SEARHC Mt. Edgecumbe Hospital

BCMA (IHS PSB 3*42) Deployment Site Visit

September 14 – 25, 2015

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

Mt. Edgecumbe Hospital BCMA Team

• Diane Linn, RN, BCMA Coordinator, Nursing• Susan Ward, RN, BCMA Coordinator, Nursing• CDR Jill Reid, BSPharm, BCACP, NCPS, Assistant Chief of Pharmacy • CDR Eric Skan, PharmD, Pharmacy Clinical Informaticist, IT• Rhonda Stiles, Clinical Applications Specialist, IT• Darin Gagner, RN, Clinical Applications Specialist, IT• Peter Apathy, BSEE, MS Biomedical Engineering, Project Manager, IT

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 via Remote Adobe Connect •Mike Allen, MIS, RPh, Pharmacy Informaticist, IHS/OIT -

Remote

VA On Site/Remote Cross Functional Team

• Cathi Graves, Project Manager, BCRO, OIA, VHA• Kirk Fox, Clinical 1 Support Team, OI&T, VA• Jaculyn Bloch, 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

ANTHC Team

• Carlene McIntyre, PharmD, MPH, Pharmacy Consultant• Scott DuFour, BSIT, Clinical Applications Trainer

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 4 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 FBCMA 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 & Test Week One – 1

• Minimal configuration required due to significant prior remote and onsite participation by Pharmacy and IT• Nursing should now use BCMA for their patient medication profile• CPRS Med Order button• Hyphens not allowed in bar code entry field in CPRS Med Order Button -

recommend early testing with locally packaged medications• Corrected slow performance issue with software developers (resetting PSB

Parameter did not fix the issue)

• Swing bed configuration

BCMA Configuration & Test Week One - 2

• Preliminary curriculum testing and classroom training on Friday• Learned that bedside medication administration processes need to be

delineated and refined• Reexamined use of RPC broker ports

BCMA Training & Go Live PlanWeek Two

• Thursday & Friday –Training Preparation and Practice Session (16 Hours)• Sunday – Morning & Afternoon Pharmacy Training (8 Hours)• Monday – Morning & Evening Nursing Super User Training, Afternoon BCMA

Coordinator Training (12 Hours)• Tuesday – Morning, Afternoon, & Evening Nursing Super User Training (12 Hours) • Wednesday – Morning BCMA Coordinator Training, Afternoon Nursing Super User

Training – *Go Live Wednesday afternoon • Thursday & Friday – Go Live Support Continues• Friday – Morning Nursing Super User Training (4 hours)• A Total of – 40 Training Hours, 103 Training Encounters, of these 51 were

Unduplicated Educational Encounters

Mt. Edgecumbe Hospital Training

Mt. Edgecumbe Training Statistics

Participants

Sunday Pharmacy 9/20/15

2 Sessions(8 Hours)

Monday Super User

BCMA Coordinator

9/21/153 Sessions(12 Hours)

TuesdaySuper User

9/22/153 Sessions(12Hours)

WednesdaySuper User

BCMA Coordinator

9/23/152 Sessions(8 Hours)Go Live

Total

SEARHC 10 11 22 19 62ANTHC 2 4 4 2 12OIT (Onsite & Remote) 2 5 6 6 19

VHA/VA (Remote) 0 3 4 3 10

Total 14 23 36 30 103

Go-Live - Wednesday 9/23/15

BCMA Training Lessons Learned – 1

• Printing vs. Viewing Medication Due List• Insulin delivery from Pharmacy has changed• Two nurse verification of Insulin• Competing priorities & projects, especially for Nursing Administration• Defining context of verbal orders• Helpful for pharmacy to understand nursing processes• BCMA team needs to continue to meet, possibly as part of P&T

BCMA Training Lessons Learned - 2

• Pharmacy – Incorporate BCMA in workflow (Use BCMA Cover Sheet vs Computer Generated MAR)• Nurses should not EHR Verify until medication is either pharmacy

finished (daytime) or nurse finished (nighttime)• Patch removal to be evaluated to accommodate <24h application, and

alternating removal of patches• Pharmacy to change process regarding Hospital Supplied Medications

vs Self Medications. This includes accessibility of and self-application of medications such as ointments, inhalers etc.

BCMA Training Lessons Learned - 3

• Medication transport: Evaluate lockable drawers for carts• Identify and delineate infection control P&P for mobile med carts• Identify training model for new nurses• Delineate use of flow sheets vs BCMA documentation• Standardization of terminology – policies, standing orders, protocols• How to administer and document urgent or emergent postpartum

medications• New process for documenting PRN effectiveness

BCMA Training Lessons Learned

•Update Policies & Procedures to Align with New BCMA Processes:• Each Ward needs to Designate a BCMA NURSING CHAMPION(S)

for ongoing BCMA support & orientation• Each Nurse to View Missed Med & PRN Effectiveness Reports at

beginning of shift, after every major med pass, and at end of shift• Identify Medications that Require “Comments”• Supervisory/Charge Nurse Generating Specified BCMA Reports

(Medication Variance, Missed Medications, PRN Effectiveness)

Go Live Lessons Learned

• Nurses to stop using Pyxis as their due list• Scenarios covered during training addressed actual situations

encountered after go-live

Baseline Scanning Statistics

WristbandsCount

Processed via Scanner

%Total Event

92.9%

Scanner By-PassKeyed EntryUnable to ScanOption

0.0%7.1%

Total WristbandScan Events 14

MedicationsCount

Processed viaScanner

%Total Events

100%

Scanner By-PassKeyed EntryBCMA Unable to ScanVista Manual MedEntry

0.0%

0.0%

0.0%

Total MedicationLabel Scan Events 45%

Post Implementation Scanning Statistics

WristbandsCount

Processed via Scanner

%Total Events

95.7%

Scanner By-PassKeyed EntryUnable to ScanOption

4.3%

0.0%

Total WristbandScan Events 23

MedicationsCount

Processed viaScanner

%Total Events

98.6%

Scanner By-PassKeyed EntryBCMA Unable to ScanVista Manual MedEntry

0.0%

1.4%

0.0%

Total MedicationLabel Scan Events 71

Thank You and Good Luck!

We want to take the opportunity to recognize the outstanding efforts of the SEARHC Mt. Edgecumbe BCMA Team and their Executive Leadership for committing financial and human resources to contribute to a highly successful BCMA Training and Implementation to assure Patient Medication Administration Safety