(CPA) User Guide - Physicians
Contents
1. ET Lea LL ete La om Ll ml nk 15 40 15 45 15 50 15595 16 00 Config Options a L L Sm J Co LL Jk Dal la 15 05 15 10 15 15 15 20 15 25 15 30 The Config icon allows the user the ability to re order the grid or graph monitor contents remove items or add items not already displayed w Grid Graph Configuration a LX Grid Graph Configuration Available Variables Existing Variables Current Display Tab Monitor ECG Monitor ST1 Monitor CO2 Ambient Pressure Vent Compliance Add to Vent Intrinsic PEEP Both Vent Minute volume l m State Entropy ty spe Up Vent Total Fresh Gas Flow Temp Monitors JR Monitor Nitrous Insp SPV Monitor Oxygen Insp Vent Vent FIO2 Down Monitor CO2 Fi Esophageal temperature SaO2 Pulse Monitor 5pO2 Monitor ETCO2 Monitor ETCO2 Resp Vent Peak pressure Vent PEEP CPAP monitore Vent Rate Setting Vent Tidal volume inhaled m Graph Y Axis Min o Graph Axis Max 200 Cancel Documentation Tips To add items to the grid highlight the choice in the left column and add to the right using the arrow button Blue arrow The screen shot illustrates the grid tab When the grid tab is displayed the appropriate tab should be selected first Monitors or Flows Centricity Perioperative Anesthesia User Guide Page 33 of 56 A fraserhealth Items on the Mon2. DRE ofl Note Case date time cannot be modified m after selecting the anesthesia script Finish Cancel A new heading will appear as the first entry in the list of scripts with your name as the heading and the script you selected will appear below your name The example below shows the favorites of the generic user Anesthesia Attending Case Startup Wizard Contirm Room Room AB OR4 Select a CBD Script Collapse a P E Attending Anesthesia cm CARDIOTHORACIC s EPIDURAL amp GENERAL T B A P m Mote Case date time cannot be modified Te after selecting the anesthesia script Finish Cancel To remove the script from your favorites highlight it in the list and click on the blue push pin again Centricity Perioperative Anesthesia User Guide Page 56 of 56
3. SU OR SU ORO05 1 3 In order to start a monitor session in a room where you have just ended one you must Proposed capture start time overlaps with another session on the increase the time by one minute When you click start you will receive the following message informing you that there Lentricity Perioperative Anesthesia selected device last session ended 08 10 35 02 07 2013 Centricity Perioperative Anesthesia User Guide Page 52 of 56 Fraser Health Authority Surgery Information Systems will be an overlap of time if you start the monitor session Click OK 4 Click Start on the Session Start Time Session not started Device Manager screen Rendering Start Time Rendering End Time Monitor Location Unit SMOR xl Room smMoRd4 x z Instance ID Monitor Type Monitor Name Monitor IP 172 22 52 162 SN Location ready for vital sign capture Close ij Observation time Ea Observation time On the Observation time 02 07 2013 08 08 screen select 1 to ma Cs increase the time by one Times gt minute OK cane You will then get confirmation that the device session has started Centricity Perioperative Anesthesia User Guide Page 53 of 56 S gt u v fraserhealth Fraser Health Authority Surgery Information Systems Altering the Data from the Device Capture The monitor automatically captures data thro
4. Date of Birth 06 03 1980 TESTING CPA 4 Unit AB OR Timers VO Total Room AB OR1 0069999511 000069999511 32 yo U 3 3j E dit Logout Close 14 20 14 25 14 30 14 35 14 40 14 45 14 50 14 55 15 00 15 05 15 10 Total Current All Providers must SIGN IN Confirm OR Equipment verified Anesthesia machine circuit checked and calibrated Patient identified chart reviewed status from preoperative evaluation NPO status Peripheral IV 0 9 NaCl 1000 ml Lactated Ringers 1000 ml Briefing Midazolam Cefazolin 1000 mg Anesthesia Induction Patient preoxygenated P yg NIBP Sys NIBP Dia Fentanyl art Sys Lidocaine 100 mg ml art Dia Propofol 500 mg ml HR Sp02 Rocuronium 50mg ml 1 D D D I 14 15 14 20 14 25 14 30 14 35 14 40 14 45 14 50 14 55 15 00 15 05 15 10 15 15 15 20 Orally intubated using __ blade after __ attempt Proc TEST Event 14 48 Patient In Room History 14 47 Anesthesia Start 14 46 Case Initiated Dx Picklists Script items with underscores embedded in them will present a drop down list of choices to select Many times a default value will appear but this can be altered by selecting the field and a value from the list displayed Anesthesia Start Patient identified chart reviewed status Confirm OR a from preoperative evaluation Equipment verifie
5. and press enter w Patient Manager x Patient Manager Weight kg 62 Height cm ASA Status 2 Weight Ib 136 7 Height in Procedure Procedure Code Procedure Description Surgeon Description Add Delete Patient Manager x Patient Manager Weight kg 62 Height cm ASA Status 2 Weight Ib 136 7 Height in Procedure Procedure Code son d ABOVE KNEE AMPUTATION um KNAMPB BELOW KNEE AMPUTATION KNAO KNEE ARTHROSCOPY Delete KNAOBI KNEE ARTHROSCOPY BILATERAL KNARD ARTHRODESIS KNEE KNAROX KNEE ARTHROTOMY hd Click on the appropriate description and then click ok Repeat if more than one procedure was performed e Click on Record Close when you are finished The End of the Case When the patient is leaving the OR there are still several objects that remain to be documented At the end of the case the user will Total Inputs and Outputs o Click on the I O tab at the right side of the screen o Click on each outstanding output to produce the detail screen e g Estimated blood loss Centricity Perioperative Anesthesia User Guide Page 41 of 56 I fraserhealth Fraser Health Authority Surgery Information Systems m Edit Output X Estimated blood loss ml 15 00 22 03 2013 Omi Action Volume 100 e Chart 4 Update Time 15 00 22 03 2013 Comment El Delete Eecord Record Ciose Cl
6. 03 1993 U 0069999527 14 00 ARTHROSCOPIC AB OR3 27 03 2013 ORTEST KELLYFOUR OPEN REDUCTION INTERNAL FIXATION Rose James Kelly Partick 25 03 1885 U 0069999526 08 00 WRIST AB OR3 26 03 2013 testkelly pat TTLKNEE ARTHROPLAST REVISION Dong Raymond Kelly Partick 26 03 1980 M 0069999525 12 20 15T STAGE From Date 22 03 2013 ast Name Surg Attending To Date 02 04 2013 irst Name Surg Resident Reg Number User HASANA 1015 02704 2013 The OR Census is a listing of all patients meeting the search criteria Patients will populate primarily from the Meditech OR scheduling system The Census consists of the following components OR Census Toolbar Icons displayed will vary based on the role and privileges granted to that role o w m o s e Q 9393 o 9 amp 4 Prod Back Log Out Conversion Mew Case Meditech MSP PAT Clinic Unit Monitor WorkList Print Refresh Centricity Perioperative Anesthesia User Guide Page 5 of 56 S gt v fraserhealth Fraser Health Authority Surgery Information Systems Icon Specified Function to be performed The Back icon is used to close the current screen and go back to the previous screen The Logout icon logs off of the application and returns application to the logon screen The Conversion icon is a conversion tool that can be used to convert between units of measure such as weight temperature
7. 17 06 2013 lt Alert configuration O Repetitive alert Every i minutes hg 47 06 2013 09 38 Set End Time All previous alerts created by you will appear if you click on the down arrow to the right of the alert name This will save time in future cases if you use the same alert frequently The illustration below shows how a repetitive alert is initiated Timer and Alert Manage X Timers x Alert Name CefazodintGmiV PA Set Start Time 15 58 13 03 2013 4 Timer stop event chart to stop timer fert configuration Stop Mfner None c Repetitive alert Every 4 O minutes hours for E times Alerts Start Next Alert Time Set End Time 07 58 14 03 20 Ql Add alert D Edit Alert Cancel Alert Close Centricity Perioperative Anesthesia User Guide Page 39 of 56 A fraserhealth Fraser Health Authority Surgery Information Systems The alert reminder will display as below at the timed intervals Centricity Perioperative Anesti x E n 1 Reminder Far alert Cefazolin 1000 mg ml 1 m Iv This is a repetitive alert scheduled to remind again at 10 00 26 09 01 2013 Ok The last alert reminder will display as below Centricity Perioperative Anesthesia X P h i Reminder Far alert CeFazalin 1000 mg ml 1 Gm Iw This is the last time reminder For this repetitive alert and iE
