1. Anesthesia Manager Training “Version 8.5 Changes”

2. Presentation TitleDate Critical Changes 2 critical changes LDAP interface Quality Measures (required fields)  Anesthesia Start Time  Antibiotic Compliance You will NOT be able to TRANSFER your patient without completing the above quality measures

3. Presentation TitleDate Critical Changes “LDAP Interface”  Allows you to login to SIMS using your TOH Windows Password  No longer have to create a separate SIMS Password

4. Presentation TitleDate Critical Changes “Quality Measures-Required Fields” 1. The Quality Measures screen will launch automatically when you transfer the patient 2. The standard Demographics window will open to remind you that any event in RED must be completed to insure your record is complete. The only two fields that should be in RED at this point are “Anesthesia case finish time (F)” and “ANES: QA Indicator” 3. Hit the “Close button”

5. Presentation TitleDate Critical Changes “Quality Measures-Required Fields” As per the previous slide, we have decided to create TWO “Required Fields” You will NOT be able to TRANSFER your case until completed Anesthesia Start Time This should be the first macro you click when starting a case. It is very important for MOHLTC reporting. Currently, ours SIMS Analysts need to enter this time when it is missing. This is OUR responsibility. Medications (Anti-Infective) This should NOT be an issue if an antibiotic (of any class) is documented prior to surgical incision In situations where NO antibiotic is administered (not requested or received at another location), we will place a “0” (ZERO) in the CEFAZOLIN order at any point in the Anesthesia Session.  This has been determined to be the most accurate way to determine antibiotic compliance –Antibiotic compliance helps to reduce SSI –Antibiotic compliance may be tied to AFP remuneration in the future

6. Presentation TitleDate Critical Changes “Quality Measures-Required Fields” 4. Hitting “Close” in the Demographics box will launch the “Quality Measures” screen. You will NOT be able to TRANSFER unless “Required Fields” are completed. RED text = NOT COMPLETED Transfer button remains “greyed out”. You must cancel and enter what is required (in this case, the antibiotic)

7. Presentation TitleDate Critical Changes “Quality Measures-Required Fields” 4. Hitting “Close” in the Demographics box will launch the “Quality Measures” screen. If “Required Fields” are completed (BLACK text), the TRANSFER button will activate.

8. Presentation TitleDate Other Changes Demographic information bug fixed Custom Icon changes System Icon changes Listing of Medications and Fluids Preop Manager changes Event Set changes

9. Presentation TitleDate Demographic Information BUG FIX Banner Name MATCHES Patient Identification (bug fix) Patient will no longer have duplication of middle name Banner will now show: Procedure BMI

10. Presentation TitleDate Custom Icons Antibiotic “1’st dose removed as: there are multiple safeguards in place to insure drug is administered (if required) prior to surgical incision. Business Intelligence software now runs in the background to remind end user that 3.5 hours has passed since last dose of antibiotic. Reminder: If antibiotic NOT required, place a “0” in the Cefazolin field 8. 1 8. 5 “End GA” now has two options to reflect either the A/W device being removed or left in place. Choose one or the other, NOT both. Choose NEITHER if Anesthetic Type is something other than GA

11. Presentation TitleDate System Icons 8.1 Notice the very different look to the “Preop Manager and “OR Manager” icons. These new icons will also appear on the Desktop NEW “Quality Measures” Icon

12. Presentation TitleDate Medications and Fluids Current 8.1-Medications are displayed alphabetically 8.5-Medications are NOT displayed alphabetically. Service Request launched with PICIS to correct problem

13. Presentation TitleDate Medications and Fluids Medications are actually displayed as if the “Show subheadings” box has been selected Medications are listed by FAMILY and then alphabetically within the family We will therefore default to the “Show subheadings” until issue resolved

14. Presentation TitleDate Preop Manager Currently ALL Body Systems are contained in field of view 8.5 will require you to hit an icon to see body systems out of field of view

15. Presentation TitleDate Preop Manager “Frailty Index” Frailty Index has been placed as an additional Body System. PAU leads to provide additional information

16. Presentation TitleDate Protocol Changes Protocols are an easy way to add multiple medications/fluids to a flowsheet

17. Presentation TitleDate Protocol Changes Protocols also allow us to easily add “combined medications”. In our original build, we had to create multiple permutations of a “combined medication” due to a system bug which allowed the end user to overwrite the entire database. This has been corrected and we will introduce a much cleaner list of combined medications for specific protocols. This change will be take place after the 8.5 Go LIVE and specific instructions on how to create a combined medication will follow at that time.

18. Presentation TitleDate Event Set Changes Additions will be take place after the 8.5 Go LIVE and will be communicated once completed

19. Presentation TitleDate Auto Discharge Tired of receiving e-mails informing you that you have NOT discharged your patient after 72 hours The system will now automatically DISCHARGE a patient if left in “transfer” mode > 12 hours. Please continue to be vigilant and “DISCHARGE” a patient when required.  This insures there is no issue when a patient needs to return to the OR within the 12 hour window.

20. Presentation TitleDate Summary To summarize, there are few changes to Anesthesia Manager The major change in SIMS is primarily at an IT/IS level These changes will facilitate much better system maintenance For anesthesia, requested or required changes will occur more readily as system “down time” will not necessarily be required. Please feel free to communicate any requests to Ian Zunder or Rob Jee