P.H. User Manual - LogicaInformatica
Contents
1. Shouldn t the desired medication be included into the medications list it is possible add it through the relating function see 5 2 2 44 Analgesia page The analgesia page is aimed at specifying all the information that concerns the post surgical medications to be given to the inmate who has underwent surgery You can specify the medication time the protocols to be given and post surgical prescriptions that could be used if the inmate has side effects Normally this medical file is filled by the anaesthetist during the surgical or immediately after it The provided section of this page are the following e Medication period Treatment duration _ 6 hours _ 12 hours _ 24 hours _ 48 hours C 72 hours Time interval between post surgery IT measurements The medication period and the range of measurement it means how often the measurement is required by the nurses are information relating with how is specified in next page Assessment e Protocols Protocols You can indicate a maximum of one protocol per kind see next paragraph e Prescription relating post surgical period Post surgery prescriptions vont pony ame C__ LH Ca O In case of pruritus Note e comment D mm O Rescue dose 1 NRS gt 4 Note e comment MI C B Minimun interval _ ore C Rescue dose 2 TR ba Catheter removal date C Observe the routine administration of heparin Note ken iii In this section it2. 8 Orthopedics ORTH H Otorhinolaryngologist OTO 2 Thoracic surgery THOS x It allows adding a new wards Save It saves the data lt closes the file without saving the data eventually modified W It cancels the selected profiles in order to confirm the removal you need to save the data through the button save after having done the removal It is not possible to cancel a ward if it is associated to an inmate or to a user Users definition This paragraph allows the definition of the users and the association of both the qualification and the warde The page appears showing only the entered personal data as in the figure below 48 PH Painless Hospital LITE 1 0 User Guide Users x nn Save Surname Name Title User Id Code Physician Canc Rener Author ales Pass Oper Smith John f Dr super SJ E The page is divided in three different areas the first is the one already described i e the personal user area the second is the one that includes the information relating to the profiles associated to the user while the third one shows the wards associations Abilitazioni SA administrator anesthetist nurse reader supervisor Enabled departments Dentistry General surgery Neurosurgery Obstetrics Gynecology Ophthalmology Orthopedics Otorhinolaryngologist Thoracic surgery The personal user s area has to be filled with the surname name and the userid to be use
3. PH Painless Hospital to treat post surgery pain LITE Version 1 0 User guide first edition Consulenza scientifica Dott Maurizio Massetti logica iNformatica Li PH Painless Hospital LITE 1 0 User Guide INDEX 1 INTRODUGTIION iii anioni ata 4 bl SERIE aan 4 li MR aseswuae sop stances E EE E es 5 o PR 5 li ag E eg RE ba 6 lis ADDITIONAL INFORMATION csi 6 2 HOW TO BEGN aa a T E earn 7 2 Sai 7 29 me EN ag Zar CHEN E E e TION EE i A BAsCINSTRUCIONSTORE E la 9 di PO 9 KE 11 Lol Miei 11 det OS e S aa E E cases amuceuscuveavatad Cumsaatntnentareee 12 E RIG E E 13 2404 dla 13 2452 Lili conan EE eie E EE E EE E i 15 2 4 5 3 Fields containing a date and or time Le 15 2 4 5 4 Fields with a selection from the down drop liSt 16 240 ADDIO ae 17 e AE 18 2 5 PREPARATION OF BASIC DATA erranti rg 18 E Miane 18 204 WII 18 4 UR iii 18 3 APPLICATIONS FUNCTIONS 11 1rrssrrrrs cinese iii 19 LI COMPLETING THERAPY Lo 19 3 2 CONFIGURATION AND PERSONALIZATION OF THE SYSTEM 19 3 3 DEFINITION AND MANAGEMENT OF THE USERS ce eee ceci eee eee 19 IA OPERATION LOG alano 20 3 5 FUNCTIONS NOT INCLUDED IN LITE VERSION A 20 4 MAIN MEDICAL FILE E 21 echte 21 CZE OS We RE 21 EE FIV OCG seca sccateccsaaeeacecacemsces E E sere saa eas ee 22 ddla L k telecase ahd renewal ila 22 4 1 4 Informative warnings and error messages 23 bi EMA EDAT TA E a nner t
4. Description Progr intravenous elastomeric pump 12 hou 1 intravenous elastomeric pump 24 hou 2 x intravenous elastomeric pump 48 hou Ia I intravenous elastomeric pump 72 hou 4 Ti intravenous elastomeric pump 96 hou sl m intravenous elastomeric pump 120 ho T intravenous elastomeric pump P C A i intravenous elastomeric pump elctron Ti dial a flo 9 m epidural catheter I x perineural catheter Lo I no devices 12 m The functioning of this section follows the rules described in paragraph 5 2 3 UUU U U I 42 PH Painless Hospital LITE 1 0 User Guide 5 2 8 Surgery types The different kinds of surgical operation list can be customized through this section The data shown in this area are used in the inmate personal area Surgery types x Id Description ji Abdominal open for stress incision Abdomino Perineal Resection Abdomino Perioneal Exomphalos Ablation of Endometriotic Spot endos Ablation of Endometrium hysteroscor Abscess Drainage of Lid Accessory bone Excision l El El Acromion reconstruction Coe e Adeno Tonsillectomy Adenoidectomy JHUUUUUUUDLU GH Adenoma Parathyroid Excision The functioning of this section follows the rules described in paragraph 5 2 PH Painless Hospital LITE 1 0 User Guide 5 2 9 Administration types Kinds of medications can be customized through this function The data shown i
5. i no devices Admin straton type i ea Progr pive n pe l malpasia IM BD i Start dove Lei I L Biti Adjuvants Q del Lk Lal Gastroprotection gt RH RM Bit J Petrethece Crust F D e EE PLM Lite 1 0 4 acari If the device is used vertically or it is rotated in at any time vertically the main file expands until it fills all the screen while the left side containing the lists PH Painless Hospital LITE 1 0 User Guide disappears This function is replaced in the toolbar down on the left by the button List If you press it you obtain overlapped on the main screen the same list that could be seen on the left side horizontally Number 00000002 Bed nr 12 NEUR pa amp Soe inmate Wilson Poter Status Draft x Hi fi i Data successfully saved Inmate Anaesthesia O Analgesia Evaluation Page completed freeze it with Lock include closed Inmates White Paul Bed 34 Or Smith J Status Draft Wilson Peter Bed 12 O Maile n Female Dr Smith J Status Oratt Weight 67 Physician Or Semo A re Surgery Ampuan Upper Fore Arn Surgery end In this position if you want to make the list disappear you only need to touch the screen out of the same list 10 PH Painless Hospital LITE 1 0 User Guide 2 4 2 Information bar The already described button List is set on the toolbar that always appears down on the left side of the s
