1. Endoscopy Lab Intro to Sedation Narrator
GO-Live Date: TUESDAY, December 9, 2014

2. Sedation Narrator Benefits
Same charting system for all nursing activity
Don’t have to open another chart to look at patient information
Floor nurses have access to procedure information
Medication Charting
When documentating medication administration, a doctor’s order is generated and sent to his in-box for signing
Chart format encourages standardized documentation
“everyone on the same page”

3. Sedation Narrator
Interoperability—the ability for other institutions to see our documentation and for us to see their documentation
Speed—check boxes vs. free text
Data collection for current and future use
Quality of Care Event (basically a PSN within the Narrator) documentation at time of event

4. Sedation Narrator Getting Started Log in to SME environment
User ID: iprn
Password: Uchtest1!
Department: GI Pre/Post
Find patient, open chart
Locate Sedation Narrator navigation tab and click to open
“Patient/Team Arrival = time in room with patient. Click “accept”

5. Sedation Narrator Set up Favorites
Click on to open “Edit Favorites” box
Click on next to Bronchoscopy
Look down Procedure list and select GI Intra-Procedure
Close Edit box

6. Sedation Narrator
Click on GI Intra-Procedure (top left in box) to open Procedure Flow Sheet
The blue section with the check-marked boxes is called the Table of Contents. By unchecking boxes, these rows or sections will be removed from your flow sheet.
Let’s remove Central Line Section by unchecking the box
Look at the flow sheet, starting at the top. Sections include:
Pre-Sedation Information, including Emergency Equipment. Take a minute to familiarize yourself with options included for multiple selection.
Last PO Intake should flow over from PreProcedure Flow Sheet

7. Sedation Narrator Flow Sheet sections, continued.
Universal Protocol is our Time-Out. Please take a minute to familiarize yourself with this section
Start Time and Stop Time definitions: only use for a non- scope procedure, i.e. LVP
Patient Positioning is self-explanatory
Vitals can be added here or via the Event Log in Sedation Narrator
Our vital sign monitors will be linked to Epic when we go-live
Oxygen Therapy is self-explanatory
Pain Management is same as our other Flow Sheets. Per hospital policy for moderate sedation, pain should be assessed and documented on every 5 minutes during sedation

8. Sedation Narrator
Sedation Scale: We are now using the Moline Roberts Sedation Scale. When you click in the box, the definitions of each level of sedation are provided.

9. Sedation Narrator GI Procedure
Here is where we will document our times:
Scope in
Scope Out
At Cecum
Interventional Therapeutic Maneuvers is where we will chart our Interventional Procedures.
If you are assisting or sedating in High Tech, this is where you will chart
Additional Maneuvers is where you will chart additional items—these are generally used for Interventional Procedures
Fluoroscopy time. Contrast Dye Injection, Patient Safety

10. Sedation Narrator
Luminal Therapeutic Maneuvers is where you will chart any interventions during luminal procedures
Click inside the box to see what is available for documentation
Abdominal Pressure
APC
Banding
Biopsy
Brushings
Clips
Dilation
Take some time to explore options in this section.
Grounding pad
Liver Biopsy
Polypectomy
Radiofrequency Ablation (RFA/BARRX)
Therapeutic Injection

11. Sedation Narrator
Now that we have looked at the flow sheet, let’s look at what Sedation Narrator has to offer:
Click on Sedation Narrator Tab, lower left in screen
We left off at Procedure Start
Click on the icon of arrows to expand the options for all of the categories
Click on Staff Add/Remove Staff
Document staff, click “accept”
You can add additional staff as needed by clicking on the

12. Sedation Narrator
Staff will now be visible in the box on left side of screen
Click on “IN” when that staff member arrives in room and “OUT” when that staff member leaves the room.
Inside of the Sedation Narrator Event Log window, the staff member will now be visible.

13. Sedation Narrator
Click on “Procedure Start” –this term is defined as the time the patient arrived in the room.
Select “GI scope”
Click on “Accept”
Look at Medications (1 step)
Our commonly used sedation medications, reversal agents, antiemetics, IV fluids, and antibiotics are listed here.
Click on “Add’l Meds” to search for medications not listed. In the future, we will be able to select from an “Only Favorites” list personalized for our department
Click on any of the medications in blue to open documentation window.

14. Sedation Narrator Document giving a dose.
Spaces that have to be completed have an ! beside them
Remember that if you make an error, click on the blue hyperlink in the event log and you can correct your mistake
By completing the medication administration, you are sending an order for that medication to the provider’s inbox for signing.
Once a medication has been documented, it will be visible under the MAR section to the right of the Event Log window
By clicking on the blue MAR at the top of the window, you can visit the MAR and see what you have documented.
Inside the MAR, you can “hover to discover” any additional information that was documented at the time of administration.

15. Sedation Narrator
New Process for post procedure medication administration communication between Sedating RN and Provider
RN will place a patient sticker on a medication log sheet, fill out the amount of medications given and place it on the desk where the provider completes their Provation MD note.
At the end of the day, these log sheets will be placed in the shredder box.
Please continue to verbalize the amount given as well.

16. Sedation Narrator Additional Options for charting in Sedation Narrator
IVs
Tubes
Under Tube Care GI you can document any tube that is placed during a procedure, i.e. NG tube, OG tube, etc
Drains
This is where you chart PEG or PEJ tube placement
Airway
This is where you chart Nasal Pharyngeal Airway or Oral Pharyngeal Airway under “Non-Surgical Airway”
Remember to document removal of airway by clicking on
Pain
Here is another way to open the pain management section

17. Sedation Narrator And FINALLY Procedure End
Procedure End time-this is defined as the time the nurse leaves the room with the patient
Quality of Care event
Any time we have to do some sort of intervention, ie airway maintenance, reversal agent, etc.
If no event occurs, select “No event occurred” and click on “accept”
Disposition: Where the patient is taken after the procedure
Discharge: Closing Sedation Narrator or as we say, “finalizing the note”

18. Sedation Narrator Let’s Play! Scenario 1: Document Colonoscopy
Pt/Team arrival
Staff
Emergency Equipment in the room
Universal Protocol (Time Out)
Set of VS
Moline Roberts Sedation Scale
100 mcg Fentanyl; 2 mg Versed
Scope In
4 mg. Zofran, 50 mcg Fentanyl, 1 mg Versed
Cecum reached

19. Sedation Narrator Document, continued
2 polyps removed via cold forceps
1 polyp removed via hot snare with 1 clip placed
Biopsy taken using cold forceps
Scope out
No Quality of Care event
Disposition to recovery

20. Sedation Narrator Scenario Two: Document EGD
Patient positioned on left side
Oxygen 3 L/NC
Pain 0/10
Universal Protocol
Safety equipment in room
100 mcg Fentanyl, 2 mg Versed, Cetacaine spray x1
50 mcg Fentanyl, 1 mg Versed
Scope in
Variceal banding x 3
Scope out

21. Sedation Narrator Scenario Three: Document EUS with Sedation
Pt/staff arrival
Staff
Emergency Equipment
Universal Protocol
Patient Positioning VS
Moline Roberts Sedation Scale
Pain Scale

22. Sedation Narrator
Scenario Three: Document EUS with Sedation, continued
Fentanyl 100mcg, Versed 2 mg, Phenergan 6.25 mg, Cetacaine Spray VS
Fentanyl 50 mcg, Versed 1 mg
Scope in
MRSS (Moline Roberts Sedation Scale)
Pain Scale
FNA passes x 5, site 1; FNA passes x 2, site 2
Scope Out
Disposition: Recovery