Ward Watcher

1. Ward Watcher A guide for beginners A reminder for the rest

2. Introduction • Entering the data into ward watcher(WW) is an unfortunate but necessary chore. • With a little forethought, the time needed can be minimised. • This short guide is intended to show people which parts of it they need to fill in, the common mistakes and omissions.

3. Introduction The data entered is used for many purposes including: • Monthly data to determine line infection and VAP rates • Annually the data used to calculate the mortality and other useful statistics. • All these bits of data are used by ourselves, the Trust and The Scottish Executive to inform decisions about ICU, at both a local and national level.

4. Passwords • Everyone should have an individual ID to login and password. If you don’t then please get in touch with Drs Cole, Macmillan or Mellor to arrange one.

5. What do I need to do? • The guide will nominally be split into a general section and sections for the Residents and Senior trainees. • There is useful information for you all in both sections.

6. General Residents Senior Trainees The links above will take you to where the most relevant information is for you. Feel free to read it all though (it doesn’t take long).

7. BAGGINS Bilbo POTTER Harry PYTHON Montgomery 0104720044 3006270032 1311380019 BYRNISON Iorek 1007370021 BEAKER Tracy 1609550032 BASIC SCREEN

8. Basic Screen • This is a graphical representation of our ICU. • To update the data for a particular patient a single left mouse click on the appropriate bed will bring up the admission screen for that patient. • If the bed is empty, an admission box will come up instead asking for basic demographic data • Fill this with the relevant data. (Please note that dates must be in the format 01/01/1900 etc)

9. BAGGINS Bilbo POTTER Harry PYTHON Montgomery 0104720044 3006270032 1311380019 BYRNISON Iorek 1007370021 BEAKER Tracy 1609550032

10. This data is automatically populated from the pop-up box which was filled in to initially admit the patient. BYRNISON Iorek 1007220016 10/07/1922 01/01/2010 87 1007220016 These boxes should be filled in by the person admitting the patient to the unit. This is usually the Senior Trainee or Consultant. Though there is nothing to stop anyone of us doing this. 01/01/2010 Svalbard By Dundee 87 yo admitted in MOF and ARF after laparotomy for a perforated diverticulum. Hartmann’s procedure and washout performed. Unstable requiring High FiO2 and Vasopressors in theatre. PMH: Little of note Good exercise tolerance Use these buttons to Navigate to other screens that you need to use to input or use data. Depending on the level of access you have some buttons may be greyed out and inaccessible.

11. BYRNISON Iorek 1007220016 10/07/1922 01/01/2010 87 1007220016 01/01/2010 Svalbard By Dundee 87 yo admitted in MOF and ARF after laparotomy for a perforated diverticulum. Hartmann’s procedure and washout performed. Unstable requiring High FiO2 and Vasopressors in theatre. PMH: Little of note Good exercise tolerance Several of the fields are populated from drop down lists. The vast majority of patients are covered by these options. If you come across someone that isn’t leave the field blank and let one of the consultants know.

12. This field is used to show which ICU Consultant is responsible for the patient. In the drop down list they are shown as follows, for convenience they are the names at the top of the list: BYRNISON Iorek 1007220016 10/07/1922 01/01/2010 87 1007220016 01/01/2010 Svalbard By Dundee 87 yo admitted in MOF and ARF after laparotomy for a perforated diverticulum. Hartmann’s procedure and washout performed. Unstable requiring High FiO2 and Vasopressors in theatre. PMH: Little of note Good exercise tolerance This field is used to show who the referring consultant is. Occasionally the patient may be appropriately referred by more than one interested consultant. If this is so, they should go under the consultant deemed most appropriate (often the one to whom they will be discharged back to once their ICU stay is over).

13. BYRNISON Iorek 1007220016 These fields are to explain where the patient has been admitted from. 10/07/1922 01/01/2010 87 1007220016 01/01/2010 Please select the correct GP from the list. If the GP doesn’t exist then please let us know and they can be added Svalbard By Dundee 87 yo admitted in MOF and ARF after laparotomy for a perforated diverticulum. Hartmann’s procedure and washout performed. Unstable requiring High FiO2 and Vasopressors in theatre. PMH: Little of note Good exercise tolerance If a location doesn’t appear to fit into any of these or there is no correct GP then leave it blank and please let someone know, it can then be sorted.

14. Therapy Screen • It is the job of the residents to keep this screen up to date. • It should be regarded as being as important as all other tasks. • There are 2 sections on this screen • INTERVENTIONS • DRUGS

15. Iorek BYRNISON 0000

16. Therapy screen The controls are common to both drugs and interventions • To view/ modify an intervention then click VIEW HIGHLIGHTED • To add an intervention then click NEW • To view only the active interventions then click CURRENT

17. Interventions This is used to record: • Mode of ventilation, airway devices etc • lines • Investigations • Feeding • Ideally this should be updated by the end of every shift. If it has not been possible then it must be handed on as a specified task when the next resident comes on shift. • All the interventions should be updated by the end of the following shift.