6. save Description Compose Paracetamol 4 die iv Ba Quantity Posology Route of admin paracetamol ig mg 4 die iv m Add drug The functioning of his section follows the rules described in paragraph 5 2 5 2 2 Drugs Through this function you can customize the drugs list The data of the area are used in the whole function to allow the user to choose the given drugs 36 PH Painless Hospital LITE 1 0 User Guide Drugs A p Save f Unit aceclofenac acemetacin acetilsalicylic acid TT acrivastatino 1i alcofenac TT alfentanyi TT almotriptan TT aloperidolo 1i alprazolam TT The functioning of this section follows the rules described in paragraph 5 2 Lem d j dd el 19 L amp n a ld dl li oe be do PH Painless Hospital LITE 1 0 User Guide 5 2 3 Time schedule Through this function you can customize the time The data shown in this area can be used to set the medication time in the fixed time protocol Time schedule Id Description HUGO The functioning of this section follows the rules described in paragraph 5 2 38 PH Painless Hospital LITE 1 0 User Guide 5 2 4 Hospitalization modes Through this function you can customize the hospitalization used in the inmates personal area Hospitalization modes Description Day surgery Delayed emergency Planned intervention emergency The functioning of this section f
7. 4 1 Next chapters are dedicated to Chapter 2 how to begin Instructions for the installation the start up and the first use Chapter 3 Application function Preliminary description of the several application features Chapter 4 The main medical file Detailed description of the medical file for the registration of the therapy Chapter 5 Configuration and customization Features description to reconfigure application in the manner that best meets own needs Chapter 6 Definition and administration of the users Description of the features to represent the own organization as users roles and wards Additional information If you need further information and for any other kind of communication please refer to the manufacturer s website Computer Logic Lid http www logicainformatica it PH Painless Hospital LITE 1 0 User Guide 2 How to begin 2 1 2 2 2 3 Install PH Lite is a standard application for Apple iPad distributed through the online store AppStore For this reason it can be used only on iPad In order to download and to install it on its own device we have to proceed in the standard mode obviously having a iPad The download can be done directly on the iPad using the appropriate application App Store or from the program iTunes for Windows or Mac The application is in the Medicine category but the quickest way to find it is by typing the name Painless Hospital in t
8. a large choice between protocols and fixed continuous or peridural perinervous time schedules and at last it makes possible to report the used continuous infusion device thus controlling its consumption Thanks to PH application it is possible to set the save dose for pain and the save dose for P O N V which have to be considered as real prescriptions During the post surgical operation period both the control and the pain registration are simplified by the movable device that containing all inmates information will be transferred in the ward and thus it will be used to measure the pain pain scales NRS VRS and so on Moreover it is possible to record side effects and during monitoring and statistic assessment compare them with the use of the different protocols The application is perfectly suited to the management of a comprehensive database of surgical inmates and the continuing review of adopted protocols PH allows the complete management of a surgical inmate from the operating room to the ward Through the application of PH it is possible to e Apply suitable protocols to the operated inmates such protocols can be chosen between those already present within the application or we can create some new and costumized protocols e Customize the post surgical analgesia with all drug choice of F A N S drugs opioid local anaesthetic adjuvants paracetamol and so on e Choose between fixed time protocols intra
9. before the surgical operation this page is divided in three areas that are kind of used anaesthesia device and kind of medication The anaesthesia area represented in the figure below allows specifying one or more kind of used anaesthesia The list is customizable through the administration functions see 5 2 6 Applied anaesthesia A _H a _AAAAHT gt ae _ spinal anesthesia _ sedation 1 plexus block _ spinal epidural anesthesia _ local anesthesia The Device area represented in the figure below allows specifying one or more kinds of used devices This list is customizable through the administration functions see 5 2 7 Device intravenous elastomeric pump 24 intravenous elastomeric pump 1 Des el 120 hours _ epidural catheter g avenue elastomeric pump 72 O intravenous elastomeric pump elctronic P C A a L no devices The kind of medication field represented in the figure below allows specifying the information concerning the kinds of medications Administration type Preemptive analgesia _ Intrathecal drugs 4 3 1 Fields explanation You can specify the kind of medication and for each of them it is possible to specify besides the information also the taken medications the quantity and the way to take medicine It is possible associating several medications to one kind of medication through the button L 25 PH Painless Hospital LITE 1 0 User Guide
10. field expects a large description The latter can be typed by the user or it can be generated by the application selecting the button A The generation must be done after having specified all the protocol information Once that all the protocol information have been entered he data must me saved by clicking the button Ko It is not possible to modify the data of an already used protocol in some inmate medical files 34 PH Painless Hospital LITE 1 0 User Guide 5 2 5 2 1 Other basic tables In this paragraph you can find the description of other basic tables of the application reachable from the second item of the administration functions list All the pages that manage the table share the same function to interact with the data In particular x Sie Add a new element Close the page D Cancel the selected element Ten Save Save all the carried operations After having done all the changes to the data that is to say insert new elements deletion or modification to really save the data you need to select the button Save It is not possible to cancel the elements that have been used once at least in one inmate medical file Time therapy Through this function you can customize the time therapy This section data are aimed at adding the list concerning the time therapies that are in the analgesia page 35 PH Painless Hospital LITE 1 0 User Guide Fixed Hours Protocollo standard m X lt
