1. Anesthesia Manager Training Working with Real-Time Data

2. Objectives By the end of this module the participant will be able to:
Change the Viewing Resolution for the Composite Flowsheet
Manually enter RT data
Copy forward or Delete forward manually entered RT data
Edit RT data and view the audit trail

3. Real Time Variables: A Detailed Look
Important concepts in Real Time Variables:
Real Time Data Interval (data in database)
Viewing resolution (number of columns in flowsheet)
Editing data
Manually entered data

4. Real Time Data Flowsheet Viewing Resolution
All monitor and ventilator information will automatically populate the relevant field
Exceptions are 02, N20 and AIR (they will have to be entered manually
New GE Anesthesia Machines (July 2015) will have electronic flow control that WILL capture Fresh Gas Flows
Default data interval display resolution is 5 minutes.

5. Real Time Data Flowsheet Changing the Viewing Resolution
RTD is being captured every 30 seconds and is stored on the local workstation**
The screen resolution can be changed at anytime.
You can view the data in composite flowsheets in many different time resolutions.
This does NOT effect the interval of data stored in the database or saved to the patient record.

6. Changing the Viewing Resolution “1 minute”
Changing the viewing resolution can be accomplished in any of the flowsheets
Changing the viewing resolution does NOT change the frequency of data collected to the local machine or to the database

7. Changing the Viewing Resolution “10 minutes”
Changing the viewing resolution can be accomplished in any of the flowsheets
Changing the viewing resolution does NOT change the frequency of data collected to the local machine or to the database

8. Real Time Data Flowsheet Data Collected and Stored on the Server
The RTD Interval represents how often data is collected and saved to the database. The default interval is 1 minute.
DO NOT CHANGE THIS INTERVAL
This insures that a COMPLETE Anesthetic Record is ARCHIVED and AVAILABLE as required at any point in the future.
The PDF generated at the end of a case and uploaded to vOACIS is the best possible interpretation of a complicated electronic record that contains thousands of data points. The paper record only plots data points at 5 minute intervals.
Interval 1 min
The PDF should NEVER be used when there are questions related to the Anesthesia Record
ALWAYS refer back to the ELECTRONIC (ARCHIVED) RECORD for the most accurate information

9. Data Resolution-What are those blue triangles??
Resolution drop down is configurable.
Time columns: Blue tick marks indicate that there is more data for this time period than is currently shown. Increase the viewing resolution to view this data.

10. Data Resolution-What are those blue triangles??
Change resolution to 1 minute
Blue triangles disappear
Resolution drop down is configurable.

11. Real Time Variable Properties
Each real time variable has properties that can be customized
Properties can be viewed by right clicking on the variable label.
Alert and artifact limits can be set from the properties window.
Can’t change CNL code #.
Can change Long and Short Names in CS Customize, not on the fly.
CNL vars.lib holds all the CNL codes, now it is visible in dbTouchup in the CNL table v7.0 change.
Template setting to enable or disable alerts: overrides on the fly setting of Alert limits.
Setting them on the fly will override settings if they are set to be on at the template level.
Alert limits: shows for 6 variables in Vital Signs bar must be set at the template level.
Artifact limits: unless the data is between the high and low limits, Anesthesia Manager will drop the data.
Can use for inaccurate A-line readings, but you are keeping the Arterial line for blood draws.

12. Setting Artifact and Alert Limits
Alert limits can be set for any variable
Exceeding the Alert limits (high or low) will create a red circle around the variable
This is analogous to setting alarm limits on the Datex Monitor although there is NO audible prompting from Anesthesia Manager
Artifact limits will prohibit the data from being entered in Anesthesia Manager, unless it is between the High and Low artifact limits.
These limits currently exist for HR and BP in order to keep invalid data from being captured (eg. Electrocautery/zeroing arterial line)
Alerts can be set for any variable, not just those 6 picked for the vital signs bar.
Cells are bordered in red when the variable is out of the alert limits that have been set

13. Setting Artifact and Alert Limits
1. LEFT click on variable
Notice limits pre-entered.
NEED A PICTURE OF HEART RATE VARIABLE PROPERTY WITH ALERT AND ARTIFACT REJECTION LIMITS
Both artifact and alert limits can be set on the same variable, but the artifact limits have to be equal to or above the High Alert limits, and equal to or below the Low Alert limit.
2. Artifact limits may be pre-populated or blank.

14. Setting Artifact and Alert Limits
Data cell is bordered in Red when value is above “Alert Limit”

15. Manually Entered Real Time Data
Not all real time data in the composite flowsheets comes from medical devices. Some must be entered manually.
Eg. Fresh gas flows
Click in the time cell in which you want to enter data.
New GE Anesthesia Machines (July 2015) will have electronic flow control that WILL capture Fresh Gas Flows
NEED A VARIABLE OF FGF
Very few monitors give you fresh gas stream, so this is often manually entered.
Can set up a variable to copy forward, even though it is normally coming from a device. Vent 1 PEEP comes from the vent.
Copies forward to current time, or to next validated time cell.

16. Input desired value for 02
Manual Entry of Data
Enter or Delete value (if you want a change to the selected cell only)
Enter>>> or Delete>>> (if you want the action to be repeated in succeeding cells)
Input desired value for 02

17. Manual Entry of Data Enter (selected cell only)
Enter>>>> (action repeated on a go forward basis)

18. 2. Real time properties will be displayed
Editing Real Time Data
Due to artifact or other reasons, clinicians may need to change real time data values.
An audit trail of the data values appears in the Edit/Review Data window.
Edited data color can be changed from Red to something else.
1. Double Click value in question

19. 4. System registers the change made by the user
Editing Real Time Data
3. New value entered
Note: Edited data will appear with a different color (RED)
Edited data color can be changed from Red to something else.
4. System registers the change made by the user

20. Real Time Variables: Exercise
Open Anesthesia Manager and admit a patient to the Standard Anesthesia Template, if not already done.
Change the viewing resolution of a flowsheet.
Edit some RT data that came from a device.
Manually enter the FGF rate of oxygen (not being collected from the driver) and use the copy forward function.
Discuss your observations and ask questions!

21. Questions And Answers