18. Airway Support Arterial Line Bronchoscopy Cardiopulmonary Resuscitation Central Venous Catheter Chest Drain Investigation Monitoring Nutrition Other Therapy Regional Analgesia Renal Support Respiratory Support Theatre after Admission Interventions The interventions are on a drop down list. There are several broad headings, with more specific items under each. The vast majority of interventions are in there. If you find that you want to put something in that doesn’t appear to be there, then let us know.

19. This is the screen that comes up when you modify or create an intervention. Iorek BYRNISON 0000

20. To add another intervention when this was is complete click NEW Iorek BYRNISON 0000 To view the next or previous items in the list of interventions then use NEXT or PREVIOUS DELETE will erase the current intervention you are viewing

21. Drop down box for interventions Iorek BYRNISON 0000

22. Drop down box for interventions Iorek BYRNISON 0000 Date started. If you click the ‘D’ of date it should put the current date in for you. Don’t worry about the time

23. Drop down box for interventions Iorek BYRNISON 0000 Date started. If you click the ‘D’ of date it should put the current date in for you. Don’t worry about the time The date ended must be filled in when the device or intervention is changed or stopped. It must also be filled in when the patient is discharged

24. Drugs This screen is used to record a significant proportion of the drugs used in ICU. The most important being the use of antibiotics. • These should be updated by the end of every shift. If it has not been possible then it must be handed on as a specified task when the next resident comes on shift. • All the interventions should be updated by the end of the following shift.

25. Drugs Iorek BYRNISON 0000 01/01/1900 This is the screen that comes up for entering drugs. The only fields that need to be filled are the Drug, Date started and Date finished.The controls are exactly the same as for the intervention screen.

26. Drugs The drugs are grouped under several sub headings: Acid/base Analgesics Antibiotics Anticoagulants Cerebral Protection GI Protection Glucose Control Haemostatics Inotropes Relaxants Renal Support Reversal Sedation Steroids Vasoactive Agents Not all drugs are here. If you find you want to put something in but can’t then please ask.

27. Residents • It is your job to keep the drugs and interventions up to date. • You should also be able to admit a new patient to the unit. At least so that there is a name, time of admission etc.

28. Senior Trainees • The senior trainee has a more extensive remit: • Ensure that the patients are admitted onto the computer and that all the details are correct. • Ensure the drugs and interventions are kept up to date • Ensure the HAI (Hospital Associated Infection) screen is kept up to date • Ensure that all the patients are appropriately discharged

29. Admissions • Fill in the admission and identity data screen. • Fill in the history screen - not all the data may be immediately available

30. These boxes should be filled in as completely as possible. Any items not known, please leave blank. BYRNISON Iorek 1007220016 10/07/1922 01/01/2010 87 1007220016 The GPs details are in a drop down box. If you cannot see the GP you need then please enter a new GP IF you have all the details of their name and address. IF you don’t , leave it for now and let Jeanette or the consultant doing the audit for the week know. 01/01/2010 Svalbard By Dundee 87 yo admitted in MOF and ARF after laparotomy for a perforated diverticulum. Hartmann’s procedure and washout performed. Unstable requiring High FiO2 and Vasopressors in theatre. PMH: Little of note Good exercise tolerance Use these buttons to Navigate to other screens that you need to use to input or use data. Depending on the level of access you have some buttons may be greyed out and inaccessible.

31. Iorek BYRNISON 0000 This should be filled in when the information is available. This may not be for a while after admission. There are strict definitions for heart disease, respiratory disease etc. if you don’t know them, then click on the help icon and it will guide you. In general if ward watcher thinks that you are doing something wrong or that has significant consequences then it will ask you to confirm what you are doing.

32. Hospital Associated Infection - Surveillance • This screen needs to be filled in daily for all patients. • Just after the microbiology ward round is the best time. • This will soon be mandatory data for the Scottish Executive. It needs to be correct, but above all be honest. • The way the data is at the moment, not all infections fit the criteria for inclusion. The definitions used are the basic HELICS criteria. • Click on this link to see the results of the pilot study/definitions. [HAI pilot study]

33. Iorek BYRNISON (0000) This section needs to be filled in on the first day. The questions are self explanatory. This section is filled in every day. Each day you need to click on the new day button to fill in the new data. This is the basic screen for HAI. All other parts for HAI are accessed through this. This is accessed through the individual patient records. Using the icons at the bottom of the screen, click the green bug to get this screen.

