Transcript SIMS for the Advanced User

Update on SIMS
Ian Zunder & Bob Elliott
Sept – Oct. 2011
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Talk Objectives
 Highlight changes
 Pointers
 Identify common errors
 Review key concepts
2
What’s new
myTOH has Preop Manager
Ward / ICU Consults
3
What’s new
Cubicle Computer with “LIVE” SIMS Apps
4
What’s coming
iPad – myTOH / vOacis
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What’s coming?
 ICU autologin machines
 vOACIS – new Census
“Surgery patients for tomorrow”
 Will be able to review your cases in one spot
rather than cutting MRN numbers from the OR
schedule
 Lab Interface
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Printout
Changes
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Printout Changes
8
Printout Changes
Drug routes clearly identified
Drug infusions in this section use
MASS per Time Column
Combined Meds & Infusions
denoted by “>>”
Prefix (Reg) used for Regional drugs
Drug infusions in this section use RATE
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At this time, PICIS is not able to program the PrintOut so that
Combined Infusions appear in the Infusion section with a RATE
Printout Changes
The problem of Drug Infusion RATES
Until PICIS can fix the problem of Combo Infusions not showing up
in the Printout as a RATE, we are going to use a PARTIAL work-around.
Single Drug Infusions will revert to the original PICIS
style as a FLUID (will appear OnScreen in green)
Single Drug Infusion
as COMBO
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Single Drug Infusion
as FLUID
Printout Changes
The problem of Drug Infusion RATES
Single Drug Infusions:
• will appear OnScreen in green as a FLUID
• can be selected in Protocols as before
• will appear in the PrintOut in the INFUSION section
• will appear as a RATE both OnScreen and in Print
Combo Drug Infusions (2 or more drugs):
• will appear OnScreen in the MEDICATIONS section
• will appear OnScreen as a RATE
• will appear in the PrintOut in MEDICATIONS
• will appear in Print as MASS per Time Column
(usually 5 min)
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Printout Changes
•Invasive pressures (in red) trended with non invasive pressures (same graph)
•Y-axis with BP incremental values of 20 rather than 40 (with grid on graph)
12
•SpO2 values documented as number in addition to histogram scale
Printout Changes
FFP has had bag
levelled to zero
RBC paused – and levelled to zero
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To get the proper display in the Printout
– use Pause when bag finished
Data Archiving
Will be every minute by default
 Data is (currently):
 captured – q30secs
 displayed – currently q5min (NIBP is exception)
 archived (stored on server) – q5min
 Data will be:
 captured – q30secs
 displayed – q5min in table / q1min in graph
 archived – q1min
 Rationale: In a Critical Event, will you remember
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to use Emergency Data to insert q1min data into
record for archiving? Probably not...
Data Archiving
Will be every minute by default
 Will you see anything
different on-screen?
Art Line shown with
RT Interval 5 min
RT Interval can be set
by clicking this box
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Art Line shown with
RT Interval 1 min
Tricks/Pointers
Artifacts
 Artifacts are a common problem
with Anesthesia Information
Systems
 Whatever is on the monitor at the
precise moment when the AIMS is
checking, gets recorded
 You must be vigilant!
 Is an artifact in the graphical trend
captured in the “real time
variables”?
 If “YES”, this will appear on the
printed record
 If “NO”, this will NOT appear on the
printed record
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Artifacts
 How do you fix artifacts?
 Correct the variable
 Memo the artifact
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Artifacts
Correct the Variable
1. Click on
variable to be
corrected
2. Input corrected value
4. Hit Enter button
3. Use the Comment
field to document
“Artifact”
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Artifacts -
Finding the Variable to Correct
Switching to 1 min res,
the artifact is now seen
on both Graph & Table
At usual 5 min res, the
artifact is seen on
Graph but not in Table
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Artifacts
Memo the Artifact
If you encounter more
than the odd artifact,
(e.g. repeated electrocautery interference)
you will probably want to
enter a formal Memo
21
Tricks/Pointers
Labeling IV Lines
 Two IV lines running the same solution
 How do you keep track??? Label the line!!
Click on First IV Bag
for this IV line
Hover Pointer over
IV Fluid to see IV Site
Select alternate IV site
from Drop-down
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Tricks/Pointers
Changing the Rate for a Combo Infusion
Switch from “Infusing”
to “New Bag”
Change Pump Rate using the
rate from your pump
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Now you can edit Dose
Tricks/Pointers
Eliminating White Space
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Tricks/Pointers
Eliminating White Space
2. Select the
variables you want
to remove
1. Right Click over any
point of the Variables
Or on heading
“Real-Time Variables”
3. Hit
Remove
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4. Hit “OK”
Tricks/Pointers
Eliminating White Space
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Tricks/Pointers
Finishing a Case before hitting the PACU
 Normal Procedure
 Transfer the patient off the
local workstation in the OR
 In PACU, login to dedicated
SIMS computer and locate the
patient in Remote View
 Complete PACU handover
Report
 Finish the Case and Print record
 Logout
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1
2
3
Tricks/Pointers
Finishing a Case before hitting the PACU
 Modified Procedure
 Initially skip the Transfer
 In the OR, document PACU
handover Report and forward time
the event
 In the OR, document a Finish time
and forward time the event
1
4
 When the Print dialogue box appears,
make sure that you forward time the
“End Time” to capture the handover
and the finish activity
2
3
 Transfer the patient
 Printout should be waiting for you
on your arrival
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•Can save time in high volume list
Anesthesia Manager
Launching the Application
 Wait until you see the eyes of the patient outside
the OR
 A patient can only be active on 1 workstation at any given
time
 If you “start session” on a patient NOT present outside the
OR, this patient is not available to the nurses in the
Preoperative area.
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Anesthesia Manager
Selecting a Patient – Starting a SESSION
 “Start Session” not available
 Patient can only be “active” on one machine
 Assume patient is active in Preop area until proven otherwise-how can you
tell?
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Anesthesia Manager
Selecting a Patient – Starting a SESSION
•“Remote View”
- Investigate
•Look for GA (Transfer)
•Look for Event To OR
in the log
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•If patient is NOT in the Transfer zone, then contact Preop area
•If patient IS in the Transfer zone, technical problem,
contact HELP Desk-SIMS technical pager
Anesthesia Manager
Selecting a Patient - MOR Default List & Emergency Patients

