1. Anesthesia Manager Training Working with Real-Time Data

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

3. Presentation TitleDate 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 Emergency data Snapshot Manually entered data Validating data Variable properties

4. Presentation TitleDate Real Time Data Flowsheet Viewing Resolution All monitor and ventilator information will automatically populate the relevant field Exceptions are 0 2, N 2 0 and AIR (they will have to be entered manually) Default data interval display resolution is 5 minutes.

5. Presentation TitleDate 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. Presentation TitleDate 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. Presentation TitleDate 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. Presentation TitleDate 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. This is DIFFERENT than how data is captured in real time during the case (every 30”) Reviewing a record in the future will only display data points at 5 minutes* (even though the user may be viewing results in real time at shorter intervals) Interval 1 min *unless user has taken SNAPSHOTS or entered EMERGENCY DATA

9. Presentation TitleDate To Change the RTD Interval 1. Click on F3 or 2. Click on the Configuration Menu/Real- Time Data Interval or 3. Click on Interval Display 4. The Real-Time Data Interval box will open 5. Select a new interval 6. Click OK

10. Presentation TitleDate Why change the RDT Interval ?? Want to capture data that will be stored to the database at a more frequent interval Induction of anesthesia Initiation of regional anesthesia  Situations where you are expecting rapid changes in hemodynamics Changing the RTD only changes the capture on a go forward basis, it will not capture retrospectively We will discuss how to do this later

11. Presentation TitleDate Data Resolution-What are those blue triangles?? 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.

12. Presentation TitleDate Data Resolution-What are those blue triangles?? Change resolution to 1 minute Blue triangles disappear

13. Presentation TitleDate Snapshot Snapshot inserts a new column of data at the exact time you choose Analogous to creating a “mark” on the Datex record Click on the Configuration Menu/Snapshot or Click on the Snapshot icon These columns are saved in the database

14. Presentation TitleDate Emergency Data Emergency Data lets you add real time data at a greater resolution than was originally captured….retrospectively! Click on Configuration/Emergency Data Click the “Emergency Data” icon Once added these columns are saved in the database Note**: Emergency Data is stored in the RAM of the local machine for a maximum of 6 hours. If the application is closed, pt transferred or the machine is rebooted…you will lose the data in the buffer

15. Presentation TitleDate Real Time Variable-Add/Remove Variable eg. Remove N 2 0 and Sevoflurane from the home screen You may choose to add or remove a variable from the home screen To clean up unused parameters To add parameters you choose to see 1. Right click on variable to be removed.

16. Presentation TitleDate Real Time Variable-Add/Remove Variable eg. Remove N 2 0 and Sevoflurane from the home screen 2. Highlight desired variable to remove 3. HIT “Remove” 4. Hit “OK”

17. Presentation TitleDate 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.

18. Presentation TitleDate 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. Use this to keep invalid data from being captured  Eg. Electrocautery causes the Heart Rate to read 200  Opening an arterial line to air for zeroing (arterial value=0)/flushing blood from arterial line (arterial value=bag pressure level)

19. Presentation TitleDate Setting Artifact and Alert Limits

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

21. Presentation TitleDate 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. Manually Entered Real Time Data

22. Presentation TitleDate 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 0 2

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

24. Presentation TitleDate 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. Editing Real Time Data 1. Double Click value in question 2. Real time properties will be displayed

25. Presentation TitleDate Editing Real Time Data Note: Edited data will appear with a different color (BLUE) 3. New value entered 4. System registers the change made by the user

26. Presentation TitleDate 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. Insert Emergency Data at 30 second resolution for a two minute period. Take a Snapshot. 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!

27. Presentation TitleDate Questions And Answers