Use of SuperUsers in EMAR “Go-Live”

Presented by: Trina Allison, RN, MSNClinical Educator

Objectives• Discuss how Memorial Hermann is committed

to excellence by their brand promise• Describe how the organization’s behavioral

expectations of accountability, innovation, collaboration, and competence resulted in successful implementation of eMar

• Discuss why identifying SuperUsers are important to the planning and implementation of Informatics

• Identify methods used to keep SuperUsers up-to-date with upcoming changes of eMar

Leadership

• “Breakthroughs Everyday”

• Vision: “Best of the Best”

• Brand Promise: “We create the best possible clinical outcomes with exceptional patient care experiences”

Leadership

• Behavioral Expectations

- Accountability

- Innovation

- Collaboration

- Compassion

- Competent

- Respectful

Teamwork• What is teamwork? Memorial Hermann partners working together to achieve a common goal:

“Successful implementation of eMar”

• Building your “dream team” “The collaboration and cooperation of

Memorial Hermann partners being accountable for the successful implementation and innovation of electronic documentation (eMar)”

Teamwork• Identifying the SuperUsers - The “go-to” person that is able to answer

questions, trouble-shoot, and problem-solve during implementation of eMar

- Those individuals with “Star Power” that are identified in each unit to assist ISD with implementation

- All Clinical Educators identified as SuperUsers to provide continued education to new partners entering the organization

Informatics/eMar

• Preparation

- Train-the-trainer (SuperUser)

Four hours of user training combined

with ‘trouble-shooting’ techniques to

ease the transition to implementation

Hospital educators were all designated

SuperUsers in addition to unit-based

designees

Informatics/eMar

• Preparation

- Hospital-wide: Two hour sessions for

clinical staff. SuperUsers conducted

several education sessions to increase

their knowledge and confidence.

• Accountability and Competence

99% of nursing staff and 100% of

pharmacy and RT staff completed formal

training!

Informatics/eMar• “Go-Live” is here Saturday, February 12, 2006!

- eMar News Team Updates Daily updates and reminders regarding order-entry and retrieval - SuperUsers daily de-briefings at the

command center Collaboration with ISD and SuperUsers to ensure implementation was going smoothly, to receive daily updates, and answer call-in questions

User Meetings Daily!!!! All in the Aspen/ Birch rooms: 11:00—Womens and Childrens 12:00—ICUs, IMUs 1:00—General Floors

MHHS eMAR, PAL Project

1/10/2006

Second Nurse Witness

Nurse prepares a medication requiring a second nurse verification of accuracy

Positive patient ID when bracelet scanned, Medication

administered, and documented

Second Nurse Prepares to document witnessing

medication using own sign on

Right clicks on the documented dose he/she

witnessed

Second Nurse Verifies accuracy of dose

Dose will Show an * to identify a comment has been added when viewing the eMAR

Selects “add a comment”

Enters Witnessed by ...Initals

Time Lapse

To the left is a review of the method for documenting the witnessing high risk medications. The current policy of which medications are to be witnessed in your units has not changed, just the method. This is a lso in your class booklet, and on line in the PiL library.

HH & HCH eMAR NewseMAR/PAL Help -ASK Your Superuser or call 45370!

MHHS Team Update

February 21. 2006

End of Shift Reminders:-Orders to Review-Overdue medication tasks

Process Meetings: Pediatric Bracelets – Product search in Progress RT Wireless – in Progress – Next meeting Wednesday 2/22 @ 2:30Plan for Adult Dialysis – in Progress

eMAR/PALDAY 11!

Using the Active Intervention sheet

Two Main Purposes of the Active Intervention Sheet

1. Review orders and medication times during nursing report

2. Reconcile orders with the 24 hour chart checks

Report Time• Off-going nurse -

– With the PAL open, Report any scheduling changes that need to be communicated to the next shift

• Ex – Patient’s afternoon dose still needed after 3pm because patient is in x-ray. “Please give on eve shift.