11. a Only after TT Lock page having confirmed the analgesia data with ea fs button it is possible to enter the data that concerns the pain assessment during periodic surveys The above button will be shown only after having been saved the data contained in the analgesia field 4 1 3 Lock release and renewal functions TS Lock page You can confirm the data in each page with rt in button CHANGES LOCK From this moment on the data can t be amended anymore but can be made amendable again by selecting the button change unlock 22 PH Painless Hospital LITE 1 0 User Guide dorso binlock paga available if the user is authorized in doing this operation see chapter 6 Moreover you can renew the protocol through the button protocol renew the III Protocol renewal latter is available only for authorize users after confirming the analgesia This operation blocks the data entering within the Analgesia and Assessment pages and it makes available two new pages Analgesia and Assessment whose aim is arrange a new therapy phase with a different protocol It is possible to go back by selecting the button delete replacement _ that you can find in the analgesia page of the new protocol This operation eliminates the new protocol e Gancel renewal KW To unlock the change you have to select the button UNLOCK that is in assessment fie
12. at enlarge the assessment scale to allow the persons who can t speak to indicate the felt pain directly touching the screen 29 PH Painless Hospital LITE 1 0 User Guide When you touch the enlarged image the program detect the point indicated by the inmate and consequently it assigns the pain level corresponding on the numeric scale The assessment registration is automatically followed by the USERID it means the nurse who has done the pain measurement After having saved the data the system automatically blocks the typing of the already entered pain measurement data and it is ready for a new pain measurement insertion The system allows the modification of the previously entered data but only concerning the last pain measurement to allow for immediate correction of mistakes during the data insertion 4 5 2 Explanation field The only compulsory value to specify in the felt pain all the other values are optional Anyway it is expected the space to record blood pressure heart rate blood oxygen saturation and diuresis value moreover there are the checkbox to indicate any side effects If during or after the pain measurement medications are given the latter must be indicated in the measurement itself 30 PH Painless Hospital LITE 1 0 User Guide 5 Configuration and customization In order to make the created system very flexible and customizable according to your hospital reality it has been planned and managed the cust
13. cel the data without a trace The operations log Or paper is maintained both at a global level and individual inmate medical record Please se paragraph 4 1 and 7 1 for further details Functions not included in LITE version As regards to Full and Enterprise versions Lite version fails some functions summarized in the table below LITE FULL ENTERPRISE version version version Compilation of the inmate medical record Administration functions Configuration functions Printing functions Export functions Sending data Synchronization of database with server synchronization between multiple iPdad Data acquisition from a central database Customization functions of the graphic format 20 PH Painless Hospital LITE 1 0 User Guide 4 Main medical file 41 Generalities It is possible to access this function from several application points particularly you can reach this area after having logged in the application e By selecting an inmate from the list e By selecting an inmate from a list of inmates recently shown e By using the function new inmate e The selection surfing of medical files The medical files will be already filled or not depending on the selection previously made The registration of the entered data is done through the buttons that are on the toolbar on the top within the medical files The medical record is divided into many areas concerning different competences according to th
14. creen if it is used horizontally it is set down on the right side of the screen 2 PLH Lite 1 0 logicainfonmatica Dr John Smith s The bar besides the button List contain e Thenameandthe version number of the application OSD Lite 1 0 e The button Info to display the user guide this same guide e The user name which is indicated as user to define until we proceed to the described operation in paragraph 2 5 e The button to logout 2 4 3 Working with lists Lists that have been earlier mentioned are used with the usual mode for the iPad the scrolling is simply made dragging with your finger while the selection of an element is made with a simple touch on the respective line In some cases see figure the list provides for an alphabetic index on the right side touching which a quick setting can be obtained on the space of the list corresponding to the selected letter aceclofenac acemetacin acetilsalicylic acid acrivastatine alcofenac alfentanyl almotriptan N e Dv CH PH Painless Hospital LITE 1 0 User Guide 2 4 4 Using popover windows In many cases the application shows a window which is overlapped to the main window as in the above described lists These windows can be closed in three ways 1 using the button close x as in the following Description aceclofenac acemetacin acetilsalicylic acid acrivastatine alcof
15. d to login the function Selecting the item Doctor means that this user is a doctor so he will be in the doctors list in the inmate medical files see 4 2 x lt closes the file without saving the data eventually modified It allows creating a new user a It saves the data D It cancels the selected profile It resets the user s password only the user can change it during next login It makes visible or not the area that includes the profiles connected to the user In makes visible or not the area that includes the units wards connected to the users 49 PH Painless Hospital LITE 1 0 User Guide To confirm the changes you need to select the button Ko before exiting the page For each user you can connect one or more profiles and one or more wards A user who has more than one profile will be enabled for each function to the highest level of qualification of the profiles assigned to him The units assignment allows the user to see the inmates according to their ward Once you have done all the changes relating the qualifications they will be available to the users during next login 6 1 4 Password change E If you want to change the password you need to reset it J then you need to save the data by using the buttons below During next login it will be allowed to the user to specify the new password 50 PH Painless Hospital LITE 1 0 7 Other functions 71 Log view User Guide Many of th
