The anesthesia module is a full featured anesthetic record for recording specifics of anesthetic medications delivered to a patient. As such, it is comprised of 3 component parts: 1) The anesthetic record 2) an anesthetic medication inventory system for maintaining records of scheduled anesthetic medications stored on premises and 3) a post anesthesia scoring system for evaluating a patient’s readiness for discharge.
Before using the Anesthesia module, it will be necessary to perform several setup functions first. In Setup > Modules, check the “Enable anesthesia module” check box (located in the Chart section) which will enable the Anesthesia button in the Chart toolbar. Next, create an Anesthesia Admin group in Setup > Security > Edit Groups, and assign a user to this group.
Assign anesthesia security rights to your users accordingly. Usually, a regular user should only have “Intake anesthetic medications into Inventory” checked, which will prevent this type of user from affecting inventory counts or altering an individual patient’s medication history, as a safeguard against theft and abuse of scheduled anesthetic medications. Anesthesia administrators should have both boxes checked, so that they can make adjustments to inventory as needs arise.
Managing anesthetic inventory
Before delivering anesthetics to patients, it will be necessary to setup your existing inventory of medications, so that proper inventory counts are maintained as the medications are delivered to patients. To begin adding medications to inventory, go to Setup > Anesthesia > Anesthetic Medication Inventory, which will launch the anesthetic medication inventory window:
Click “Add New” to add a new medication to inventory. Fill out the name of the medication and the unit dose it is dispensed in, how it is supplied, and its DEA schedule.
Click “Save and Close” when you are done. (NOTE: The medications entered into inventory will populate the anesthetic medication dropdown on the anesthetic record).
Once the list of anesthetic medications has been entered, click “Intake new meds” to add quantities of anesthetic medications into inventory. This will launch the anesthetic medication intake form.
The anesthetic medication dropdown on this form is populated with the medications you previously entered on the anesthetic medication inventory form. Enter the quantity and invoice number of the medications you want to intake into inventory. Click “Add new supplier” to add a new supplier. This will populate the supplier dropdown. Select the appropriate supplier for this order and click “Save and Close” to update the quantity in inventory. Repeat the process for all the items you want to intake into inventory.
Creating a new anesthetic record Now that the inventory has been entered, you may create a new anesthetic record for a patient. Click the Anesthesia button in the Chart toolbar.
This will launch the Anesthetic Record module. In the list box at the upper right, click “Add” to create a new anesthetic record for today’s date. Past anesthetic records will also be displayed here in the event you need to recall the specifics of a previous anesthetic for any reason.
An anesthetic record is typically filled out beginning in the upper center, and continuing down along the right hand side to the bottom in clockwise fashion.
Anesthetist, Surgeon, Assistant, Circulator
Populate these dropdowns with the appropriate provider for each category. These dropdowns are populated from the provider list that you have previously setup in Open Dental. You may place providers into one of two categories: Anesthetist/Surgeon or Assistant/Circulator, which will filter the names that appear in the corresponding drop down boxes. To do this, go to Setup > Providers from an anesthetic record, double click on a provider name in the resultant window, and select the appropriate category as shown.
The default is "None".
This number represents the American Society of Anesthesiologists designation of the relative health of the patient as it pertains to anesthesia. An E code modifier is present to the right of this dropdown in the event the anesthetic is done emergently.
Select oxygen and/or nitrous, the flow rate of each in L/min, and the delivery method.
IV administration route, IV catheter gauge, IV Site, side and # of attempts
Select one of the radio buttons for delivery of anesthetic medications, the type and gauge of the catheter, the IV site, the side of the body the IV was placed on, and the number of attempts to start the IV. If the route of administration is anything other than IV catheter or butterfly (eg., IM), leave the IV Site and IV fluid fields blank.
Select the desired type of IV fluid administered to the patient. If you are not administering fluid, leave this field blank.
Check all that apply. Choices are BP, SpO2 (oxygen saturation), EKG, EtCO2 (end-tidal CO2), Temp(erature) and Precordial stethoscope.
Enter the patient’s height in inches or cm, and select the inches or centimeters radio button.
Enter the patient’s weight in lbs or kg, and select the lbs or kg radio button.
Select a time that the patient last had food or drink by mouth.
Free-form notes regarding particulars of the anesthetic, such as type and quantity of local anesthetics, other medications delivered, or alternative medication delivery sites (eg., right deltoid muscle for an intramuscular injection) may be entered here. If you have a Topaz signature pad, you may save a signature which is tied to these notes. If the notes are changed, the Topaz signature will be cleared (NOTE: Currently, Topaz signature pads are not functional on 64 bit systems).
Enter the patient escort name, contact number (usually a cell phone #) and relationship to the patient.
Delivering anesthetics and recording medications delivered to a patient
Once all of the preliminary data has been entered, it is time to begin the anesthetic. Click the Anesthesia Open button to record the anesthesia start time. As the surgery progresses, Surgery Open Time, Surgery Close Time, and Anesthesia Close Time buttons will be clicked to record these times. The Anesthesia score button is clicked when the patient is ready to be discharged. Clicking this button will launch the anesthetic score window which will allow you to record the post anesthesia recovery score.
Anesthetic medications may be selected from the dropdown list. Use the dose calculator to the right of the table to enter the appropriate dosage. If you enter a dose less than one, the dose calculator will automatically prepend a "0" before the decimal point. (NOTE: Doses must always be entered in milliliters(ml) in order for inventory counts to calculate properly).
To waste unused portions of anesthetic medications, from say, an open ampule, double click on the medication in the Anesthetic Medications table. Enter the quantity to waste in the form that appears and click ‘OK’. Wasted quantities will show in the Anesthetic Medications table in the ‘Waste’ column. To delete a medication dose, double click the item you want to delete, then click ‘Delete’.
Quantities in inventory will automatically be adjusted accordingly.
Larger quantities, such as those from a dropped or broken vial, should be wasted from the Medication Inventory screen. The Medication Inventory may be reached by clicking on Setup > Anesthetic Medication Inventory near the top of the Anesthetic Record window, or from Setup > Anesthesia > Anesthetic Medication Inventory from the main Open Dental menu bar.
Vital signs may be automatically imported into the vital signs table if you have a network capable vital sign monitor capable of broadcasting HL-7 packet data. Additional software and outside vendor setup is required for this functionality. Alternatively, printed vital sign data (such as that from your vital sign monitor’s strip recorder) may be manually scanned into Open Dental. You can manually enter the model name and serial number of your vital sign monitor for medico-legal purposes. If you have a network capable monitor, and the functionality has been added to your system, vital sign monitor's model name and serial number will be entered automatically for you.
Once the Anesthesia Close button has been clicked, and the patient is ready for discharge, the Anesthesia Score button should be clicked. This will launch the Post Anesthesia Score form. Fill out the form as you evaluate the patient, and indicate the discharge disposition of the patient.
After clicking ‘OK’, the post anesthesia score will display as a number in red in the lower right hand corner of the main Anesthetic Record form. The anesthetic record for this patient is now complete, and may be saved. A completed anesthetic record is shown below:
Saving anesthetic records to the database
Adding a new anesthetic in the listbox towards the upper right hand side of the form will automatically save a blank anesthetic record in the database for the current date and time. To save the particulars of an anesthetic, click either the “Save” or “Save and Close” button. The “Save” button will not close the form, but the “Save and Close” button will. It is a good idea to use the “Save” button frequently during delivery of an anesthetic, so that anesthetic data (especially times) are properly recorded and saved to the database. If a patient has more than one anesthetic showing in the listbox, you may toggle between them by simply clicking on the one that you want to display.