Anesthesia (Ax) Mode is a digital anesthesia sheet used to track vitals and other important metrics during surgeries and procedures, including the ability to order treatments from the same screen. This feature allows by-the-minute monitoring and a special 15-minute treatment scheduling interval.
In June 2022, we released our long awaited digital anesthesia sheet (Ax Mode) to a few beta hospitals to evaluate the feature and gain valuable feedback for our team. We are receiving great reviews from our hospitals about Ax Mode and are proud to announce that this feature is ready for prime-time! To begin the set up process at your hospital, please have an admin contact us at email@example.com. Due to the data set up that is needed and the popularity of this feature, the estimated time for roll-out can be 30 days.
Table of Contents
The anesthesia sheet (Ax Sheet) vitals and treatments are tied to the patient’s active visit and will lock for editing 12 hours after an extubation time is recorded or 12 hours after the patient is checked out. After this time, please add a detailed addendum to reflect any changes that were made.
💡 ProTip: You can check a patient into the On The Way (OTW) Board to prepare an Ax Sheet for an upcoming visit!
Any time a patient is checked back in for any type of visit, the anesthesia sheet will reset and you’ll see a “No Ax Sheet Created Yet” message when navigating back to the Ax Mode screen. In order to view an Ax Sheet from a previous visit, you must navigate to that visit date.
You can only create a new Ax Sheet when the current Ax Sheet has been completed with an Extubation time being recorded. A visit can have multiple Ax Sheets that you can easily navigate through with the arrows on the page header.
Clicking the New Ax Sheet button opens a blank anesthesia sheet which is broken out into three sections:
🏥 Procedure Information
At the top of the Ax Sheet, you’ll see details about the procedure entered from information set up within the Ax Sheet Setup button.
- Procedure name
- ASA Status
- Emergency status icon
- Team members
- Monitoring Equipment
- Procedure Location
Hovering over the Ax Sheet Setup button displays a tooltip with more details from information set up within the Ax Sheet Setup.
Clicking the Ax Sheet Setup button opens a side panel, which is broken down into three sections:
- The Procedure and Anesthesia team are populated from a dropdown list of all staff members.
- Optional notes can be added for each team member and it will display as an orange chat bubble next to their name. Hovering over the chat bubble shows the tooltip text.
- Code status: Changes made here will be reflected anywhere a patient’s code status displays.
- Patient and Visit Alerts: These alerts will also be reflected anywhere patient alerts are displayed.
- ASA Status: ASA Status I-V options are available to select.
- Emergency procedure indicator box: Checking this box displays a red EKG icon next to the ASA Status in the Procedure Info section.
- PE/Dx Abnormalities & Pertinent Medications: Free text fields with all Snippet options available.
📓 Please Note: Snippets are available for use within the PE/Dx Abnormalities & Pertinent Medications free text field. However, for Instinct Treatment Plan hospitals the RX Meds and MPL Snippets will not populate any information as these Snippets are only available in Instinct EMR.
- Procedure list selection is populated from a default list of standard procedures created by our medical team. Contact us at firstname.lastname@example.org if you need a procedure added to the list. There is a Miscellaneous Procedure option you can utilize and include additional details in the note section.
- Free text fields for: Procedure Location, Patient Position, Endotracheal Tube, Catheters, Monitoring Equipment, and Notes & Comments.
⌚ Ax Timers
To the right of the Procedure Information section are the main Timers that display information about how long the patient has been under anesthesia (Anesthesia Time) and how long the procedure has been underway (Procedure Time).
Under each Timer you’ll notice a Record Time button only when you have advanced to the next Timer. Clicking the Record Time button logs the following times:
- Premed: This is the only optional time recording. It can be marked as Not Complete to move on to Induction.
2. Induction: Recording this time starts the Anesthesia Timer and triggers a blinking red dot indicator.
3. Procedure Start: Recording this time starts the Procedure Timer.
4. Procedure End: Recording this time stops the Procedure Timer.
5. Ax End: Recording this time stops the Anesthesia Timer.
6. Extubation: Recording this time completes the procedure and allows a new Ax Sheet to be created.
Once a time has been recorded, it can still be edited until the Ax Sheet is locked.
If a Timer is started by mistake, you can click the down arrow button and select Undo Previous Recorded Time to take one step back in the process.
🩺 Vitals Entry
Vital recordings are divided into two sections: Vitals Table and Vitals Grid.
You can enter one or multiple vitals at the same time and you can edit the time when these vitals measurements were recorded. There are 15 Vitals to track in the Ax Mode screen:
- Oxygen (Flow-by/Mask) L/min
- Mucous Membranes
- Capillary Refill Time (CRT)
- Pulse/Heart Rate
- Respiratory Rate
- BP Systolic
- BP Diastolic
- BP Mean
- BP Doppler
- Ax Events & Comments
- Wasted Controlled Substances
The Vitals Table displays recordings in time increments of 15 minutes. The most recently entered value for each vital sign is displayed, and you can hover over the displayed value to view any additional values entered during that 15 minute interval.
