Acoma-Canoncito-Laguna Service Unit (ACL)

BCMA (IHS PSB 3*42) Deployment Site Visit

June 8 – June 11, 2015

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

ACL Service Unit BCMA Team

• Teresa Sanders, BSN, RN, BCMA Coordinator• Melvina Murphy, (A) DON, RN, Albuquerque Area Nurse

Consultant• Kimberly Phillips, BSN, RN, (A) Inpatient Nurse Supervisor• CDR Dan Fletcher, BSN, RN (A) Outpatient Nursing Supervisor• CAPT Suryam Palanki, PharmD, Pharmacist Informaticist• LT Jeremy Peacock, BSN, RN, BCMA Coordinator• CAPT Wil Darwin, PharmD, (A) ACL CEO, Albuquerque Area

CAC & Pharmacy Consultant• Merlin Lucero, IT Specialist

IHS On Site 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 On Site 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 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• 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

• Removed Medications from Nursing Text Orders

• Reviewed all Order Sets• Realigned Sliding Scale Insulin Order Sets• Cleaned up Nursing Location File• Configured and Realigned IV Labels and

Patient Wristbands• Resolved User Configuration and Permissions

BCMA Configuration and Test

BCMA Training & Go Live Plan

• Monday – Configuration and Test (8 Hours)• Tuesday – Training Preparation and Practice Session (6 Hours), Evening

Nursing Super User Session (4 Hours)• Wednesday – Morning BCMA Coordinator Session (4 Hours), Afternoon

Nursing Super User Session (4 Hours), Evening Nursing Super User Session (4 Hours)– Go Live Wednesday Morning with 8:00 AM Medication Pass– Troubleshooting Throughout Evening

• Thursday – Morning Pharmacy Training Session (4 Hours) – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday Major Medication Passes ( 8 AM, 9 PM) on Wednesday and Thursday

• A Total of – 16 Training Hours, 38 Training Encounters, of these 24 were Unduplicated Educational Encounters

ACL Service Unit BCMA Training

ACL Service Unit BCMA Training

ACL Service Unit Training Statistics

Participants

Tuesday 6/9/15

Configuration & Test

(6 Hours) Super User 1 Session(4 Hours)

Wednesday 6/10/15

Super User1 Session(4 Hours)

BCMACoordinator (4 Hours) Go-Live 8:00

AM

Thursday 6/11/15 Pharmacy1 Session(4 Hours)Go-Live

Troubleshooting Continues to Nursing Night

Shift

Total

ACL 4 10 14OIT 4 8 12VHA/VA 4 8 12ABQ Remote 0 0 0Total 12 26 0 38

BCMA TrainingLessons Learned

• Not all Nurses and Pharmacists had Necessary Keys

• Add “Clinical Key©”, “Micromedex©”, and “Do Not Crush Tablet List” to the BCMA Tool Menu

• Many Users with Multiple RPMS Accounts

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 LiveJune 10, 2015

Go Live Findings

• No Local Technical Support for Mobile Workstations– Mobile Workstations Lack Capability of Powering Laptops,

PCs, Monitors, etc. on Battery Power• No Network Ports for the Mobile Workstations in the

Patient Rooms• Current Setup Presents both Safety and Infection Control

Concerns• No Ability to Securely Store Patient Medications in

Patient Rooms (eg. Creams)• Use of Outpatient Prepacks in Pyxis with Non-Scannable

Barcodes

Go Live Recommendations

• Configure Network Ports for the Mobile Workstation Carts in the Patient Rooms Until Wireless Connectivity is Available

• Mobile Workstations to have Capability of Powering Laptops, PCs, Monitors, on Battery Power

• Lockable Bedside Medication Drawer for Self Administered Ointments, Creams, Inhalers

• Re-examine Administration Times• Scrutinize Drug File, Quick Orders, and Bar Coding of

Medications

Baseline Statistics06/10/2015 @ 0700 to 06/10/2015 @ 1400

Wristbands MedicationsCount

Processed via Scanner 9

%Total Events

100%

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

0.0%

Total Wristband Scan Events 9

Count

Processed via Scanner 22

% Total Events

78.6%

Scanner By-Pass 6 Keyed Entry (1)BCMA Unable to Scan (4)Vista Manual Med Entry (1)

21.4

Total Medication Label Scan Events

28

Post Implementation Statistics06/10/2015@1400 to 06/11/2015@0900

Wristbands MedicationsCount

Processed via Scanner 14

%Total Events

93.3 %

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

6.7%6.700

Total Wristband Scan Events

15

Count

Processed via Scanner 97

% Total Events

94.2 %

Scanner By-Pass 6Keyed Entry (0)BCMA Unable to Scan (6)Vista Manual Med Entry (0)

5.80

5.8

0

Total Medication Label Scan Events

103

Thank You Hospital Leadership!

We want to take the opportunity to recognize the outstanding efforts of Teresa Sanders

and Suryam Palanki for their BCMA Team leadership. We also thank the Acoma-Canoncito-

Laguna Service Unit Leadership for providing financial and human resources, which helped

contribute to a highly successful BCMA Training and Implementation