SIMS PerioperativeManager

PACU

Daylight Savings Time

© 2019 The OttawaHospital

SIMS Perioperative Manager

Daylight Savings Time – PACU

TABLE OF CONTENTS

TABLE OF CONTENTS

1Daylight Savings Time

1.1Spring Daylight Savings Time

1.1.1Specific Behaviour Changes in Spring

1.2Fall Daylight Savings Time

1.2.1Actions to take in Fall

1.2.2Functionality that is available in Daylight Savings Time mode

1.2.3Restrictions during Daylight Savings Time mode (Fall)

1.2.4Specific Behaviour Changes in Fall

\\c-gen-fp1\IS\Projects\ICT Strategic Plan Programs & Projects\OR Project\14 Sophie\Training Manual PACU\Daylight Savings Time\Daylight Savings Time PACU v4.doc / – 1 – / Saved: 2010/11/10 10:28

SIMS Perioperative Manager

Daylight Savings Time – PACU

1Daylight Savings Time

In Canada and the USAclocks are adjusted twice a year for Daylight Saving Time. The dates for Daylight Savings Time are the second Sunday in March and the first Sunday in November at 0200 hours local time.

  • In the Spring (March), the clock goes forward one hour, 0200 hours becomes 0300 hours. Times between 0200 hours and 0300 hours do not officially exist.
  • In the Fall (November), the clock goes backone hour, the hour between 0100 hours and 0200 hours is repeated. Times between 0100 hours and 0200 hours are ambiguous.

For two weeksprior to Daylight savings time Perianesthesia Manager will display the following Daylight Saving Time warning message. This message will be seen until completion of the time change.

Perianesthesia Manager includes functionality to automatically adjust flowsheets and other system features for the clock changes. Slight modifications in the way items are documentedwill be required during this time.

1.1SpringDaylight Savings Time

In the Spring the clocks move ahead one hour at 0200 hours. The missing hour will be between 0200 hours and 0259 hours.

  • It is impossible to schedule anyactions for the “missing” hour. You will also be unable to document actions that have been performed during that hour.
  • If you add orders with schedules attached, that coincide with a period between 0200 hours and 0259 hours you will see a warning message that the order may be adjusted.
  • The system will log an event to mark the time change. This event will be added at the time of the change.

1.1.1Specific Behaviour Changes in Spring

Although there are no special preparations required for the Spring Daylight savings time, the clock change will have other impacts you should be aware of.

Log on/Log off

If you Log on before the actual time change (i.e. 0130 hours) and logged off 45 minutes during the missing hourlater (i.e. what would have been 0215 hours), the system will show the Log off as 0315 hours.

Flowsheets

Flowsheets appear the same during the transition to and from Daylight Saving Time; however, the behaviour of the column(s) corresponding to the period between 0200 hoursand 0300 hours is different.

The columns corresponding to the missing hour will be present, but they will be greyed out so you cannot enter data in them.

Example showing one hour columns: (Spring)

Example showing half hour columns: (Spring)

Lab Results

Laboratory results received from the Laboratory Information System (LIS)interface between 0200 hours to 0259 hours will be displayed in the 0200 hourstime column. If the LIS was not reset for the time change the result time would be 60 minutes earlier than actual time.

Example: A laboratory result was received by Perianesthesia Manager with a time stamp of 0215 hours. The result would be displayed in the 0215 hours time column on the Laboratory Results Flowsheet, regardless of whether or not the LIS time was adjusted for Daylight Savings time.

Fluid Balance bar graph

The fluid balance bar graph will be based on a 23 hour day on the day of the time change. If you are looking at the Shift view for an 8 hour shift the window will display 7 one-hour bars instead of 8.

Adding Treatment Orders starting between 0200 hours and 0259 hours

If you are adding a single order, you cannot select a starting time in this time period. Starting times for standard orders that start during this hour will be automatically moved to 60 minutes earlier.

Example: An order with a starting time of 0230 hours will be moved to 0130 hours.

Scheduled treatment orders between 0200 hours to0259 hours

Treatment orders scheduled between 0200 hours and 0259 hours will be shifted 60 minutes earlier. Later orders will not be rescheduled as a result of the change. If the shift results in two treatment orders being scheduled for the same hour, one of them will be eliminated. If a treatment order was scheduled to be performed hourly, the one at 0200 hourswill be lost.

Example: An order for a medication scheduled for Q4hours starting at 2230 with additional doses at 0230, 0630 hours etc. The 0230 dose will be shifted to 0130 hours on the flowsheet (three real hours from the first dose). The next dose will remain scheduled for 0630 hours (four real hours after the previous dose).

