1. Zuni Comprehensive Health Center BCMA (IHS PSB 3
Zuni Comprehensive Health Center BCMA (IHS PSB 3*42) Deployment Site Visit
June 1 – June 6, 2015

2. IHS RPMS EHR Deployment

3. BCMA Inpatient Deployment

4. Zuni Comprehensive Health Center BCMA Team
Rebecca Grizzle, RD, Project Manager
Erica Harker, PharmD, Director of Pharmacy
Benjamin Le, PharmD, Pharmacy CAC
Terry Kanesta-Brislin, BSN, RN, DON, BCMA Coordinator
Melanie Romancito, CAC
Roxanne Salvador, IT
Keith Martinez, IT
Wil Darwin, PharmD, (A) CEO, Albuquerque Area CAC

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 (Remote)
Mike Allen, MIS, RPh, Pharmacy Informaticist, IHS/OIT

6. VA On Site 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 (Remote)
Stephen Corma, BSPharm, RPh, Pharmacist Consultant, BCRO, OIA, VHA

7. VA/IHS BCMA CFT 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

11. 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 – 3 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, AZ Whiteriver, AZ
Gallup, NM Shiprock, NM
Claremore, OK Tahlequah, OK
Talihina, OK

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
Printer Naming Convention
Transfer and Release Events
From L&D  Obstetrics  GMS
Allowed an Interward Transfer to follow an Interward Transfer (Previously could only move patient once)
Pharmacy “Auto Verify” Activated for All Pharmacists
CPRS Medication Order Button was Tasked
BCMA Parameter Default Answer List was Incomplete

14. BCMA Training & Go Live Plan
Monday – Configuration and Test (8 Hours)
Tuesday – Training Preparation and Practice Session (9 Hours)
Wednesday – Morning Pharmacy Training (4 Hours), Afternoon Nursing Super User Session (4 Hours), Evening Nursing Super User Session (4 Hours)
Thursday – Morning BCMA Coordinator Session (4 Hours), Afternoon Nursing Super User Training Session (4 Hours), Evening Nursing Super User Session (4 Hours)
Go Live Thursday Morning at 11:30 AM
Go Live Support and Troubleshooting Continued Simultaneous to Training and Over to Nursing Night Shift
Friday – Morning Nursing Super User Session (4 hours), Afternoon Nursing Super User Training Session (4 hours)
Troubleshooting Throughout Evening
Saturday – Debriefing, Go Live and Troubleshooting Continues Throughout Saturday Major Medication Passes (0900 and 2100, as well as other medication med passes scattered throughout the day) ~12 hours on Friday and ~12 hours on Saturday
A Total of – 32 Training Hours, 120 Training Encounters, of these 53 were Unduplicated Educational Encounters

15. Zuni Comprehensive Health Center Training

16. Zuni Comprehensive Health Center Training Statistics

17. BCMA Training Lessons Learned
Documentation of IVs Needs to be Standardized for Both Nursing and Coders
Start Time, Stop Time, and End Time Documentation for IV infusions needs to be Clarified for Both Nursing and Coders
POC Blood Glucose Values are Not Entered into EHR via POC Button
At a Minimum Enter Blood Glucose Values into EHR via the POC Button for SS Insulin Doses

18. BCMA Training Lessons Learned
Both Sliding Scale and PRN Insulins are Confusing for Nurses
Standardizing ALL insulin sliding scales via P&T committee
The “Scanner Barcode Fix” was Added to the BCMA “Tools” Menu
Inpatient Birth Control – Nexplanon Process to be delineated and Pharmacy will scan the Contraceptive into BCMA and Add Comment: “Dispensed to (Provider)”
Medical Provider Education needs to be provided so Nexplanons removed from the pharmacy are scanned into BCMA by a pharmacist to ensure adequate Medication documentation.

19. BCMA Training Lessons Learned Pharmacy Issues
Hospital Supplied Meds (HSM) Functionality to be Examined and Clarified by Policy (i.e. lanolin in breastfeeding moms, clotrimazole cream, hydrocerin lotion, etc)
Standardize a Multidisciplinary Policy & Procedure for Patient Supplied Medications to be Examined by Pharmacy and Packaged for Medication Cart and Scanning
Numerous Old Pending Orders in ^OTHER Queue
Cleanup Task Queued to Run Daily
List was Reduced from over 50 obsolete medication orders to 12
Pharmacy will review Remaining Obsolete Medication Orders and Discontinue as Appropriate

20. BCMA Training Pharmacy Issues
Define:
NOW dose time frame
ONCE (ONE TIME) dose frame
Self administered Insulin must be re-educated with Nursing Staff that stock supply insulins cannot be shared
Re-Orient Staff on Pharmacy Call-Back Policy
Re-educate Standard Time Schedules (i.e. meal times, dialysis, weekly meds, etc)

21. BCMA Training Pharmacy Issues
Education:
Delayed orders do not include NOW doses
Separate order will be required for a NOW dose
Refer back to education on Standard Times
After hour medications need to be removed from the Inpatient Night Cabinet
Stock bottles removed from outpatient pharmacy will not scan in BCMA
Overall Clinical Education: NO PAPER MARs
Find info on Med Admin History (EHR)

22. BCMA Training Pharmacy Issues
After hour use Folder
Insulin labels, common cream labels, etc
Will be located on top of the Med Cart in a Cardex
Needed Items
Move IV infusion label Aztec Bar Scan to upper right hand corner to prevent smearing and unreadable bar codes
Utilizing MAR label printer as an alternate to the WASP system

23. 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)

24. Go Live Lessons Learned
BCMA GUI Not Installed On All Nurse Workstations
Lack of Standard Medication Administration Schedule Times – Medication Administration Time was Scattered Throughout all Shifts
Workstations On Wheels (WOWS) will be used in some Patient Rooms since Wall Cabinets have not arrived
WOWs do not all have Scanners Attached, one WOW had a Scanner but it was not Ported

25. Go Live Lessons Learned
Equipment – West Side Rooms have Work Stations in Rooms but No Place for Scanner
Limited work space in the West Rooms along with infection control concerns
Printed Virtual Due Lists need to be SHREDDED After Each Med Pass
Practice what we were taught this week

26. Baseline Statistics 6/4/15@1200 to 6/5/15@0900
Wristbands
Medications
Count
Processed via Scanner
%Total Events
100%
Scanner By-Pass 0
Keyed Entry (0)
Unable to Scan Option (0) %
Total Wristband Scan Events 14
Count
Processed via Scanner
% Total Events
90.0%
Scanner By-Pass 3
Keyed Entry (0)
BCMA Unable to Scan (0)
Vista Manual Med Entry (3)
10%
Total Med Label Scan Events
100%

27. Post Implementation Statistics 6/5/15 @ 2000 to 6/6/15 @ 2100
Wristbands
Medications
Count
Processed via Scanner
%Total Events
97.8%
Scanner By-Pass
Keyed Entry (0)
Unable to Scan Option (1)
2.2%
Total Wristband Scan Events 45
Count
Processed via Scanner 76
% Total Events
98.7%
Scanner By-Pass
Keyed Entry (0)
BCMA Unable to Scan (1)
Vista Manual Med Entry (0)
1.3%
Total Medication Label Scan Events 77

28. Thank You Hospital Leadership
We want to take the opportunity to recognize the outstanding efforts of the Zuni 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.