Endoscopy Lab Intro to Sedation

NarratorGO-LIVE DATE: TUESDAY, DECEMBER 9, 2014

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”

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

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”

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

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

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

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.

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

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

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

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.

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.

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.

Sedation NarratorNew 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.

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

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”

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

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

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

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

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