Intermittent medication infusions

Scheduled orders for medication infusions with predefined durations that are in progress during the time of the clock change will appear to be one hour more than scheduled because of the column for the skipped hour (0200 to 0259). Fluid balance calculations will be correct.

Example: An IV infusion that was scheduled to infuse over a duration of 2 hours beginning at 0100 hours would normally show in the system as infusing in the 0100 and 0200 hours time columns. This will display as 0100, 0200 (the missing hour) and 0300 hours.

Viewing periods in the Patient Summary

Viewing periods that include the hour of the time change will be one hour less. For example an 8 hour viewing period will display as 7 hours.

Date-time controls

Any controls for selecting the date and/or time for a treatment order will not let you select times between 0200 to 0259 hours.

Miscellaneous Issues (Spring)

  • Dose details are sometimes not displayed for urgent medication orders added in the hour before the missing hour. If an urgent medication order is added during the hour before the missing hour, the dose will appear correctly on the flowsheet, but the dose details may be missing from the Review or Edit Documentation window. This occurs when the viewing resolution is set to one or two hours.
  • The missing hour is not taken into account when the system calculates whether or not you are still in time to delete an event.

Example: With the clock change is 0200 hours, if an event is added at 0030 hours and the time limit for deleting an event is 5 hours you should be able to delete the event until 0630 hours. In practice however you can only delete the event up until 0530 hours, as if there was no time change.

1.2Fall Daylight Savings Time

In the fall when clocks are set back one hour, the system enters Daylight Savings Time (DST) mode for approximately one hour to adjust for the extra hour in that day. The day includes an extra hour because the hour between 0100 hour and 0200 hours is duplicated in the system.

The first duplicated hour is called the “inactive hour”. During this inactive hour system functionality is highly restricted. You cannot document any actions or make changes to patient data. Data collection from monitors (or other devices) is suspended.

  • Five minutes before the first (inactive) 0100 hour all Admission-Discharge-Transfer (ADT) and data collection functions will become unavailable. A message advising you of this will appear five minutes before it actually happens.
  • At this time the vital signs bar will display Stdby (Standby) in place of data from the monitor.

  • At the beginning of the second 0100 hour (the active hour) which is the actual time change, the system will resume normal operations.
  • If you add orders with schedules that coincide with the period of 0100 to 0159 hours you will receive a warning that the order may be adjusted.
  • The system will log an event to mark the time change. This event will be added at the time of the change (i.e. 0159 hours).

Event marker– hover over the event to read the comment balloon.

The event can also be seen in the Event Log.

1.2.1Actions to take in Fall

  • Plan to perform all ADT functions (i.e. patient admissions, transfers or discharges) before 0055 hours or after the time change.
  • Minimize the number of items that need to be documented between 0055 and the time change. Be prepared to document any monitor (or other device) readings on paper during this hour.
  • You can document actions/treatments that were performed in the 65 minutes that follow 0055 hours with an administration time between 0100 and 0159 hours. The system will consider that they occurred in the second hour. No tasks can be documented in the first 0100 hour.

/ Note: During the “inactive hour” you cannot document any actions or make changes to the patient data. Monitor (device) data collection is also suspended during this time. You will leave your patient logged on to the workstation for the time the system will be “inactive” (i.e. do not put the patient in Transfer).
The Contingency plan during this time is to do manual data entry of vital signs and all other documentation on paper. The nurse will document in Perianesthesia Manager “System unavailable for one hour due to Daylight Savings Time, see paper documentation in chart for this time period”.
If the nurse wishes to re-enter data that was captured on paper for the inactive hour when the system is active again she may do so as a memo(s).

1.2.2Functionality that is available in Daylight Savings Time mode

You will have access to the following system functionality during Daylight Saving mode(i.e. the inactive hour):

  • Open Perioperative Manager.
  • Log on/off.
  • Open the Census window. This can be done by clicking Menu  Window  Unit Census.
  • Open a record for viewing (through the Unit Census window).
  • Change the viewing options and scroll on flowsheets and trends.
  • View and print Demographic information in the main window. You can do this via the Menu  Demographics  Summary; or by using the F2 function key on the keyboard. Opening Demographics via the blue Patient ID band will not work at this time.
  • View a preoperative evaluation.
  • View audit trails.
  • Print.
  • Restart a patient after an abnormal system close.
  • View the Patient Summary.
  • Use online help.

1.2.3Restrictions during Daylight Savings Time mode (Fall)

You will not be able to do the following when the system is in Daylight Saving mode (i.e. the inactive hour):

  • Admit, transfer or discharge a patient.
  • Enter or edit any data (device, medication, fluid, assessments, scores, events). See below for some behaviour specific to these functions).
  • Add orders to the patient chart.
  • Add or edit Demographic information (or open windows for adding and editing data).
  • Add memos or notes.
  • Use shortcut menus (displayed by right-clicking a flowsheet).
  • Collect data from devices.
  • Place the system in Standby mode or return to normal mode (DST mode is the same as Standby).
  • Open windows for viewing details of documented data.

