Guardian CTG Only User Guide
IMPORTANT WARNING
The system is NOT intended to be used to:
· Automate fetal monitoring
· Reduce contact time with patients
· De-skill Clinicians. The Clinician remains responsible for the care of the patient
Guardian Overview
Guardian provides the full electronic capture of CTG and related information. It enables these details to be easily shared with the patient and other clinical staff. Reviews can be performed from the bedside, a central station, a Consultant’s office, or even another Hospital.
Clinical information is easily entered via the touch screen and interactions are quickly authenticated using your fingerprint. CTGs and associated information can be retrieved, displayed, audited and printed at any time. This information can then play a significant part in your quality improvement process.
Interaction with Guardian at the bedside is performed via the K2 Portal. The K2 Portal is a rugged, Medical Grade, Panel PC, designed for the bedside environment. It captures and stores the CTG data from attached fetal recorders, and enables the entry of details of clinical tasks and events. The portal is easy to clean and has been designed to reduce the risk of bio-contamination.
The Central Station provides an overall view of activity on the ward, and can display different levels of clinical detail. The central station is an important tool for sharing clinical information during shift changes and ward rounds. It means that only those staff offering direct care to the patient need enter the room.
The birth suite and individual patient status can also be viewed by authorised users outside the ward using the Remote View application.
Using the Bedside Portal (Front view)
Finger Print Authentication
Guardian uses fingerprint recognition to provide an audit trail of who documented or edited what, where, and when. Fingerprint recognition has been chosen as the preferred method of authentication because it is both quick and convenient for repetitive usage when compared to using passwords or swipe cards.
Clinicians are required to authenticate against their name whenever they admit a patient, enter or change data, view confidential information, or assign fetal monitor data to a patient.
The fingerprint is used just like a password in that you must nominate your name as the ‘Current User’ for the system to check against. The current user is displayed above the fingerprint image display box.
First, check to see if your name is displayed, and if it is not, touch the down arrow to the right of the displayed name to select your name, either from the list of the five most recent users, or the complete user list by choosing [Other…].
Choosing [Other…] will display the detailed user selection list shown below.
You can find your name in the detailed user selection list in one of two ways:
1) Choosing the user group you belong to (listed on the left hand side of the screen), and selecting your name from the corresponding list to the right; or
2) Touching the [By Initials] button will allow you to search for your name through the entire Hospital user list by entering your initials. You will then be able to select your name from a list of possible matches.
1) Choosing the user group you belong to (listed on the left hand side of the screen), and selecting your name from the corresponding list to the right; or
2) Touching the [By Initials] button will allow you to search for your name through the entire Hospital user list by entering your initials. You will then be able to select your name from a list of possible matches.
Search by User Group:
Search by Initials:
Once you have selected your name, the screen will close and your name will appear as the ‘Current User’ above the fingerprint image display window.
Once your name is displayed as the current user, apply the appropriate fingertip, usually from your right index finger, to the reader located in the bottom right hand corner of the back of the portal. Once you have placed your finger on the optical window, gently apply an even pressure. Hold your finger in place until a print is displayed in the fingerprint display box.
The name selected and authenticated against will be automatically used as the current name for authentication next time.
Fingerprint Enrollment
If this is the first time that you have accessed the system, and you are a permanent member of staff, a message will be displayed below the fingerprint display window in red as shown. Touching the [Enrol] button will then start the fingerprint enrollment process.
You will be required to authenticate yourself using your password before continuing. The system will then ask you to place your right index finger on the fingerprint reader four times to capture your fingerprint details. Once this has been successfully completed you will be able to use your fingerprint to sign information into the system.
If this is the first time you have accessed the system, and you are NOT a permanent member of staff, please ask your supervisor to enrol you onto the system.
Admitting a Patient
After settling the patient in the room, the patient's details should be entered into the Bedside portal. If you decide to use a CTG recorder, establish CTG monitoring (after switching the portal on) before you enter the patient's details. If you are using a trolley mounted CTG machine that can be moved from room to room, the portal will first ask which room it has been re-located to.
To start a new patient pregnancy episode or re-open an existing one, select the Patient Details button from the toolbar at the top left of the bedside screen. The Patient Admission screens will then be displayed.
If a CTG recording has already been started a reminder to admit the patient will appear. Touch the [Admit Now] button, and you will be directed to the patient admission screen.
If the entered hospital UR is not found in the K2MS Guardian system database or not found in a query of the IPM system then you will be asked if you would like to create an emergency pregnancy episode. If [Yes] is selected then you can create a patient and episode record by entering the details of the patient. You can then either quickly admit the patient by selecting [Admit Now], or selecting [Next] and enter further details of the patient, and following patient data screens. If [No] is selected then the Patient Admittance dialog is reset for another hospital UR.
Obstetric Details
You will be asked to review and confirm the patient’s obstetric details on the next screen.
