1. Northern Navajo Medical Center BCMA Deployment Site Visit “No Nurse Left Behind” May 12 – May 23, 2014

2. IHS RPMS EHR Deployment

3. BCMA Inpatient Deployment

4. Northern Navajo Medical Center BCMA Team Clint Krestel, PharmD, Inpatient Pharmacy Supervisor Kendall Van Tyle, PharmD, BCPS, Pharmacy Informaticist Farrah Smiley, BSN, RN, Med/Surg Nurse Supervisor, BCMA Coordinator Harriet Jones, BSN, RN, Med/Surg Clinical Coach Nicola Pierce, MSN, RN, Pediatric Nurse Supervisor, BCMA Coordinator Regina Thompson, BSN, RN, ICU Nurse Supervisor, BCMA Coordinator Gary Russell-King, Chief, Health Information Manager Marilyn Bowman, CRT, RT Supervisor Lilita Burton, Registration Supervisor Neil Fischer, BS, MT(ASCP), Hospital CAC Darlene Begay, Information Technology Specialist Sharon Bekis, Information Technology Specialist Arlin Bekis, Information Technology Specialist Sam Namoki, Information Technology Specialist Lilly Benally, Information Technology Specialist Kathy Ray, CNM, CPCHITPro, Navajo Area CAC

5. 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 Phil Taylor, BA, RN, Medsphere Corporation Chris Saddler, RN, BCMA Information Technology Consultant, IHS/OIT via Remote Adobe Connect Mike Allen, MIS, RPh, Pharmacy Informaticist, IHS/OIT Cecelia Rosales, BCMA Analyst, Contractor Data Networks Corporation

6. IHS OIT BCMA Team

7. 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

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 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

10. Special Thanks To Michael Belgarde, CIO, Navajo Area IHS Kerri Culligan, PharmD, GIMC Josh Valgardson, PharmD, GIMC Andrew Ruddle, RN, BCMA Coordinator, GIMC Anna Garcia, RN, BCMA Coordinator, GIMC Nick Bird, RN, BCMA Lead, CCHCF Andrew “G-Status” Gentles, PharmD, BCPS, CCHCF Valerie Cooper, PharmD, BCPS, CCHCF Jeanetta Fields, BSN, RN, BCMA Coordinator, CCHCF Renee Chase, BSN, RN, BCMA Coordinator, CCHCF

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 Services Staff if the Medication Administration Arm of the System is Work Optimally

12. 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.

13. BCMA Configuration & Test Week One Cohort Activities Configured Day Surgery as a Ward, will require Admission/Discharge Process Changes Configured Inpatient Surgical Suite as Ward to Accommodate Transfers between Inpatient Wards and Surgery Resulting in Auto Discontinue of Orders and Use of Delayed Orders Possible in Day Surgery and Inpatient Surgery BCMA now Available for Use in Day Surgery and Inpatient Surgery, thereby Increasing Patient Medication Safety through Medication Reconciliation Chris Saddler Facilitated Cohort Installation of RPMS Report Routines Parallel Drug-File Cleanup & Configuration

14. BCMA Week Two Training & Go Live Plan Friday & Saturday – Training Preparation and Practice Session (16 Hours) Sunday – Morning Nursing Super User Training Sessions (4 hours), Afternoon Pharmacy Session (4 hours) Monday – Morning Nursing Super User Training Sessions (4 hours), Afternoon Pharmacy Session (4 hours), Afternoon BCMA Coordinator (4 hours) Tuesday – Morning Nursing Super User Training Session (4 hours), Pharmacy Afternoon Training Session (4 hours) Wednesday – Morning Nursing Super User Training Session (4 hours each), Afternoon Pharmacy Session (4 hours) – Go Live Wednesday Evening – Troubleshooting Thursday – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday and Friday Major Medication Passes (10:00 AM, 5:00 PM, 10:00 PM) 14 hours on Wednesday and 14 hours on Thursday A Total of – 36 Training Hours, 195 Training Encounters, of these 95 were Unduplicated Educational Encounters for NNMC

15. Northern Navajo Medical Center Training

16. BCMA Training Statistics

17. BCMA Training Lessons Learned BCMA Team and HIM Review, Approve “Comments” Identify/Delineate Pharmacy Processing of PreOp Medications for Timely Administration Titration of Pain Medication Syringes in Day Surgery and Standardized Practices Consider use of “Cheat Sheet” to complete steps for Special Medication Scanning Processes (insulins, ointments, etc)

18. BCMA Training Lessons Learned Update Policies & Procedures to Align with New BCMA Processes: – 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 (Missed Medications, PRN Effectiveness) Impact of Multiple-use Medications on Infection Control/possible use of Hospital Supplied – Self Administered Medications – Need for Best Practice

19. Go-Live Medical Surgical Ward “The Insulin Brigade”

20. Go-Live Lessons Learned No Training Plan for Respiratory Therapy Contractor Training Multi-Dose Containers and Infection Control (creams & inhalers) Need for Sufficient “At-the-elbow” Support Immediate & Well Identified IT Support Ensure Enough Carts/Equipment for Go-Live

21. Go Live Lessons Learned Use of the “IV Status Report” in a Consistent Manner Early Communication to the Staff Regarding Goals & Impact of BCMA Project Ensuring Competency of Contract Providers Staff Who do Not Attend Planned Trainings Require Disproportionate “At-the-elbow” Support

22. Baseline Scanning Statistics Wristbands Medications Count Processed via Scanner 13 %Total Events 65% Scanner By-Pass 7 Keyed Entry (0) Unable to Scan Option (7) 35% Total Wristband Scan Events 20 Count Processed via Scanner 27 % Total Events 90% Scanner By-Pass 3 Keyed Entry (1) BCMA Unable to Scan (2) Vista Manual Med Entry (0) 10% Total Medication Label Scan Events 30

23. Post Implementation Statistics Wristbands Medications Count Processed via Scanner 29 %Total Events 100% Scanner By-Pass 0 Keyed Entry (0) Unable to Scan Option (0) 0% Total Wristband Scan Events 29 Count Processed via Scanner 79 % Total Events 96.3% Scanner By-Pass 3 Keyed Entry (1) BCMA Unable to Scan (2) Vista Manual Med Entry (0) 3.7% Total Medication Label Scan Events 82

24. Thank You & Good Luck!