Mescalero Service UnitBCMA (IHS PSB 3*42) Deployment Site

Visit

June 16 – June 20, 2015

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

Mescalero Service Unit BCMA Team

• Yolanda Adams, BSN, RN DON, BCMA Coordinator• Jason Harris, PharmD, (A)Chief Pharmacist• Marina Mendez, Mescalero Service Unit CAC;

Meaningful Use Coordinator• Kathy Murphy, Information Management System

Site Manager• Wil Darwin, PharmD, (A) CEO, Albuquerque Area

CAC & Pharmacy Consultant

IHS On Site/Remote Cross Functional Team

• David Taylor, MHS, RPh, PA-C, RN, BCMA Federal Lead, IHS/OIT

• Deborah Alcorn, MSN, RN, CPC, BCMA Nurse Consultant, IHS/OIT

• Chris Saddler, RN, BCMA Information Technology Consultant, IHS/OIT

• Mike Allen, MIS, RPh, Pharmacy Informaticist, IHS/OIT

VA Remote Cross Functional Team

• Cathi Graves, Project Manager, BCRO, OIA, VHA

• Kirk Fox, Clinical 1 Support Team, OI&T, VA• Jonathan Bagby, MSN, MBA, RN-BC, Nurse

Consultant, BCRO, OIA, VHA• Stephen Corma, BSPharm, RPh, Pharmacist

Consultant, BCRO, OIA, VHA

VA Cross Functional Team

VA IHS BCMA Collaboration Effort• Includes BCMA Software, Hardware, and Medication Administration Process

Reviews• FY13 – Implementation at 2 Indian Health Care facilities• FY14 – Implementation at 9 Indian Health Care facilities• FY15 – Implementation at 9 Indian Health Care facilities• FY16 – Implementation at ~8 Indian Health Care facilities• VA IHS BCMA Cross Functional Team Kick-off March 19-21, 2013• Remote Participation for Initial Configuration/Test/End-User Training-April 8-19,

2013, Albuquerque, NM• Ongoing Remote RPMS Pharmacy Drug File Cleanup – 6 week series• ADT delayed orders/auto DC of orders optimized to align with CMS 2 midnight

rule and Interqual® criteria• Integrate ADT and BCMA implementation with the Baby Friendly Initiative

including rooming-in

Four Essential Components

• Patient – “Perfect” Admission, Discharge, & Transfer (ADT) Process and Release Events (Delayed Orders and Auto Discontinuation of Orders between “Transitions of Care”)

• Medication – “Perfect” Orders, Pharmacy Processes, and Drug File

• Nurse - Nurse Medication Administration Process• Equipment – Wristbands, Medication Bar Codes,

and Scanners

What Is BCMA?“Patient Safety First…

Because Second is too Late!”• BCMA is an Integral Part of Patient Safety, Nurses Administer

Medications Including IV Medications through BCMA• All Medication Information is Documented with Date/Time

Stamp for Improved Accuracy of Clinical Information• The Documented Information is Available Throughout the

Facility to Any Clinician as Part of the Patient’s Health Record• Pharmacy and Nursing Staff must collaborate closely with

Information Technology Staff if the Medication Administration Arm of the System is to Work Optimally

Bar Code Medication Administration (BCMA)• IHS-VA Interagency Agreement &

Collaborative• MU Stage 2 Criteria for EHs and

CAHs• FY 2013 – 2 beta test sites• FY 2014 – 9 EH• FY 2015 – 9 EH• FY 2016 – 3 EH – (No VA IAA for

implementation)• Error reduction:• 91% reduction in Category E• 84% reduction in Category F

BCMA Data from 9 IHS/Tribal Hospitals:Cherokee, NC, Chinle, AZFt. Defiance, AZ Whiteriver, AZGallup, NM Shiprock, NMClaremore, OK Tahlequah, OKTalihina, OK

Meaningful Use Criteria

• Meaningful Use Stage 2 Criteria for Eligible Hospitals (EHs), and Critical Access Hospitals (CAHs):– Objective: Automatically track medications from order

to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).

– Measure: More than 10% of medication orders created by authorized providers of the EH or CAHs inpatient or emergency department during the EHR reporting period for which all doses are tracked using eMAR.

