Re: [Gnumed-devel] CPR feature idea

[J Busser]

At 2:47 PM +0100 11/19/05, Karsten Hilbert wrote:
> Imagine a "big red" button in the "right upper" corner. When
> you hit it all other clients at the local site pop up a
> modal (yes ;-), all-red page with large yellow letters:

Is this version 0.2 or post 0.2? ;-)

I can wiki it once we come back on line. Do we need to look to 
provide, or fund, an alternative wiki host?

At minimum there needs to be a way to revoke the process, in the 
event of false alarm or upon "all clear" but if this functionality is 
to be considered we may as well leverage it for some extra benefit.

It could be used not only for CPR, but for any panic situation 
(dangerous patient etc). So when invoking:
- assume worst case scenario where the invoker *may* be unable to 
fine-tune their request. They may have to immediately assist the 
patient or may themselves need a medical assist (as we are short of 
doctors in my province, it could be a 65yo doc working in clinic, 
suddenly getting angina pectoris :-))
- therefore if the red button is invoked, gets committed in "overt" 
(obvious/loud) mode if not fine-tuned within say 5 seconds
- within the 5 seconds, user can cancel using the "escape" key or a 
mouse click on a Cancel button, or can accelerate to immediate commit 
in "obvious/loud" mode by clicking the icon a second time 
(essentially a double rather than single click)

To cover the possible need for a "stealth mode" where the user is 
able to navigate it, in preference to calling a cardiac arrest
     provide a second way to activate... suggest a key binding, in 
case the user's hands are on the keyboard and it is useful to not 
draw patient's attention (in case they can visually track the screen) 
to the clicking of a big red button
     suggest it be alt-F14 (F14 lives above my help key)
     suggest alt-F14 be incorporated in small text, italicized, into 
the button icon
     if invoked in this manner, the user, having gotten their fingers 
to alt-F14, should be able to resume eye contact with the patient and 
attempt to keep them calm. So upon the first "press" of alt-F14, I 
would have the "status line" at the bottom of GNUmed say "Help 
request ready, alt-F14 to issue, esc to cancel" and if no action it 
would auto-issue in 5 seconds.

The "all other clients" modal popup should reasonably
- distinguish between the overt mode (assumed to be a cardiac arrest 
/ code blue or other medical emergency, until determined otherwise) 
versus stealth mode (assumed to be a "risk situation").
- display the identity and location of the person whose login is 
associated with the invoking event
- recognizing that which patient is in the room may or may not be 
correctly informed by the scheduler, and may or may not be the 
"active" patient in that invoking instance of GNUmed, consider 
whether the latter is still *likely* to be the person of interest 
therefore whether to display, on the other clients:
     patient may be name X age Y weight Z
     <any other info> e.g. some EMRs provide storage for Alerts or 
Cautions (deaf, hx of aggressive verbal or physical threats or 
behaviour, HIV positive)

> The initiating client would show a slightly different page:
> -----------------------------------------------------------
>  Resuscitation: Start: 14:37 (3 minutes ago)
> [snip]
>  help status
>  -----------
>  room 3 ... coming
>  room 1

While the event is running, it could be important to access the 
patient's EMR in GNUmed - to look at active problems, medications, 
allergies, whether they had on file a directive "NO CPR" ;-)

Therefore at the initiating end, maybe a click can dismiss the status 
screen to permit use of the record BUT the process keeps running 
(retaining the start time for later documentation purposes) and the 
CPR screen can be raised again by again clicking the red button 
(since the event has not yet been cancelled, it would not issue a new 
call), From this screen one could, as Karsten suggested, access CPR 
guidelines and/or when the circumstance warrants, amend the call. I 
am thinking a few options for "amending":
- condition revoked / false alarm
- condition under control (i.e. we have enough help, if you were late 
to notice this alert just keep working, sorry to trouble you)
- condition ended

Upon ending the event, it might be handy for the start date / time to 
still be recoverable. Maybe the contents could be written to memory 
(on Mac the term is "clipboard") or some kind of buffer to enable 
pasting into a progress note. Maybe not directly into a record, since 
the person who collapsed might not be the active patient (could be 
someone who had accompanied a patient).