8. From Date fen M013 LastName Surg Attending Snes Attending Anesthetist Defaults Ta Date 09 01 2013 013 FirstName Surg Resident Anes Resident Room Clear Heg Numer Locked v r Case Mum Case Status Unit AB OR search fields can be used to limit the results seen in the OR Census Display area As a user logs in to the application if they are assigned to one of the roles in the search area their name will default in the initial search If the user has not been assigned to cases they can select Clear and Search to remove the provider criteria Remember to select the correct unit to populate the patient list for your site Popup Menu Options Refresh CES Help Quit dy Conv 3 Log Out io ersion New Case Meditech MSP z Print Moni itor WorkList PAT Cin Un it Peri DOB Attending Anesthesia 18 02 2002 F 0069999554 Centricity Perioperative Anesthesia User Guide Page 7 of 56 ID fraserhealth Fraser Health Authority Surgery Information Systems Return to the OR Census and use the search fields to locate the patient The popup menu is the vertical menu bar illustrated above that is a portal to other options for the patient by left clicking anywhere on the patient row Intraoperative Record Used to access the intraop record Procedure Note
9. Ortest Nicole ABOO000 TE Discharge Date SMO0000088 SMO00686 05 03 2013 12 44 12 SM00000088 SMOO0774 13 03 2013 07 45 12 SMO0000732 SMO001339 04 02 2013 13 10 12 SM00003279 SMO02699 18 02 2013 00 00 12 SU00000237 SU000393 1 13 03 2013 08 04 2 SU00000237 SU000447 1 19 03 2013 07 45 2 Cancel Centricity Perioperative Anesthesia User Guide Page 46 of 56 amp 4 v fraserhealth Fraser Health Authority Surgery Information Systems Click on the correct visit for your site to highlight the choice and then click on Link If the correct visit does not appear select cancel and click on Quick start case see below Required fields are labeled in red Ensure the patient information and the Unit are correct Click on the down arrow beside Room and select the correct room iw Create Case Select case type and enter case information Case Type O Quickstart case Manual admit Manual admit with link Link Case Information First Name bev Last Name ortesimoncap Gender Hale T 9 Female MRN 0069999496 is Q Other Visit Number 000069999496 Rom Case Date Time 16 04 2013 14 18 lt Procedure Procedure Code CPT Code e Delete Diagnosis Scheduled Staff Surgeon bh dl Fa Y H Record Cancel Required Fields Click on Add to ente
10. another bag hung To discard an amount remaining in the bag and hang a new bag reduce the Infused Volume to the correct amount and click on New Bag Syringe Unit and then click Record Close You will be prompted to infuse or discard the remaining volume To record only the partial volume infused click on Update and then Record Close im Edit Fluid Fa 0 9 NaCl 1000 ml Total Volume Infused og Stat Infused 10 23 30 04 2013 started 1000 ML 0 ML started Start Infused 1000 ML BTE Volume 1L Volume eo ey a v lt a BagSyrngefUnit Infused Volume O Change Rate Current H O New Bag syringelllnit Stop O Update O Resume yoa Manual volume Total 53 Time Site 10 23 30 04 2013 Comment E Milestones The Milestone time button will show the next milestone in the case This can be used to create a time stamp for a series of events to be documented after the fact Centricity Perioperative Anesthesia User Guide Page 23 of 56 A fraserhealth To create a time place holder click on the milestones button Fraser Health Authority Surgery Information Systems Timers VO Total ortestbev scripttest9 E it AB OR Wt m AB OR9 Ht 0069999482 000069999482 43 yo vn MSP 3 Sign In Logout s Close Meditech The button will create a time stamp for that milestone in your documentation and then show the next milestone Milestones are shown in bl
11. tabs o Meds All documented meds and infusions to display on this tab along with a running total of amounts administered o Monitors Monitor populated data as well as user documented values related to the monitor data o I O Fluid inputs and outputs such as IV fluids blood and urine o Flows Gas inputs and outputs such as anesthetic agents O2 and N20 Graph Monitor populated data defined to appear Event History Narrative of all script items documented Script amp Script Objects The documentation elements typically used for the type of script selected Centricity Perioperative Anesthesia User Guide Page 10 of 56 ID fraserhealth Intraop Toolbar Fraser Health Authority Surgery Information Systems 93 Logout Close The Script icon is used to reset the script list display and will return to the script after other functions are completed The Find icon is used to search for available documentation items that are not on the script e g blocks The Other icon displays a window for free text to be documented The Medications icon is used to search medications to add to the medications tab The Infusions icon is used to search infusions to add to the current document Infusion The Fluids icon is used to search fluids Fluids a Zz The Outputs icon is used to search outputs Output The Blood icon is used to search blood products The Sites
12. the Anesthesia Assessment form it will be displayed Allergies can be entered in the Pat Info icon or by selecting the space directly on the patient banner allocated for allergies Allergies entered into Meditech will also display from the OR scheduling system Enter the weight height and ASA Status The procedure and diagnosis should appear from the OR scheduling system The Pat Info button will be yellow if the procedure and diagnosis are blank Centricity Perioperative Anesthesia User Guide Page 15 of 56 A fraserhealth Switching or Adding a Script Fraser Health Authority Surgery Information Systems The script can be switched or added to by selecting the ellipsis beside the script title Switching scripts will exchange the current script items with ones from the new selected script Adding a script will combine the script items and remove any duplicate items in the script Anesthesia Start All Providers must SIGN IN Confirm OR Equipment verified Anesthesia machine circuit checked and calibrated Patient identified chart reviewed status from preoperative evaluation NPO status Any documented script items will remain untouched by switching or adding scripts Centricity Perioperative Anesthesia User Guide Page 16 of 56 i v fraserhealth Fraser Health Authority Surgery Information Systems Documenting Script Items The following will review the various script objects and behaviors
13. will be removed From the list of active alerts OK Documentation Process Select the Alerts icon Select Add New Inthe Alert Name list select the documented item which the alert will be triggered Select the start time for the alert usually the time the item was first documented Select the repetitive configuration and record The alert icon will appear green any time there is an alert or timer running The example above shows the message that appears once the alert fires No information is documented from an alert as it only serves as a reminder to the provider Document the Actual Procedure s Performed e Select Patient Manager from the Census Popup Menu or the Chart icon on the intraop desktop x Patient Manager Weight kay 62 Height fem ASA Status Weight lb 136 7 Height in Procedure Procedure Code SHAO SHOULDER ARTHROSCOPY Ada Delete Centricity Perioperative Anesthesia User Guide Page 40 of 56 I fraserhealth Fraser Health Authority Surgery Information Systems e Compare the Procedure Description to the actual procedure performed o If they are the same do nothing further and the existing Procedure Description will appear on the intraoperative record o If they are different Delete existing Procedure Description if it was not done highlight and click delete Click Add and then click the Procedure Description box and type a partial description e g knee
