Implementation of the Epic Rover App® to improve Barcode-

Assisted Medication Administration (BCMA) Compliance

among nurses in the Adult Emergency Department

Heather Gardner, MS, RN, CEN & Mathew Waweru, RN, BSN, CEN

December 4, 2017 1

Presented by: Mathew Waweru RN, BSN, CEN

Objective:

• Identify challenges of executing the new BCMA

workflow

• Implement strategies for improving nursing

compliance by using Barcode-Assisted Medication

Administration systems

• Use of multidisciplinary team approach to improve on

safe medication administration

• Increase patient ID band scanning compliance at or

above 95%

December 4, 2017 2

Background:

• Barcode-assisted medication administration systems are integrated in

the hospital’s electronic health record (EHR), to promote safe and

accurate medication administration.

• Approximately 500,000 medications are administered monthly in JHH

and emergency department averages 20,000 medications

administration.

• Epic EHR Implemented in July 1, 2016, barcode medication

administration (BCMA) became a new workflow for the staff in the

Emergency Department (ED).

• Initial BCMA compliance among nurses in the ED was at 77%, well

below the overall hospital average and had not met the 95%

benchmark.

December 4, 2017 3

Purpose:

• Quality Improvement Project

– To achieve the desired benchmark of 95% or

greater compliance with using the BCMA system

for administering medications in the Emergency

Department.

December 4, 2017 4

Measures:

• Project was conducted in two phases over an 8-month period

• Phase 1:– Evaluated nurses’ compliance with using BCMA (January

2017 – May 2017)

– Identify barriers and challenges faced by nurses

– Pre and post Implementation

– Identify clinical area with most medication administration

• Phase 2:– Piloting the Epic Rover App® (June 2017 – August 2017)

– Review overall compliance and end pilot program

December 4, 2017 5

Key Metrics:

• Monthly Reports with individual performance ( BCMA reports)

December 4, 2017 6

Phase 1: January – May 2017

December 4, 2017 7

Graphs displaying department and Nurses compliance details.

Phase 1: January – May 2017

December 4, 2017 8

Graphs displaying department and Nurses compliance details.

Analysis

Identifying root causes of poor performance during Phrase 1

• Workflow barriers

– Medication handoff to providers i.e. Lidocaine

– Unconventional patient care areas: hallway

– Medication mapping in Epic - Pyxis or pharmacy i.e. Nicardipine

– Faded barcodes

• Equipment

– Missing Scanners- lost vs misplaced

– Computer on wheels- cumbersome and difficult to maneuver (Screening area)

• Computers in room not available – used by Registration or Providers

• Practice habits

– RN discard medication bottles after mixing medication

• Others challenges

– Damaged or Torn barcodes

– Tethered scanner limited reach

– Treatment room layout – Scanners unreachable when families in the room or other

discipline are using computer

December 4, 2017 9

Phase 1: E.D Monthly Data

December 4, 2017 10

Resolutions:

• Communication

– Held one-on-one discussions with nurses both high and low compliance

– obtain feedback from staff with low and high scanning percentages

– Nursing education and reinforcement on appropriate use of BCMA

– Send out email updates regarding scanning issues and resolution

– Monthly reports to track individual progress

• Multidisciplinary team to resolve issues with BCMA

– Team leader to follow up with staff and discussion incentives, remediation

– The ED leadership team

– Meeting with clinical pharmacists, Epic pharmacists

– Joint meetings with Comprehensive Unit-based Safety Program (CUSP) and

ED informatics committee to discuss BCMA issues.

December 4, 2017 11

Resolutions:

• Practice habits

– Intentional and conscious effort to scan medication/self accountability

– Adapt to the new practices and get accustomed to scanning patient ID

bands and medications

– Incentive program- “Starbucks” reward program for nurses scanning above

monthly goal. Redeem various department gift Items

• Workflow

– Using “Document for another user” Feature in Epic-allow RN be able to

document medication administered by provider

– Pharmacy dept fixed printers

– Epic medication Mapping

– Piloted use of rover in the Upfront Screening area current workflow affected

compliance to increase portability

December 4, 2017 12

Staff comments:

• “The Bluetooth scanners are great but they go missing”

• “ for hallway patients computer on wheels, that thing is

huge…………. They steer terribly”

• “Can we get mobile apps. Like if you go to DSW they can check

you on the floor because of handheld devices”

December 4, 2017 13

Phase 2 - Epic Rover ®

December 4, 2017 14

Phase 2 - Epic Rover ®

•Goal of using the Epic Rover App®:

– Provide nurses with a more portable, feasible, and convenient

method for accessing the BCMA system.

– Timely medication administration - decrease time from Medication

order to Medication administration in ED screening area

•Training:

– Face to Face education, with hands on demonstration to users

– Power Point education material

December 4, 2017 15

Epic Rover 3 Month Pilot Results

December 4, 2017 16

• Increase in Departmental compliance was observed

Phase 2 Trend

December 4, 2017 17

. December July August

Total Meds given in E.D 19,954 19,862

Meds scanned 18,939 18,978

Total Meds not scanned 1,015 884

ED Medication Compliance 94.9 95.5

Total Rns with less than 70% compliance 2 2

Total Meds of RNs with less than 70% compliance 42 40

Survey Results 1:

Qualtrics survey:

–How successful was the software in performing its intended task? i.e.

Medication administration, entering vital signs

December 4, 2017 18

Question Total

Very successful 42

Moderately successful 8

Neutral 1

Somewhat successful 1

Not at all successful 0

Survey Results 2:

December 4, 2017 19

Question Total

Strongly agree 47

Somewhat agree 5

Neither agree nor

disagree0

Somewhat disagree 0

Strongly disagree 0

Do you recommend continued use of the rover app for our

emergency department staff?

Results:

• BCMA compliance increased to 82%,

reaching to 95% by the end of initial

evaluation period. In Phase II, the compliance

rates augmented compliance to 95%,

successfully meeting the desired hospital-

based benchmark.

December 4, 2017 20

BCMA Percentage Distribution

December 4, 2017 21

Conclusion:

• BCMA usage among nurses in the ED improved after

initiation of the education program and the Epic

Rover App®.

• The Epic Rover App® serves as a sustainable

solution to improving nurses’ compliance with using

BCMA systems in most clinical setting especially

area with high patients volumes and medications

administration.

December 4, 2017 22

References:

• Aspden, P., Wolcott, J. A., & Bootman, J. L. (2007). Institute of Medicine (US).

Committee on identifying and preventing medication errors. Preventing

medication errors. Washington, DC: National Academies Press, 16, 463.

• Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J., Prier, B., Reichert, E., ... &

Weber, R. (2013). Effect of barcode‐assisted medication administration on

emergency department medication errors. Academic Emergency

Medicine, 20(8), 801-806.

• Cabilan, C. J., Hughes, J. A., & Shannon, C. (2017). The use of a contextual,

modal and psychological classification of medication errors in the emergency

department: a retrospective descriptive study. Journal of Clinical Nursing.

• Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-

Korach, O., ... & Churchill, W. W. (2010). Effect of bar-code technology on the

safety of medication administration. New England Journal of Medicine, 362(18),

1698-1707.

December 4, 2017 23