1. Kanakanak Hospital BCMA (IHS PSB 3*42) Deployment Site Visit January 24 – February 5, 2016

2. IHS RPMS EHR Deployment

3. BCMA Inpatient Deployment

4. Kanakanak Hospital BCMA Team Vincent Thrutchley, BSN, RN, BCMA Project Lead & Information Technology Kane Olson, PharmD, BCMA Pharmacy Coordinator Patrick Mahoney, RN, BCMA Nurse Coordinator Johanna Darrough, CIO

5. ANTHC Remote Site Support Carlene McIntyre, PharmD, MPH, Pharmacy Consultant Kimiko Gosney, MS, ANTHC CAC

6. IHS On Site/Remote Cross Functional Team David Taylor, MHS, RPh, PA-C, RN, BCMA Federal Lead, IHS Office of Information Technology Deborah Alcorn, MSN, RN, CPC, BCMA Nurse Consultant, IHS Office of Information Technology Chris Saddler, RN, BCMA Information Technology Consultant, IHS Office of Information Technology via Remote Adobe Connect Mike Allen, MIS, RPh, Pharmacy Informaticist, IHS Office of Information Technology

7. VA Cross Functional Team – Remote Support Cathi Graves, Project Manager, BCRO, OIA, VHA Jonathan Bagby, MSN, MBA, RN-BC, Nurse Consultant, BCRO, OIA, VHA Stephen Corma, BSPharm, RPh, Pharmacist Consultant, BCRO, OIA, VHA Kirk Fox, Clinical 1 Support Team, OI&T, VA Jaculyn Bloch, Clinical 1 Support Team, OI&T, VA

8. VA Cross Functional Team

9. 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 FY 16 – Implementation at 10 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

10. 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

11. 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

12. 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 – 10 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, AZ Ft. Defiance, AZWhiteriver, AZ Gallup, NMShiprock, NM Claremore, OKTahlequah, OK Talihina, OK

13. 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. MU Stage 3 MU Measure is “Topped Out”

14. BCMA Configuration & Test Week One Lessons Learned Pyxis – Profiling and Witnessing ADT Process Changes – L&D, Postpartum, Real-time Discharges Special Situations Policy Orders for Newborn Admissions On Call Orders for Postpartum CIWA Protocol Pharmacy Consultation – Adverse Reaction Tracking System, CIWA Medication Order Sets

15. BCMA Training & Go Live Plan Week Two Sunday – Pharmacy Focus Staff, End User (Nursing Content) 8-12, 1-5 Pharmacy Specific Curriculum Monday – End User (Nursing Content) 8-12, BCMA Coordinator 1-5, End User (Nursing Content) 6-12 Tuesday – End User (Nursing Content) 8-12, End User (Nursing Content) 1- 5, End User (Nursing Content) 6-12 Wednesday – End User (Nursing Content) 1-6 A Total of – 44 Training Hours, 99 Training Encounters, 30 of these were Unduplicated Educational Encounters

16. Kanakanak Pharmacy Training

17. Kanakanak Coordinator & Nurse Training

18. Kanakanak Hospital Training Statistics

19. BCMA Training Lessons Learned ADR – Notification Maintenance Pill Splitting Practice Home Medication Policies (Orders and Storage in Pharmacy) Lidocaine “Remove Order Barcode” IV Fluid/Additives on Override in Pyxis Sharps Container Signs in Medication Room Room 4 Medication Storage (including Multidose Containers) Ward Group CPRS Med Order Button Newborn Admission Process Newborn Policy Note Template

20. BCMA To Do List Standardize Discharge Process Develop Policy & Procedures for Ampule Medications Delineate Methods for Wasting Medications in the Medication Room Identify Medications that Require “Comments” Add Physicians as Pyxis Witness Only Identify Nursing Positions for “PSB Manager” Key “Hide” or Remove Unused Wards from the BCMA Ward Dropdown

21. BCMA To Do List (continued) Identify Acceptable Time Frame for Medication Finish Process (Pipeline and Hospital Pharmacy) – Communicate Realistic Expectations to Inpatient Nursing Staff Consider “Urgent” Drugs (Pitocin) for Override – ER Nurse in Code at Time when OB Nurse Needs Postpartum Hemorrhage Medications High Alert Drugs – If Only 1 “Sound Alike” Drugs on Formulary, can Drug be Removed from the List? Identify the BCMA Functionality for Partial Dose Medication Administration (Edit Med Log)

22. BCMA Policy & Procedures Update Policies & Procedures to Align with BCMA Processes: Each Nurse to View Missed Med & PRN Effectiveness Reports at Specified Shift Intervals Designate BCMA NURSING SUPERUSERS for ongoing BCMA Support & New Employee Orientation Supervisory/Charge Nurse Generating Specified BCMA Reports (Medication Variance, Missed Medications, PRN Effectiveness) Consult with HIM for Approved Barcoded Comments Review Verbal Orders Policy and HIM Approved Abbreviation for CPRS Button

23. Recommendations Integrate BCMA functionality into Medication Safety Performance Improvement Medication Errors to Include Near Misses Unable to Scan PRN Effectiveness Medication Variances

24. Baseline Scanning Statistics Wristbands Count Processed via Scanner 3 %Total Events 100 Scanner By-Pass 0 Keyed Entry 0 Unable to Scan Option 0 0 Total Wristband Scan Events 3 Medications Count Processed via Scanner 2 %Total Events 100 Scanner By-Pass 0 Keyed Entry 0 BCMA Unable to Scan 0 Vista Manual Med Entry 0 0 Total Medication Label Scan Events 2

25. Post Implementation Scanning Statistics Wristbands Count Processed via Scanner 13 %Total Event 100% Scanner By-Pass Keyed Entry 0 Unable to Scan 0 Option Total Wristband Scan Events 13 Medications Count Processed via Scanner 24 %Total Event 96% Scanner By-Pass 1 Keyed Entry BCMA Unable to Scan 1 Vista Manual Med Entry 4% Total Medication Label Scan Events 24

26. Thank You and Good Luck! We want to take the opportunity to recognize the outstanding efforts of the Kanakanak BCMA Team and their Executive Leadership for committing financial and human resources to contribute to a highly successful BCMA Training and Implementation to assure Patient Medication Administration Safety