14. Centricity Perioperative Anesthesia User Guide Page 48 of 56 A fraserhealth Fraser Health Authority Surgery Information Systems w Create Case X Select case type and enter case information Case Type sss il iQuick start case Manual admit Manual admit with link Link Case Information First Mame Last Name Gender Male Female Other Room Procedure Procedure Code Procedure Description Surgeon Description Delete HE Cr Cr Device Capture Moncap Device capture has several components within the process Device Capture Verification Device Capture Start Start Parameter Notification Stop Parameter Notification and otopping the Device Capture session Details to keep in mind Device Capture matches the patient data to the patient record by the room selected The monitor button must display a Active there is a brief period of about 30 60 seconds where this will be and will read Unknown while the connection is being confirmed If it is and reads Inactive there is NO data being captured and the session is not running Device capture looks at data over a 5 minute period i e 12 50 00 12 54 59 Once this 5 minute period has occurred then the system will post to the grid this will appear at approximately 12 56 Device Capture verification Physiologic data populating the patient record is matched on the patient location It is very imp
15. I fraserhealth Sf fraserhealth iil Better health Best in health care Anesthesia Information Management System AIMS Centricity Perioperative Anaesthesia CPA User Guide Version 8 Surgery Information Systems Fraser Health Authority December 2013 A fraserhealth Fraser Health Authority Surgery Information Systems Contents PUORO MNT ee oe eee ern ee ee eer eee 4 Hospital Naming CONVESNMUOINS e sescaeussckexeses cuesienainendacescecieceeeeedeeadseedaeedceedexedectdesndewedsexsesedsiencs 4 eje tbe Ez RR T 4 OR CON SUS KERN 5 OR Census Toolbar TETTE 5 OR Gensus DIPY INE eee eee EM eno ee eee ee eee 7 OR Census Search FIeldS ccccccccseececeeeeeceeeceeeeeceseeeeeceeeeeseeeeseeeesseeeessaeeessaeeesseeeeeas 7 FOPUP NENU ORION eiii EIE URINE PEINE EFIE 7 IMAC irc lids ROCO ra 8 FICOBAN a ee 9 Understanding Device Capture Moncap cccccceccccseeeeceeeeeeeeeeesaeseeseeeeeseaeeeseaeeesaees 9 Entenag tne Intraoperauve MOCO usconxioctepiciuszcundivite med cuc xh ducts dud dade dE Macte intu xia 10 Ira SCreC li Ore NAUN em E E 10 MUO COND AN em m 11 vien 13 seo m 14 Pauen elegan WO ET T UT 15 Switching or Adding a Script sexscexciscenensversvavedexpoeneiiexeneusijextvaxedevscexeiexesexe extwexedexeesedexeees 16 FI CIR IO ccteceetearentettnterted nsec nad te
16. O E ee ee 41 Locking the Case amp Addendumas ccccccceecccceeeeeseeeeeseeeeseeeeeseeeeessaeeesseeeesseeesaeeeeeas 43 Radama ay A OI IET 46 Device C apre MONA ado 9522 452 4295 0 5490 9 024 0 000 008 00 5 0 000 EE E ee ox dU 49 Altering the Data from the Device Capture esseeesseeerneeeennn 54 Marking Artifact esses nennen nennen nnne nenne nnne nnne nnne nnns 54 Manually entering Gatar cccceccsscccseecsecceececseeseueccececseesaueeeeeesseeseueeeaeesseesueenaeeseeesags 54 Set SCP aS FIVES rreri rE EnEn Ea EEA eee eee 55 Centricity Perioperative Anesthesia User Guide Page 3 of 56 ID fraserhealth Audience This document contains an overview and descriptions for common tasks performed in the Anesthesia Information Management System It will assist Anesthesiologists in performing their day to day activities Fraser Health Authority Surgery Information Systems Hospital Naming Conventions Please identify the correct site abbreviation when searching for patients or confirming the right location and room e g AB OR1 would indicate Abbottsford Hospital Operating Room 1 for AIMS Site specific first two characters Abbottsford AB SMH SM JPOCSC SU Login Screen Centricity Perioperative Anesthesia Use of this application iz limited to Logon Name authorized users only Unauthorized use is illegal Password Change Password Cancel The softwar
17. Used to document specific procedures separate from the intraop record such as analgesic procedures OB procedures and pain blocks Case Manager Alter case detail information such as the assignment procedure room diagnosis or case time Patient Manager Allows documentation of Height Weight ASA Procedure Diagnosis and Allergies without entering the Intraoperative Record Print Record Option to print the intraoperative record without entering the patient s record Intraoperative Record Verify the room and select the appropriate script Case Startup Confirm Room Unit Meam Select a CBD Script Collapse a CARDIOTHORACIC EPIDURAL Procedure Note Case Manager GENERAL GA ECT GA ETT Patent Manager GA Ey e GA LMA Print Record Note Case date time cannot be modified after selecting the anesthesia script Finish Cancel Select Intraoperative Record using the popup menu shown above the dialogue box appears to select a script Highlight and select the Finish button Centricity Perioperative Anesthesia User Guide Page 8 of 56 IF fraserhealth Patient Banner Date of Bith 28 02 1960 Fraser Health Authority Surgery Information Systems CP A Test Unit AB OR WE 60 kg 10 46 11 Allergies DRUG Penicillins Timers 10 Total Room AB OR1 Ht Ed 0069999543 000069999543 53yoF ASA 20022013 The patient banner contains im
18. ability to expedite the documentation by carrying similar values forward to the next cell when the patient s condition is unchanged e Highlight the cell following the timeframe documented select the time itself e Select the copy forward recent assessments Lit a n qe d recent a 12 00 12 05 12 10 Total Current TUF State Entropy 82 Temp 3b 8 SPW Vent FID e he display box below will appear select those items you would like to copy forward from the previous time period Data Confirmation The following data is eligible to be saved into the 11 45 column Flease verit the accuracy of this information before proceeding All data confirmed willbe saved under your credentials X TOF 22 4 Charted by Beverly 5 aumer c3 09 50 SelectAll Clear All Cancel Set Scripts as Favorites You can mark specific scripts as your favorites in the Script Selection dialog box at any time All scripts remain available for other users but Favorite script folders are only viewable by the owner Click on the script you would like to make a favorite Once it is Centricity Perioperative Anesthesia User Guide Page 55 of 56 e fraserhealth Fraser Health Authority Surgery Information Systems highlighted click on the blue push pin the top right corner Case Startup Wizard Confirm Room Select a CBD Script Collapse All 8 CARDIOTHORACIC EPIDURAL GENERAL GA ECT DA ETT GA Eye GA LMA
19. d Preoperative unchanged evaluation l Anesthesia machine circuit checked and Patient status calibrated i ion a ug p ar unchange Patient identified chart reviewed status Comment from preoperative evaluation Close NPO status x Patient In Room Centricity Perioperative Anesthesia User Guide Page 17 of 56 ID fraserhealth Fraser Health Authority Surgery Information Systems Ellipsis Function Selecting the ellipsis button will appear on the right When the end user clicks on it it will display a small horizontal menu of choices Edit will allow the user to edit hard coded defaulted values no underscores The item may be removed from the script if it is not needed for this particular case Time can be altered in 1 5 and 10 increments later we will discuss more options to alter the time beyond these increments The Other option presents a list of other choices related to the script item In the screen shot below Rocuronium was the original medication and the other related choices are presented in a list where the script typically displays Rocuronium 50mg ml Remove 1 Min 5 Min 10 Min Atracurium Cisatracurium Pancuronium Pancuronium Induction Pancuronium Pre curarize Rocuronium bOmg ml Succinylcholine 100 mg ml Vecuronium Centricity Perioperative Anesthesia User Guide Page 18 of 56 IF fraserhealth Event H
20. e does not make final clinical medical or other decisions and is not a substitute for competent properly trained and knowledgeable staff who bring professional judgment and analysis to the information presented by the software The Centricity Perioperative Anesthesia CPA login screen allows the user to log into the CPA Application and change the password Centricity Perioperative Anesthesia User Guide Page 4 of 56 ID fraserhealth Fraser Health Authority Surgery Information Systems The permissions granted are based on the role of the user In the following screen shots and instructions all users based on their role may not perform some actions OR Census The OR Census is a listing of all patients meeting the search criteria Patients will populate primarily from the Meditech OR scheduling system The Census consists of the following components OR Census Toolbar OR Census Display Area OR Census Search Fields Q 9 3 59 i0m Alas Bll cv Back LogOut Conversion Meditech MSP PAT Clinic Unit Monitor WorkList Print Refresh nT EL TS LEE FS ESE Se Ld ESE EE aS _ ELLE a el AB OR1 26 03 2013 ORTEST KELLYONE KNEE ARTHROSCOPY ose James Attending Anesthesia 25 03 1990 M 0069999529 08 00 AB OR1 26 03 2013 ORTEST KELLYTWO HEMIARTHROPLASTY HIP James Attending Anesthesia 25 03 1995 M 0069999528 10 00 ACETABULUM AB OR1 26 03 2013 ORTEST KELLYTHREE DEBRIDEMENT ANKLE ose James Attending Anesthesia 25