34. Iorek Byrnison (0000) This section needs to be filled in on the first day. The questions are self explanatory. Once the patient has been in for 48 hours, this section then needs to be filled in every day. Each day you need to click on the new day button to fill in the new data. This is the basic screen for HAI. All other parts for HAI are accessed through this. This is accessed through the individual patient records. Using the icons at the bottom of the screen, click the green bug to get this screen.

35. Iorek BYRNISON 0000 This section is filled in daily. If you answer YES to new infection diagnosed then the button new infection will become active. Click this and you are taken to another screen you will be taken to another screen. This will ask various questions and will effectively help decide whether this represents a true HAI under the various definitions. The infection should be noted for the day the specimen was taken, NOT the day you get the result. This may mean that you will have to go back and alter a previous day. Select the day in the list and click

36. You think that there is an infection? Once you have said that a patient might have an infection, this is the top of the screen that you will get to. The next thing is decide, and click against the appropriate type of infection: Blood Stream Infection CVC related infection Pneumonia Once you do this a set of questions will appear. Unfortunately the system does not yet record any other infections.

37. Depending upon what type of infection you will get a different set of questions. Answer them honestly rather than trying to get a positive just so that you can record a result. Pneumonia Central Venous Catheter (CVC) related infection Blood Stream Infection

38. Once you have answered the questions, click the check button. If the check doesn’t confirm an infection, then click cancel and alter the previous questions to No For a BSI or CVC related infection it will either confirm that it is an appropriate infection or not. For a pneumonia a different screen will appear IF it fits the criteria to ask about the specimens used

39. Pneumonia specimens collected We do not culture or report results in this way. So don’t tick these boxes. These are the most common in this ICU

40. If no infection is confirmed then click cancel Don’t alter this to fit unless the patient actually fits these criteria Then alter the New infection confirmed today box to NO. This doesn’t mean there is nothing, merely that it does not fit the criteria for an HAI

41. Once the computer agrees that this is an HAI, then you can fill in the details about the organism in the boxes in section 3. If it is a mixed growth / cause then up to 3 organisms can be entered. Then you can click OK to finish.

42. Discharges • Should be filled in before the patient leaves the unit, as the printed summary provides a formal discharge letter. • Once it is complete AND the patient has left the unit, then drag the ‘bed space’ down into the patients with missing unit information box.

43. Iorek BYRNISON (0000) This man was admitted requiring multiple organ support after a laparotomy for a perforated colonic diverticulum. He stabilised reasonably quickly but then required a prolonged period of ventilation for a pneumonia. He is now fit for discharge back to the care of the colo-rectal The Discharge Screen There are several aspects to this screen that must all be filled in

44. Iorek BYRNISON (0000) When the patient is ready for discharge When the patient actually leaves (not when you do the letter) What any delay is due to. Where the patient is going. Please record the destination as accurately as possible, changes from the original plan have been known This man was admitted requiring multiple organ support after a laparotomy for a perforated colonic diverticulum. He stabilised reasonably quickly but then required a prolonged period of ventilation for a pneumonia. He is now fit for discharge back to the care of the colo-rectal Discharge Times, Destination etc

45. What is felt to be the likely outcome. Iorek BYRNISON (0000) What the likely decision would be about readmission if the patient was referred again. The commonest answers are: 1. Would readmit 3. Uncertain Rarely 2. Would not readmit is chosen. This should put only after discussion with the ICU consultants This man was admitted requiring multiple organ support after a laparotomy for a perforated colonic diverticulum. He stabilised reasonably quickly but then required a prolonged period of ventilation for a pneumonia. He is now fit for discharge back to the care of the colo-rectal

46. Iorek BYRNISON (0000) This man was admitted requiring multiple organ support after a laparotomy for a perforated colonic diverticulum. He stabilised reasonably quickly but then required a prolonged period of ventilation for a pneumonia. He is now fit for discharge back to the care of the colo-rectal Questions that must be answered if the patient has died

48. If you find the small box on the screen too restrictive then click Expand comments for more space. Remember that WW has no spelling or grammar checker. You do need to read and check it properly before you send it. Discharge summary Please remember that although brevity is the soul of wit, that the ward and the GP both get a copy. This is often the first inclination that their patient has been so unwell and required intensive care that many GPs get. More than a single sentence might be appreciated. A little information about what was wrong goes a long way. Unfortunately, the space for a more complete letter is limited.

49. Final bits and pieces Please remember to fill in the replies for these questions as well. You should print 2 copies of the discharge summary, one is sent to the GP (sign it) and one is filed in the letters section at the front of the notes. Do NOT attempt to discharge the patient (see next slide) 15.00

50. BAGGINS Bilbo POTTER Harry PYTHON Montgomery 0104720044 3006270032 1311380019 BYRNISON Iorek 1007370021 BEAKER Tracy 1609550032 Discharging a Patient To discharge a patient LEFT click on the bed and drag it down into the bottom Left hand box.