October 2, 2010

How to Write Carestream/Kodak PracticeWorks Dental Notes: Local Anesthetics

Tutorial: The first basic note that every one should have is the local anesthetic note.  This PW note code will appear in every procedure note you write that has the chance of using a local anesthetic. This how it looks:

Topical anesthetic <Topical> with <AnesNumMg> of <Anesthetic> <AnesthFil> <AnesthBlock> <AnesthMental> <AnesthPulp> <AnesthLig> <AnesthAkin><CompuDent>
Pt informed not to eat food, bite or chew on lips or tongue while anesthetic is still working.  <OraVerse> <Next Visit>

Notice that the variables are enclosed within <> signs and regular text is in-between. This makes your note read well, but if you don’t use any anesthetic then you will have to edit the final note by deleting all the left over text.  This is OK and very quick to do once you get the hang of it.

How to find the place to write your code:  In every PW patient chart there is a note button.  Open it by pushing the button.  You will see in your list some previously made notes that are so basic, they are practically useless.  However, once a note has been made, it can never be deleted.  No worries, it can be changed instead to a good note by just modifying it. Pick from the list the anesthetic button if you have one.

Push the “Note” button

This is a list of my notes and obviously yours will look different.  Select the “Anesthetic Used” button if you have one and press “Edit below.  If you have your password hierarchy set-up correctly then it should ask you to enter your password.  Note only a higher level password should open this edit window to prevent unauthorized dental staff from changing a notes code.

If you don’t have such a note or any notes at all then press the “Define new” button.

You will come up with a box like this one below.  If it is empty then fill in the fields like the one below.  If it says something different, then replace the fields with what you see below.

Good idea to start grouping your notes into categories such as Anesthetic, TMJ, Implants, etc…

The summary field is the actual name of the note.

Notice the variables are embedded between text to make it look good in sentence form.

There is a hard part to this and it is that variables and the note questions are actually different sometimes.  To make it as easy as possible make your question (listed in the right hand column) similar to the actual variable name. For example, notice the first variable is called <Topical>.  Push the “Define new variable” and the below box will show up.

I already have this variable created so it is dimmed out and marked as in use. But you need to fill out the “Variable name” and “Description” fields as you see it with “Topical”.  Now your variable and question are the same and easy to find in the future.

Choose the drag-down “Type” field tab and choose “Multi-choice list” and it will look similar to this.

Push “Add choice” and enter in the types of topical you use at your office by repeating the “Add choice” button.  Remember do not add any extra spaces and the field is limited in size. If you want the field to show up when writing the note as empty, then push the “Add choice” button, leave it empty and push “OK”. Then pick the blank entry as the “Default choice”.

Press “OK” to close the writing of the variable.  You can either physically type in the variable inside <> or place the cursor in the text and double click on the variable you want to insert from the right hand list of variables.

Getting the hang of it yet?  The next variable is called <AnesNumMg> for number of milligram given.  This is where you begin to set yourself apart from the rest of the dental profession.  It is going to take some math to figure this out, but I’ve already done most of it for you so let begin.

Remember, to make a new variable press the “Define new” button.

Again, my variable is already made and is dimmed out and is not editable, but you can fill in all the fields as you see them by adding “AnesNumMg” in the “Variable name” field and “Anesthetic Amount” in the “Description” field.  Pull down the drag-down box and choose “Muli-choice list”.

My main anesthetics are mepivacaine 3% without epi, mepivacaine 2% with 1:20,000 neo, articaine 4% with 1:100,000 epi, and bupivacaine 0.5% with 1:200,000 epi.  Each carpule has 1.7ml and so many grams per ml.  To do the math you basically look at how many mg/ml and multiply it by 1.7.

The asterisks are just my way of remembering ball park doses for pedo, older kids, average adults, and maximum dosages.

Fill out the “Multi-choice list” with all of these numbers, exactly like this in the correct order, or as you see fit for your particular anesthetic.  Remember, it is done all in a row and cannot be edited in the middle.  If you make a mistake then you will have to delete everything up to, and including, the mistake and fill it in correctly from that point.  This is a major bummer when you make a mistake so pay attention during this part.  The best part is that once it is done right it can be used in all the other notes without having to duplicate it all over again.  Once done press “OK”.