16. e hospital organization Particularly you can find the inmate personal data that can be filled by the nurses or doctors both anaesthesia fields and analgesia falling within doctors competence and finally the post surgical measurement field falling within nurses competence There is an input order regarding the information that implies personal data followed by anaesthetic and analgesic data Only after having completed and settled these information it will be possible enter the post surgical evaluation 4 1 1 Toolbar and buttons use There are two toolbars one on the top see the figure below used for managing the inmate medical file and one on the bottom already described in paragraph 2 4 2 Number 00000002 Bed nr 34 DENT X Om Save Inmate White Paul Status Active the toolbar contains besides identification data of the inmate file the following buttons This button switches to the previous inmate medical file We recommend to use this function with landscape mode so that you can see at the same time the inmates list and the selected medical file This button switches to the next medical file We recommend to use this function with landscape mode so that you can see at the same time the inmates list and the selected medical file 21 PH Painless Hospital LITE 1 0 User Guide x This button closes the current medical file After switching off you can access to another medical file or from the list recent na T
17. e operations carried out by the users are recorded in an appropriate log The recorded information is available both individually and globally globale The logs of each medical record are visible by selecting the function na on the top toolbar Ihe logs of the whole function are available in the administration functions under the item History Here below you can find an example of a log page History of this file Date Time 2011 05 24 12 26 12 22 10 56 10 56 10 56 10 56 10 56 10 56 10 55 10 55 10 55 10 55 10 55 10 24 10 24 10 24 User Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John Smith John 51 Action Page 3 blocked in inmate file 2 Page 1 blocked in inmate file 2 Inmate data changed White Paul Inmate White Paul quantities changed in the administration type Inmate White Paul post surgical prescriptions changed Inmate White Paul standard protocol applied F Inmate White Paul post surgical drug prescriptions changed The inmate file 2 status changed to Active Inmate data changed White Paul Inmate White Paul data changed in area Anestesia Inmate White Paul data changed in area Dispositivi Inmate White Paul drug administration data changed The inmate file 2 status changed to to be completed Entering new inmate file Pa
18. enac alfentanyl almotriptan alprazolam amethocaine aminofenazon amitriptyline articaine ascorbic acid 2 selecting one of the elements for which the windows has been created as in the figure PH Painless Hospital LITE 1 0 User Guide aceclofenac acemetacin acetilsalicylic acid acrivastatine alcofenac alfentanyl almotriptan 3 touching the screen at a point outside the same popover 2 4 5 Data entry In the main file of the application chapter 4 and in different other main files there are fields for data entry and or value selection fields Their mode use is described in the following paragraphs 2 4 5 1 Text field The insertion of the text or numbers in the form s fields is made trough the keyboard that appears when you touch the screen within the desired field PH Painless Hospital LITE 1 0 User Guide Carrier 11 49 AM Number 00000002 Bed nr 12 NEUR x mm inmate Wilson Peter Status Draft Inmate Anaesthesia O Analgesia O Evaluation 9 O Page yet to be filled Applied anaesthesia _ general anesthesia 1 blended anesthesia _ field block anesthesia L 1 spinal anesthesia _ sedation L 1 plexus block _ epidural anesthesia _ analgo sedation L 1 spinal epidural anesthesia _ local anesthesia Device intravenous elastomeric pump 12 intravenous elastomeric pump 96 hours hours I dial a flo intravenous elastomeric
19. he search field If you operate directly through the iPad the installation is automatic after the download if you use iTunes you need to connect the iPad to the computer with the USB cable and proceed with the function Synchronize of iTunes Uninstall If you want to uninstall PH you only need to cancel it from the iPad with the usual method you have to enter in the edit mod click for 2 seconds the icon and then you touch the red dot with the x that appears on the corner NOTA BENE With the uninstall function the data which have been created with the application are also cancelled from the iPad i e inmates and their therapy medical files Startup and initialization Immediately after the installation the first time that you startup PH Lite asks the user to create a userid username and a password which will be from that moment on the userid and the password asked to the main user This is the panel that appears during the first start PH Painless Hospital LITE 1 0 User Guide Specifies the main user name and password Note that the userid is case insensitive it means that it can be written either with small or capital letters the password instead is case sensitive it means that takes into account the difference between uppercase and lowercase letters and it shall be at least 3 of characters So the main user will be considered as the administrator see paragraph 6 1 1 a permanent feat
20. his button show the amendments history carried in the inmate file D This button cancel the inmate file confirmation is asked before cancelling the file It allows to enter a new inmate file The icons that are on the toolbar are visible or less according to the certifications associated to the connected user 4 1 2 Medical file pages To be more accessible and organized the inmate medical file has been divided into 4 pages tab and precisely Item Anaesthesia Analgesia and Assessment If necessary you can use also the protocol renewal that is to say the change of the protocol in progress by opening a new one to follow from then on in this case you generate more pages of Analgesia and Assessment Each tab includes in its header a text to indicate the data contained in the tab and in one icon to indicate the status of the contained data The relevant icons are Page not yet editable because the previous pages have to be consolidated O no entered data The entered data are not completed but however you can go on The entered data are not corrected or you miss basic information iad The entered data are correct and they have been confirmed by the user The compilation of a new medical file must follow an accurate way regarding the data entered in the pages first you need to enter personal data after the data concerning the anaesthesia and finally those concerning the analgesi
21. ing The possible levels are e Read only the user can t modify any data e Reading Writing the user can modify the data without cancel them e Reading Writing Editing The user has the whole data control It is not possible to cancel a profile already used by any users you can only modify it There is always a profile administrator that has the whole control of the application it isn t shown because it cant be modified it is the profile automatically assigned to the main user during the installation time The profiles definition is managed through the following buttons x Close the file without saving the data eventually saved Allows a new profile creation Legend It saves the data _ It cancels the selected profile in order to confirm the removal you need to save the data through the button save after having done the removal 47 PH Painless Hospital LITE 1 0 User Guide 6 1 2 Departments The wards management is allowed only to the enabled users The wards are used both in the inmate personal area see 4 2 and in the users qualification see 6 1 3 Here below you can find the page that allows the wards management Departments x save Id Description Code 6 Dentistry DENT 1 General surgery GENS 4 Obstetrics Gynecology 3 Neurosurgery m Cc D O LI G lt 5 Ophthalmology OPHT
