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CodeDoc® User's Manual
CodeDoc is a Docutimer® for Code Blue
Docutimer® definition: A docutimer automatically stamps the real time to any data you select. This allows it to keep tract of elapsed time of events that require ongoing calculation and summary at the same time.
Pathogenesis by inherent definition implies a time factor that is critical to medical diagnosis and treatment. This is especially important in an arrest, "Code Blue", where time factors are critical to outcomes. Code Blue documentation has always been less than optimal because the person documenting may not be the first on the scene, has difficulty writing to keep up with the pace of events, may do much of it from recall after the event, and can't do analysis at the same time. Hence there is obvious need for improvement of Code Blue documentation. So we developed CodeDoc®, a docutimer for Code Blue that enables easy real-time data collection and analysis at point-of-care to help in decision-making.
Part One: The Basic Steps
Introduction:
CodeDoc allows medical personnel to accurately and quickly document the medical treatments and assessments during a code blue. The program runs on a hand held computer. It allows the user to navigate among a series of screens to input exactly the data that needs to be recorded to document the code blue. Most data items can be selected and entered with just a few pen presses; unusual information can be entered in a free form manner. CodeDoc maintains a record of all user input during the code blue. Each entry is time stamped. All editing and changes to the record are saved and time stamped so that the exact sequence of data entry can be recreated. In general CodeDoc is an to aid to documenting a code blue. It is not specific to ACLS, BLS, PALS, or ATLS yet it uses the basic principles found in each in order to enhance documentation. It has a unique built in code blue timer that includes a medication assessment timer and a medication database that is updatable. This manual will provide you with a few basic steps to get you started. Please take the time to read the disclaimers below.
DISCLAIMER NOTICE: Medicine is an ever-changing science. In view of the possibility of human error or changes in medical science, users are advised to confirm the information in this product (and, in particular, drug doses and usage) through independent sources. Changes may occur in dosages or contraindications in medications that may not be accounted for in this program. It is the user's responsibility to update and verify any medical information before actual use. This program provides no recommendations. Nor is this program intended to be used for direct Order/Entry. It can NOT correct human input error. So users must verify the output and make any necessary corrections. Thus The output of this program is only a draft. It is the user's responsibility to edit or change the draft for final insertion into a medical record. THIS PRODUCT IS PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. ALL RISK ASSOCIATED WITH USE OF THIS PRODUCT IS ASSUMED BY THE USER. IN NO EVENT SHALL ANYONE ASSOCIATED WITH THIS PRODUCT BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, CONSEQUENTIAL OR INCIDENTAL DAMAGES RESULTING FROM ITS USE.
# BASIC STEPS:
Step One: Tap the [START] button on the center of the beginning screen. When you tap [Start], the timer begins. It will take you to the next screen, Initial Status.
Step Two: Either document the current status of the patient by filling in the screen, or tap [Next] to go to the next Initial Status Screen for defibrillation, or [Done] at the bottom of the screen. [Done] will record any data you have selected or entered, place it in the full Master Log, and take you to the Master Log screen. [Cancel] will skip the Initial Status screens, discarding any data you may have entered, and take you directly to the Master Log. If you skip the Initial Status screens, you can enter an Initial Status later by selecting it from the Assess menu. Once you have entered an Initial Status, it is removed from the Assess menu. Only one Initial Status can be entered for a code. You can, however, always edit the Initial Status by selecting it from the Master Log. Even though you may skip the Initial Status and go directly to the Master Log by [Cancel], it is suggested that you begin by filling in the Initial Status Screens first. To document the Initial Status, there are shortcuts so that you do not have to bring up the Palm keyboard. You may elect to use Palm graffiti or the Palm keyboard, but this program was designed to save you time by cutting out these steps where possible. The following shortcuts are similar throughout the program:
KEYPAD: For example, on the first line of the Initial Status screen, 'Code started....minutes ago', tap on any number(s) on the keypad to fill in this information. You may put in an estimated time, or leave it blank. If you put in a time, please note that you will manually have to add these minutes to the built in timer that began when you tapped the [Start] button. Use the backward arrow on the keypad to delete or change a number.
BOXES: With one tap you select a box of choice. Boxes are sometimes mutually exclusive. There are some screens where multiple boxes may be checked. Such occurrences will be evident. For example, mutually exclusive boxes occur on the second, third and seventh lines of the Initial Status Screen. On the seventh line you may select either []Pulse or []No Pulse. One example of multiple box selection occurs on the [Order] Lab Screen to document multiple lab orders.