Patients on the Emergency List are initially NOT found on the Main Census List
 They are maintained on a “Waiting List” which we don’t have access to

Ward Clerk (or Nurse) moves patient onto the Main Census List
when called for the OR
 If you do NOT see your patient on the Main Census List, please ask whether the
transfer from the Waiting List has occurred.
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Anesthesia Manager
Selecting a Patient - MOR Default List
• …OR - Sort the list by last name
 Occasionally, patient is on the Census list
but not under the expected OR

CIVEM01, CIVEMO2, CIVEMO3
 Scan the list – right to the bottom!
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•A Jon/Jane Doe will show up in a room as above
using an alphanumeric name
Anesthesia Manager
Selecting a Patient - Satellite Default Lists
 All workstations outside the Main OR (Civic or General Campus) have a
generic pull down list (Lithotripsy at the Riv has a dedicated census)
 CIV Dental - Admitted Today
 CIV Endoscopy - Admitted Today
 CIV Labour and Delivery - Active Patients
 CIV Medical Imaging - Admitted Today
 CIVMOR Surgery patients – Today (This is the DEFAULT)
 CIVMOR Surgery patients - Tomorrow
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 CIVMOR Transfer patients
 ZZZ SIMS Version 2.2.7 A
Anesthesia Manager
Finding a Patient - Using MRN #
•Avoid unless absolutely necessary
•Use the patient encounter # to help
select the correct SIMS session
-Encounter number is 12 digits
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•Look for a Surgery Date and/or
Booking ID
Anesthesia Manager
Launching the Application-Using MRN #
 What happens if I pick the wrong SMS admission
 Anesthesia Manager won’t talk to OR Manager and the case will show up on a
System Admin census as not being complete.
 What about Remote areas (Diagnostic Imaging/Endoscopy/Brachytherapy)
 These cases do NOT have a Booking ID
 Pick the most appropriate encounter/SMS admission
 This is usually the encounter at the top of the screen search
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 Date you choose should match the day of the procedure
Anesthesia Manager
Demographics-System Bug
 Demographic Screen does not match the active patient
 Known bug
 All information entered into the system will be archived and printed
CORRECTLY
 Exiting and re-starting Anesthesia Manager will resolve the problem.
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Anesthesia Manager
Demographics-System Bug
 It is OK to quit application/power down-unplug computer when a
patient is ACTIVE on a local workstation
 All data is uploaded and archived on the server (cloud) in 5 minute
increments (soon to be 1 min)
 Rebooting the computer/Re-launching Anesthesia Manager should
bring up a text box identifying the patient active on the local
machine and providing you with options
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Anesthesia Manager
Demographics-Remote Areas
 Demographics subsections are BLANK and need to be populated
 Labor and Delivery
 Dental Clinic
 Diagnostic Imaging
 Endoscopy
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 Lithotripsy
Anesthesia Manager
Demographics-Remote Area Procedure
 We are responsible for entering the procedure
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Anesthesia Manager
Demographics-Remote Area Procedure
•All remote areas have cheat sheets
•Handful of keywords in any remote
area will bring up the list of procedures
“Remote” – important!
“Cysto”
“Cesarean”
(not “Caesarean”)
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Anesthesia Manager
Demographics-Remote Area Procedure
2. Enter
keyword
3. Find Now
1. Hit “Add”
4. Select
Procedure
5. Hit “Add”
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Anesthesia Manager
Demographics-Remote Area Medical Team
 We are responsible for entering the medical team
 NO medical personnel (Anesthesia/Surgery) will be listed in Remote areas
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Anesthesia Manager
Demographics-Remote Area Medical Team
 All physicians practicing in remote areas will be listed in the pull down list
 Please inform a SIMS super user if a physician does NOT appear in the list
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Macros
 Inserted into the program
because of the lack of visual
prompts typical of a paper
record
 If followed, ensures (as best as
possible) that important
components of the record are
NOT forgotten
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Macros
 Very important to use the “Start” icon
 Places the important Start-Time stamp (event) on the anesthesia record
 (Can be done manually through Add Event – but why bother?)
 System Admin checking to make sure that certain prerequisite
information is on the record
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Macros
 You will be notified if “Anesthesia Start Time” is NOT documented
 IMPORTANT OHIP NOTE:
 Make sure you enter a Anesthesia Start Time that is the same as the
Start Time you submit to OHIP
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Macros
Correct Start
Time entered 2nd
Incorrect Start
Time entered 1st
 Only use the Start Icon ONCE!
 Above example – 1st click => incorrect Start Time of 21:20 entered
2nd click => tried to correct Start Time to 21:15
 End result => SIMS will use the chronologically LAST Start Time listed!
 Proper way to correct => EDIT the time by double-clicking
or Use the Edit Button
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Macros
 The events in this Event Set
(A010) are to be used to provide
proof that the physician has
reviewed a formal Preoperative
Assessment/Consult
 Previously done in Preoperative
Manager-viewed in vOACIS)
 It does NOT replace a formal
Preoperative Assessment
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Macros
 Simply choosing events may not provide ample proof to having
reviewed a Preoperative Assessment done by a colleague
 “bullet points” in the Comments section suggest that you have
reviewed the Preoperative Assessment or had a discussion with the
patient
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Macros