Risks
Once you have reviewed the patient’s obstetric details and selected [Next], you will be asked to indicate the patient’s obstetric risks.
Once all required information has been captured and the [Finish] button is touched, a summary of the entered values is displayed. Authenticating with your fingerprint will then confirm that the information is correct, and write the information to the patient's record. Touching the more button allows you to enter more data, or if the information is incorrect, touching the modify button will return you to the wizard to edit your responses.
The information captured within the Obstetric History and Risks screens will be displayed in the Patient Display Bar at the bedside and at the central station.
Bedside Toolbar Overview
Along the top of the bedside screen is a toolbar from which relevant screens can be selected. Once admitted, the patient’s details are shown in the patient display bar at the top of each of the CTG Trace and Notes screens.
Reviewing the CTG
The bedside portal will automatically collect and store data from any fetal monitor connected to it. Once the patient’s details have been confirmed, any other sessions of CTG trace assigned to that patient will also be displayed. To perform a CTG summary/review, information can be recorded via accessing either the [CTG Summary] tab or by clicking on the [Actions] tab.
On selection, this will either show the CTG review wizard if continuous CTG monitoring has previously been indicated or a message will display asking you to indicate monitoring status, if it has not. The CTG summary screen will first display a table of previous CTG reviews. If you wish to record a new CTG review, touch the [New] button.
CTG Review
Touching the [New] button on the CTG Summary screen will start a new CTG Review. Please note that the CTG classification terms differ between antenatal and delivery.
CTG Trace Labels
The start and end of the CTG trace sessions are marked with green and red bars respectively with the date, time and room number were the session was recorded.
Black labels on the trace display key data for events that have been entered for the patient. Touching a label will display the full details of the event that will disappear when the finger is removed.
Signing the CTG Trace
The CTG display screen has a Sign Trace button which allows clinicians to quickly mark the electronic trace that they have reviewed it. The user simply selects the button and the authentication dialog is displayed. When this is authorised a ‘Signed’ label is added to the CTG trace and the authorising name is inserted into the history.
CTG Display Control
The buttons located underneath and to the right of the CTG chart control the chart display and format. There are three modes, with each mode having a different set of buttons. Touching the Function button cycles through the available modes.
CTG Display Scroll Buttons
The first, and default mode, is used to scroll the CTG trace backwards and forwards. The buttons also allow movement directly to the end of the trace.
The trace can be scrolled manually at any time by touching anywhere on the trace and moving the finger left or right over the screen.
There is also a slider bar directly underneath the trace which allows rapid scrolling of the trace.
CTG Display Zoom Buttons
Touching the Function button again, cycles to the next mode to enable zooming. The CTG chart can be displayed in three different sizes, small, standard, and large, represented by the three different buttons.
The standard view is similar in size to the paper trace produced by fetal recorders.
CTG Display Label Buttons
Touching the Function button cycles to the next mode that enables and disables the labels on the CTG trace.
The Labels On button displays labels on the CTG trace and the Labels Off button removes them for easier interpretation.
Add Note
Standard notes annotations and free-text documentation can be added to the CTG trace and [Notes]. Touch the Add Note button to display a set of folders that have annotations within. Click on the [Free Text] button to enable free-text documentation that can be displayed on the CTG if required.
Reviewing Patient Information - Notes
Touching the notes tab on the main toolbar at the top of the screen will display a chronological list of all events that have been entered.
Any note that has been deleted, or edited, is shown in grey with a line through it. Double touching an event row will display all the details, and optionally allows editing or deleting the event.
The buttons to the right of the screen allow the user to scroll through the information. Buttons will cease to be highlighted and will not function if the summary is at either the top, or the bottom of the list.
A notes position on the CTG can be directly accessed by touching the appropriate note row and pressing the [Goto] button. If the note is present on the CTG, then the CTG will be shown at the trace position for the associated label.
Actions
Touching the [Actions] button displays a drop down menu of shortcuts to the most common clinical tasks. This is the primary method for entering data. As a button is touched either more options appear or the input screen is opened up.
The actions in the drop down menu are listed in the following order: CTG Review; Finished in Room; Print
Finished in room
To indicate to the system that a patient has finished in the room, and been moved elsewhere, touch the actions button from the main toolbar and then touch [Finished in Room].
Caution
It is important that patients are marked as finished in a room in a timely manner. This prevents CTG trace and events being incorrectly assigned to a different, incorrect, patient.
Print
Reports of the patient's current pregnancy episode can be printed by selecting Print from the actions drop down list. A dialog box of options for the report will then appear.
Report Printing Dialog
The dialog box allows you to select what will appear in the printed report:
Patient Summary - a paper copy of the patients details.
CTG - a paper copy of the CTG trace.
Notes and Observations - textual report of the recorded events for the episode.
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