22. is specified which medication should be used in case of side effects or as save dose if the therapy is not enough 26 PH Painless Hospital LITE 1 0 User Guide Many information of this page are pre filled lists that can be customized through appropriate administration functions Particularly it is possible to modify the list concerning the medication time span list see 5 2 1 protocols see 5 1 drugs see 5 2 2 the medication mode see 5 2 11 and the codes of intervertebral spaces One you have filled all the information and you have saved you have to block the e RK changes of the data by clicking the button Changes Block This operation allows the filling of the post surgical assessment page see 0 Lock page 4 4 1 Indication of treatments protocols Protocols have been divided into three different typologies and both standard and non standard protocols Standard protocols are those defined by the system administrator through an appropriate function see 5 1 while the non standard protocols are those that are customized by the anaesthetist during the analgesia page compilation The customization is possible by selecting the button You can specify only one protocol per typology and you can specify at the same time several kinds of protocols The following protocols are provided e fixed time protocol paracetamol 2 mg 3 die Orario Os Os Ow Ow Ou Qie Cis Sro Ez F In the time field you need
23. ld at this point you can also unlock the analgesia data editing 4 1 4 Informative warnings and error messages Some controls are foreseen of different importance relating the data entered by the user Any anomalies found during the data backup are available in an appropriate window that is under the toolbar on the top of the screen All the warnings contain both an icon to indicate the level of importance and the text of the warning itself The expected levels of Importance are the following dd Information A Warning it means an something incomplete or a not important input error A Error missing or incorrect data 23 PH Painless Hospital LITE 1 0 User Guide 4 2 4 2 1 re New inmate data Bed 34 Date 24 5 2011 PS Surname White Name Paul Inmate code ww Sex Male Female Age ai Weight 104 Department DENT Dentistry Physician Dr Smit Pe Hospitalization C OOOO surgery a Surgery start C a S Surgery end iu S Inmate data page The firs page of the medical file contains all the inmate personal data and it is important to go on with the compilation of the other pages that make up the medical file The data contained in this page help with the identification of the inmate also in an anonymous way if necessary specifying the data concerning the surgical operation made and finally associating the inmate to a ward The latter information is very useful in order that the health worker
24. n in the case above you can use the alphabetic index on the right and the function search 2 4 6 Application exit To exit the application you can do it using two modes e clicking the stop button of the iPad the round one on the screen edge e touching the icon of exit down on the left side of the information bar see 2 4 2 It is to be noted that in the first case if the iPad operating system is 4 2 version or next version available from December 2010 on the application will be not completed but put waiting in background shown in the background area opened by a quick double click on the interruption button PH Painless Hospital LITE 1 0 User Guide 2 4 7 2 5 2 5 1 2 5 2 2 5 3 Timeout For security reasons if you leave the application opened for more than 5 minutes without doing any operation it means without touching the screen the system automatically logs out from the PH Lite In this way you can avoid that an unattended device is used by someone who hasn t the required qualifications Preparation of basic data During the first start up the system already includes basic data to work but it is useful that the owner user administrator pays attention to some important information for a correct use and place them in the best way before starting the effective work Main user data The first operation to be done after the login is defining the name and surname of the main user just to a
25. n this area feed the kinds of medication list in the anaesthesia area of the main file Administration types x Kos Id Description Adjuvants Gastroprotection Intrathecal drugs Other drugs Sh Sh eh Preanesthesia Preemptive analgesia Start dose PARA AR The functioning of this section follows the rules described in paragraph 5 2 PH Painless Hospital LITE 1 0 User Guide 5 2 10 Units of measurement Units of measurement can be customized through this function The data shown in this area are use to manage the medications see 5 2 2 Measurement unit x Save Id Description 23 meg dd 1 mg A The functioning of this section follows the rules described in paragraph 5 2 5 2 11 Vie di somministrazione Medications methods can be customized through this function The data shown in this area are aimed at feeding the medications methods list to associate to the any single drug Routes of administration x Save Id Description 4 im II L A w l UI a oral 3 a i H te UE The functioning of this section follows the rules described in paragraph 5 2 45 PH Painless Hospital LITE 1 0 User Guide 6 Definition and management of the users This paragraph describes the management of the applications accesses and the relating authorization s level The function is different according to its use in the several profiles associated to the connected user so acc
26. n this category are included drugs infusion devices kind of anaesthesia kind of medications and so on see 5 2 Particularly you can create and customize de predefined protocols divided into fixed time protocols intravenous protocols and peridural perinervous protocols Each protocol can be identified both by an acronym and a denomination and it consists of a list of one or more drugs with additional optional indications number of medications per day quantity concentration Regarding the medical file compilation the doctor can use a standard protocol completing or amending it or he can create a new one Definition and management of the users PH Lite Is designed to be used on a shared device between several users for this reasons the administrator can define the users with several usage profiles including those specific for doctors nurses and possible supervisors Each user is identified by a userid and a password and he can be limited to work on a limited group of data and functions for example typically a nurse can handle only a part of the evaluation of the therapy file for all the inmates who belongs to the ward falling within his own competence PH Painless Hospital LITE 1 0 User Guide 3 4 3 5 All the details that concerns the users definition are described in chapter 6 Operation Log PH Lite tracks all carried operations indicating the time and the person user so that nobody can modify or can
