📓 Please Note: To begin the set up process at your hospital, please have an admin contact us at [email protected].

Ax Mode

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/No Intubation 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 can select the Ax History tab next to the New Ax Sheet in the Ax Mode.

You can only create a new Ax Sheet when the current Ax Sheet has been completed with an Extubation time being recorded, or a selection of No Intubation.

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 & Timers
Vitals Entry Table & Grid
Orders & Monitoring

🏥 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:

Staff

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.

2. Patient

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.

3. Procedure

Procedure list selection is populated from a default list of standard procedures created by our medical team. Contact us at [email protected] 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: Documenting this time finishes the procedure, turns off the Orders & Monitoring section, and enables the creation of a new Ax Sheet. For sedated patients, you can bypass extubation by choosing No Intubation.

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.

If needed, the anesthesia end time can be completed before the procedure end time, allowing for recording the time the anesthetic gas was turned off.

🩺 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:

Temperature
Oxygen (Flow-by/Mask) L/min
Mucous Membranes
Inhalant
Capillary Refill Time (CRT)
Pulse/Heart Rate
Respiratory Rate
BP Systolic
BP Diastolic
BP Mean
BP Doppler
EtCO2
SpO2
Ax Events & Comments
Wasted Controlled Substances

Vitals Table

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.

Vitals Grid

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.

Vitals Time Picker

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.