PULLDOWN MENUS: These are indicated by down pointing arrows. By tapping on the down arrow, an alphabetical list of items appears. To select from this list, just tap on the item you want to record. So the fourth line of the first Initial Status screen has a pulldown menu that lists various types of airways including an 'Other' category in case you do not find what you are looking for.
BUTTONS: These usually appear at the bottom of each screen for navigating through the program. Tap to activate each. Tap [Done] to record what you have entered in the Master Log and return to the Master Log screen. Tap [Cancel] to discard what you have entered, record nothing in the Master Log, and return to the Master Log screen. The Initial Status, Breathing, History, and Exam assessments, and the Stop Code order are too long to fit on one screen. These assessments and orders use multiple screens, and each screen has [Next] or [Prev] buttons at the bottom to move to the next or previous screen. When you press [Done] on these multi-screen assessments and orders, data from all screens is recorded in the Master Log. Pressing [Cancel] discards data from all screens. Be sure to view each screen and enter all appropriate data before pressing [Done]. When you tap [Done] on the second initial status screen, the program takes you to the Master Log, step three.
Step Three: The Master Log is at the center of CodeDoc. On the Master Log you will be able to view from each previously documented Palm screen a few items of importance. All data items recorded are entered into a full Master Log for each code in the program. Because of Palm screen size, we prioritized viewable items. Although by no means perfect, we assigned a priority to display items on the screen's Master Log so that they may be viewed on the actual Palm screen during a code documentation. With Hot Sync, the full Master Log will be transported to your desktop with all documented items for editing, not just those viewable on the Palm screen. Once on your desktop, you should transport it to your word processor for editing. The Master Log represents a timed list of events of a code recorded by you. The Master Log is only as accurate as the person using the program to document events. The buttons, [Assess],[Order], [Sum], [Exit], on the Master Log screen will allow you to document any assessment made of the patient or any orders or to see a summary of the code or exit the program.
From the Master Log more about [Assess] and [Order]:
[Assess] brings up a list of 12 different types of assessments you may document and [Order] brings up a list of 12 different types of orders you may document plus the 'Stop Code' order.
Both [Assess] and [Order], like the rest of CodeDoc, are arranged by ABCD (Airway, Breathing, Circulation, Defibrillation). 'Other' is included on both lists so that you may make notes on items not included or unique events that you may want to note in your documentation of the code. 'Other' brings up a screen for your unique comments. For such unique entries you will need to use Palm graffiti or Palm's keyboard. Be brief, the Others Screen is limited to 399 characters. The first choice of the [Assess] list is a screen for documenting Basic Assessments of the patient like vitals and rhythm.
The last choice of the [Order] menu list is the 'Stop Code' order. Selecting 'Stop Code' order is how you record the time the code was stopped. 'Stop Code' order is an important screen. When you tap 'Stop Code', the built in timer records this time so that it may calculate the total time elapse (ET). The 'Stop Code' screens also contains fields for documenting patient identification and outcome. There are two ways now to access the 'Stop Order' screens. One is to tap the [Stop] button at the bottom of the Master Log and the other is at the bottom of the Order menu as shown above. You may go back to the Master Log after finishing the documentation of the 'Stop Code' by tapping [Done]. From the Master Log Screen you may then edit or document more or tap [Exit] to exit the program.
The [Info] button appears at the bottom of screens when you might need additional information about either medications or rhythm protocols. Once you select a rhythm to document or a medication, tap on the [Info] button for a quick refresher of a protocol or algorithm or medication dose. Note the [Info] for medications is divided into Adult, Pediatric and Geriatric. Please note that with new CodeDoc ® versions, [Info] about drugs may be edited on the desktop with the drug database.
Step Four: To review the events of the code you have recorded, you may either scroll through the Master Log with the arrow on the right-hand side of the Master Log Screen or use the [Sum] button for a few statistics or use the filters to locate specific items. The [Sum] button tells you:
1. Total code time thus far
2. Total time in CPR
3. Total number of Defibrillations with Max J used
4. Total Input in ml separates blood from other fluids
5. Total Output in ml
6. I/O Balance
From the [Sum] screen you may go to either [Med] [Rhythm] or [Log].
The [Med] button tap will take you to a screen that provides:
1. The total number of unique medications used.
2. The name of each unique medication used.
3. The number of times that medication was documented as an order from the Medication Order screen.
4. The elapsed time from the start of the code to when the medication was last ordered.
5. The total dose of medication used during the code thus far. So if epinephrine was ordered and documented as being ordered three times at 1 mg each time the total would be 3 mg. (DISCLAIMER-REMEMBER THESE FIGURES ARE ESTIMATES AND RELY ON HOW ACCURATE THE PERSON DOCUMENTING IS. IF THE PERSON MISSES A DOSE OF MEDICATION THEN THESE NUMBERS WILL NOT BE ACCURATE).