21. ed ESAE AEE EAEE EEEE EEEE EEA AEEA EEEE EAEE E EERE 17 EDSS UM CHO RETE TT TETTE TTEULTETEM 18 VC IG OFY RR TT TT 19 Documerntauon or an IMsssseseoweevesepevew ede sexe vicia vv ale EAM Vb XA aM Vb YAT DE NON 19 Documentation of Fluids sesenta nnn 22 DAMN SLOTS NOTER 23 Documeritaton of MedlcallOFlS ceps usi ots ne pene E aus ir onn rne ex eh ener 25 Documenting Items not in the Script seeseeeesseesesseeeeeeennennnn enne 27 gljcM 27 Centricity Perioperative Anesthesia User Guide Page 2 of 56 A fraserhealth Fraser Health Authority Surgery Information Systems DOCUMENTING INFUSIONS ccccccccecccseeceeeeceeeceueceuceceeseueceaeesseeseeeeaeeseeeseusenseessesseaeess 29 Documentation of Output cece ccc cccceceeececeeeeeceeeeeceeeeeseeeeseeeeesseeesseeeessaueessaeeeseaeeeeas 31 Altenno CGrnd Gapi COMEN cem 33 Documenting Retrospectively seessessesssssesseeeeee nennen nennen nnn nnn nnn nn 34 Mrd ER T UE E 34 PICS ZING Ne OC Co 35 OVENS SOT S m 35 Documenting a Clinical Event c cccccceccceececeeeeceeeeeeeeeseeeeseeeeseeeesaaeeseeeesaeeesaeeesaeeeeas 37 MS SO TUT SU SS REEL 38 Document the Actual Procedure s Performed cccccceccceecceeeeeeceseeeeeeeaeeseeesaneeas 40 TOS ENGONIE CaS
22. ed with the word Addendum and followed with the user information The items will appear in the event history in the order they were timed 10 24 Addendum Bite block placed Attending Anesthesia Centricity Perioperative Anesthesia User Guide Page 45 of 56 A fraserhealth Adding a New Case Fraser Health Authority Surgery Information Systems Select New Case from the OR Census toolbar ew case In the create case screen select Manual admit with link and click on Link w Create Case Select case type and enter case information Case Type O Quick start case O Manual admit Link Case Information First Name Last Name Gender O tale MRN rT O Farnals O Other Visit Number Unit AB OR Room Case Date Time 02 04 2013 10 26 3 Admit Date Time 02 04 2013 10 26 2 Procedure Procedure Code Procedure Description Surgeon Description Add Delete Diagnosis zi Scheduled Staff Surgeon E H Record Cancel Required Fields In the Existing Visits screen enter the MRN Unit or the patient name Click Search MRN PATIENT NAME w Existing visits Search for existing visit to link MRN Name Last First ORTEST ERIN j Visit DS AB00002751 ABO01397 1 22 02 2013 00 00 2 Search for existing visit to link MRN 4800000977 Name Last First Visit ee
23. empt Proc TEST Dx Centricity Perioperative Anesthesia User Guide Page 19 of 56 IF fraserhealth Documentation of an IV Fraser Health Authority Surgery Information Systems Documentation of an IV can be done from the Peripheral IV script object Typically the script item is used to document the first site and subsequent sites would use the site icon from the toolbar The Sites icon allows for the site information to be added edited or the IV site discontinued Documentation Tips The peripheral or central catheter type selected will determine the fields and values that become active in the subsequent fields Select the clock directly on this screen to alter the time Selecting Peripheral IV in the script Briefing Anesthesia Induction Midazolam Fentanyl Lidocaine 100 mg ml Propofol 500 mg ml Rocuronium 50mg ml Orally intubated using blade after __ attempt Grade laryngoscopic view Atraumatic laryngoscopy Stylette was used Difficult Intubation Equal bilateral breath sounds auscultated Bite block placed Eyes Protected __ temperature probe checked and value o4 d Centricity Perioperative Anesthesia User Guide CS x A pf New Site Peripheral IV Periphery Catheter Type Peripheral Central Central Type Slee 20 g Site Location eft O Right Location rege nes O NIA Site S
24. entation after the lock will require an addendum e Select the Lock object from the script e The Confirm Locking box appears Centricity Perioperative Anesthesia User Guide Page 43 of 56 IP fraserhealth Confirm Locking X Fraser Health Authority Surgery Information Systems signed in staff with locking access Enter Password for PAT Dac pmo Proceed With Lock Cancel e Highlight the name enter password and select Proceed with Lock e lf there are required items not completed the user will be alerted to this e All buttons will become inactive and clock freezes Date of Birth 28 02 1960 CPA Test Unit AB OR Timers VO Total Room AB OR1 d 7 NW Paging Any further documentation performed on the case will require the Addendum Mode object to be selected from the script first What was previously an inactive Edit icon on the toolbar now becomes an active Addendum icon Sign In Logout J Close Chart MSP eg Addendum Addendum Confirm Addendum box appears highlight name and enter password Centricity Perioperative Anesthesia User Guide Page 44 of 56 ID fraserhealth m Confirm Addendum X Fraser Health Authority Surgery Information Systems Stat with Addendum access Enter Password for PAT Dac iz Proceed with Addendum anea Items documented in Addendum mode are prefix
25. h popup item 2 Search on last name full or partial or role 3 Highlight user from the list and select Sign In 4 Enter the password select applicable options and click OK m Password x Enter password for Attending Anesthesia xj Enter search criteria Last Name e 0 Search sign In options Re s SEG wW Assume Audit Role M Include Electronic Signature P Full Name Re Attending Anesthesia Anes Attending m Physically Fresent Time 08 01 2013 14 26 06 Sign Out a Anes Attending To sign out of a case click on history eee ee ee a ruit c LC ee Modi Eesh Snes Attending History will list anyone who has signed into Seach the case Centricity Perioperative Anesthesia User Guide Page 14 of 56 s gt u v fraserhealth Fraser Health Authority Surgery Information Systems To sign out click on the name to highlight it then click sign out ia Sign In Sign Out History Case Participants Electronic 11 06 2013 14 35 11 06 2013 14 56 Modi Eesh Anes Attending Yes 11 06 2013 14 56 11 06 2013 14 56 Attending Anesthesia Anes Attending Delete Sign Out Time In Time Out Assume Audit Role l Close Patient Information The next step in the workflow is to verify the patient information is completed by using the Pat Info icon The icon directs the user to the same screen accessed via the Patient Manager icon from the OR Census If the information was capture in
26. he listed items is not being captured Centricity Perioperative Anesthesia User Guide Page 50 of 56 amp gt u v fraserhealth Fraser Health Authority Surgery Information Systems Parameter Notification WARNING Data not received for parameters within expected interval Verity the device session is started device cables are connected Parameter Name Last Observation Date HR Monitor spO NIBP Dia NIBP Sys Select Al lear All Ok Cancel Stop Parameter Notification The parameter notification feature has a configuration to stop the alert of data usually once the patient is no longer on the monitors The stop trigger is the Patient Out of Room object in the script Patient Out of Room Stop Device Capture The Anesthesia End object will stop the session from collecting to the patient record At this time the monitor session is released from this patient and is available for the next patient Once Anesthesia End is documented a box will appear confirming you wish to stop it Centricity Perioperative Anesthesia User Guide Page 51 of 56 A fraserhealth If another patient is receiving vitals from the room you are in you will get the following message Fraser Health Authority Surgery Information Systems 1 This message may m Device Manager indicate that the room Session Start Time Session not started showing on the screen is Rendering Start Time not the room yo
