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Smart Anesthesia Messenger Codes

SAM Message code Message description Cause of message Action to take
ABX1 Make sure you document the antibiotic drug and administration time. (You have documented that the antibiotic was given by the anesthesia team)  Antibiotic note says that the "Antibiotic was given prior to incision by the anesthesia team", but no corresponding antibiotic drug has been documented Document the given antibiotic through the bolus drug category. Or if the Antibiotic Note choice is wrong, correct it.
ABX2 Make sure you administer the antibiotic prior to the procedure start as needed.  "Anesthesia Ready" event marked, but no antibiotoc drug or antibiotic note has been documented Document Antibiotic note first and then the antibiotic drug if applicable
ABX3 The procedure has started. Document Antibiotic Management.  "Procedure Start" event marked, but no antibiotoc drug or antibiotic note has been documented Document Antibiotic note first and then the antibiotic drug if applicable
ABX4 For <Med Name>, the drug should have been administered <duration> prior to incision. (You have documented that the antibiotic was administered prior to incision) Antibiotic note says that the "Antibiotic was given prior to incision by the anesthesia team", but the corresponding antibiotic drug has been documented with administration time EITHER AFTER incision or BEFORE 1 hour (or 2 hours for certain antibiotics) prior to incision. If antibiotic drug is documented with administration time AFTER INCISION (Procedure Start), correct the administration time. If  antibiotic is documented BEFORE Incision (or Proceduer Start) AND if antibiotic was stil running within 60 min (or 120 min for some antibiotics) prior to incision, adjust administration time to 60 min before Incision (procedure Start). IF the antibiotic infusion has been completed 60 min (or 120 min for some Aantibiotics) prior to incision, please select option " Failed to administer antibiotic prior to incision" in the Antibiotic note and make an annotation to the note saying that "within the recommended time interval". So the entire note will say: Failed to administer the antibiotic prior to incision within the recommended time interval."
ABX5 You have documented the antibiotic drug, but NOT the Antibiotic note. Antibiotic drug is documented, but no corresponding Antibiotic Note is documented Document the correct Antibiotic Note from DocuNotes >> Quality Measures
ABX6 Multiple Antibiotic notes for INITIAL dose are documented. Please delete the one that is not applicable.  Multiple Antibiotic Notes (maybe duplicates) exists. SAM doesn't know which to use Go to Record Editor and Delete the duplicate or non-applicable note
ABR1 <Time> has elapsed since the last dose of <Drug name>. Please REDOSE antibiotic before <Time> The recommended redose interval for the administered antibiotic is close to being elapsed (15 min or less). Time to redose If antibiotic needs to be redosed, redose the antibiotic and document the antibiotic drug with the correct time of administration
ABR2 <Drug name> should have been redosed prior to <Time>. If antibiotic was redosed, please document medication dose and time.
If antibiotic was NOT redosed, please document antibiotic note with choice - "Antibiotic NOT REDOSED for medical reasons” 
The recommended redose interval for the administered antibiotic has elapsed and there is no documentation of the redosed antibiotic medication not an Antibiotic Note saying that the Antibiotic was NOT REDOSED for a medical reasons. If the antibiotic was redosed, document the antibiotic with the correct time of redosing. If the antibiotic was not redosed for a medical reason, document the antibiotic note with option: "Antibiotic NOT REDOSED for medical reasons” and explain the reason in the comments field.
BIL1 The attending anesthesiologist has attested for the placement of: <Invasive Lines>. Please document the procedure details via the corresponding docunote(s) under "Invasive Procedures" category.   The Attending Anesthesiologist has signed for the presence of one or more of A-live, CVP, PA Catheter and Spinal Drain, but no corresponding Invasive Procedure note that describes these are present in the record Document the missing invasive line procedure note by going to Docunotes >> Invasive Procedures >> select the appropriate note(s). Remember this can be completed by any member of the anesthesia team and need not be the Attending Anesthesiologist.
EVT1 In room time should be after Anesthesia Start Time.  In Room time is before Anesthesia Start time Edit the I-Room time to the correct time when the patient entered the room. It should be noted that the In Room is automatically entered when the patient is selected in the Intra-op mode ans one reached the main charting screen. NEVER delet this comment as a new one cannot be specified from within teh Intra-Op screen. Just edi teh time. If automatically entered "In room" time is deleted EVT1 is disabled.
