1. Gallup Indian Medical Center BCMA (PSB 3*42) Deployment Site Visit April 21 – May 2, 2014

2. IHS RPMS EHR Deployment

3. BCMA Inpatient Deployment

4. Gallup Indian Medical Center BCMA Team Vicky Chavez, PharmD, Pharmacy Director Ray Cope, PharmD, Inpatient Pharmacy Supervisor Kerri Culligan, PharmD, BCMA Pharmacy Coordinator Joshua Valgardson, PharmD, Pharmacy Informaticist, Pharmacy CAC Anna Garcia, RN, Nurse BCMA Coordinator Andrew Ruddle, RN, BCMA Coordinator Adrian Haven, GIMC OIT Supervisor Marcie Platero, RN, Nurse CAC Dawn Dineyazhe, PT, CAC Edward Smith, Information Technology Specialist Harriett Beyuka, 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 Chris Saddler, RN, BCMA Information Technology Consultant, IHS/OIT via Remote Adobe Connect Mike Allen, MIS, RPh, Pharmacy Informaticist, IHS/OIT Wil Darwin, PharmD, National Pharmacy Council Chair

6. VA On Site/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 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

8. 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

9. 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.

10. BCMA Configuration & Test Week One Lessons Learned Admissions Notification of PWB Print Failure Contingency Plan when BCMA is Taken Offline for Planned Maintenance BCMA Shortcut Icons on All User Desktops RPMS Guest Accounts Tested and Working Prior to Onsite Arrival RPMS Primary/Secondary Menu Verification at All Sites All Staff and Guest Pharmacist Accounts Set to Auto Verify Confirm IV Label Printers are Changed Before Orders are Finished to the Test Printers - Pharmacist must Log Off and Back On to Reset Printer Parameters Consistency on how Pharmacy orders are finished Ensure Users have Ability to Enter Policy Orders RPC Broker Allowed through the Firewall Plan Non-Site Specific Meetings to Early in the Week to Allow Friday for Training Preparation

11. 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 and Evening Nursing Super User Training Sessions (4 hours Each), Afternoon Pharmacy Session (4 hours) Tuesday – Morning and Evening Nursing Super User Training Session (4 hours each), Pharmacy Afternoon Training Session (4 hours) Wednesday – Morning and Evening Nursing Super User Training (4 hours each), Afternoon BCMA Coordinator (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 – 48 Training Hours, 325 Training Encounters, of these 181 were Unduplicated Educational Encounters for GIMC

12. Gallup Indian Medical Center Training

13. BCMA Training Statistics

14. Gallup Indian Medical Center Pharmacy Session

15. BCMA Training Lessons Learned BCMA Team and HIM Review, Approve Selected “Comment” Bar Codes prior to training Identify Medication Flow Sheets that may be Replaced with BCMA Medication Therapy Reports prior to training For our staff each trainee have own computer for training (have extra training stations/patients if needed in each session)

16. 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” (e.g., “See Titration Protocol”, Insulin, Lab Values) Per Facility and Provide List for Nurse Users Add links to tools prior to training (ran out of time) Re-addressed nursing student issue – Student needs to be with nurse

17. Go Live Lessons Learned Create small card with steps to review before passing meds for nurses on the floor – Common reports to run – Common troubleshooting techniques Adding links to tools menu in BCMA Nurse in limited access cannot scan PRN range orders (MD needs to include parameters for these and split the orders) Dermatologic items in room Nurses to verify all med orders before administration

18. Go Live Lessons Learned Pharmacy issues – Pop-up frequency for provider comments – Reprinting of labels – Troubleshooting – Dispense drug fields – Flag labels (inhalers, dermatologic) – Possible dosages set up for multiple dose items (syringes, inhalers, etc)

19. Go Live Lessons Learned Administration to be briefed that despite BCMA implemented – “Fun is just beginning” lots of on going work, staff behavior change, and maintenance continues, the need for human and financial resources continues Evaluate processes and protocols in ICU that are impacted by BCMA – VA/IHS CFT to create BCMA ICU Workgroup to examine BCMA Best Practices in the ICU, Women’s Health Create local GIMC workgroups to develop “tips & tricks” e.g. customizing EHR View to streamline the Nurse Verification process

20. Post Implementation Statistics Wristbands Medications Count Processed via Scanner 113 %Total Events 97.4% Scanner By-Pass 3 Keyed Entry (0) Unable to Scan Option (3) 2.6% Total Wristband Scan Events 116 Count Processed via Scanner 218 % Total Events 97.8% Scanner By-Pass 5 Keyed Entry (1) BCMA Unable to Scan (4) Vista Manual Med Entry (0) 2.2% Total Medication Label Scan Events 223

21. Thank You & Good Luck!