27. icon allows for documentation for vascular or arterial access The Mark Time icon sends the user to another census displaying the follow up items pending or needing additional attention Centricity Perioperative Anesthesia User Guide Page 11 of 56 ID fraserhealth a The All Time Events icon displays critical time events in Anesthesia Start sequence Fraser Health Authority Surgery Information Systems The Alerts icon displays the Timer and Alert Manager window The Patient Info icon displays the Patient Manager window which allows for documentation of patient Note This button is yellow when the Procedure and Diagnosis fields have not been charted Not currently active The Chart icon provides a pop up menu for navigation to other areas of the application The Meditech icon provides a link to the Meditech system The MSP icon provides a link to the MSP website The Edit Addendum icon allows edits to be made to documentation Addendum will be displayed only if case has been locked The Sign In icon displays a list of anesthesia providers assigned to the case or have previously signed into a case ign In search option access and history access 3 The Logout icon logs off of the application and returns application to the logon screen Logout Centricity Perioperative Anesthesia User Guide Page 12 of 56 A fraserhealth Fraser Health Authority Surge
28. istory All documented script items appear in the event history By clicking on the event history box at the bottom right of the screen the information expands to the box on the left as illustrated below Fraser Health Authority Surgery Information Systems Date of Birth 06 03 1980 TESTING CPA 1 Unit ABOR rig Room AB OR1 0069999511 000069999511 32 yo U VO Total CAS A Q i 3 aj Meditech Edit Logout Close pn 15 14 20 14 25 14 30 14 35 14 40 14 45 14 50 14 55 15 00 All Providers must SIGN IN d 14 48 PatientinRoom cg Confirm OR zt 47 Anesthesia Start Select the Event History e E and it will expand to display hocce aa P im chronologically on the right Select the X to return to a closed state NPO status Peripheral IV 0 9 NaCl 1000 ml Lactated Ringers 1000 ml Briefing Midazolam Cefazolin 1000 mg Anesthesia Induction Patient preoxygenated P y NIBP Sys Fentanyl xe NIBP Dia art Sys Lidocaine 100 mg ml art Dia Propofol 500 mg ml HR Sp02 Rocuronium 50mg ml na ia Uae eel EUST 14 50 14 55 pa post mss 14 45 Ces pest DR Im RT Ts EORR 14 25 14 30 T Op Ula J L COEUE tCeApAeAELLLZAGICC LULLGCGLIOALLILLOALLLLULL a Event 14 48 Patient In Room History 14 47 Anesthesia Start 14 46 Case Initiated 0 p Sina Jt al 14 15 14 20 Orally intubated using __ blade after att
29. itor tab will be populated automatically with mapped items sent via the monitor Items on the variables tab will be available for manual documentation only Groups tab can add a common group of items o remove items from the grid highlight the item on the right column and move the left column using the arrow Use the Up and Down buttons to re order the display Fraser Health Authority Surgery Information Systems Documenting Retrospectively The patient is the first priority and the documentation will still be there when ready to chart As users become more familiar with the scripts retrospective charting will decrease but will occur The next two screen shots will discuss options to facilitate the retrospective charting process Date of Birth 06 03 1980 TESTING CPA 1 Unit AB OR ci Room AB OR1 0069999511 000069999511 32 yo U 15 00 15 05 14 50 14 55 tes Loo Y ua 14 30 14 35 14 40 14 45 Test Surgical __ E All Providers must SIGN IN Be 14 48 Patient In Room 14 47 Anesthesia Start Confirm OR 14 46 Case Initiated Equipment verified Anesthesia machine circuit checked and calibrated Patient identified chart reviewed status from preoperative evaluation NPO status Peripheral IV 0 9 NaCl 1000 ml Lactated Ringers 1000 ml Briefing Midazolam Cefazolin 1000 mg Anesthesia Induction NIBP Sys Patient preoxygenated NIBP Dia art Sys Fentan
30. ive Anesthesia User Guide Page 26 of 56 ID fraserhealth Fraser Health Authority Surgery Information Systems Documenting Items not in the Script P lg E re 3k 9 Anesthesia Meds Infusion Fluids Output Blood altes Mark nenenant 5 22222 10 10 15 10 20 tourniquet TOF State Entropy Tourniquet Deflated _ Temp SPY Vent FID 2 amp Esophageal temperature un Sal Pulse fa 108 Tourniquet Injury 5pn02 qq gn ETLU2 3b ee U FTCN Resn J T n Tourniquet Inflated Find The Find icon can be used to search for items that may not appear in the script but are commonly documented items In the example above tourniquet has been entered and three possible pre configured choices appear Any of these can be selected for documentation some items have been specially built to accommodate specific procedures that the user may want to incorporate into the intraoperative documentation such as a pain block To access the pain block screen click on the Find button and enter pain block Press enter or click on the Search button Centricity Perioperative Anesthesia User Guide Page 27 of 56 ID fraserhealth ORTEST BEV Unit AB OR Allergies Room AB ORA 0069999516 000069999518 18 yo F 4 A f P ly 4 Pain Block Neuro exam revealed Script Find Other Meds Infusion Fluids Output Bloo prepped located by pain block IE with Ei cce eere e
31. m Chloride Procainamide NIBP Sys Propofol Infusion NIBP Dia i art Sys Remifentanil 2mg 100ml E UA Documentation Tips Infusions can be documented through the script or the infusion icon For weight based infusions the patient s weight must be documented in the Pat Info icon prior to accepting the entry The grid entry will display the rate and when Anesthesia End is documented the rate will automatically be stopped and a total documented The user can also adjust the rate and stop manually through the infusion on the grid In order to change dose stop update the entry or post a manual volume of infusion access the infusion by clicking directly on the grid for the infusion item o When the box appears highlight the line entry o Select the action o Make the appropriate change o Record Close Centricity Perioperative Anesthesia User Guide Page 29 of 56 ID fraserhealth w Edit Infusion i Remifentanil 2mg 100ml 0 2 meg kg min 2 MG per 100 ML Total Volume 0 Imi Automatic E ated 7 T 3 0 3 20 13 megi aikai min Fraser Health Authority Surgery Information Systems Dose I9 imcgkgimin H Concentration MG per 100 IML Action Fluid rate 35 94 ml hr Change Dose O Stop OQ Resume O Update Manual Volume Total Time 15 28 13 03 2013 Comment Select the action first and complete the remaining fields If Manual Volume Total is selected the total is entered in
32. m the Chart Fluid screen Fraser Health Authority Surgery Information Systems Yolume f ood Flow Type Maintenance Hate Ly Bag swyrindge NN L Init Site l eft hand 20 g Comment El Documentation Tips The volume field should represent the volume of the IV bag being hung For example If the patient comes into the room with 400 ml remaining in an existing bag then document 400 in the volume field When you have to document the next bag of fluids the software remembers that you have set the volume to 400 so you will have to change it back to 1000 if you are hanging that volume The Flow Type defaults to Maintenance a maintenance flow type does not give credit for volume infused until the user documents the volume This is a drop down field that also allows such options as rate based that would document as a rate based volume throughout the case The IV site field and time can be altered within this dialogue box but will default to the IV site documented in the previous step Once an IV bag has been completely infused the software will automatically document the next bag being hung f a heal v traserhealth Fraser Health Authority Surgery Information Systems Documenting the infused volume of fluids is done by clicking on the fluid name in the I O tab The default shows the infused volume as the total volume started Clicking on Record Close will show this total volume infused and will show
33. milestone and the clock will then freeze to the time that the button was clicked for that milestone This allows the user to document several items from the script with that time stamp Allergies Ht ADA 16 04 2013 12 34 on 5 sf aa Set Indef Now Click again on the milestone button to choose the next time placeholder or click on Now to unfreeze the clock and continue with the script Centricity Perioperative Anesthesia User Guide Page 36 of 56 A fraserhealth Fraser Health Authority Surgery Information Systems Documenting a Clinical Event If it is necessary to document a clinical event e g dental injury hypothermia laryngospasm etc use the Find feature Enter clinical event and click search Click on the Clinical Event object and then enter the type of event from the list provided Enter the treatment details in free text and click on record Clinical Event Treated with Type of event Clinical Events Treated with Failed Intubation Failure ta ventilate by Mask High Spinal Hypothermia Infiltrated Iv Intraoperative Awareness Comment uid Larynagospasm Malignant Hyperthermia suspected Ocular Injury Peripheral Merve Injury Pneumoathoarax Prolonged Meuramuzcular Relaxant Pulmonary Edema Reintubation Respiratory Arrest Respiratory Arrest During Regional MAC Seizure skiniLimbiloint Injury Surgical Airway Transtusion Reaction Unintended Extubatio
