Transcript SIMS for the Advanced User

Emergency Situations
 In emergency situations, simply ADMIT the patient
into the system
 This allows for vital signs to be captured while you LOOK
AFTER THE PATIENT
 Information can be entered afterwards
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Emergency Situations
Starting the Record
 If you forget to “Start Session” when an emergency patient
enters the room, you have several choices:
 “Start Session” on patient and manually enter data (using the Datex
monitor as a source of information)
 You will need to use a series of memos q5min
You cannot enter data in the (BEFORE ADMISSION) section
 “Start Session” on patient and use paper for the initial period that
is not captured electronically
 Make a note on both records as to what has occurred.
 Chart entire case on paper
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Emergency Situations
How do I chart BEFORE the Chevrons?
Two ways:
1. Add the Order again
using Protocols –
set earlier time
2. MOVE the order
by Right-clicking
on the Order
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Emergency Situations
Inserting Emergency Data
 SIMS system collects data on
an active patient on a local
workstation q30”.
Snapshot
Insert Emergency Data
2011-09-15
2011-09-15
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15:00
15:05
Emergency Situations
Inserting Emergency Data
 The emergency data will be
archived electronically
 Intermittent data (eg. NIBP) will
not print to the paper copy of the
anesthesia record
 Beat to beat data (invasive
pressures, HR, Sp02) will print to
the paper copy of the anesthesia
record
 30 second data intervals are
cleared from the local workstation
on transfer/discharge
 Ensure you capture important data
prior to transfer/discharge
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Transfer &/or Discharge
 Transfer ONLY
 Patient will be picked up/cared for on another bedside SIMS workstation
 PACU/SDCU
 Transfer & Discharge
 Patient will be picked up on another SIMS workstation but care will NOT continue
at the bedside
 ICU
 Labor and Delivery PACU
 “Start Session” on the local machine (NOT Remote View)
 Document handover events on the local machine
 Manually enter handover vital signs into the electronic record
 Document “Anesthesia Finish” and print record
 Discharge the patient from SIMS
 (choose “ICU”from pull down menu if discharging to ICU)
 (choose “Nursing Area” from pull down menu if otherwise)
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Transfer &/or Discharge
 What happens if I don’t discharge my patient??
 Patient is left in the transfer zone (cloud)
 Creates chaos when patient returns to the OR
 Patient WILL appear on the census list
 Starting Session will pull the old encounter back down from the
transfer zone (cloud) and merge the encounters creating one
potentially very large anesthetic record encompassing days
 Hopefully you will recognize problem
 Medications other than the default med template are apparent
 Fluids/infusions may continue to be running
 Demographic information is showing different anesthesiologists/surgeons, etc.
 What do I do??




Document a memo stating that patient had not been discharged
DISCHARGE the patient
Return to “CIVMOR-Surgery patients for Today” Census list
Locate the patient and “START Session”proper encounter should load

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You will have to add vitals manually
You may elect to document on paper if significant time has passed.
Transfer &/or Discharge
 Discharge ONLY
 Patient will be NOT be picked up on another SIMS workstation/care will
NOT continue at the bedside
 Dental Clinic
 Lithotripsy
 Endoscopy
 Case MUST be finished in the OR
 DO NOT hit the TRANSFER icon
 Document handover events on the local machine (forward time)
 Document “Anesthesia Finish” and print record (forward time)
 Discharge the patient from SIMS
 Choose “Nursing Area” from pull down menu
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Printing
•Surgical Encounter is analogous to a document/book with
several chapters
•Before Admission
•GA (Surgical Pre-Op)
•GA (Transfer)
•GA (Anesthesia Standard)
•GA (Transfer)
•GA (PACU Post Op)
•Discharge
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Printing
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Printing
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Printing
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Preop Manager
 How do we know whether a formal MD Assessment
has occurred????
vOACIS is your friend
 DO
NOT use Preop Manager on a workstation that is ACTIVE
with a different patient in Anesthesia Manager
 (high potential to produce a second but blank assessment for the
same surgical encounter!!)
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Preop Manager
vOACIS as a Starting Point
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•If you see this, you do NOT have to open Preop Manager
Preop Manager
Patient only seen by an RN before the date of Surgery
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Preop Manager
Patient only seen by an RN before the date of Surgery
 Logical thing to do would be to open this previous assessment and
complete the MD fields
 YOU CAN’T-The record has been LOCKED
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Preop Manager
Patient only seen by an RN before the date of Surgery
 You must open a NEW Preoperative Assessment
(Will be linked to correct date of surgery and Encounter number),
 Complete the usual fields
 Signature-assessing physician
 Signature-Final Chart Signoffupload to Voacis
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 YES, there will now be 2 Preoperative Assessments on vOACIS
Preop Manager
Inside the OR
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Launch Anesthesia Manager
Preop Manager
Inside the OR
 Preop Manager should find the ACTIVE patient (same Encounter #
and date as Anesthesia Manager)
 Open the Preoperative Assessment
 Complete ALL fields as previously described
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Preop Manager
Final Chart Signoff
 If you are the last person to
interact with the patient in a
preoperative setting, you must
do a
“FINAL CHART SIGNOFF”
 Upload to vOACIS
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Preop Manager
Inside the OR
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Copy Forward
 Wonderful time saving tool
 Allows previous MEDICAL assessments to populate the current
assessment
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Copy Forward
 In this example, there are 2
previous assessments in the SIMS
database
 The most recent assessment loads
automatically
 The MD Assessment of June 27,
2011 is seen in the window
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Copy Forward
 If this assessment is
satisfactory and closely
resembles the current
medical history, check the
MD assessment box and
hit OK.
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1. Hit MD
Assessment and
OK
Copy Forward
Hit Close
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Copy Forward
 It is your responsibility to insure the information displayed in the new
assessment is accurate
 This assessment is current and NOT locked
 If necessary, edit the information (add/revise/delete)
 Complete the usual fields
 Signature-assessing physician
 Signature-Final Chart Signoffupload to Voacis
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Copy Forward
 In this example, there are 2
previous assessments in the SIMS
database
 The MD Assessment of Sept. 29,
2010 is selected
 In order to see the contents of the
assessment, hit the LOAD button
 the assessment of Sept. 29 does
NOT have a MD Assessment
 Notice how the Copy Forward is
greyed out
 Do NOT carry forward a Nursing
Assessment
 You are not a nurse
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Consults-Residents
Changing
Current to:
Inpatient
Consult
Complete
Anesthesia Consult
Complete
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•Suggestion to choose “Ready for Surgery”
•Final Chart Signoffupload to vOACIS
•If follow-up required, then use Addenda
PACU/ICU
 Handing over difficult cases
 Consider printing out the Preop Assessment from vOACIS to accompany the
anesthetic record
 Default printer location in the OR is the respective corridor printer
 I’m called to re-intubate a patient
How difficult was it during the recent GA?
I don’t have time to look it up in vOacis...
 You can use the Nursing computer on an active patient to scroll
back through the entire patient encounter (different template)
 You are able to hit the Event icon (F4) to see a complete
description of what occurred intraoperatively.
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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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