27. n tree nner ert en ere 24 Zi Picci 24 40 SANE cia 29 GE PIO cacare Zi 4A ANALGESIA PAGE EE 26 4 4 1 Indication of treatments PLOtOCOIS i 27 A ASSESSMENT PAGE sorio 29 4 5 1 Insertorchangea pain measurement iii 29 re E aes ses ceursaaevuas ove pase anv E N angn aod Gees Es 30 9 CONFIGURATION AND CUSTOMIZATION 11 s1rrsrrrrreiire eee 31 PH Painless Hospital LITE 1 0 User Guide Sl WHER APE U ING PRO VOC ON Sari 32 a OMRE Eege 35 RI IVE T acciai 35 T Dialer 36 Ri Md 38 gt Hd iis 39 IDS YS EE 40 Jel Aae I A ara 41 o DI 42 0 DIDO ian 43 5 2 9 Administration Tune 44 5 2 10 Units of measurement iii 45 5 2 11 VICAI SOMINIMISITOZIONE enee ee EE eech eege 45 6 DEFINITION AND MANAGEMENT OF THE USERS c ccceccesseecensescensesenneesenseees 46 6 1 1 Usage profiles and enabling function 46 DI 48 0 OLN ARES O ee CO rere Omen fet er mene Tent Serr Sear rn er tte On tert tr tenner 48 di 10 50 T B lelz27 alieagtely LEE 51 il Vlad 51 PH Painless Hospital LITE 1 0 User Guide 1 Introduction 1 1 What is PH Painless Hospital PH is an Apple iPad s application designed both to streamline and simplify the management of post surgical operation pain within surgical wards In addition to meeting the requirement for registration folder law n 388 03 2010 PH makes it possible both the creation and the use of analgesic customized protocols and the offer of
28. ng the function from the list you can enter in the appropriate management area in which besides visualizing the protocols list previously entered you can add some others You have to access in the edit page of a definite protocol through the protocol selection from the list You can enter a new protocol by selecting the button 32 PH Painless Hospital LITE 1 0 User Guide Protocols management Fixed Hours FI y Paracetamol 4 die LV F2 5 Paracetamol 3 die v F3 5 Tramadol 4 die i v F4 5 Tramadol 3 die v F5 gt Ketorolac 3 die i v The page relating the protocol management is shown as the following one 33 PH Painless Hospital LITE 1 0 User Guide Fixed Hours Protocollo standard Description F1 Paracetamol 4 die i v List Drug Quantity Posology Route of admin paracetamol i mg 4 die iv Wel Add drug The layout differs according to the selected protocol particularly according the figure above Both in endovenous and peridural protocols there isn t the dosage moreover in the peridural one it is shown the strength It is compulsory to specify all the fields except the quantity that shall to be specified during the application protocol It can be specified one or more medications and for each one you need to indicate the asked information The sign field expects the insert of a customizable code aimed at the prompt identification of the protocol while the description
29. ns are based on the compilation of the pain therapy files in order to manage and monitor the analgesic post surgical therapies in a surgery ward To this activity first participate anesthetises responsible for inmates and secondly nurses who take care of the inmates during the post surgical phase The doctor arranges the therapy file starting from the operating room entrance indicating the type and method of anaesthesia and in order to complete it with the prescriptions relating to analgesia in the post surgery period Once in the ward the inmate is cared by the nurses who provide to the periodical survey at prearranged intervals recording the level of pain perception according to the numerical scale report or view the possible side effects and the occurred medications of analgesic drugs The medical file compilation and the medical record handling is monitored by the flexible system of qualifications foreseen by PH Lite that prevents not authorized changes and it tracks all the carried operations For all the details that concerns the medical files compilation modes you have to see chapter 4 Configuration and personalization of the system The composition of the file therapy is largely customizable to be adapted to a specific organization s needs and to the protocols drugs and technologies evolution over time Indeed all the directories contributing to the compilation are defined in amendable tables by the authorized user I
30. ollows the rules described in paragraph 5 2 PH Painless Hospital LITE 1 0 User Guide 5 2 5 Vertebral spaces Through this function you can customize the intervertebral spaces list The data shown in this area are aimed at adding the intervertebral spaces list to be specified in peridural protocols Vertebral spaces Id Description Cate il Lu a m Lg Gu tl mit Caer TI Cd Gen TT C Dm TT Cd TT O st TT Cd Ge 4 TT 3 Ger TTI The functioning of this section follows the rules described in paragraph 5 2 PH Painless Hospital LITE 1 0 User Guide 5 2 6 Anaesthesia types Different kinds of anaesthesia can be customized through this function The data Shown in this section can be used in the anaesthesia page to represent the used types of anaesthesia Anaesthesia types x save Id Description analgo sedation i blended anesthesia epidural anesthesia field block anesthesia Op general anesthesia local anesthesia plexus block sedation i l El spinal anesthesia spinal epidural anesthesia JUUHUOU UU The functioning of this section follows the rules described in paragraph 5 2 41 PH Painless Hospital LITE 1 0 User Guide 5 2 7 Device types Kinds of device normally used can be customized through this function The data shown in this area are available in the anaesthesia page of the inmate medical file Device types A Save
31. omization of many information dynamically used by the function You can access to these functions from the toolbar down on the bottom of the screen through selecting the button t Lis assi on the navigation bar on the bottom Remember that the administration functions can be seen only by enabled users see chapter 6 you can see it if you use portrait mode Once in the list use the button Administration functions are organized as in the figure below Users management gt Reference Tables gt Protocols gt History gt The first function Users Management is described in chapter 6 the second one is explained in 5 2 the protocols are described in the next paragraph The function History allows visualizing the activities register Note that the modified data in these sections are directly visible and available within the function and particularly within the medical file without restarting the function if they are modified while a file is opened you need to exit and the re access to the file to see them 31 PH Painless Hospital LITE 1 0 User Guide 5 1 Therapeutic protocols In this section the third among the administration function you can define and modify the three different kinds of expected protocols so you need to select in advance the kind of protocol that you want to update Admin Protocols management Fixed Hours gt intravenous gt Peridural perinervous gt Selecti