The [Rhythm] button will tell you:
1. Number of unique rhythms
2. Most frequent unique rhythm
3. Longest time in any unique rhythm
4. The time each rhythm happened into the code.
The [Log] button at the bottom of the screen will take you back to the Master Log screen.
Near the bottom of the Master Log Screen, are filters. Filters help to quickly locate, review, and see what has already been documented in specific areas. The filters are another way for you to quickly locate and review what has already been documented. Filters provide a different type of summary than that provided by [Sum]. The Filters are located on the line above the navigation buttons at the bottom of the Master Log Screen. The filter line is set on 'All' and 'All Events' by default. If you tap on the first down arrow after 'All' there are two other choices in left filter: 'Assess and Order'. If you select 'Assess', everything but the assessments you have already documented with their time on the Master Log will be filtered out. If you choose from the left filter 'Order', the Master Log Screen will let you view only all of the documented orders you have completed. To be more specific, the right filter changes with the left filter. Both filters work together to help you locate specific screens. The filters provide another way to find and review documented data. For example, to review all medications with dose and time that have been ordered thus far by your documentation, select 'Order' from the left filter and 'Medication' from the right filter. Compare [Sum] and [Med] to see how filters work differently.
Step Five: To exit the program, select [Exit] on the bottom of the Master Log. Note [Exit] does not record the time the code was stopped or ended. Select 'Stop Code' order from the [Order] menu list and it will also ask for patient identification information if known. [Exit] simply quits CodeDoc application and resets for the next code. [Exit] and [Stop] are not the same. Beginning in version 1.62 [Stop] will be from either the Master Log screen or the Orders menu. Once you tap [Stop] the button on the Master Log changes to [Exit].
To print, select the Menu icon. The menu icon is the silkscreen button in the bottom left corner of the Graffiti writing area under the house or home icon. When you tap on the Menu icon, you will see at the top of the screen the menu changes. Next select the Other Menu. Under Other, you will find choices like 'Print All, 'Print log' or 'Print Summary'. See the the graphic below of the 'Other' menu. Select what you want to print and the program will send this information to one of the printers supported by Stevens Creek Software's PalmPrint. Or you may use the direct SiPix A6 portable printing software, but Stevens Creek Software's PalmPrint includes this printer as well. Beginning with CodeDoc ® version 1.63 it is no longer necessary to PRINT, BEFORE YOU [EXIT]. You may print before or after [Exit].
If you select 'Print Summary', you will be able to print out a list of all of the current medications and their total dose in real-time.
Select what you want to print and the program will send this information to one of the printers supported by Stevens Creek Software's PalmPrint. Beginning with CodeDoc ® version 1.63 it is no longer necessary to PRINT, BEFORE YOU [EXIT]. You may print before or after [Exit]. [Exit] resets for another code, but you can view any code not yet transferred to the desktop. Notice that the new version of CodeDoc® has a slightly different 'Other' menu with more print options. You may now print all data in CodeDoc® directly, not just Summary, Master Log, Med Summary, or Rhythm Summary. You may print for example history and exam.
Also notice under Other, if you select Preferences this is where you may change formats like how times are displayed. From this screen you also may elect to save medications not in the current drug database. If you write the name of a drug not already on our list after Other:____ on the screen and have checked to save it, this medication will appear at the end of the drugs already listed. So if you use this medication again, just select it from the bottom of the drug list. There are options on the Preferences screen for different time formats and places for example, ET (elapsed time) in the upper right corner or clock time there.
If you want to [View] a code before you transfer it to a desktop, you may now do so beginning with CodeDoc ® version 1.62. To [View] or [Edit] prior codes still on a Palm OS PDA:
1. Before you tap [Start], tap the silkscreen menu icon. MAKE SURE YOU DO NOT TAP [Start]. Instead you select the 'Menu Icon', at the bottom left corner. This 'Menu' icon is located under the 'House' or 'Home' icon. Once you tap it, a menu of items appears in drop down form from the upper left screen. Select 'Other'.
