Chickasaw Nation Medical Center BCMA (PSB 3*42) Deployment Site Visit

January 27 – February 7 , 2014

IHS-VA BCMA Deep LookCherokee NC 2008

VA-IHS-ITU Choctaw

Background

• 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.

Bar Code Medication Administration Assistive (BCMA)Technology

• BCMA is an Assistive Technology Software Application Developed and Used by the Veterans Health Administration (VHA) Facilities to Document Medication Administration Activities and Reduce Medication Errors

• The VHA Bar Code Resource Office (BCRO) will verify Indian Healthcare facilities wristbands, as well as drug products that will not scan at the point of care, and provide test results

• The BCRO has Developed a Structured Process for Performing Usability Assessments of New Features to Assure Successful Adoption by End-Users

• BCMA is a Component of the RPMS-EHR Certified Electronic Health Record

What is BCMA?

• BCMA is an Integral Part of Patient Safety, Nurses Administer Medications, Including IV Piggyback Medications and IV Large-volume Medications, through BCMA

• All Information is Documented with a 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 Services Staff if the Medication Administration Arm of the System is to Work Optimally

Chickasaw Nation Medical Center BCMA Team

• Travis Freeze, PharmD, BCMA Project Lead• Jesse Anderson, CPHIT, EHR Sr. CAC• Melissa Kennedy, BSN, RN, BCMA Coordinator• Landon Trimble, BSN, RN EHR CAC• Patrick Simpson, Programmer• Robert Carlile, RPh, PhC, Pharmacy Informaticist

VA Remote Cross Functional Team

• Cathi Graves, Project Manager, BCRO, OIA, VHA• Kirk Fox, Clinical 1 Support Team, OIT, VA• Randall Baylis, BSBA, Clinical 1 Support Team, OIT, VA• Jonathan Bagby, MSN, MBA, RN-BC, Nurse Consultant, BCRO, OIA,

VHA• Jan Zeller, MBA, BSN, RN, Education Project Manager, VA EES • Daphen Shum, BSPharm, RPh, Pharmacy Supervisor, Perry Point,

MD, VAMC• Stephen Corma, BSPharm, RPh, Pharmacist Consultant, BCRO, OIA,

VHA• Hugh Scott, MS, RNC, VHA Management & Program Analyst,

Washington, DC, IHS/VHA Interagency Liaison

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• Phil Taylor, BA, RN, BCMA Nurse Consultant, MSC Contractor• Chris Saddler, RN, BCMA Information Technology Consultant,

IHS/OIT via Remote Adobe Connect • Kathy Ray, CNM, HIT-PRO CP, CIMTAC Chair, IHS Navajo Area

CAC• Northern Navajo Medical Center BCMA Team – Remote • Gallup Indian Medical Center BCMA Team – Remote • Chinle Comprehensive Health Care Center BCMA Team –

Remote • Pine Ridge IHS Hospital BCMA Team – Remote

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

Configuration & Test Lessons Learned

• BCMA Deployment Required Updating Current Patch Level• PIMS Patch 1016 is Required for PIMS Patch 1017 Routines for Patient

Wristband Printing• Patch Installation Brought to Light a Pre-existing but Unrecognized

Issue by CNMC• BCMA Installation by Script Did Not Complete on All Workstations (20

out of 80 failed)• Recommended for Script Installs That Each Installation is Verified• Verify Correct Path for BCMA Application Target• Wristbands Printed Prior to Launch through Pre-Admission Process

Failed to Scan• The Extensive Preparation Done by Travis and Melissa Enabled an

Outstanding Configuration and Go-Live

Training Activities• Friday – Training Preparation and Practice Session (11 Hours)• Sunday – Afternoon Super User Training Sessions (4 hours)• Monday – Morning and Afternoon Super User Training Sessions (4 hours each), Evening

BCMA Pharmacy Training Session (4 hours)• Tuesday – Morning and Afternoon Super User Training Sessions (4 hours each)• Wednesday – Super User Training (4 hours), Afternoon BCMA Coordinator Training (4 hours)

– Go Live Wednesday afternoon– Troubleshooting

• Thursday – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday and Friday Major Medication Passes (10:00 AM & 10:00 PM) 14 hours on Wednesday and 14 hours on Thursday

• A Total of 241 – Includes Chickasaw nursing, pharmacy, and respiratory therapy staff and VA/IHS remote attendees. This also includes remote representatives from Pine Ridge, Chinle, Gallup, Shiprock and Alaska area (SEARHC).