BCMA Configuration & TestBegan June 16, 2015

• Realigned and Tested Printer Configuration• Examined BCMA Configuration & Tested• Prepared for Training and Practice Session (8

Hours)• Began Necessary Work in Drug File– Drug File and Pharmacy Work Incomplete

BCMA Training & Go Live Plan

• Wednesday - Morning Nursing Super User Session (4 Hours), Afternoon Nursing Super User Training Session (4 Hours)

• Go Live Wednesday Morning at 9:00 AMTroubleshooting Throughout Day

• Thursday –Morning Nursing Super User Session (4 Hours), BCMA Coordinator Training (2 Hours), Evening Nursing Super User Session (4 Hours)

• Friday – Morning Nursing Super User Session (4 Hours)• Debriefing, Go Live and Troubleshooting Continues Throughout Major

Medication Passes (9 AM, 11 AM, 9 PM) 8 hours on Friday • A Total of – 27 Training Hours, 43 Training Encounters, 12 of these were

Unduplicated Educational Encounters

Mescalero Service Unit Training Statistics

Participants

Tuesday 6/16/15

Configuration & Test

(8 Hours)

Wednesday 6/17/15

Go Live @930 Super User 3 Sessions (12 Hours)

Thursday 6/18/15

Super User 2 Sessions (8 Hours)

BCMA Coordinator

(3 Hours)

Friday 6/19/15

Super User1 Sessions(4 Hours) Go-Live

Continued

Saturday 6/20/15

Go-Live Continued Total

Mescalero 4 9 8 2 2 25OIT 4 4 4 4 2 18VHA/VA Remote 0 0 0 0 0 0ABQ Remote 0 0 0 0 0 0Total 8 13 12 6 4 43

BCMA TrainingLessons Learned

• Medical Providers – Delayed Orders, Observation versus Inpatient Status, Medication Orders

• ADT Processes Must be Delineated• Coders, (A) HIM Manager, and (A) Business

Office Manager Attended End User Training to Identify BCMA Reports in EHR for Inpatient Charges

BCMA TrainingLessons Learned

• Update Policies & Procedures to Align with New BCMA Processes:– Each Ward & Shift needs to Designate BCMA NURSING

CHAMPION(S) for ongoing BCMA support & orientation– Each Nurse to View Missed Med & PRN Effectiveness

Reports at Specified Shift Intervals– Identify Medications that Require “Comments”– Supervisory/Charge Nurse Generating Specified BCMA

Reports (Medication Variance, Missed Medications, PRN Effectiveness)

BCMA TrainingLessons Learned

• Medical Provider Decides to Admit (Either Observation or Inpatient)

• Enters(writes) & Signs Delayed Orders• Medical Provider Notifies their Assigned RN• Assigned RN Notifies Inpatient RN• When Patient Arrives on Floor, Inpatient RN Calls

Patient Registration with the Patient Room Number and the Patient is Admitted through ADT

• ADT Admit Releases and will Cancel Delayed Orders Ready or Not!

Go LiveLessons Learned

• Wall Ports Must be Raised for Accessibility • Pyxis Cabinet to Arrive Soon, Consider Location

to Accommodate a Terminal to View BCMA• Inpatient Medication Delivery System • Observation versus Inpatient Medication

Administration Process and Documentation• Reconfigured Admission Order Screen• Use of Text Orders• Managing Patient’s Personal Medications

Baseline Statistics

Wristbands MedicationsCount

Processed via Scanner 3

%Total Events

100%

Scanner By-Pass 0 Keyed Entry (0)Unable to Scan Option (0)

0.0%

Total Wristband Scan Events 3

Count

Processed via Scanner 0

% Total Events

0%

Scanner By-Pass Keyed Entry (1)BCMA Unable to Scan (10)Vista Manual Med Entry (0)

100%Unable to Scan

Total Medication Label Scan Events 10

Post Implementation Statistics

Wristbands MedicationsCount

Processed via Scanner

%Total Events

%

Scanner By-Pass Keyed Entry ( )Unable to Scan Option ( )

%

Total Wristband Scan Events

Count

Processed via Scanner

% Total Events

%

Scanner By-Pass Keyed Entry ( )BCMA Unable to Scan ( )Vista Manual Med Entry ( )

Total Medication Label Scan Events

Thank You Hospital Leadership!

We want to take the opportunity to recognize the outstanding efforts of Yolanda Adams, RN, DON, for her BCMA Team leadership. We also thank the Mescalero Service Unit Leadership for providing financial and human resources,

which helped contribute to a highly successful BCMA Training and Implementation