Beware of Potholes July 2, 2012 Bar Code Medication Administration (BCMA) Back to Basics 3: 1 Tom Vagedes, RN Clinical Applications|BCMA Coordinator Tucson

Note the VHA/BCMA Non Standard Environment Review the Flow of Medication Orders, Turbulence and Risk Discuss the Inevitable Need for Testing Add to Understanding Order Finishing &Verification Provide Examples of Basic Potholes in BCMA Flow Identify BCMA Coordinator Interventions that can Reduce Turbulence and Risk, Fill Potholes and Minimize Interruptions to Medication Administration Objectives VHA|BCMA 2

the Computing Environment is not Standardized Wireless LAN (WLAN) quality varies widely BCMA Equipment Issues Contribute to the current Refresh Project CPRS Med Order Button Functionality may or may not be used Volume of Medication Transactions – 1.39 million BCMA Coordinators Effectively Practice Informatics, Nursing, Pharmacy, QM/QC, and Other BCMA Environment in VHA VHA|BCMA 3

4 Medication Order flows: Vista-CPRS Order Entry [signed/released] Provider Writes or Nurse Enters the Order Vista Inpatient Medications (IOE 5) Finishing & Verifying Pharmacist Finishes and Verifies Vista-CPRS Order Verification Active Order Review and Verification Vista-BCMA Medication Administration Medication Orders

- Except when it Doesn’t BCMA Works Exactly As Expected VHA|BCMA 5 The Inevitable – Troubleshooting Order Flow Interruptions

VHA|BCMA 6 BCMA Testing – When it Doesn’t BCMA problems can be roughly divided into two categories o Simple o Less Simple Testing BCMA in the Test Account - the gold standard o Depends on the Amount of Time Allotted to BCMA Troubleshooting o A Recent Mirror Means Less Time Updating Files for Testing Test User Profiles (if not created) - Consider Test Profiles for: o Nurse (of course) o Provider o Pharmacist o Respiratory Therapist (possibly) o Appropriate Key Allocation and Menu Assignments Value: Enables Testing the Full Range of Actions that Result in a Medication Order Appearing in BCMA

VHA|BCMA 7 Provider Order Entry Example (OE/RR)

VHA|BCMA 8 Pharmacist Finish & Verify Example

VHA|BCMA 9 Nurse/Respiratory Therapist View

Fractional Dose Orders VHA|BCMA 10 Potholes – Examples to be Aware Of

Fractional Dose Orders (cont) VHA|BCMA 11

Fractional Dose Orders (cont) VHA|BCMA 12

Fractional Dose Orders (cont) VHA|BCMA 13 Select Inpatient Rx Barcode Options Option: syn Synonym Enter/Edit Select DRUG GENERIC NAME: metoprolol 1 METOPROLOL 5 MG/5 ML INJ. 5 ML AMP CV100 2 METOPROLOL 12.5 MG (PARTIAL) TAB CV100 3 METOPROLOL 12.5 MG *E.R.*(PARTIAL) TAB CV100 4 METOPROLOL 25 MG *E.R.* TAB CV100 5 METOPROLOL 25 MG TAB CV100 Select SYNONYM: // INTENDED USE: NDC CODE: // CHOOSE 1-5: 2 METOPROLOL 12.5 MG (PARTIAL) TAB CV100 `Select SYNONYM: ? Choose from:

Multiple Dose Order Finishing Potholes – More Examples VHA|BCMA 14

Finishing a Multiple Dose Order (cont) VHA|BCMA 15

Finishing a Multiple Dose Order (cont) VHA|BCMA 16

Hospital Self Medication (HSM) VHA|BCMA 17 HSM Functionality in BCMA The Order is Finished in IOE 5 Field #7 prompt - Answered with Y(es) SELF MED: NO// Y then the second prompt appears: HOSPITAL SUPPLIED SELF MED: Two Alternatives HOSPITAL SUPPLIED SELF MED: ‘NO’ Causes ‘SM’ (Self Medication) to Appear in the Column The Patient Administers And Provides the Medication HOSPITAL SUPPLIED SELF MED: YES// Causes ‘HSM’ to Appear in the Column The Patient Administers But The Hospital Provides Pothole – Minor

Hospital Self Medication (HSM) (cont.) VHA|BCMA 18 Pothole #1: The pharmacist must be aware before finishing the order that the medication is to be supplied by the Hospital or by the Patient Pothole #2: The nurse must be informed of a standard process (competency) for documenting these (currently) uncommon orders

Note the VHA/BCMA Non Standard Environment Review the Flow of Medication Orders Describe “Potholes” that Interfere with Flow Add to Understanding Pharmacist Finishing and Verification Demonstrate Potholes Viewed in the BCMA GUI Identify BCMA Coordinator Interventions that can Avoid or Minimize Interrupting Medication Administration Summary VHA|BCMA 19

Observations? Questions? Thoughts? VHA|BCMA 20 July 2, 2012 Tom Vagedes, RN Clinical Applications|BCMA Coordinator Tucson