1. Use of SuperUsers in EMAR “Go-Live”
Presented by: Trina Allison, RN, MSN
Clinical Educator

2. Objectives
Discuss how Memorial Hermann is committed to excellence by their brand promise
Describe how the organization’s behavioral expectations of accountability, innovation, collaboration, and competence resulted in successful implementation of eMar
Discuss why identifying SuperUsers are important to the planning and implementation of Informatics
Identify methods used to keep SuperUsers up-to-date with upcoming changes of eMar

3. Leadership “Breakthroughs Everyday” Vision: “Best of the Best”
Brand Promise: “We create the best possible clinical outcomes with exceptional patient care experiences”

4. Leadership - Accountability - Innovation - Collaboration - Compassion
Behavioral Expectations
- Accountability
- Innovation
- Collaboration
- Compassion
- Competent
- Respectful

5. Teamwork Memorial Hermann partners working
What is teamwork?
Memorial Hermann partners working
together to achieve a common goal: “Successful implementation of eMar”
Building your “dream team”
“The collaboration and cooperation of Memorial Hermann partners being accountable for the successful implementation and innovation of electronic documentation (eMar)”

6. Teamwork Identifying the SuperUsers
- The “go-to” person that is able to answer questions, trouble-shoot, and problem-solve during implementation of eMar
- Those individuals with “Star Power” that are identified in each unit to assist ISD with implementation
- All Clinical Educators identified as SuperUsers to provide continued education to new partners entering the organization

7. Informatics/eMar Preparation - Train-the-trainer (SuperUser)
Four hours of user training combined
with ‘trouble-shooting’ techniques to
ease the transition to implementation
Hospital educators were all designated
SuperUsers in addition to unit-based
designees

8. Informatics/eMar Preparation - Hospital-wide: Two hour sessions for
clinical staff. SuperUsers conducted
several education sessions to increase
their knowledge and confidence.
Accountability and Competence
99% of nursing staff and 100% of
pharmacy and RT staff completed formal
training!

9. Informatics/eMar “Go-Live” is here Saturday, February 12, 2006!
- eMar News Team Updates
Daily updates and reminders
regarding order-entry and retrieval
- SuperUsers daily de-briefings at the
command center
Collaboration with ISD and SuperUsers
to ensure implementation was going smoothly,
to receive daily updates, and answer call-in
questions

11. HH & HCH eMAR News
eMAR/PAL Help -ASK Your Superuser or call 45370!
MHHS Team Update
February
Day 10
Process Meetings:
Pediatric Bracelets – Product search in Progress
RT Wireless – in Progress – Next meeting Wednesday 2:30
Plan for Adult Dialysis – in Progress
End of Shift Reminders:
Orders to Review
Overdue medication tasks

12. Using the Active Intervention sheet
eMAR/PAL DAY 11!
Using the Active Intervention sheet

13. Two Main Purposes of the Active Intervention Sheet
Review orders and medication times during nursing report
2. Reconcile orders with the 24 hour chart checks

14. “Please give on eve shift. Pt is still in X-ray”
Report Time
Off-going nurse -
With the PAL open, Report any scheduling changes that need to be communicated to the next shift
Ex – Patient’s afternoon dose still needed after 3pm because patient is in x-ray.
“Please give on eve shift. Pt is still in X-ray”

15. Report Time On-coming nurse
Circle doses due for your shift by the times indicated to help create a Pyxis pull list

16. Challenges of Implementation
SuperUsers had dual roles -
Some were assigned to patient care in
addition to SuperUser
Some SuperUsers were less than novice
with computer applications and navigation
Some SuperUsers did not demonstrate
the commitment necessary to facilitate a smooth implementation

17. Overcoming the Challenges
ISD staff was visible in all units with the
assistance of the clinical educators who
were dedicated SuperUsers in the units
ISD staff and clinical educators were on the units to assist and answer questions for those less than novice SuperUsers
ISD staff and clinical educators demonstrated the dedication and commitment necessary by assisting those who were less committed to the role of SuperUser