2. The menu of items appears under 'Other' includes: About CodeDoc, License, Codes, Preferences, Start, Exit.
3. Select 'Codes' from the menu and a screen with each code identified by year, month, day, and time appears. Other ID like patient initials, sex, and age only appear if entered by the user who should only enter this information if in accordance with their institution's privacy policy for HIPPA compliance. CodeDoc ID is only a start time down to seconds of when the documenter tapped [Start]. Once you select 'Codes', a Screen of codes will appear with some information like:
Codes ID ID Patient
20021026132737 /YA-M-56
20021026143321 /DFK-M-83
20021027080001 /SM-F-45
20030127090001
20030227071737
[RESTART] [Edit] [View] [Done]
4. At the bottom the the 'Codes' screen are four buttons: [Restart], [Edit], [View], [Done]. First highlight the code you want with a tap, and then tap one of the four buttons with your choice. Notice you may restart any code still listed on the Palm OS PDA, you may just view it and elected to edited on the desktop, or you may do limited editing on the PDA. Editing on the Palm OS PDA of a prior code is intentionally limited. And it is best to actually try than explain. You may only edit existing orders and assessments and you can't add new ones. Plus the clock is stopped at the time of the last entry still.
You may [Exit] at any time from the Master Log as well as from the 'Other' menu. Remember [Exit] resets for another code. [Stop] records the time and allows you to add additional identification if need. Make sure you are done documenting before you [Exit].
To bring the information over to your desktop in a HotSync, first [Exit] CodeDoc, then press the HotSync button. This will bring over the code into a text file with a number. No patient name is used. From this text file you may then shape the raw data log into a formal medical record. You may elect to copy and paste it into your word processing program or directly edit it in the text file. At the current time this option is available for Windows 98, 95, NT only. Mac users have full CodeDoc® function but no desktop.
With this basic information, any user should be able to operate the program. If you still have any questions about basic functions of the program or have other suggestions to pass to other users, please email info@md-software.com.
Part II Desktop
Overview for CodeDoc
Beginning with version 1.62 users will be able to do all tasks from any Palm OS PDA including printing of all items. We do not yet have a Mac conduit. But all past codes are viewable on a Palm for editing and printing so there is less need for the companion desktop that Windows users have. The Windows desktop provides Code Viewer and CodeDoc's drug database. They will help you organize codes and keep current with an updatable drug database. CodeDoc 's drug database allows you to customize the drug database to suit your own needs. You can change the [Info] about doses and you can change the "Alert Times' plus you can add and delete medication names. For any one who has to keep tract of statistics for a hospital about the number of codes and outcomes, Code Viewer will help you cut down on the manual work involved. On a Windows desktop, both Code Viewer and CodeDoc's drug database have their own unique icons. Click on the one you want to use.
From Code Viewer you will find a list of codes in order of date
and time they were documented. Code Viewer organizes the codes by year/month/day/time.
From Code Viewer you may select the code you wish to see and all of the
data entered from it is seen. You may also copy it to your own word processor
for editing or remove it. Code Viewer is is an organized list by date
and time of documented codes from various Palm PDAs and it lets you see
all documented data that was entered for each code. Those familiar with
Windows should be able to navigate the Code Viewer without instructions.
In Code Viewer you will see two windows, a large one for viewing the information documented in a code and a smaller one at the top of the screen. The smaller one contains a number. This number represents the year, month, day, and time of a code and this is CodeDoc's code ID. Notice the drop down arrow at the right side of the small window. If you tap on it the list of previous codes will be shown by their unique number in time. Codes are listed in order by latest time first. To view any code select the one you want from this list by clicking on it. To the left of the small window, you will find a 'Delete button'. Once you have selected a number you may view it by all of the information, the summary or the master log or tap the 'Delete button' to remove it. Under the small window you will find a few basic statistics: running total of codes, with outcomes. On the left hand side of the screen there is a list of buttons that allow you to copy, save, and print. Copy/paste the code into your own word processing program for full editing and medical record formation.
From CodeDoc' s drug database, you may create your own drug database
by first giving it a name and then add, delete from CodeDoc's drug list
or completely removing it to building your own. You may up load this list
in the next HotSync, but you may only have one drug database at a time
on a PDA. You may also change 'Alert Times' of any medication in the drug
database as well as change anything provided in the [Info] part.
CodeDoc® Rx drug database program on the desktop allows a user to
create multiple drug databases, but only one is allowed at one time to
be transferred to any Palm OS PDA. And only one drug database is allowed
for use in CodeDoc at any single time.
There is only one large window in CodeDoc drug database. The default database is what comes with CodeDoc. To create your own drug databases, first you must give your drug database a name. Click the [New] button on the right hand of the window and type in your selected name like ICU, Shands Hospital, Blue Cross etc. Notice there is a check box that is by default checked and this will bring al9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡɁ9ԡ