For each vital entry, a corresponding icon will display on the grid at the recorded time (x-axis) and value (y-axis).
As with the Vitals Table, hovering over an icon on the grid displays a tooltip with details about the entry.
Hovering over a 5-minute block on the grid highlights that interval in purple and displays a tooltip with all grid vital entries from that time interval.
When Recording a Vitals entry, the selected time defaults to the current time and is updated every minute.
A special free text field can be used to record a vital at a specific minute.
⌛ Anesthesia Sheet Timeline
At the top of the Vitals Table, Vitals Grid, and Order Entry sections, you’ll find a timeline indicator, broken down into 15 minute increments. You can navigate back and forward in time by using the < and > buttons. You can also jump back to the current time by clicking the Now button.
A red line will display down the length of the Ax Sheet indicating the current time.
✍ Orders & Monitoring
This section allows you to order and complete treatments specific to your anesthetic procedure.
Order Entry (Tx Sheet)
You can Order or One-Off any active product from the Tx Sheet and use the Ax Mode toggle to include that order on the current Ax Sheet. You can even order Ax Mode products if the patient does not have an active Ax Sheet yet. If there isn’t an Ax Sheet in progress at that moment, the Ax Mode tagged orders will be added when an Ax Sheet is created.
To order an Ax Mode product on the Tx Sheet:
- Select the product from the order dropdown
- Toggle Ax Mode ON
- Select an Ax Tag
- Complete the other required fields
- Click Order
For Ax Mode orders you can set frequencies of every 15 minutes, 30 minutes, or 45 minutes. This means that up to four treatments may be scheduled in one hour block on the Tx Sheet for Ax Mode.
📓 Please Note: Only one treatment schedule can be ordered for the same hour block. Two different schedules (2 tabs) of the same treatment can not overlap.
Hovering over the scheduled Treatment on the Tx Sheet displays a tooltip if more than one Treatment is scheduled within that one hour block for Ax Mode.
Ax Mode Treatments will display with a purple background to stand out from non-Ax Mode Treatments.
To order an Ax Mode product as a One-Off:
- Select the product from the One-Off button
- Complete the required fields
- Toggle Ax Mode ON
- Select an Ax Tag
- Click Complete
Ax Mode Fluids and CRIs:
If patient has an existing order on the TX sheet for IV Fluids or CRIs but will continue on IVF/CRI during and after procedure, it is recommended to use the pre-made AX vitals as to not clash with Tx sheet orders. As part of the setup process, our team will add new products such as AX IV Fluids, AX CRIs, AX IVF Additives, and AX Transfusions to be used on the Ax Sheet.
📓 Please Note: Product Groups and Bulk Editing are not supported for Ax Mode features on the Tx Sheet at this time.
Order Entry (Ax Sheet)
All products ordered from an Ax Sheet will display on the Tx Sheet.
Ordering a product from the Orders & Monitoring section of an Ax Sheet will follow the same process as ordering a product from the Tx Sheet, with two differences:
- The Ax Mode toggle will default ON and cannot be toggled OFF (unless you’re editing an existing order in the Orders & Monitoring section).
- The frequency menu will offer 45 minute, 30 minute, and 15 minute options for any Ax Mode toggled Treatments.
🏷️ Ax Tags
Ax Tags are used to indicate the anesthetic category the Ax Mode enabled treatment will be labeled as. If Ax Mode is toggled ON, an Ax Tag is required. Instinct will display either a long name or short name depending on the space available for the Ax Tag label.
- Induction Meds (long name) / Induction (short name)
- Local/Regional Meds (long name) / Local (short name)
- Perioperative Workup (long name) / Ax Workup (short name)
- Perioperative Treatments (long name) / Ax Treatment (short name)
🎓 Student/Draft Mode Restrictions
Student/Draft Mode restricts certain staff members from ordering medications, diagnostics, continuous infusions, and miscellaneous treatments without approval by another staff member that has approval access prior to these orders being “live” on the Tx Sheet or Ax Sheet. However, students may edit the Ax Sheet Setup Panel without requiring approval.
When approving drafts from the Tx Sheet, only non-Ax drafts can be approved.
When approving drafts from the Ax Sheet, only Ax drafts can be approved. Ax Mode orders can ONLY be approved from the Ax Sheet.
🖨️ Printing The Ax Sheet
You can print the Ax Sheet from the Ax Sheet Setup panel:
Or at the bottom of the Ax Sheet, below Orders & Monitoring:
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