent Agent selected by medical director appropriate for age and weight or Glucagon Dose as indicated for weight and medical director setting Recovery Carbohydrate Calculated recommendation of carbohydrate to counter balance the Treatment amount of insulin on board IV Detrose D5 or 10 as indicated for age and weight or Oral Agent Oral glucose agent as set by Medical Director Next Check Displays specific time or meal interval at which next glucose check should occur Not all glucose check times will conform to the schedule selected Glucose checks will be determined by the patient s response and current recommendations Frequency can be as little as 15 min and no longer than the schedule selected at setup 11 Confirmations With the exception of the first glucose and or meal entry the Confirmations screen will be the first screen encountered when a patient entry occurs The Confirmations allow the user to provide the system with two types of information First the user updates the system as to whether or not the patient received the recommended doses of insulin and or carbohydrate If not the user changes the values to what was given Second the user updates any Continuous Nutrition rate such as dextrose containing IV fluids Tube feeding or TPN If changes to Tube Feeding type or
33. will appear This shows the updated model based on the patients individual response in the past 24 hours The Clinician must confirm the updated TDD each day An option exist to Delay the acceptance of the new values if the ordering doctor cannot confirm In this case the previous days TDD and Distribution will be used to continue treating the patient until confirmed or updated A EndoTool Daily Dose updated recommendations PREVIOUS DAY CORRECTION Last Confirmed SI Recommended 45 Basal 55 Bolus TOG NSULIN BREAKFAST LUNCH Basal a d D cep Cio CIR 12 73 grams unit ISF 79 97 mg dL unit Monarch Medical Technologies EndoTool SubQ User s Guide Page 20 of 36 yd Monarch Medica ENDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM IF Delay is selected each subsequent BG entry will return the user to the TDD Update advisory and prompt the user to Confirm or Change the TDD and distribution After Confirm is selected this advisory will only appear at the scheduled time for daily TDD updates ADVISORIES Last Confirmed 47 Basal 53 Bolus IN SULIH BREAKFAST 9 39 CIR 12 73 grams unit ISF 79 97 mold unit Delayed Monarch Medical Technologies EndoTool SubQ User s Guide Kal Page 21 of 36 Monarch Medical Technologies F NDOTOOL SubQ GLUCOSE MANAGEMENT SYSTEM 9 Blood Glucose Meal Entry At the specified time or when clinically necessary complete the required fields to ent
34. ws the user at the physician s direction to accept or override the patient s initial dosing model TOTAL DAILY DOSE AND BASAL DISTRIBUTION Recommended 100 Basal 0 Bolus IN SULIN 8 b Detemir Aspari unitsiday CIR 32 75 grams unit Crm ISF 327 82 mg dL unit Additional information on the factors used to calculate the TDD are found in the Information section INSULIN DISTRIBUTION EndoTool has calculated the following recommendation based on the planned carbohydrate intake infusions and insulin sensitivity estimated from the patient s weight height gender and type of diabetes m Monarch Medical Technologies EndoTool SubQ User s Guide Page 19 of 36 h Monarch Medica 8 1 Changing the TDD and Distribution The Physician may select to Change the recommended TDD and Distribution at any time Select the Change Button and then enter the new values for TDD and Basal distribution The Chart will update to reflect the new values TOTAL DAILY DOSE AND BASAL DISTRIBUTION TDD 24 Current Distribution Basal 50 Bolus 50 PREVIOUS DAY CORRECTION Last Confirmed Recommended 28 39 Updated 50 Basal 50 Bolus Basal INSULIN BREAKFAST DINNER BEDTIME A 50 Lantus 0 0 d Of Novol 8 8 0 O og Lantus CIR 0 grams unit units day ISF 0 mg dL unit 8 2 Daily Update to the TDD After the first blood glucose of the day is entered typically the fasting BG entry the TDD advisory screen
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