34. milestone in the case This can be used to create a time stamp for a series of events to be documented after the fact To create a time place holder click on the milestones button ortestbev scripttest9 SUA ORE Hs 13 22 07 Allergies Timers VO Total 0069999482 000069999482 43 yo F ASA 16 04 2013 MSP Blood Paging my 7 amp Sign In amp Pat Info ei Close VAX Meditech s Output Chart 3 Logout Centricity Perioperative Anesthesia User Guide Page 35 of 56 A fraserhealth The button will create a time stamp for that milestone in your documentation and then show the next milestone Milestones are shown in blue on the script Fraser Health Authority Surgery Information Systems When time permits you can go to the clock and click on the Times button to display the list of milestones which have been documented Only the times which have been documented will appear in the drop down so depending on where you are in the script the list of milestones will be different 16 04 2013 13 26 16 04 2013 12 41 Patient In Room Patient In Room Anesthesia Induction Anesthesia Ready surgical Incision Patient Qut of Room Anesthesia End The arrows to the left and right of the milestone can also be clicked to advance to the next milestone or go back to a previous milestone Click on the appropriate
35. n E Centricity Perioperative Anesthesia User Guide Page 37 of 56 A fraserhealth Use of Timers and Alerts Fraser Health Authority Surgery Information Systems The application has paired events that when documented will note the start time stop time and elapsed time between the two For example a tourniquet being applied a tourniquet being removed and the total tourniquet time during a case Alerts can be set up as a pre configured option when an item is documented or can be manually initiated when the item is documented If there are existing alerts the toolbar button will be Green To View or Create an alert click on the Alerts button on the toolbar Existing alerts will show in the window To create a new alert click on Add Alert i Timer and Alert Manager Timers Timer stop event chart to stop timer Mone FEE UEM Alerts tart Next Alert Time He dose DRUGONE 09 08 41 One time alert 09 38 00 00 23 07 Add Alert Edit Alert Cancel Alert Centricity Perioperative Anesthesia User Guide Page 38 of 56 ID fraserhealth To set up a one time alert as in the example above create a name for the alert and click on the Set End Time clock button Set the time click OK and then click on Record Fraser Health Authority Surgery Information Systems i New Alert X New Alert Alert Name Re dose DRUGONE i Alert End Time x Alert End Time Set Start Time 09 08
36. ning Mark events H it Mergies imers CPA Testing Edirne Hiis 0069999557 000069999557 0 ASA 08 40 08 45 08 50 08 55 03 00 03 05 03 10 03 15 0 0 0 0 0 Remifentanil meg kg min 0 J Cefazolin 1000 mg ml C Gm Peripheral IV 09 31 Mark Time 09 31 04 15 45 0 9 NaCl 1000 ml Bag Syringe Unit 1 1000 ml Maintenance 15 45 NG 80 ml 15 42 Remifentanil 0 2 mcg kg min 0 025 mg per 1 ML Started 14 59 Cefazolin 1000 mg ml 1 Gm IV Briefing Anesthesia Induction Midazolam Fentanyl Lidocaine 100 mg ml 14 58 Patient In Room Propofol 500 mg ml 14 58 NPO status NPO Roc ronium Om 14 58 Patient identified chart reviewed status Orally intubated using __ blade after __ unchanged from preoperative evaluation Sr attempt 14 58 Anesthesia machine circuit checked and calibrated Grade laryngoscopic view Freezing the Clock Freezing the clock occurs by selecting the clock A box appears allowing the user to adjust the time The Set Indef button will stop or freeze the clock at the time indicated indefinitely All documentation performed with the clock frozen will be documented with the frozen time Monitor and flow documentation continues and is not affected by the freeze To restore the clock to the current time select the clock icon and select the Now button Milestones The Milestone time button will show the next
37. ortant to use the verification process to ensure you are capturing vital signs on the correct patient Device verification will display the dialogue box below when the script item below is documented Centricity Perioperative Anesthesia User Guide Page 49 of 56 I fraserhealth Device Capture Start Starting of device capture is when the data from the monitor will begin posting to the patient chart When Anesthesia Start is documented the device capture is kicked off Anesthesia Start m m Device Manager Fa Fraser Health Authority Surgery Information Systems Session Start Time Session not started Rendering Start Time Unlimited Xen Ong Denim Monitor Location Room AB ORS Save Roam Monitor Type S5 AM Monitor Name IORS Monitor Plug lD 3727 Location ready for vital sign capture Instance IL Il Back Time Session Start End Close E HH Start Device Notification The parameter notification feature was developed to alert users when the documentation is not collecting data The start parameter notification is set to begin when the Patient In Room object is documented Patient In Room e Some reasons for this may be e Patient not connected to monitors e Connections from physiological monitors are not secure no data being sent Below is the Parameter notification box that will display to alert when data is not being captured The box will alert when any of t
38. ose o Enter a volume and click on Record Close o Click on each outstanding input to produce the detail screen e g NaCl m Edit Fluid E X Lactated Ringers 1000 ml Total volume Infused l Start Infused 11 30 19 03 2013 Started 1000 ml Omi Started Velum um Rs p oot Fe 8 x Bagisyringe Init Infused volume Change Rate Current i O New BagfoyrngefUnit O Stop Update O Resume ol Manual Volume Total site Fight hand 20 g 15 00 22 03 2013 Comment E o Enter the infused volume and click on Record Close Centricity Perioperative Anesthesia User Guide Page 42 of 56 I fraserhealth o Click on the I O button at the bottom of the screen to check that all inputs and outputs have been totaled Fraser Health Authority Surgery Information Systems Document Patient Out of Room Document Patient transported to PACU will default Anesthesia End will log out user this also stops device capture and prints intraop record Stop Monitor Session Do vou wank to stop monitor session Ves Mo Cancel Transmit Intra p Record to LCR Outbound Print Comments Diagram Print History Print Provider List Template Default Copies ll FH5U29762 Select the Lock object in the script Locking the Case amp Addendums Anesthesia providers will document the Lock object to close the case to documentation Any further docum
39. portant information on the selected patient that can be seen with higher visibility at the top of the form Information is populated from documentation from scheduled case information Information displayed includes DOB Name MRN Account Unit Room Age Gender Weight Height ASA Allergies Timers I O Total m Understanding Device Capture Moncap Device Capture is the mechanism that posts patient data to the intraoperative record from the physiologic monitors and Anesthesia machine What you need to know Device Capture matches the patient data to the patient record by the room selected Verifying the room prior to starting device capture is very important The monitor button must display A Active there is a brief period of about 30 60 seconds where this will be and read Unknown while the connection is being confirmed If it is IB and reads Inactive there is NO data being captured and the session is not running Moncap starting is triggered on the Anesthesia Start script object Prompt documentation of this object will start device capture and values posting to the patient record at the appropriate time Anesthesia End stops posting the data to the patient record Centricity Perioperative Anesthesia User Guide Page 9 of 56 A fraserhealth Device capture looks at data over a 5 minute period i e 12 50 00 12 54 59 Once this 5 minute period has occurred then the system will post