32. ording to the profiles you can access or not to certain pages and you can carry out or not certain operations and so on 6 1 1 Usage profiles and enabling functions The profile list appears as in the following figure Profiles gt A Save Profile Canc Author supervisor anesthetist nurse reader MA Pa a nu La i a ER e d E A H Through selecting the button profile you can see in detail the data of the selected A profile defines the enabling profiles to each individual function All the profiles allow seeing the same function the only change is the associated enabling level Each profile is connected to the represented function in the figure below Abilitazione profilo Configuration Reaaiwite Delcte__ H Inmate files Reagvinte Deiete D management New inmate file _ System administration ee SS C User authorizations management synchronization Ep Table Inmate personal data Read Write Delete management Filing anesthesia esggs e D Filing analgesia page poste D Filling post S surgery Read Write Delete wa Unlock pages _ measurements Protocol n management n 46 PH Painless Hospital LITE 1 0 User Guide There are two different kinds of qualifications connected to each individual function the first one has only two possible modes enabled check box on or not enabled check box off the second one has different level of enabl
33. ow the use of the same device by several persons each one with its own authorization level and also allow the adjustment of the application to different organizational realities PH versions Painless Hospital exists in three versions Lite the version relating to this manual allows to work with stand alone modality that is that each iPad manages its own data individually un integrated with the server and with other iPads Full adds to the Lite version the functions able to synchronize the data with a server component which allows the aggregation of those data on a traditional computer on which we can for example perform statistical processing and transferring to other databases It also adds features for printing and sending data directly from the iPad Enterprise contains full functions of integration which allows the sharing of information between a central server and any number of PH copies in this way we can control at a central level all the parameters for system customization i e the standard protocols see chapter 5 sharing the inmates database control the authorization and the users roles PH Painless Hospital LITE 1 0 User Guide 1 4 1 5 Structure of this manual This manual describes the functions and the usage modalities of Painless Hospital Lite version 1 0 after abbreviated as PH Lite Note that this manual is also included in the application called up by pressing the info button see 2
34. pump 24 intravenous elastomeric pump Pies amp 150 hours _ epidural catheter intravenous elastomeric pump 48 intravenous elastomeric pump hours P C A intravenous elastomeric pump 72 intravenous elastomeric pump hours elctronic P C A _ perineural catheter L 1 no devices Administration type _ Preanesthesia Preemptive analgesia _ Start dose _ Adjuvants _ Gastroprotection _ Intrathecal drugs To make the keyboard disappear you can use the button placed down on the left side of the same keyboard 14 PH Painless Hospital LITE 1 0 User Guide 2 4 5 2 Fields containing a date If we have to enter a date in a field i e the date of the therapy file we can manually enter it as a normal text field with a free form i e dd mm yy Near the field appears however a calendar icon to facilitate date insertion as the one showed below Inmate Anaesthesia Analgesia Evaluation Mancano alcuni dati opzionali possibile proseguire comunque Lock page 3 New inmate data Bed 34 Date a Surname white sd Name Inmate code ou Sex Age 81 Weig Department DENT Dentistry Wd Physic Hospitalization D Surge mode Surgery start 1228 PS Surge 2 4 5 3 Fields containing a date and or time If in a field you have to enter a time with or without a date i e the date and the time measurement of the assessment page of pain you will p
35. roceed as with the fields containing a date it means that you can use the rotating selector that appears if you touch the small icon clock near the relevant field Lock page New inmate data 24 5 2011 m TTT Surname Paul Inmate code Male _ Female Department Dr Smith J Hospitalization Hospi oe Surgery start 12 23 bei Surgery end PH Painless Hospital LITE 1 0 User Guide 2 4 5 4 Fields with a selection from the down drop list The down drop lists are generated touching the fields providing this kind of selection They can be simple lists as those in the figure below DENT Dentistry GENS General surgery NEUR Neurosurgery OBGY Obstetrics Gynecology OPHT Ophthalmology ORTH Orthopedics OTO Otorhinolaryngologist THOS Thoracic surgery in which you can only select a value including the empty one on the first line or you can delete the window touching an external point or they can be more complex as the one in the following figure PH Painless Hospital LITE 1 0 User Guide Selected surgery Abdominal open for stress incision Abdomino Perineal Resection Abdomino Perioneal Exomphalos Ablation of Endometriotic Spot endoscopic Ablation of Endometrium hysteroscopic Abscess Drainage of Lid Accessory bone Excision Acromion reconstruction Adeno Tonsillectomy In which you can do further operations besides the simple selectio
36. s within the several wards know the inmates of their own area Field explanation In order to perform the data backup you have to specify the fields surname name ward and doctor The remaining fields are optional Regarding the anonymity you can indicate instead of the name and surname some codes or anonymous letters In this case a good information could be at least to insert the inmate bed number The entered data can be confirmed by selecting the button Changes unlock that makes the data of the page not amendable Of course you can make the data amendable again by clicking the button unlock changes The figure below shows the already described page layout In this page there are the pre filled lists that can be customized by certain functions Particularly it is possible to amend the wards list see 6 1 3 the doctor list see 6 1 2 hospitalization list see 5 2 4 and the surgical operations list see 5 2 8 There three date fields date both starting and end of surgical operations that represent respectively the date of the medical ward compilation that usually coincides with the surgical operation date the starting date and time of the surgical operation and the end date of the surgical operation 24 PH Painless Hospital LITE 1 0 User Guide 4 3 Anaesthesia page This page allows specifying the information that concerns the kind of used anaesthesia with the relating medication It is usually filled
