Mescalero Service Unit BCMA (IHS PSB 3*42) Deployment Site Visit June 16 – June 20, 2015

IHS RPMS EHR Deployment

BCMA Inpatient Deployment

Mescalero Service Unit BCMA Team Yolanda Adams, BSN, RN DON, BCMA Coordinator Jason Harris, PharmD, (A)Chief Pharmacist Marina Mendez, Mescalero Service Unit CAC; Meaningful Use Coordinator Kathy Murphy, Information Management System Site Manager Wil Darwin, PharmD, (A) CEO, Albuquerque Area CAC & Pharmacy Consultant

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 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 9 Indian Health Care facilities FY16 – Implementation at ~8 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

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 Began June 16, 2015 Realigned and Tested Printer Configuration Examined BCMA Configuration & Tested Prepared for Training and Practice Session (8 Hours) Began Necessary Work in Drug File – Drug File and Pharmacy Work Incomplete

BCMA Training & Go Live Plan Wednesday - Morning Nursing Super User Session (4 Hours), Afternoon Nursing Super User Training Session (4 Hours) Go Live Wednesday Morning at 9:00 AM Troubleshooting Throughout Day Thursday –Morning Nursing Super User Session (4 Hours), BCMA Coordinator Training (2 Hours), Evening Nursing Super User Session (4 Hours) Friday – Morning Nursing Super User Session (4 Hours) Debriefing, Go Live and Troubleshooting Continues Throughout Major Medication Passes (9 AM, 11 AM, 9 PM) 8 hours on Friday A Total of – 27 Training Hours, 43 Training Encounters, 12 of these were Unduplicated Educational Encounters

Mescalero Service Unit Training Statistics

BCMA Training Lessons Learned Medical Providers – Delayed Orders, Observation versus Inpatient Status, Medication Orders ADT Processes Must be Delineated Coders, (A) HIM Manager, and (A) Business Office Manager Attended End User Training to Identify BCMA Reports in EHR for Inpatient Charges

BCMA Training Lessons Learned Update Policies & Procedures to Align with New BCMA Processes: – Each Ward & Shift needs to Designate 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)

BCMA Training Lessons Learned Medical Provider Decides to Admit (Either Observation or Inpatient)  Enters(writes) & Signs Delayed Orders Medical Provider Notifies their Assigned RN Assigned RN Notifies Inpatient RN When Patient Arrives on Floor, Inpatient RN Calls Patient Registration with the Patient Room Number and the Patient is Admitted through ADT ADT Admit Releases and will Cancel Delayed Orders Ready or Not!

Go Live Lessons Learned Wall Ports Must be Raised for Accessibility Pyxis Cabinet to Arrive Soon, Consider Location to Accommodate a Terminal to View BCMA Inpatient Medication Delivery System Observation versus Inpatient Medication Administration Process and Documentation Reconfigured Admission Order Screen Use of Text Orders Managing Patient’s Personal Medications

Baseline Statistics Wristbands Medications Count Processed via Scanner 3 %Total Events 100% Scanner By-Pass 0 Keyed Entry (0) Unable to Scan Option (0) 0.0% Total Wristband Scan Events 3 Count Processed via Scanner 0 % Total Events 0% Scanner By-Pass Keyed Entry (1) BCMA Unable to Scan (10) Vista Manual Med Entry (0) 100% Unable to Scan Total Medication Label Scan Events 10

Post Implementation Statistics Wristbands Medications Count Processed via Scanner %Total Events % Scanner By-Pass Keyed Entry ( ) Unable to Scan Option ( ) % Total Wristband Scan Events Count Processed via Scanner % Total Events % Scanner By-Pass Keyed Entry ( ) BCMA Unable to Scan ( ) Vista Manual Med Entry ( ) Total Medication Label Scan Events

Thank You Hospital Leadership! We want to take the opportunity to recognize the outstanding efforts of Yolanda Adams, RN, DON, for her BCMA Team leadership. We also thank the Mescalero Service Unit Leadership for providing financial and human resources, which helped contribute to a highly successful BCMA Training and Implementation