40. pror t M 3j has been documented Atraumatic laryngoscopy 19 18 13 03 2013 M Stylette was used Site New Site previously a al Comment subsequent doses of either drugs will be Difficult intubation Equal bilateral breath sounds auscultated Bite block placed Record Cancel charted on the arid Eyes protected Documentation Tips The initial dose of any medication can be documented by either using the script entry or by using the Meds icon The dose will post in the event history and on the grid on the Meds tab Any edits made to the entry should be done via the grid entry A starting dose will appear and the arrows will allow for incremental increase or decrease of the amount Centricity Perioperative Anesthesia User Guide Page 25 of 56 IF fraserhealth When accessing the medication entry via the grid the box will display all entries of the medication documented Fraser Health Authority Surgery Information Systems Highlight the line entry Select the Action Chart Update or Manual Volume Total Make the appropriate edits i e volume time etc Select Record Close Edit Medication Cefazolin Total volume Mot Charted 15 17 13 03 2013 1 Gm IV l Dose per unit weight Dose fi em I Weight unknown Action 9 Chart O Update Manual Volume Total Route fw IE 1820 13032013 Site Nen site Comment Centricity Perioperat
41. r nee ondhe Fentanyl mcg Pain Block __ Neuro exam revealed Lidocaine 1 mg Block Type o prepped _ located by _ with um E Fraser Health Authority Surgery Information Systems Nh Propofol 500 rg Clonidine Racurenium mg Neuro exam Cefazalin Grn Ketorolac mu Ondansetron mg Deficits Sufentanil mcg alycopurrolate ma Neostigmine mg Side prepped a Area prepped r Placed Comment E select the box on the left to produce the procedure screen shown on the right for documenting the selected procedure within the script NIBP Sys MIBP Dia art Sus art Dia HR Spe If the search is unsuccessful a free text note can be documented Select the Other icon and type the details in the box Centricity Perioperative Anesthesia User Guide Page 28 of 56 ID fraserhealth Documenting Infusions Fraser Health Authority Surgery Information Systems 4g 2 J Ki P ly f A Og Anesthesia Start Script Find Other Meds Infusion Fluids Qutput Blood cites Mark 14 25 14 30 14 35 14 40 14 45 1 Infusions _ Eoin Ee 3 E x Lidocaine 16m 250ml Lorazepam Magnesium Sulfate B Concentration 9 MG Midazolam E per 100 ML Fluid rate O Milrinone Infusion Tim Morphine Sulfate E 26 Heu NS Nitroglycerin n site v Comment Nitroprusside 50mg 250ml um Norepinephrine 4mg 250ml Re Octreotide Infusion ue Potassiu
42. r the proposed procedure Centricity Perioperative Anesthesia User Guide Page 47 of 56 A fraserhealth Fraser Health Authority Surgery Information Systems Enter a partial description of the procedure and press lt enter gt Procedure Procedure Code Procedure Description CPT Code BODEC DECOMPRESSION BOWEL BOLTAD Lisl ADHESIONS BOWEL BOLYADLO Lisl ADHESIONS BOWEL LAPAROSCOPIC BORS BOWEL RESECTION BORVANA REVISION ANASTOMOSIS BOWEL xl Click on the slider on the left side of the box to peruse the list and double click on your choice then click on OK More than one procedure can be selected To add another procedure click on Add again and repeat the previous step if necessary Enter a Diagnosis and click on Record The case will now appear on the census and can be selected for documentation NOTE If the interface is not working and there are no visits displayed in the Manual Admit with Link selection click on Quick start case Enter the patients First and Last Name and their Visit Number Account Number from their chart or their arm band Enter the OR Room that will be used for the monitor capture and the Procedure Description as explained in the previous section The visit number will be used later to reconcile this case with the Meditech electronic record to ensure that the documentation is entered on the electronic record for legal requirements and future reference Click on Record when finished
43. ry Information Systems The Close icon returns user to the OR Census screen Sign In Sign in using the sign in icon from the intraop toolbar gt the popup menu displays If resources were assigned to the case in Case Manager and display on the OR Census these users will automatically appear in the list The first process below will illustrate how to sign in when the users in the popup are in the case We will then illustrate how to sign in when the user is not on the popup menu Enter password for Attending Anesthesia Sign in options Mw Assume Audit Role M Include Electronic Signature M Physically Present Time a 08017013 14 26 06 M Search History sign in In the example above the generic system user Attending Anesthesia has been assigned to the case on the slate If the user logged into the application is Attending Anesthesia the password field will show active when he she clicks on the box with his her name This will display inactive for any other user who is already logged into the application Also the first user to sign into the case will default to assuming the audit role The time of signing in can be altered by selecting the clock and adjusting Centricity Perioperative Anesthesia User Guide Page 13 of 56 ID fraserhealth Fraser Health Authority Surgery Information Systems If the user logged in was not showing in any box 1 Select the Searc
44. s and length The New Case icon starts a case for a patient including patient name time of admittance diagnosis and scheduled staff on the case The Meditech icon provides a link to the Meditech system The MSP icon provides a link to the MSP website Not currently active The Unit icon displays a list of units available to change the patient list to an alternate unit The Active Monitor Session icon provides a list of all patients with active monitor sessions and the room This will be Monitor available for Intraop use The Pending Worklist icon sends the user to another census displaying the follow up items pending or needing additional Pala attention The Printer icon when selected on the OR Census will print the census content Centricity Perioperative Anesthesia User Guide Page 6 of 56 IF fraserhealth Fraser Health Authority Surgery Information Systems The Refresh icon provides a refresh or update to the screen of the most up to date data OR Census Display Area OR Sched Time Name Type Periop Procedure Surgeon AnesAttend DOB Gender visit sys Reg Number Locked ABORT 0601 2013 CPA Testing AD Testing CFA Attending Anesthesia 30 12 1833 0 10146261 0069999557 14 04 The census displays the results of the search fields The columns can be sorted by double clicking on the column header OR Census Search Fields
45. tatus Active Site Initiation Existing Site Attempts 1 Placed Ey Where Placed Time 15 05 05 08 01 2013 A O Discontinued Comment Page 20 of 56 ID fraserhealth Selecting the Sites icon from the Intraop Toolbar Fraser Health Authority Surgery Information Systems Y i f Anesthesia Induction Paging Chart Infusion Fluids Output XP New site 0s Existing Sites New Site Stat Time Comments EE Peripheral O Central Central Type Size rSite Location O Left O Right O NA Location rSite Status Active O Discontinued rSite Initiation O Existing Site Attempts 1 Placed By Where Placed EI Time 15 09 04 08 01 2013 Comment New Edit Delete Discontinue Close tylette was used ifficult Intubation qual bilateral breath sounds auscultated NIBP Sys ite block placed yes Protected _ temperature probe checked and value NIBP Dia art Sys art Dia HR Centricity Perioperative Anesthesia User Guide Record Cancel Page 21 of 56 ID fraserhealth Documentation of Fluids IV fluids such as Lactated Ringers are documented in the script by selecting the script item The Fluids icon presents another option to select additional fluids A new site can also be added fro
46. the field at the top of the box Centricity Perioperative Anesthesia User Guide Page 30 of 56 ID fraserhealth Documentation of Output Fraser Health Authority Surgery Information Systems EBL and Urine are defaulted on the grid for documentation directly on the I O tab For all other outputs select the Output icon The initial entry is documented using the script or icon and subsequent entries are documented on the grid at any time throughout the case A running I O total will be displayed in the banner TESTING CPA 1 Unit AB OR Timers ljO Total 4 Room AB OR1 0069999511 000069999511 32 yo U sy FAS 3 3j Logout Close D r ging E dit La 1 1415 14 20 14 25 14 30 1435 14 40 14 45 14 50 14 55 15 00 15 05 Total Current Outputs OF Output EBL 0 0 Urine Volume cc 0 Chest tube Anesthesia Induction Chest tube Left Chest tube Right i Chart Output Ea NG Custom output Emesis Estimated blood loss Time a Volume Gastric i 30 f 4 15 06 06 03 2013 lleostomy Comment Jejunostomy X T tube s ha Urine Record Cancel Ventriculostomy More detail on the I O can be seen using the I O icon above the Event History w I 00 Balance x Input Infusions 10 ml FRBCSs Units 2 Units Total Input 10ml 2 Units Fluid Output Estimated Blood Loss 50 ml Fluid Output Urine Om Total Output 50 mi Close Centricit
