Gallup Indian Medical Center BCMA (PSB 3*42) Deployment Site Visit

April 21 – May 2, 2014

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

Gallup Indian Medical Center BCMA Team

• Vicky Chavez, PharmD, Pharmacy Director• Ray Cope, PharmD, Inpatient Pharmacy Supervisor• Kerri Culligan, PharmD, BCMA Pharmacy Coordinator• Joshua Valgardson, PharmD, Pharmacy Informaticist, Pharmacy CAC• Anna Garcia, RN, Nurse BCMA Coordinator• Andrew Ruddle, RN, BCMA Coordinator• Adrian Haven, GIMC OIT Supervisor• Marcie Platero, RN, Nurse CAC• Dawn Dineyazhe, PT, CAC• Edward Smith, Information Technology Specialist• Harriett Beyuka, Information Technology Specialist• Kathy Ray, CNM, CPCHITPro, Navajo Area CAC

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

• Wil Darwin, PharmD, National Pharmacy Council Chair

VA On Site/Remote Cross Functional Team

• Cathi Graves, Project Manager, BCRO, OIA, VHA• Kirk Fox, Clinical 1 Support Team, OIT, VA• Jaculyn Bloch, 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, VHA EES • Stephen Corma, BSPharm, RPh, Pharmacist Consultant, BCRO, OIA,

VHA• Daphen Shum, PharmD, Pharmacist SME, VA Maryland HCS• Hugh Scott, MS, RNC, VHA Management & Program Analyst,

Washington, DC, IHS/VHA Interagency Liaison• Barbara Connolly, Clinical 1 Support, OIT, VA

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

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 Services Staff if the Medication Administration Arm of the System is 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 Lessons Learned

• Admissions Notification of PWB Print Failure• Contingency Plan when BCMA is Taken Offline for Planned Maintenance• BCMA Shortcut Icons on All User Desktops• RPMS Guest Accounts Tested and Working Prior to Onsite Arrival• RPMS Primary/Secondary Menu Verification at All Sites• All Staff and Guest Pharmacist Accounts Set to Auto Verify• Confirm IV Label Printers are Changed Before Orders are Finished to the Test

Printers - Pharmacist must Log Off and Back On to Reset Printer Parameters• Consistency on how Pharmacy orders are finished• Ensure Users have Ability to Enter Policy Orders• RPC Broker Allowed through the Firewall• Plan Non-Site Specific Meetings to Early in the Week to Allow Friday for

Training Preparation

BCMA Week TwoTraining & Go Live Plan

• Friday & Saturday – Training Preparation and Practice Session (16 Hours)• Sunday – Morning Nursing Super User Training Sessions (4 hours), Afternoon

Pharmacy Session (4 hours)• Monday – Morning and Evening Nursing Super User Training Sessions (4 hours

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

each), Pharmacy Afternoon Training Session (4 hours)• Wednesday – Morning and Evening Nursing Super User Training (4 hours each),

Afternoon BCMA Coordinator (4 hours), Afternoon Concurrent Pharmacy Session (4 hours)– Go Live Wednesday Evening– Troubleshooting

• Thursday – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday and Friday Major Medication Passes (9:00 AM, 5:00 PM, 9:00 PM) 14 hours on Wednesday and 14 hours on Thursday

• A Total of – 48 Training Hours, 325 Training Encounters, of these 181 were Unduplicated Educational Encounters for GIMC

Gallup Indian Medical Center Training

BCMA Training Statistics

Participants

Sunday Super User

1 AM Session(4 Hours) Pharmacy

1 PM Session (4 Hours)

Monday Super User2 Sessions(8 Hours)Pharmacy1 Session(4 Hours)

TuesdaySuper User2 Sessions(8 Hours)Pharmacy1 Session(4 Hours)

WednesdaySuper User2 Sessions(8 Hours)

BCMA Coordinator

(4 Hours) Pharmacy 1 Session (4 Hours)

Total

GIMC 32 39 36 57 164Chinle 3 2 3 5 13Shiprock 10 10 4 20 44Pine Ridge 4 8 8 4 24Remote Participants 0 8 5 5 18VHA/VA 10 13 10 11 44OIT 4 6 4 4 18Total 63 86 70 106 325

Gallup Indian Medical Center Pharmacy Session

BCMA TrainingLessons Learned

• BCMA Team and HIM Review, Approve Selected “Comment” Bar Codes prior to training

• Identify Medication Flow Sheets that may be Replaced with BCMA Medication Therapy Reports prior to training

• For our staff each trainee have own computer for training (have extra training stations/patients if needed in each session)

BCMA TrainingLessons Learned

• Update Policies & Procedures to Align with New BCMA Processes:– Each Nurse to View Missed Med & PRN Effectiveness Reports

at Specified Shift Intervals– Identify Medications that Require “Comments” (e.g., “See

Titration Protocol”, Insulin, Lab Values) Per Facility and Provide List for Nurse Users

• Add links to tools prior to training (ran out of time)

• Re-addressed nursing student issue– Student needs to be with nurse

Go Live Lessons Learned

• Create small card with steps to review before passing meds for nurses on the floor– Common reports to run– Common troubleshooting techniques

• Adding links to tools menu in BCMA• Nurse in limited access cannot scan• PRN range orders (MD needs to include parameters for

these and split the orders)• Dermatologic items in room• Nurses to verify all med orders before administration

Go LiveLessons Learned

• Pharmacy issues– Pop-up frequency for provider comments– Reprinting of labels– Troubleshooting– Dispense drug fields– Flag labels (inhalers, dermatologic)– Possible dosages set up for multiple dose items

(syringes, inhalers, etc)

Go Live Lessons Learned

• Administration to be briefed that despite BCMA implemented – “Fun is just beginning” lots of on going work, staff behavior change, and maintenance continues, the need for human and financial resources continues

• Evaluate processes and protocols in ICU that are impacted by BCMA – VA/IHS CFT to create BCMA ICU Workgroup to examine BCMA Best Practices in the ICU, Women’s Health

• Create local GIMC workgroups to develop “tips & tricks” e.g. customizing EHR View to streamline the Nurse Verification process

Post Implementation Statistics

Wristbands MedicationsCount

Processed via Scanner 113

%Total Events

97.4%Scanner By-Pass 3Keyed Entry (0)Unable to Scan Option (3)

2.6%

Total Wristband Scan Events

116

Count

Processed via Scanner 218

% Total Events

97.8%

Scanner By-Pass 5Keyed Entry (1)BCMA Unable to Scan (4)Vista Manual Med Entry (0)

2.2%

Total Medication Label Scan Events

223

Thank You & Good Luck!

Thank You & Good Luck!

Thank You & Good Luck!