37. strength 28 PH Painless Hospital LITE 1 0 User Guide 4 5 Assessment page The assessment page is aimed at monitoring the post surgical phase of inmates recording the variation of the felt pain any side effects and the required medications Normally this paged is filled by nurses who are in charge of post surgical pain measurement To have an idea of the page you can see the figure below Post surgical measurements 4 5 1 ain Postsurgical valu ation ing drowsiness agitation unplanned measurement 4 bk rescue dose nausea C itchin CBO CB Measurement done by Dr John Smith In this page there are pre filled lists that can be customized through appropriate functions Particularly you can customize the drugs list see 5 2 2 and the medications modes see 5 2 11 Insert or change a pain measurement The pain measurement insert provides that it is specified the pain level felt by the inmate all the other values that are in the page are optional The coloured area includes the pain valuation scales e Visual VAS Visual Analogue Scale e Verbal VRS Verbal Rating Scale e Numeric NRS Numeric Rating Scale The coloured checkbox corresponds to the 10 values of the numeric scale if you touch them it appears the tick The inmate can specify if he prefers the K H visual or verbal valuation It is expected also a zoom function th
38. to select the boxes relating the medication time schedule you have to select many boxes as the medications are indicated in the dosage e Intravenous travel ct E1 Tramadol Ketorolac 24 h i v ketorolac 2 mg tramadol 3 mg e Peridural Perinervous aA n LL bupivacaine 2 mg 2 Vertebral space 710 111 depth cm 2 In this case besides the drug quantity and the drug strength you have to specify the position and the depth of the insertion 27 PH Painless Hospital LITE 1 0 User Guide When you select a standard protocol it is shown the figure below that allows seeing and modifying the details of the data concerning the protocol itself By doing so the doctor can use both a completely specified standard protocol without changes or he can complete it specifying the changeable data as the quantity the strength and the medication mode Custom protocol E Peridural Perinervous Quantity Concentr If you want to create a customize protocol you have also the possibility to create and combine any number of medications among that of the reference table described in 5 2 2 Note that the information regarding the medications used in the protocol are different depending on the protocol type Particularly for those medications concerning fixed time protocols you need to specify also the dosage number of medication per day and for those medication of peridural perinervous you need to specify the
39. ul White Inmate White Paul post surgical prescriptions added New inmate file created with n 2
40. ure He can define and enable other users To each new user for the first access will be asked to create its own password For next accesses the login panel looks like that PH Painless Hospital LITE 1 0 User Guide Cancel Confirm 24 Basic instructions for use 2 4 1 Screen structure PH Lite application can be used with the iPad both horizontally landscape mode and vertically portrait mode In the first case the screen appears divided into two sides on the left side there are two lists which allow the navigation the inmate medical records configuration function etc on the right side the main part of the screen is assigned to the therapy file see chapter 4 Intiute closed Depts inmates aon White Paul e w ale Bed 34 States Actes ra orzo sti Inmate Anaesthesia Analgesia Evaluation 8 Page competed feere E with Lock Bed 12 gt Status Orat Applied anaesthesia general mastnesia fisted Glock anasihesia tpirai amgrsiisa _ Plexus back 1 epettural mesthesis ul spinai epidura anesthesia Livwhte E intravenoui ciastormerie pump Woravencul castomerc pump Bry or di A Zo iravennaus Mathovenic pumo Paves castomenc pump LG a epdural catheter 2 hourt 170 Tee 7 V rgegmgu gaimmeng pump lt astomert pump OR hovi PCA _ petineuret catheter rtrevencus Sastomernc pump intravenous Gastomeric pump j 72 hours Umh RBC A
41. venous protocols peridural perinervous protocols e Choose the device for continuous infusion e Set the save dose in case of pain e Set the save dose for side effects nausea vomit itching e Monitoring the pain through N R S scale numeric rating scale which offers a range from 0 no pain to 10 strong pain e Record side effects as nausea vomit itching hypertension and so on e Maintain a complete database on pain management for all surgical inmates PH Painless Hospital LITE 1 0 User Guide 1 2 1 3 Who is it for The application users are persons involved for different reasons in the post surgical pain therapy in any hospital wards For each inmate it is provided a completed file including 1 Information on the characteristics of the anaesthesia given in the operating room prescriptions for post surgical analgesia periodical survey of pain perception and the presence of other undesired symptoms for the whole post surgical period The first two actions fall behind the responsibility of the anesthetist while the last action i e the survey falls behind the responsibility of the nurses The application provides moreover useful data to control and monitor the therapeutic protocols which implies those subjects who have this kind of responsibility The many professionals involved can be managed by PH application through the definition both of users and usage profiles see chapter 6 which all
42. void that it is indicated wherever in PH with the name user to define In order to do that you have to open a list select the button run down on the right side and then the item users for further details see paragraph 6 1 2 The main user can t be cancelled and he automatically has the access to all the application s functions Wards Organization As it will be explained in next chapters both the inmates and the users can be associated to the several hospital wards Particularly each user can be explicitly enabled or disabled for the treatment of inmate medical records belonging to one or more wards During the installation there is a template of standard wards Before entering the first inmate medical record the administrator main user should control if the list is appropriate and accordingly correct it The detailed procedure is described in paragraph 6 1 2 Other important data PH Lite is prepared with some predefined information that are useful to run the therapy files these data include kind of interventions kind of anaesthesia of medication of analgesia etc It is useful verifying the content of these reference tables 5 2 and properly modify it to work according to its own standards Particularly please verify the preloaded protocols see 5 1 PH Painless Hospital LITE 1 0 User Guide 3 Applications functions 3 1 3 2 3 3 Completing therapy files PH Lite functio
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