47. to the grid this will appear at approximately 12 56 Fraser Health Authority Surgery Information Systems Entering the Intraoperative Record Date of Birth 06 03 1980 Unit AB OR Wt imers Room AB OR1 15 16 09 0069999511 000069999511 32 yo U 06 03 2013 p 5 lt PASS l a zl 4 Sl ele Q Qo Script Find Other Meds nfusi Fluids Output Blood Sites Mark All Providers must SIGN IN onfirm OR quipment verified Anesthesia machine circuit checked and alibrated Patient identified chart reviewed status __ rom preoperative evaluation PO status __ Peripheral IV D 9 NaCl 1000 ml actated Ringers 1000 ml a Briefing E idazolam Em E i IS ES la arl S efazolin 1000 mq Anesthesia Induction Patient preoxygenated entanyl idocaine 100 mg ml Propofol 500 mg ml Rocuronium 50mg ml 14 25 14 30 14 35 14 45 14 50 14 55 15 00 15 05 1510 15 15 15 20 15 25 3 UO e Config Options Total rally intubated using __ blade after __ Parameter Notification Now Intraop screen orientation Patient Banner This information can be populated by the Patient Manager popup button from the OR Census or the Pat Info button on the Intraop Toolbar Information includes height weight allergies procedure and diagnosis Intraop Toolbar Access to documentation items not in the script Each icon to be discussed later Grid Consists of 4
48. u are in Rendering End Time and another patient is Monitor Location currently connected to Room ABoRi Save Room the monitor in the room Instance ID Monitor Type you have selected Change the room if this is Monitor Name Jon the case This may also indicate that the previous patient s documentation has not been completed Back Time Session Start End Close and the monitor capture is continuing Go to step 2 below in this case Another patient is receiving vital signs from this location right now wease verify you have the correct room 2 Go to the Census E 5 and click on the Monitor dido aste button to see which case is active for the monitor capture Select the case and click End Monitor Session Return to the intraoperative documentation for your case and start the End Monitor Session Close monitor session Manita ORTEST CHRYSTAL AB00001166 18 04 2013 12 06 AB OR AB ORS 1 ortestbev buttons 2069999502 11 04 2013 09 08 ABOR AB OR2 1 ortestbev scripttest 2069999482 18 04 2013 07 08 AB OR AB OR3 1 ortestbev scripttest8 20069999482 18 04 2013 07 07 AB OR AB ORT 1 ortestbey scripttest10 2069999481 16 04 2013 14 56 AB OR AB OR1 1 ortestbev demotest 206999947 15 04 2013 14 33 AB OR AB OR4 1 Ortestcpa Moncap2 sUO0000040 11 04 2013 11 10 SU OR SU ORO02 1 4 11 04 2013 11 089 SU OR SU ORO03 1 11 04 2013 11 10 SU OR SU ORO4 1 11 04 2013 11 11
49. ue on the script When time permits you can go to the clock and click on the Times button to display the list of milestones which have been documented Only the times which have been documented will appear in the drop down so depending on where you are in the script the list of milestones will be different Eis Patient In Room Patient In Room Anesthesia Induction Anesthesia Ready surgical Incision Patient Out af Room Anesthesia End Click on the appropriate milestone and the clock will then freeze to the time that the button was clicked on for that milestone This allows the user to document items from the script with that time stamp Centricity Perioperative Anesthesia User Guide Page 24 of 56 IF fraserhealth Fraser Health Authority Surgery Information Systems Wit Allergies Ht ASA ca E EN IE e cg Hm Click again on the milestone button to choose the next time placeholder or click on Now to unfreeze the clock and continue with the script Documentation of Medications 14 30 14 35 14 40 14 45 14 50 14 55 15 00 15 05 1510 25 15 Total Current 1 1 Patient preoxygenated x First dose charted from Ke ript Fentanyl Dose Fao ae script Fentany Fentanyl Fentanyl 50mcg ml zl Lidocaine 1 A Propofol 500 mg ml Rocuronium 10mg ml E E Orally intubated using __ blade after __ O n the g rid Cefazol n attempt Grade __ laryngoscople view
50. ughout the case If there is a point where the user does not agree with the data or the data is deemed artifact the users can remove the data from the calculations Data Details Sa02 Pulse 15 10 01 03 2013 to 15 15 01 03 2013 eL E 185144 OO 01042013 15 1200 01032013 151400 01 03 2013 15 11 00 01 03 2013 15 10 00 01 03 2013 2 values Average 70 Action Chart Value prei HE Time 15 10 00 01 03 2013 Comment Mark as Artifact Record amp Next Record Close Marking Artifact Select the grid cell for the appropriate time period Highlight the value to be discarded Select the Mark as Artifact button The calculation will now reflect the data without the discarded entry Manually entering data If there is a need for a user to manually enter data that is typically populated from the monitor the user can access the cell screen above Enter the desired data in the Value field and select the Record button Manually entering data onto the grid is mandatory for all sites except for ARH The following fields will have to be entered manually e TOF Centricity Perioperative Anesthesia User Guide Page 54 of 56 ID fraserhealth Rate Setting PEEP CPAP monitored State Entropy Fresh Gas Flow l min x10 Oxygen l min Fraser Health Authority Surgery Information Systems There are several items on the grid that are configured for manual documentation The user has the
51. y Perioperative Anesthesia User Guide Page 31 of 56 I fraserhealth Documentation of Blood Products Fraser Health Authority Surgery Information Systems Select the Blood icon and use the search field to find the appropriate blood product T Infusion Fluids Output 14 55 15 00 15 05 15 10 1515 Blood Products Blo ig Chart Blood Product E X Flui Albumin 25 ml l e PRBCs ml Urir i mpr A volume fas mil Flow Type Maintenance pate _ Albumin 5 ml Autologous ml Autologous Units Cell Saver ml Cryoprecipitate ml Cryoprecipitate Units Time Tao TOO RD US Site News Site Comment z E FFP ml FFP Units Platelets ml Platelets Units PRBCs Units Documentation Tips The first box displayed is used for rate units and time Selecting the details button will provide a place to indicate blood type lot number and patient response I M na im Details xi PRBCs ml B ABs O Type d A B AB Q Lot Patient Response Record Cancel The blood administered will display on the Flow I O tab on the grid and in the I O button totals Centricity Perioperative Anesthesia User Guide Page 32 of 56 A fraserhealth Altering Grid Graph Contents Fraser Health Authority Surgery Information Systems NIBP Sys NIBP Dia art Sys art Dia HR Sp02
52. yl i art Dia Lidocaine 100 mg ml HR Sp02 Propofol 500 mg ml Rocuronium 50mg ml ra 1 bated Proc TEST Event 14 48 Patient In Room History 14 47 Anesthesia Start Dx 14 46 Case Initiated Change Time 50 Ta Mark Time Mark Time ARTE RE A Paging Meditech Ed Sign In Logout Close Mark time is a bookmark for the time an event occurred If the user does not have the opportunity to chart an entire task simply selecting the Mark icon will place a bookmark in the event history until the user does have the opportunity to chart the task Centricity Perioperative Anesthesia User Guide Page 34 of 56 A fraserhealth Fraser Health Authority Surgery Information Systems Example Scenario At the start of a case the user may select Mark when medications are administered for induction when the intubation is completed when the NG tube is placed or when an arterial line is place When the patient is settled and the user begins charting these tasks they would select the Mark Time in the event history the buttons delete comment and Go To Mark Appear By selecting Go To Mark the clock backs up to the time of the Mark The user now selects documents the appropriate script item for that Mark The Mark Time is now replaced with the actual event in the event history These steps would be followed for the remai
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