Santa Fe Service UnitBCMA (IHS PSB 3*42) Deployment Site Visit

June 13 – June 16, 2015

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

Santa Fe Service Unit BCMA Team

• Lisa Palucci, MSN, RN, Chief Nurse Executive, BCMA Project Manager, BCMA Coordinator

• Deborah Simmons, BSN, MBA, Nurse Supervisor, BCMA Coordinator

• Kyle Sheffer, PharmD, CAC, BCMA Coordinator• Luke Tenorio, IT, BCMA Team Member• Gary Bitsoie, IT, BCMA Team Member• Wil Darwin, PharmD, (A) CEO, Albuquerque Area

CAC & Pharmacy Consultant

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 Remote 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 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

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 F

BCMA 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 and Test

• IV Label, Patient Wristband, and Report Printer Configuration

• Remove Insulin Template from the Order Menu• Mobile Workstations on Wheels Not Delivered as

of this Date• All Scanners Available and Used during Training• Wireless Connectivity is Not an Option at this Time

BCMA Configuration & Test Lessons Learned

• Pharmacy Staffing – 5 Pharmacists: 2 Pharmacists Assigned to Satellite Clinics, leaving 3 Pharmacists for Santa Fe

• Limited Pharmacy Staffing Hours – RN Finish in Place at Santa Fe for Medications Ordered after 6:00 PM and Weekends

• On Call Pharmacist Available• Pharmacy Silo• Low Census – Nurses May Forget BCMA

Functionality & RN Finish Process

BCMA Training & Go Live Plan

• Saturday – Configuration and Test (7 Hours), Training Preparation and Practice Session (7 Hours) = 14 Hours – Go Live Saturday Afternoon at 3:30 PM

• Sunday – Morning Pharmacy Training (4 Hours), Afternoon BCMA Coordinator Session (4 Hours), Evening Nursing Super User Session (4 Hours) = 12 Hour + Go Live Troubleshooting Time Continues to Nursing Night Shift

• Morning Nursing Super User Session (4 Hours), Afternoon Nursing Super User Training Session (4 Hours)– Go Live Troubleshooting Throughout Evening

• Tuesday – HIM/Business Office BCMA Review, Debriefing, Go Live and Troubleshooting Continues Throughout Tuesday Major Medication Passes ( 9 AM, Noon/1pm , 9 PM) 14 hours on Monday and 6 hours on Tuesday

• A Total of – 20 Training Hours, 40 Training Encounters, of these 18 were Unduplicated Educational Encounters

Santa Fe Service Unit Training Statistics

Participants

Sunday 6/14/15 Pharmacy Training (4 Hours)

BCMA Coordinator

(4 Hours) Super User (4 Hours) Go-Live @ 15:30 on Saturday 6/13/15

Monday 6/15/15

Super User2 Sessions(8 Hours)

Go-Live & Trouble

Shooting Continues

Tuesday 6/16/15

Go-Live & Trouble

Shooting Continues

Total

Santa Fe 17 13 0 30OIT 6 4 0 10VHA/VA Remote 0 0 0 0ABQ Remote 0 0 0 0Total 23 17 0 40

Santa Fe Service Unit Training

BCMA TrainingLessons Learned

• Delineate the Start Time for Antibiotics Administered in Urgent Care for Patients Being Admitted to Inpatient

• Recommend all Pharmacists ‘Shadow’ Nurses for 9am Med-pass, Insulin Administration, & IV/IVPB

• Pharmacy Must Collaborate with Nursing for Safe Inpatient Medication Administration

• Recommend Giving Inpatient Pharmacists the “PPW” Option to Print Demo Patient Wristbands to Troubleshoot and Test Medication Barcodes

• Pharmacy must Integrate the Use of BCMA into their Inpatient Pharmacy Workflow

BCMA TrainingLessons Learned

• Access & Permissions were Lacking • Multi-Dose Medication Containers Processes Should be

Delineated • Home Supplied Medications Processes • Provider Training Regarding Standardization of Sliding

Scale Insulin Orders • ‘Now’ versus ‘Continuous’ Orders (Standard

Administration Times)• HIM to Collaborate with Nursing for Optimal Billing

Opportunities & Appropriate Comments and Abbreviations

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 Due List, 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)

Baseline Statistics6/1315 @ 1500 to 6/13/15 @ 1900

Wristbands MedicationsCount

Processed via Scanner 0

%Total Events

0%

Scanner By-Pass 2 Keyed Entry (0)Unable to Scan Option (2)

100%Unable to Scan

Total Wristband Scan Events 2

Count

Processed via Scanner 1

% Total Events

50.0%

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

50.0%

Total Medication Label Scan Events 2

Post Implementation Statistics

Wristbands MedicationsCount

Processed via Scanner

%Total Events

4 %

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

100 %

Total Wristband Scan Events 4

Count

Processed via Scanner

% Total Events

100 %

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

0

Total Medication Label Scan Events 15

Thank You Hospital Leadership!

We want to take the opportunity to recognize the outstanding efforts of Lisa Palucci, BCMA

Project Manager for her BCMA Team leadership. We also thank the Santa Fe Service Unit

Leadership for providing financial and human resources, which helped contribute to a highly successful BCMA Training and Implementation