Pine Ridge IHS Hospital BCMA (PSB 3*42) Deployment Site Visit September 8 – September 19, 2014.

Pine Ridge IHS HospitalBCMA (PSB 3*42) Deployment Site Visit

September 8 – September 19, 2014

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

Pine Ridge IHS Hospital BCMA Team

• Latona Austin, PharmD, BCMA Pharmacy Coordinator/ BCMA Lead• Rodney Sahr, BSN, RN, Clinical Applications Coordinator• Angela Nelson, PharmD, Inpatient Pharmacy Supervisor• Maxine American Horse, RN, Acute Care Nursing Supervisor• Linda Dixon, RN, Acute Care Staff Development, BCMA Nursing

Coordinator• Tasheena Schreiner, RN, BCMA Nursing Coordinator• Ed Stover, IT Supervisor• Teresa Blacksmith, RN, OB Nursing Supervisor• Leslye Rauth, MPH, RD, Great Plains Area Clinical Applications

Coordinator, Sioux Falls• Martin Hall, Great Plains Area IT Specialist, Sioux Falls

Pine Ridge IHS Hospital BCMA Team

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 - Remote

IHS OIT EHR/BCMA Team

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• Jan Zeller, MBA, BSN, RN, Education Project Manager, VHA EES • Stephen Corma, BSPharm, RPh, Pharmacist Consultant, BCRO,

OIA, VHA• Daphen Shum, PharmD, Pharmacist SME, VA Maryland HCS• Clayton Curtis, MD, VHA/IHS Interagency Liaison• Barbara Connolly, Clinical 1 Support, OI&T, VA

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 5 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

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

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 Cohort Activities

• DataRay™ on site for Printer Configurations• Drug Product and Wristband Samples Verified by BCRO

with Recommended Modifications• Labor & Delivery, Obstetrics/Postpartum, Day Surgery and

Inpatient Surgical Suite Configurations and Test• BCMA Pharmacy Configuration Activities• CPRS Med Order Button Troubleshooting• CNM and OB orientation to EHR/RPMS process of

admitting and transferring OB patients• Surgeon and OR Nurse Supervisor orientation to

EHR/RPMS process for inpatient surgery patients

BCMA Week TwoTraining & Go Live Plan

• Friday – Training Preparation and Practice Session (8 Hours)• Sunday – Morning, Afternoon, Evening Nursing Super User Training Sessions (12 hours)• Monday – Morning, Afternoon, Evening Nursing Super User Training Sessions (12

hours)• Tuesday – Morning Nursing Super User Training Session (4 hours), Pharmacy Afternoon

Training Session (4 hours)– OB Go Live Tuesday 4:00 PM– Troubleshooting

• Wednesday – Morning BCMA Coordinator (4 hours), Afternoon Pharmacy Session (4 hours)– Acute Care Go Live Wednesday 2:00 PM– Troubleshooting

• Thursday – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday and Friday Major Medication Passes (1000,1400,2200) 14 hours on Wednesday and 14 hours on Thursday

• A Total of – 40 Training Hours, 232 Training Encounters, of these 94 were Unduplicated Educational Encounters

Pine Ridge IHS Hospital Training

Pine Ridge Training Statistics

Participants

Sunday Super User

9/14/143 Sessions(12 Hours)

Monday Super User

9/15/143 Sessions(12 Hours)

TuesdaySuper User

9/16/141 Session(4 Hours)Pharmacy1 Session(4 Hours)

WednesdayBCMA

Coordinator (4 Hours) Pharmacy 1 Session (4 Hours)

Total

Pine Ridge 24 42 21 32 119OIT 6 9 6 5 26VHA/VA 11 12 9 9 41I/T/U Remote 1 0 0 1 2Browning 2 3 4 2 11Belcourt 2 6 7 6 21SEARHC 2 4 2 4 12Total 48 76 49 59 232

Pine Ridge IHS Hospital Training

BCMA TrainingLessons Learned

• Define and Develop Policies/Procedures for Hospital Supplied Medications and Patients Supplied Medications

• Delineate Nursing Notification to the Contract Remote Pharmacist and Communicate the Acceptable Response Time for Contract 24 hour Pharmacy Support

• Timely A/D/T Admission/Discharge/Transfer Processes• CPOE within Labor & Delivery and OB (Hybrid System)• Auto Discontinue Pharmacy and Nursing Orders on transfer from

Inpatient Ward to Surgery• Consider a process of reviewing Admission orders and defining

orphan orders (Nursing, Lab and Radiology) to clean up obsolete orders

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

Reports (Medication Variance, Missed Medications, PRN Effectiveness)

Go LiveLessons Learned

• Equipment Placement and Ergonomics• Keyboard Orientation and Challenges• Computer Workstation in Medication Room• Refine & Implement the Policy for Multiple Dose

Containers at Patient Bedside• Pharmacy Finishing Process Impacts End-Users• Provide Patient Education on BCMA Wristband and

Medication Scanning• Ongoing Communication between Pharmacy and

Nursing

Baseline Statistics

Wristbands MedicationsCount

Processed via Scanner 30

%Total Events

96.8%

Scanner By-Pass 1Keyed Entry (0)Unable to Scan Option (5)

3.2%

Total Wristband Scan Events

31

Count

Processed via Scanner 72

% Total Events

93.5%

Scanner By-Pass 5Keyed Entry (0)BCMA Unable to Scan (3)Vista Manual Med Entry (2)

6.5%

Total Medication Label Scan Events

77

Post Implementation Statistics

Wristbands MedicationsCount

Processed via Scanner

%Total Events

Scanner By-Pass Keyed EntryUnable to Scan Option

Total Wristband Scan Events

Count

Processed via Scanner

% Total Events

Scanner By-Pass Keyed Entry BCMA Unable to ScanVista Manual Med Entry

Total Medication Label Scan Events

Thank You Hospital Leadership!

We want to take the opportunity to thank the Pine Ridge IHS Hospital Leadership for providing financial and human resources, as well as limiting inpatient census which helped contribute to a highly successful

BCMA Training and Implementation

Thank You & Good Luck!“Patient Safety First, Because Second is Too Late”