• Students trained as BCMA Coordinator’s will continue Troubleshooting and Continue Monitoring

Training EncountersParticipants Sunday

Super User 2/2/142 Sessions

MondaySuper User2/3/142 Sessions

MondayPharmacy2/3/14Evening

TuesdaySuper User2/4/142 Sessions

Wednesday2/5/14Super User& BCMA Coord

Total

Chickasaw Nation

9 17 11 20 28 85

Claremore IHS

3 4 2 7 5 21

Cherokee Nation

2 7 9 18

OKC Area 1 6 8 8 23

OIT 3 7 2 7 10 29

VHA/VA 1 14 3 11 8 37

I/T/U Remote

8 16 3 27

Total 17 56 20 76 71 240

BCMA Training

BCMA TrainingLessons Learned

• Respiratory Therapy and ICU – May Benefit From CPRS Med Order Button

• Respiratory Treatments – Administration Times • “Now” Administration Time• Involvement of HIM BCMA Team Member for guidance to

document “High Acuity” situations i.e. “Comments” for late medication

• Provide New Hire, Agency Nurses & Students Access to the VA BCMA Training Module in preparation for BCMA Training

• Plan to Continue to Train all Inpatient Nurses and Inpatient Pharmacists

BCMA TrainingLessons Learned

• Consider Placing the “Comment” Bar Code Sheet in the Medication Notebook for Convenient Access

• Create Policies & Procedures to Align with New BCMA Processes:– Each Nurse to View Missed Med & PRN Effectiveness Reports at Specified Shift Intervals– Timely Medication Administration– Update Pyxis Medication Override Policy/Procedure– BCMA Competency Evaluation periodically (annual, bi-annual, etc.)– Documentation for All PRN Effectiveness– Consider Realistic PRN Documentation Time Frame– Accurate Medication Order Verification Process– Independent Nurse Verification for 5 Rights Medication Administration when Over-

riding Scanning Process

• Each Nurse Manager to Generate Missed Med & PRN Effectiveness Reports at Specified Shift Intervals

• Nurse Managers Will Need to be Trained for Manual Medication Entry to Reconcile Missed Medication Report

BCMA TrainingNursing & Pharmacy

Go LiveLessons Learned

• Nursing to Use EHR and BCMA to determine Medications Due, Dosages, and Administration Times

• Nursing to Keep Virtual Due List Time Parameter Narrow• Each Nurse and Charge Nurse to View Missed Medications and

PRN Effectiveness Reports at Specified Shift Intervals• RN’s View Assigned Patient’s PRN Effectiveness Report Several

Times Per Shift• Each RN and Med Nurse View Missed Med Report Beginning

Shift, After Every Major Pass, and End of Each Shift• Prior to Discharge, Complete or Stop all IV Infusions, if Ordered

Remove Patient Med Patches and Document as Removed in BCMA

Go LiveLessons Learned

• Incorporate BCMA Reports in Medication Error Review Committee and Root Cause Analysis Meetings

• Chickasaw Nation BCMA Team to Continue to Meet Weekly to Discuss Scanning Failures/Troubleshooting and Provide Feedback to All Clinical Staff

• Pharmacists to Shadow Nurse Medication Administration Periodically and Nurse shadow Pharmacists

• Continue to Implement & Monitor the Observation to Full Admit Process for both ADT and Pharmacy

Post Implementation StatisticsTOTAL MED EVENTS MEDICATIONS WRISTBANDS

Feb 5 Go Live Shift 199 93.5 % 97.2 %

Feb 7 Go Live Shift 171 97.1 % 100 %

Total Go Live 1300 95.2 % 96.6 %

Thank You