You can and should press the “Test” button to view what your programming looks like.  Garbage in is garbage out.  If you cannot find the variable then press “Test” and see what the question is for the variable and then look it up on the right hand side list of questions.  Select the question and press “Edit note variable” to see what the variables name is in the “Variable name” field.

You should be getting the hang of this by now.  The next variable is the list of anesthetics used in my practice.

The variable <Anesthetic> has already been made and is called “Anesthetic” in the dimmed out “Variable name” box.  Fill in the fields according to which anesthetics you use in your practice.  Remember to add a blank into your list as the default choice so this field shows up blank when the note first opens up.

You should be getting faster by now.  The next variables that I use are completely optional because I thing it looks good in the note.  They have to do with where or how you deliver the anesthetic.  So far we have been using the “Multi-choice list” variable, but for these other variables we will choose the “Check box”.

Remember to put the comma in the description “infiltration,” or it will not have good syntax.

I have the following “Check box” variables to explain where I actually placed the anesthetic: <AnesthFil> “infiltration,”, <AnesthBlock>”mandibular nerve block,”, <AnesthMental> “mental nerve block,”, <AnesthPulp> “intrapulpal,”, <AnesthLig> “interligamentary,”, <AnesthAkin> “Vazirani-Akinosi,”.  Then sometimes we use our Compudent machine when working on pedo patients so we have a “Check box” variable <CompDent> “with CompuDent.”.   Pay attention to the punctuation marks or your syntax will not flow well.

If you use OraVerse then create this “Multi-choice list” variable. Punctuation!

Then just for the sake of completeness the “Next Visit:” button will be added at the end of this note.  Another reason to put this at the end of this note is that this particular note can be used as a miscellaneous procedure note that you can use when there is an odd ball procedure that you used anesthetic for but didn’t have a well constructed note for yet.  Once constructed, this “Next Visit:” variable will be added at the end of just about every note you create.

A trick to doing this button efficiently is to once you have the first “Add choice” filled in, copy and paste the next entry and just change the next procedures name.  Our “Next Visit:” includes Filling(s), Re-eval, Cleaning, Denture, Endo, Crown, Extraction, Cleaning/Comp Exam/FMX, Bridge, Adjustment, PRN, Rem suture/re-eval, S+RP, maintenance, Recall, Partial Dentures, In office bleaching, MDI, Post-op, Post/crown, Hard Night Guard, FGG, CT Graft, Implant, Cement Crown, Perio Protect Imp, Perio Protect Del, Place CAD/CAM/iTero.  You can put them in any order, add and subtract as you see fit.

This is a good time for me to make an addition to this note that I’ve been meaning to do for a while but haven’t found the time.  I have this next variable in most of my other notes.  It is called the “Other Next Visit:”.

Notice this “Multi-choice list” variable is a little different in that it has a comma in front of the procedure. This variable has to be snugged up against the “Next Visit:” variable for it to work properly.  Then it can be added as many times as you want at the end of the note.  Then it is basically the same as the “Next Visit:” variable.  This allows you to list more than one next visit.

Now pay attention.  Place this variable without spaces right after the <Next Visit> variable.  I placed this variable so it appears 4 times at the end with no spaces just in case I need more procedures. If you look at this note carefully you can see that it can be modified to suit any procedure requiring anesthesia by adding text before it.

Finally, I like to sometimes use more than one type of anesthetic per procedure. This note is easy to modify by just copying the part you want to duplicate and pasting it to make the additional choice of anesthetic available for you to choose. I use the additional variable called “additional anesthetic used” to explain the use of the other types and amounts of anesthetic used.  The new variable is called <addAnesth>.

The “additional anesthetic used” is already written and dimmed out so it cannot be modified.  You use a “Check box” variable so you don’t have to see it when you have only used one type of anesthetic.  Just make this new variable <addAnesth> and place it between the pasted code. Make sure there is a space between the adjacent variables and any text.

At this point the code has been written for one of the most complicated but most widely used portions of any of the dental notes.

Press “Test” button to see if all of your variable were recognized.

Fill out the noted as if you have just treated a patient then press “OK”.

Final anesthetic note.  Note the irregular spaces inside the note.  These are areas of the note that had variables that you didn’t check or select.  I just use my cursor to remove the extra spaces before I publish it to the patient’s chart.

Good work!

The next note will go a lot faster now that you have most of the basics down.