These macros put markers on the timeline (R,
G, M) and indicate a “Start-Flag” in the log
 General Start
 Regional Start
 MAC Start

Provide a reference point for future entry of
comments/drugs

They do NOT represent Anesthesia “Start Time”
They do NOT enter a specific “Anesthesia Type”
for you
 Reminder – Anesthesia Types start with:
(G)_ or (R)_ or (C)_ or (M)_

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Macros
 You will be notified if “Anesthesia Type” is NOT documented.
 You should pick ONE-and-only-ONE Anesthesia Type!
 Admin reports will document if more that one type of “Anesthesia
Type” (including duplicates) have been entered
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Macros
 Don’t add events to the log using Macros if you have not performed the
event
 Eg. “End GA” macro when a spinal anesthetic has been performed
 Eg. “End GA” macro when a patient is left intubated
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Event Log
 Imperative that you
check your event log at
some point during every
case
 Insure timeline makes
sense
 Delete inaccurate entries
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Protocols-Combined Medications
 Extensive library of protocols, many of which contain combined
medications and organized by:
 Major categories most commonly used
 Regional anesthesia drugs
 Alphabetical by “Class”
 For system purposes, a combination can contain 1-4 different
drugs.
 Building in this fashion allows the drug to show up in both the
“medication” and “fluids” part of the electronic record
 Combinations are primarily generic
 Bolus doses kept at 0 units
 Infusion doses kept at 0 units/hr
 Exceptions are the most commonly used combinations (eg. Fentanyl 250
ug/Lidocaine 200 mg)
 Exceptions are the most commonly used epidural/spinal concentrations
(eg. Bupiviaine 0.25% + Morphine/Fentanyl)
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Protocols-Combined Medications
Don’t even Double-Click
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Protocols-Combined Medications
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If this Box appears when choosing a Protocol,
You are Editing the Protocol – CANCEL!
Protocols-Combined Medications
Do NOT enter
ANYTHING!
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SIMS Help
 FUNCTIONAL ISSUES-Super Users (working hours only)
 Civic Campus
 Zunder
 Bryson
 Charapov
 General Campus
 Elliott
 Gagne
 Szeto
 TECHNICAL ISSUE-HelpDesk (14136)
 Password resets
 Network connectivity
 Printing problems
 Computer related issues
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