18. Technical Challenges During “Go-Live”
Staggered medication administration times – Revised staggered medication times to achieve standardized administration times
Follow-up and completion of ‘PRN response’ – All PRN medications need a response to be documented

19. HOW TO STAGGER MEDICATION ADMINISTRATION TO
REHAB
HOW TO STAGGER MEDICATION ADMINISTRATION TO
ACHIEVE STANDARDIZED ADMINISTRATION TIMES
1.FIND first dose time FIND administration interval standard INTERSECT time next dose per schedule
Once you achieve a BOLD time you are back on standardized administration times
FIRST dose
time
Q 4 hr
0400, 0800, 1200
1600, 2000, 2400
Q 6 hr
0800,1400
2000, 0200
0600, 1200
1800, 2400
Q 8 hr
0800,1600
2400
Q 12 hr
0800, 2000
0700
0700, 1200
0700, 1400
0700, 1200
0700, 1600
0700, 2000
0800
0800, 1200
0900
0900, 1300, 1600
0900, 1400
0900, 1300, 1800
0900, 1600
0900, 2000
1000
1000, 1300, 1600
1000, 1500, 2000
1000, 1400, 1800
1000, 1700, 2400
1000, 2000
1100
1100, 1600
1100, 1600, 2000
1100, 1800
1100, 1800, 2400
1100, 2000
1200
1200, 2000
1200, 1800, 2400
1200, 2200, 0800
1300
1300, 1700, 2000
1300, 2000
1300, 1800
1300, 1800, 2400
1300, 2200, 0800
1400
1400, 1700 , 2000
1400, 2000, 2400
1400, 2300, 0800
1500
1500, 2000
1500, 2000
1500, 2000, 2400
1500, 2400
1500, 2400, 0800
Revised Chi Peyton, Pharm D

20. Post “Go-Live” Monthly meetings with ISD and SuperUsers
Continued collaboration with ISD and SuperUsers to discuss eMar changes and updates
eMar updates to staff
ISD’s continued commitment to respond to the concerns of the staff to improve eMar on the end-user side

21. Post “Go-Live” Update We heard your requests,
eMAR Update 5/18/2006
We heard your requests,
There are some changes you should be seeing as you work with eMAR.
For acute MI patients Aspirin and Plavix will be scheduled to start the day they are ordered.
Golytely will no longer appear on eMAR as 240cc q 10 minutes. It will appear as a one time dose with a note in the comment section “give 240 ml every 10 minutes.”
New medication orders: if the physician or nurse puts the time they need to give the med the pharmacy will schedule that time.

22. Post “Go-Live” Reminder
We are working with units to make sure the eMAR process provides quality safe care for our patients and is efficient for our clinicians.
I will be sending out helpful hints each week to improve our process.
TOP TEN REMINDERS for eMAR
1. Patient Safety! Patient’s armbands need to be scanned prior to giving medications. This will decrease medication errors.
2. All PRN medications need a response to be documented.
3. Clean up all tasks and orders to review from your list by end of your shift.
4. Use the medication request on the computer for medications needed in 2-3 hours. This allows you to not have to leave your patient and call pharmacy.
5. Enter all RT orders except vent changes in the computer and D/C them in the computer. (Under orders)
6. Do not forget to log off your computer before leaving it. You do not want anyone to document under your sign on.
7. Clean your COW each shift and PRN with a hospital approved disinfectant except the screen use alcohol for the screen.
8. Reconcile your medications and orders from the original written order and the AI.
9. All problems go through the support center Contact Margie or your manager with any process issues.
10. The teamwork and communication between pharmacy, nursing, RT, physicians, and IS was and is the key to our success.

23. Post “Go-Live” SuperUser Update Meeting
We want to hear from you !!
Join us for the Super Users Meeting to improve Workflows and Processes.
Stay Updated !!
Get information on various IS initiatives that will affect your department.
SuperUser Meeting 5/31/2006

24. In Conclusion
The successful implementation of eMar depended on the collaboration of hospital leadership, ISD, and the clinical staff
SuperUsers play an integral role in implementation because they remain in the facility post go-live to help facilitate changes and updates and educate new partners