EVT2 Anesthesia Ready time should be after In Room Time.  Anesthesia Ready Time is specified before In Room time Edit In Room or Anesthesia Ready times to the correct values so that Anesthesia Ready follows In Room time
EVT3 Procedure Start Time should be after Anesthesia Ready Time.  Procedure Start Time is specified before Anesthesia Ready time Edit Procedure Start time to the correct value so that it is after Anesthesia Ready Time 
EVT4 Procedure Stop Time should be after Procedure Start Time.  Procedure Stop time is before Procedure Start time Edit Procedure Start and/or End time so that they are in the correct sequence.
EVT5 Leave OR Time should be after Procedure Stop Time.  Leave OR time (Transport to Recovery) time is before Procedure End time Normally, you won't see this in the OR. However, if the applciation is exit via the "Exit" button, the application automatically enters a "Transport to Recovery" comment. If such an event exists and is not valid, delete it
EVT6 Multiple Anesthesia Ready Times specified. Delete the invalid ones Multiple Anesthesia Ready events are specified Delete the "extra" Anesthesia Ready events using record editor
BBK1 Multiple Beta Blocker Notes with differing information entered. Please delete the invalid note Mutiple Beta blocker notes have been specified with the notes having different options selected for the first field Delete the incorrect betablocker note
BBK2 You have documented that the patient took beta-blocker PRIOR to Surgery. Please edit the Beta-blocker note to document the following MISSING field(s): Pre-surgical Betablocker: <Name>, <Date>, <Time>. There is only one beta blocker note and the first data field says that the "Patient took beta blocker PRIOR to surgery", but one or more of the subsequent data fields are not specified Look at the message (F10) to see which field in missing and specify it. If the anesthesia team does not what to select for the missing fields, select "Unknown" or "Unable to determine" from the list of options. These options are at the end of the list.
BBK3 Please document Beta-blocker using the "Bolus Meds" or "Infusions" button. You have documented that the beta-blocker was given intra-opertively by the anesthesia team If user documents that beta blocker was given intraoperatively, but the specific betablocker medication is not documented, then this alert is generated Instruct user to document the betablocker medication. Generally it is Metroprolol. It can be given as Bolus or Infusion. If a betablocker was not given Intra-operatively, then edit the Betablocker note to mention otherwise.
NBP1 No BP Cuff measurements in the last 7 mins!! Please verify that the patient monitor is set to make NBP measurements at regular intervals An NBP measurement has been made, there is no valid Arterial line pressures, but no NBP measurement has been made for the last 7 min.  Make sure the patient monitor is set to make regular NBP measurement cycle (every 5 min). If an Arterial line is being placed with the intent of monitoing arterial blood pressure, just wait till Arterial blood pressures are coming into Docusys and the alerts will stop. Also note that the there may be a delay in the NBP parameters being seen by SAM, so there may be a "delayed" message that may not be applicable when in fact teh user may have noticed this problem independently and fixed the issue by measuring an NBP. Just close the message and the alerts will stop from the next cycle onwards (6 min). 
NBP2 It is past Anesthesia Ready time and No BP Cuff measurement has been made. Please initiate measurement in the patient monitor Anesthesia Ready event has been specified and there is no NBP or Arterial line blood pressure measurement Make sure the NBP measuremement is initialted on the patient monitor. If arterial line is placed, make sure that the measurements are initiated on the patient moniotr in the correct channel. If blood pressure is being monitoes otherwise (manometer, ultrasound) disable SAM client on the workstation to prevent non-relevant messages
BPM1 Sys BP < 80 and MAC > 1.25. Please consider adjusting DOWN the inhalation agent Low blood pressure and inhalation agent (Desflurane, Sevoflurane and/or Isoflurane) concentration high.  MAC is computed by dividing agent concentration with their MAC concentratiions (eg: 1 MAC of SEVE = 2.05%, ISO = 1.1% DES = 6%). MAC is additive, so if more than one agent is administered, total MAC is the sum of each individual agent MACs. If NBP and/or ART systolic BP < 80 and if the total MAC is > 1.25, reduce the agent concentration so that total MAC < 1.25. Or do other interventions to bring up the BP value.
