1. Chinle Comprehensive Health Center BCMA (PSB 3*42) Deployment Site Visit June 9 – June 20, 2014

2. IHS RPMS EHR Deployment

3. BCMA Inpatient Deployment

4. Chinle Comprehensive Health Center BCMA Team Andrew Gentles, PharmD, Chief Inpatient Pharmacist Valerie Cooper, PharmD, Pharmacy Informaticist Nick Bird, BSN, RN, CHTS-CP Nursing Informatics Specialist Renee Chase, BSN, RN, Nursing Informatics Specialist, EHR CAC-BCMA Coordinator Jeanetta Fields, MHA(C),BSN,RN, (A)Nursing Informatics Specialist Rayme Begay, Information Technology Specialist Kathy Ray, CNM, CPCHITPro, Navajo Area CAC Ward and Surgery Supervisory Clinical Nurses

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 Chris Saddler, RN, BCMA Information Technology Consultant, IHS/OIT via Remote Adobe Connect 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, 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

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 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

9. 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

10. 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.

11. BCMA Configuration & Test Week One Cohort Activities Examined BCMA Configuration Delineated Day Surgery and Inpatient Surgical Suite Principles, Practices, and Processes Configured, Tested and Refined ADT, Notes, and Orders to Include Day Surgery and Inpatient Surgical Suite for EHR and BCMA Go-Live (5 Area Cohorts) ADT and EHR Training Go-Live Day Surgery and Inpatient Surgical Suite EHR Friday, June 13

12. BCMA Week Two Training & Go Live Plan Friday & Saturday – Training Preparation and Practice Session (16 Hours) Sunday – Afternoon Nursing Super User Training Session (4 hours) Monday – Morning Nursing Super User Training Sessions (4 hours), Afternoon Super User Training Session (4 hours), Evening Super User Training Session (4 hours) Tuesday – Morning Nursing Super User Training Session (4 hours), Pharmacy Afternoon Training Session (4 hours), Afternoon Super User Training Session (4 hours) – Concurrent Afternoon Training and VA/IHS Cross Functional Team Conference Call with BCMA Cohort Sites Wednesday – Morning BCMA Coordinator (4 hours), Afternoon Nursing Super User Training (4 hours), Afternoon Concurrent Pharmacy Session (4 hours) – Go Live Wednesday Evening – Troubleshooting Thursday – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday and Friday Major Medication Passes (9:00 AM, 5:00 PM, 9:00 PM) 14 hours on Wednesday and 14 hours on Thursday A Total of – 44 Training Hours, 254 Training Encounters, of these 117 were Unduplicated Educational Encounters for CCHC

13. Chinle Comprehensive Health Center Training

14. BCMA Training Statistics

15. BCMA Training Lessons Learned 24 hour Pharmacy and Pharmacy Informaticist Need to Refine & Implement the Policy for Multiple Dose Containers at Patient Bedside IV Medication Labels De-Activate when Ward Transfer Need to Refine ER Medication Administration to Optimize Med Reconciliation for Patient Safety ADT Processes surrounding Surgery need to be Optimized Discharge Instructions, Medications, and Medication Processes Need to be Standardized Between Pharmacy and Surgery

16. 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 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)

17. Go Live Lessons Learned BCMA Awareness for all staff is of Utmost Importance People don’t Read BCMA Implementation Quickly Identified Potential Medication Errors & Variances “Big Bang” Implementation across all wards to include Day Surgery greatly facilitates medication reconciliation & management CPOE in ER setting should be a TOP PRIORITY BCMA Facilitates the 5 RIGHTS to include Right Medication, Right Route & Identifies Appropriate Nursing Medication Administration Practices

18. Baseline Scanning Statistics Wristbands Medications Count Processed via Scanner 107 %Total Events 89% Scanner By-Pass 12 Keyed Entry (0) Unable to Scan Option (12) 10.1% Total Wristband Scan Events 119 Count Processed via Scanner 183 % Total Events 75.9% Scanner By-Pass 58 Keyed Entry (4) BCMA Unable to Scan (12) Vista Manual Med Entry (42) 24.1% Total Medication Label Scan Events 241

19. Post Implementation Statistics Wristbands Medications Count Processed via Scanner 67 %Total Events 93.1% Scanner By-Pass 5 Keyed Entry (0) Unable to Scan Option (5) 6.9% Total Wristband Scan Events 72 Count Processed via Scanner 106 % Total Events 92.2% Scanner By-Pass 9 Keyed Entry (1) BCMA Unable to Scan (7) Vista Manual Med Entry (1) 7.8% Total Medication Label Scan Events 115

20. Thank You & Good Luck! “Patient Safety First, Because Second is Too Late”