Chinle Comprehensive Health CenterBCMA (PSB 3*42) Deployment Site Visit

June 9 – June 20, 2014

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

Chinle Comprehensive Health Center BCMA Team

• Andrew Gentles, PharmD, Chief Inpatient Pharmacist• Valerie Cooper, PharmD, Pharmacy Informaticist• Nick Bird, BSN, RN, CHTS-CP Nursing Informatics Specialist• Renee Chase, BSN, RN, Nursing Informatics Specialist, EHR

CAC-BCMA Coordinator• Jeanetta Fields, MHA(C),BSN,RN, (A)Nursing Informatics

Specialist• Rayme Begay, Information Technology Specialist• Kathy Ray, CNM, CPCHITPro, Navajo Area CAC• Ward and Surgery Supervisory Clinical Nurses

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

VA 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 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 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 Cohort Activities

• Examined BCMA Configuration• Delineated Day Surgery and Inpatient Surgical Suite

Principles, Practices, and Processes• Configured, Tested and Refined ADT, Notes, and

Orders to Include Day Surgery and Inpatient Surgical Suite for EHR and BCMA Go-Live (5 Area Cohorts)

• ADT and EHR Training• Go-Live Day Surgery and Inpatient Surgical Suite EHR

Friday, June 13

BCMA Week TwoTraining & Go Live Plan

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

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

Training Session (4 hours), Afternoon Super User Training Session (4 hours) – Concurrent Afternoon Training and VA/IHS Cross Functional Team Conference Call with BCMA Cohort Sites

• Wednesday – Morning BCMA Coordinator (4 hours), Afternoon Nursing Super User Training (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 – 44 Training Hours, 254 Training Encounters, of these 117 were Unduplicated Educational Encounters for CCHC

Chinle Comprehensive Health Center Training

BCMA Training Statistics

Participants

Sunday Super User

6/15/141 Session(4 Hours)

Monday Super User

6/16/143 Sessions(12 Hours)

TuesdaySuper User

6/17/143 Sessions(12 Hours)Pharmacy1 Session(4 Hours)

WednesdaySuper User

6/18/141 Session(4 Hours)

BCMA Coordinator

(4 Hours) Pharmacy1 Session(4 Hours)

Go-Live Begins

Wednesday 6:30 AM throughFriday

6/20/14Total

Navajo Area 1 3 4CCHC 16 45 32 53 146NNMC 2 2 4GIMC 1 1 6 8OIT 3 11 10 8 32VHA/VA 6 8 10 24I/T/U Remote (Pine Ridge, Browning,SEARHC, PIMC, Rosebud, Belcourt, Albuquerque Area) 13 20 3 36Total 20 79 73 82 0 254

BCMA TrainingLessons Learned

• 24 hour Pharmacy and Pharmacy Informaticist• Need to Refine & Implement the Policy for Multiple Dose

Containers at Patient Bedside• IV Medication Labels De-Activate when Ward Transfer • Need to Refine ER Medication Administration to Optimize

Med Reconciliation for Patient Safety• ADT Processes surrounding Surgery need to be Optimized• Discharge Instructions, Medications, and Medication

Processes Need to be Standardized Between Pharmacy and Surgery

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

• BCMA Awareness for all staff is of Utmost Importance• People don’t Read• BCMA Implementation Quickly Identified Potential

Medication Errors & Variances• “Big Bang” Implementation across all wards to include Day

Surgery greatly facilitates medication reconciliation & management

• CPOE in ER setting should be a TOP PRIORITY• BCMA Facilitates the 5 RIGHTS to include Right Medication,

Right Route & Identifies Appropriate Nursing Medication Administration Practices

Baseline Scanning Statistics

Wristbands MedicationsCount

Processed via Scanner 107

%Total Events

89%

Scanner By-Pass 12Keyed Entry (0)Unable to Scan Option (12)

10.1%

Total Wristband Scan Events

119

Count

Processed via Scanner 183

% Total Events

75.9%

Scanner By-Pass 58Keyed Entry (4)BCMA Unable to Scan (12)Vista Manual Med Entry (42)

24.1%

Total Medication Label Scan Events

241

Post Implementation Statistics

Wristbands MedicationsCount

Processed via Scanner 67

%Total Events

93.1%

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

6.9%

Total Wristband Scan Events

72

Count

Processed via Scanner 106

% Total Events

92.2%

Scanner By-Pass 9Keyed Entry (1)BCMA Unable to Scan (7)Vista Manual Med Entry (1)

7.8%

Total Medication Label Scan Events

115

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

Late”