BPM2 Sys BP > 160 and Phelynephrine infusion seems to be running. PLease consider STOPPING Phenylephrine infusion and documenting it High blood pressure and Phenylephrine infusion ongoing Stop Phenylephrine infusion to bring down the systoic blood pressure (NBP or ART) below 160. If Phenylephrine is actually stopped, then make sure that it is documented. As with other alerts that depend on patient monitor data, there is usually a delay associated with SAM messages. So if a message may seem invalid, just wait for the next cycle after pressing Force update and the message will stop being issued.
FGF1 FGF1: The Fresh Gas Flow rate is <FGF value>  L/min. To reduce inhalation agent consumption, please consider reducing the Fresh Gas Flow rate to 1.0 L/min Proceduer Start has been specified and the Fresh Gas Flow (sum of O2, Air and N2O flows) is > 1.0 +/- 0.2 L/min Reduce Fresh Gas Flow to 1.0 L/min (Actually anything between 0.8 and 1.2 L/min is okay)
FGF2 Sevoflurane consumption under low flow has reached <MAC Hr Value>  MAC Hours. Please increase Fresh Gas Flow rate to 2.0 L/min The agents if Seviflurane and the total MAC consumption under low Fresh Gas Flow (<1.9 L/min) has reached 1.9 MAC hours or higher AND the Fresh Gas Flow has not been increased to 2.0 L/Min Increase Fresh Gas Flow to 2.0 L/min (+/- 0.2 L/min)
FGF3 The Sevofurane Fresh Gas Flow rate is <FGF value> L/min, less than the recommended 1.0 L/min. PLease increase the flow to 1.0 L/min  Fresh Gas Flow is not recommended to be below 1.0 L/min. With a tolerance of 0.2 L/Min, this message is generated if the Freash Gas Flow is below 0.8 L/min and the inhalation agent is Sevoflurane. Increase Fresh Gas Flow to 1.0 L/min (+/- 0.2 L/min)
MON1 Monitoring attestation due 90 minutes has elapsed since the last monitoring attestation and the attending anesthesiologist has not changed Document Monitoring attestation
PRE1 PREOP Attestation MISSING Med Hx and findings COMMENTS In the Pre-Op Attestation, the attending has specified that there are significant findings as part of the physical exam. However, the Comments field (used to describe the significant findings) is empty EDIT the Pre-Op attestation to enter the significnat findings in the Comments field
TRF1 Transfer Attestation missing within 5 min of Attending Change A valid Transfer attestation exists, but it is not within 5 min of the Attending Transfer (Login/Logout of the new/old attending) EDIT the time of the  transfer attestation to be within 5 mins of Transfer, OR Edit the time of transfer to to the correct value (and within 5 min of Transfer Attestation)
TRF2 Transfer Attestation not applicable. Please delete No Transfer of Personnel has happened and there is a Transfer Attestatation Delete the Transfer Attestation if there is no change of Anesthesia Attendings. Of it there is a change in Anesthesia Attendings, make the second Attending login and edit the login time to the correct value
TRF3 Transfer Attestation not applicable. Please delete The Relieve Attending has specified the Transfer Attestation rather than the Attending being relieved. Delete the invalid Transfer Attestation. Request the Relieved Attending to document the Transfer Attestation if one does not already exist
IND1 Induction note after induction attestation. Please correct documentation sequence in Docusys record The Induction attestattion is before INDUCTION Docunote  Edit Induction Attestation and/or INDUCTION note to the correct time such that the attestation comes after the note. Please note that you cannot specify an attestation into the future. Advice Attendings to do the Induction attestation at the end.
EMG1 Emergence note after emergence attestation. Please correct documentation sequence in Docusys record The Emergence attestattion is before EMERGENCE Docunote  EditEmergence Attestation and/or Emergence note to the correct time such that the attestation comes after the note. Please note that you cannot specify an attestation into the future. 
SPL1 Please press "Force Update Info from Server" button from
"Manual Entry" screen
If a Force Update has not been pushed from the mobile EP TIRO machines and these machines are actively charting a case Press Force Update. This will register the IP-address in SAM to send the SAM messages.