1. Santa Fe Service Unit BCMA (IHS PSB 3*42) Deployment Site Visit June 13 – June 16, 2015

2. IHS RPMS EHR Deployment

3. BCMA Inpatient Deployment

4. Santa Fe Service Unit BCMA Team Lisa Palucci, MSN, RN, Chief Nurse Executive, BCMA Project Manager, BCMA Coordinator Deborah Simmons, BSN, MBA, Nurse Supervisor, BCMA Coordinator Kyle Sheffer, PharmD, CAC, BCMA Coordinator Luke Tenorio, IT, BCMA Team Member Gary Bitsoie, IT, BCMA Team Member Wil Darwin, PharmD, (A) CEO, Albuquerque Area CAC & Pharmacy Consultant

5. IHS On Site 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

6. 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

7. VA Cross Functional Team

8. 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 5 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

9. 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

10. 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. 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 and Test IV Label, Patient Wristband, and Report Printer Configuration Remove Insulin Template from the Order Menu Mobile Workstations on Wheels Not Delivered as of this Date All Scanners Available and Used during Training Wireless Connectivity is Not an Option at this Time

14. BCMA Configuration & Test Lessons Learned Pharmacy Staffing – 5 Pharmacists: 2 Pharmacists Assigned to Satellite Clinics, leaving 3 Pharmacists for Santa Fe Limited Pharmacy Staffing Hours – RN Finish in Place at Santa Fe for Medications Ordered after 6:00 PM and Weekends On Call Pharmacist Available Pharmacy Silo Low Census – Nurses May Forget BCMA Functionality & RN Finish Process

15. BCMA Training & Go Live Plan Saturday – Configuration and Test (7 Hours), Training Preparation and Practice Session (7 Hours) = 14 Hours – Go Live Saturday Afternoon at 3:30 PM Sunday – Morning Pharmacy Training (4 Hours), Afternoon BCMA Coordinator Session (4 Hours), Evening Nursing Super User Session (4 Hours) = 12 Hour + Go Live Troubleshooting Time Continues to Nursing Night Shift Morning Nursing Super User Session (4 Hours), Afternoon Nursing Super User Training Session (4 Hours) – Go Live Troubleshooting Throughout Evening Tuesday – HIM/Business Office BCMA Review, Debriefing, Go Live and Troubleshooting Continues Throughout Tuesday Major Medication Passes ( 9 AM, Noon/1pm, 9 PM) 14 hours on Monday and 6 hours on Tuesday A Total of – 20 Training Hours, 40 Training Encounters, of these 18 were Unduplicated Educational Encounters

16. Santa Fe Service Unit Training Statistics

17. Santa Fe Service Unit Training

18. BCMA Training Lessons Learned Delineate the Start Time for Antibiotics Administered in Urgent Care for Patients Being Admitted to Inpatient Recommend all Pharmacists ‘Shadow’ Nurses for 9am Med-pass, Insulin Administration, & IV/IVPB Pharmacy Must Collaborate with Nursing for Safe Inpatient Medication Administration Recommend Giving Inpatient Pharmacists the “PPW” Option to Print Demo Patient Wristbands to Troubleshoot and Test Medication Barcodes Pharmacy must Integrate the Use of BCMA into their Inpatient Pharmacy Workflow

19. BCMA Training Lessons Learned Access & Permissions were Lacking Multi-Dose Medication Containers Processes Should be Delineated Home Supplied Medications Processes Provider Training Regarding Standardization of Sliding Scale Insulin Orders ‘Now’ versus ‘Continuous’ Orders (Standard Administration Times) HIM to Collaborate with Nursing for Optimal Billing Opportunities & Appropriate Comments and Abbreviations

20. BCMA Training Lessons 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 Due List, 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)

21. Baseline Statistics 6/1315 @ 1500 to 6/13/15 @ 1900 Wristbands Medications Count Processed via Scanner 0 %Total Events 0% Scanner By-Pass 2 Keyed Entry (0) Unable to Scan Option (2) 100% Unable to Scan Total Wristband Scan Events 2 Count Processed via Scanner 1 % Total Events 50.0% Scanner By-Pass Keyed Entry (0) BCMA Unable to Scan (1 ) Vista Manual Med Entry (0) 50.0% Total Medication Label Scan Events 2

22. Post Implementation Statistics Wristbands Medications Count Processed via Scanner %Total Events 4 % Scanner By-Pass Keyed Entry ( ) Unable to Scan Option ( ) 100 % Total Wristband Scan Events4 Count Processed via Scanner % Total Events 100 % Scanner By-Pass Keyed Entry ( ) BCMA Unable to Scan ( ) Vista Manual Med Entry ( ) 0 Total Medication Label Scan Events15

23. Thank You Hospital Leadership! We want to take the opportunity to recognize the outstanding efforts of Lisa Palucci, BCMA Project Manager for her BCMA Team leadership. We also thank the Santa Fe Service Unit Leadership for providing financial and human resources, which helped contribute to a highly successful BCMA Training and Implementation