Pt is still in X-ray”

Report Time

• On-coming nurse– Circle doses due for your shift by the times

indicated to help create a Pyxis pull list

Challenges of Implementation

• SuperUsers had dual roles -

Some were assigned to patient care in

addition to SuperUser

• Some SuperUsers were less than novice

with computer applications and navigation

• Some SuperUsers did not demonstrate

the commitment necessary to facilitate a smooth implementation

Overcoming the Challenges• ISD staff was visible in all units with the

assistance of the clinical educators who

were dedicated SuperUsers in the units• ISD staff and clinical educators were on the

units to assist and answer questions for those less than novice SuperUsers

• ISD staff and clinical educators demonstrated the dedication and commitment necessary by assisting those who were less committed to the role of SuperUser

Technical Challenges During “Go-Live”

• Staggered medication administration times – Revised staggered medication times to achieve standardized administration times

• Follow-up and completion of ‘PRN response’ – All PRN medications need a response to be documented

REHABHOW TO STAGGER MEDICATION ADMINISTRATION TOACHIEVE STANDARDIZED ADMINISTRATION TIMES1.FIND first dose time 2. FIND administration interval standard 3. INTERSECT time next dose per scheduleOnce you achieve a BOLD time you are back on standardized administration times

FIRST dosetime

Q 4 hr0400, 0800,

12001600, 2000,

2400

Q 6 hr0800,14002000, 0200

Q 6 hr0600, 12001800, 2400

Q 8 hr0800,1600

2400

Q 12 hr0800, 2000

0700 0700, 1200 0700, 1400 0700, 1200 0700, 1600 0700, 2000

0800 0800 0800 0800, 1200 0800 0800

0900 0900, 1300, 1600

0900, 1400 0900, 1300, 1800

0900, 1600 0900, 2000

1000 1000, 1300, 1600

1000, 1500, 2000 1000, 1400, 1800

1000, 1700, 2400 1000, 2000

1100 1100, 1600 1100, 1600, 2000 1100, 1800 1100, 1800, 2400 1100, 2000

1200 1200 1200, 2000 1200 1200, 1800, 2400 1200, 2200, 0800

1300 1300, 1700, 2000

1300, 2000 1300, 1800 1300, 1800, 2400 1300, 2200, 0800

1400 1400, 1700 , 2000

1400 1400, 2000, 2400

1400, 2300, 0800 1400, 2300, 0800

1500 1500, 2000 1500, 2000 1500, 2000, 2400

1500, 2400 1500, 2400, 0800

Revised 02-06 Chi Peyton, Pharm D

Post “Go-Live”

• Monthly meetings with ISD and SuperUsers

Continued collaboration with ISD and SuperUsers to discuss eMar changes and updates

• eMar updates to staff

ISD’s continued commitment to respond to the concerns of the staff to improve eMar on the end-user side

Post “Go-Live” Update• eMAR Update 5/18/2006• We heard your requests,• There are some changes you should be

seeing as you work with eMAR.• For acute MI patients Aspirin and Plavix will

be scheduled to start the day they are ordered.

• Golytely will no longer appear on eMAR as 240cc q 10 minutes. It will appear as a one time dose with a note in the comment section “give 240 ml every 10 minutes.”

• New medication orders: if the physician or nurse puts the time they need to give the med the pharmacy will schedule that time.

We are working with units to make sure the eMAR process provides quality safe care for our patients and is efficient for our clinicians. I will be sending out helpful hints each week to improve our process.TOP TEN REMINDERS for eMAR1. Patient Safety! Patient’s armbands need to be scanned prior to giving medications. This will decrease medication errors. 2. All PRN medications need a response to be documented. 3. Clean up all tasks and orders to review from your list by end of your shift. 4. Use the medication request on the computer for medications needed in 2-3 hours. This allows you to not have to leave your patient and call pharmacy. 5. Enter all RT orders except vent changes in the computer and D/C them in the computer. (Under orders)6. Do not forget to log off your computer before leaving it. You do not want anyone to document under your sign on.7. Clean your COW each shift and PRN with a hospital approved disinfectant except the screen use alcohol for the screen.8. Reconcile your medications and orders from the original written order and the AI. 9. All problems go through the support center 45370. Contact Margie Aronowitz @ 45735 or your manager with any process issues.10. The teamwork and communication between pharmacy, nursing, RT, physicians, and IS was and is the key to our success.

Post “Go-Live” Reminder

We want to hear from you !!Join us for the Super Users Meeting to improve Workflows and Processes.

Stay Updated !!Get information on various IS initiatives that will affect your department.

SuperUser Meeting 5/31/2006

Post “Go-Live” SuperUser Update Meeting

In Conclusion

• The successful implementation of eMar depended on the collaboration of hospital leadership, ISD, and the clinical staff

• SuperUsers play an integral role in implementation because they remain in the facility post go-live to help facilitate changes and updates and educate new partners