1. Cherokee Indian Hospital Authority BCMA (V 3.0) Site Visit July 14 – 18, 2013 Cherokee, NC

2. Background 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.

3. Bar Code Medication Administration Assistive (BCMA)Technology BCMA assistive technology is a software application used by the Veterans Health Administration (VHA) facilities to document medication administration activities and reduce medication errors. The VHA Bar Code Resource Office (BCRO) has developed a structured process for performing usability assessments of new features to assure successful adoption by end-users.

4. Purpose of BCMA (V 3.0) Training BCMA is an integral part of the EHR. Nurses administer medications, including IV piggyback medications and IV large-volume medications through BCMA. All information is documented with a time stamp for improved accuracy of clinical information. The documented information is available throughout the facility to any clinician, pharmacist, as part of the patient’s health record.

5. Purpose of Training (cont.) Pharmacy and nursing staff must collaborate closely with information management staff if the medication administration arm of the system is to work optimally. Rapid computer response time is crucial to the success of a computerized medication administration system. The purpose of this week’s training is to provide BCMA training to the BCMA Super Users and Pharmacy staff.

6. VA/IHS/CIHA/CNHSA Teams

7. VA/IHS On Site Cross Functional Team Cathi Graves, Sr. Mgmt Analyst, BCRO (OIA), VHA David Taylor, BCMA Federal Lead, (OIT), IHS Jonathan Bagby, Nurse Consultant, BCRO, OIA, VHA Deborah Burkybile, BCMA Nurse Consultant, OIT, IHS Kirk Fox, Clinical 1 Support Team, OIT, VA

8. VA/IHS On Site Cross Functional Team Phil Taylor, BCMA Nurse Consultant, MSC Contractor Jan Zeller, BCMA Educ. Project Mgr, (EES), VA Daphen Shum, Pharmacy Consultant, Perry Point, Maryland, VHA Robin Bartlett, CAC, Pharmacy Consultant, Nashville Area Office, IHS Remote (via Adobe Connect) VA OIT, VHA SME, and IHS OIT staff members

9. Training Activities Sunday – BCMA Configuration, Test, and Training Preparation Monday – Morning and Afternoon Super User Training sessions (4 hours each) Tuesday – Morning, Afternoon, and Evening Super User Training Sessions (4 hours each) Wednesday – Morning BCMA Pharmacy Training, Afternoon BCMA Coordinator Training. Go Live Wednesday afternoon and evening

10. Training Activities Thursday – AM Debriefing, Pharmacy Training Morning and Afternoon (2 hours each) Go Live and Troubleshooting Continues throughout Thursday until Closeout at 4:30 A total of 35 CIHA Nursing and Pharmacy staff attended training and including remote attendees a total of 57 participants received training

11. BCMA (V3.0) Go Live July 17, 2013

12. Findings & Recommendations Time studies for medication administration processes to compare to VA benchmarks Cherokee BCMA Team to meet weekly to discuss Scanning Failures and troubleshooting Consider extending BCMA and workstation timeout (obtain nurse recommendations) Pharmacists to shadow Nurse medications administration

13. Findings & Recommendations (cont.) Nurses to shadow Pharmacist during medication order finishing process Define the Nurse Verification Process/Policy Define process for achieving and maintaining Pharmacy competence in the use of the Inpatient Medication Package to support BCMA Provide Omnicell inventory contents to Contract Pharmacist in assist with finishing medication orders accurately

14. Findings & Recommendation IT provide ongoing Error Trap monitoring Identify a FT Inpatient Pharmacist