If you try to access these items during the “inactive” time you will see the following warning message for many of them:

In the cases of assessments and scores you will not see this message but the system will not allow you to document these. When you click on the box in the time column, nothing happens.Fluids behave a little differently – see Fluid Balance bar graph section for further explanation.

1.2.4Specific Behaviour Changes in Fall

In addition to the fact the system will be unavailable or severely restricted in its functionality during the time change, Daylight Savings Time will have other impacts you should be aware of.

Log on/Log off

If you Log on before the actual time change (i.e. 0030 hours) and logged off 45 minutes later (i.e. 0115 hours) the times in the database will match the official times. In this example Log on will display as 0030 and Log off as 0115 hours.

Flowsheets

Flowsheets appear the same during the transition to and from Daylight Saving Time however the behaviour of the column(s) corresponding to the period between 0100 hours and 0200 hours is different.

Behaviour: Each column between 0100 hours and 0200 hours corresponds to both the original and the duplicate hour (Indicated by shading in one half of each such column.) You can enter data in these columns; however the system attributes all of this data to the second 0100 hour.

Example showing one hour columns: (Fall)

Example showing half hour columns (Fall)

Vital Signs on flowsheets - During the time the system is “Inactive” you will not see any vital signs flowing into the document.

When the system is active again (at the second 0100 hour) you will see vital signs flow into the document under the current time. The shaded grey area will remain where the “inactive” hour was.

Lab Results

If the interface to the Lab has been implemented Lab results received from the Laboratory Information System (LIS) between 0100 hours to 0159 hours will be displayed in the 0100 hours time column. The system doesn’t differentiate between the first and second 0100 hours. As a result the real time may have been 60 minutes earlier or later. In the event there are two results for the same components with identical time stamps, the second one will appear as a modification to the original value.

Example: A laboratory result was received by Perianesthesia Manager with a time stamp of 0115 hours. The result would be displayed in the 0115 hours time column on the Laboratory Results Flowsheet. If another result for the same component is received with a timestamp of 0115 it will show as a modification.

Fluid Balance bar graph

The fluid balance bar graph will be based on a 25 hour day on the day of the time change. If you are looking at the Shift view for an 8 hour shift the window will display 9one-hour bars instead of 8.

During inactive time the fluids cannot be changed. If you click on a box in the time column related to a fluid infusing by pump you will notice the dialog window displays differently than usual. The Actions section and the Pump Rate are greyed out indicating you cannot do any documentation at this time.

Also during the inactive hour if you click on a box in the time column related to a fluid infusing by gravity you will notice the Action is greyed out. In addition to this the Bag Level shows a yellow box with a level of -1 displaying. As with pump infusions, you will not be able to document at this time.

Adding Treatment Orders between 0100 hours and 0159 hours

If you are adding a single order (scheduled orders) with a starting time between 0100 and 0159 the system will base the task schedule and ending time on the starting time in the second 0100 hour. You cannot document a starting time in the first 0100 (inactive) hour.

Scheduled Treatment Orders between 0100 hours to 0159 hours

The actual time for all Treatment orders that are scheduled between 0100 and 0159 hours will correspond to the second 0100 hour. You cannot document the completion of a task during the first hour.

Example: For a treatment order for a medication Q4H starting at 2100 with next doses due 0100 and 0500 hours etc. The 0100 hour dose was given at 0100 (the first of the two hours) the 0500 dose would be five real hours later; if it is given in the second hour, the 0500 hour dose would be four real hours later.

Intermittent medication infusions

Scheduled orders for medication infusions with predefined durations that are in progress during the time of the clock change will appear to be one hour less than scheduled because of the column for the repeated hour (0100 hours). The two 0100 hour columns actually represent two real hours. Fluid balance calculations will be correct. The fluid balance window will represent intake between 0100 and 0159 hours in two bars.

Example: An IV infusion that was scheduled to infuse over a duration of 4 hours beginning at 2400 hours will display in the flowsheet spanning three columns 2400, 0100 and 0200 hours. The Fluid balance sheet will display this same intake as spanning 2400, 0100 (the first or inactive hour), 0100 (the second hour) and 0200 hours.

Viewing periods in the Patient Summary

Viewing periods that include the hour of the time change will be one hour more. For example an 8 hour viewing period will display as 9 hours long.

Date-time controls

Any controls for selecting the date and/or time for a treatment order will not let you select times between 0100 to 0159 hours. The system will interpret this as occurring in the second 0100 hour.