1. Claremore Indian Hospital BCMA (PSB 3*42) Deployment Site Visit
February 24 – March 7, 2014

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. What is Bar Code Medication Administration (BCMA)?
BCMA is an Assistive Technology Software Application Developed and Used by the Veterans Health Administration (VHA) Facilities to Document Medication Administration Activities and Reduce Medication Errors
The VHA Bar Code Resource Office (BCRO) provides bar code verification services to IHS for wristbands and drug products that will not scan at the point of care and provide test results to the submitting facilities
The BCRO has Developed a Structured Process for Performing Usability Assessments of New Features to Assure Successful Adoption by End-Users
BCMA is a Component of the RPMS-EHR Certified Electronic Health Record

4. How is BCMA Used?
BCMA is an Integral Part of Patient Safety – Nurses Administer Unit Dose Medications, Including IV Piggyback Medications and IV Large-volume Medications, through BCMA
All Information is Documented with a 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 to Work Optimally

5. Claremore Indian Hospital BCMA Team
Jodi Tricinella, PharmD, Pharmacy BCMA Coordinator
Cindy O’Mary, ADN, RN, Nursing BCMA Coordinator
Cory Wilton, DPh, Pharmacy/Informaticist
Marty Smith, DPh, Clinical Applications Coordinator (CAC)
Tammy Wampler, BSN, RN, Chief Nurse Executive
Jim Smith, Information Technology Specialist
Jamie Rhodes, Patient Registration Director
Cindy Cates, Asst. Director, Health Information Management Systems (HIMS)
Peggy Shults, Director, Health Information Management Systems (HIMS)
Kelly Battese, PharmD, Ambulatory Care Director
David Ponder, Information Technology Director
Danna Roberts, ADN, BCMA Super User
Walter, DeLong, BSN, BCMA Super User
Michael Lee, PharmD, Pharmacy Director
Nancy Welch, Respiratory Therapy

6. Oklahoma Area BCMA Team
Amy Rubin, PharmD, CHTS-IS, MMI, Area Clinical Applications Coordinator (CAC), Area Meaningful Use Coordinator
Max Burchett, PharmD, Area Pharmacy Informaticist
Tracie Patten, PharmD, Area Pharmacy/Lab Consultant
Rebecca Loving, MS, RN Area Nurse Consultant
Robin Thompson, MS, APRN, CNS, Asst. Clinical Applications Coordinator (CAC)
Charles Cross, CMA, CSM, MCP, Area Information Technology Specialist
Jonathan Lambeth, Information Technology Specialist

7. VA Remote Cross Functional Team
Cathi Graves, Project Manager, BCRO, OIA, VHA
Kirk Fox, Clinical 1 Support Team, OIT, VA
Randall Baylis, BSBA, 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, VA EES
Daphen Shum, BSPharm, RPh, Pharmacy Supervisor, Perry Point, MD, VAMC
Stephen Corma, BSPharm, RPh, Pharmacist Consultant, BCRO, OIA, VHA
Hugh Scott, MS, RNC, VHA Management & Program Analyst, Washington, DC, IHS/VHA Interagency Liaison
Barbara Connolly, Clinical 1 Support, OIT, VA

8. 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
Phil Taylor, BA, RN, BCMA Nurse Consultant, MSC Contractor
Chris Saddler, RN, BCMA Information Technology Consultant, IHS/OIT via Remote Adobe Connect
Wil Darwin, National Pharmacy Council Chair
Northern Navajo Medical Center BCMA Team – Remote
Gallup Indian Medical Center BCMA Team – Remote
Chinle Comprehensive Health Care Center BCMA Team – Remote
Pine Ridge IHS Hospital BCMA Team – Remote

9. 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

10. Configuration & Test Lessons Learned
Obstetrics/Newborn Wards and Beds Configured to Align with the Baby Friendly Hospital Initiative
Inpatient Medication for Outpatient (IMO) for Obstetric Triage
Wrist Band Printing
Increased Omnicell Time Interval to Allow for Medication Availability

11. Day Surgery
Used Observation Rules as a Guide for Configuration of Day Surgery to Facilitate Use of Delayed Orders, BCMA, and Safety during Transition of Care
Created Day Surgery Ward
Created New Day Surgery Specialty
Created New Day Surgery Treating Specialties
Configured ADT for New Day Surgery Ward
Programming Changes to Screen Day Surgery Patients from Inpatient Census Reports
BCMA Utilization Pre-op Medications will require additional Pharmacy Coverage

12. Claremore Indian Hospital Training

13. Training Activities
Friday – Training Preparation and Practice Session (10 Hours)
Sunday – Afternoon Super User Training Sessions (5 hours)
Monday – Morning and Afternoon Super User Training Sessions (4 hours Each)
Tuesday – Morning Super User Training Session (4 hours), Afternoon BCMA Pharmacy Training Session (4 hours), Evening Day Surgery Planning Session (3 hours)
Wednesday – Morning and Evening Super User Training (4 hours Each), Afternoon BCMA Coordinator/RN Finish Key Training (4 hours)
Go Live Wednesday Evening
Troubleshooting
Thursday – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday and Friday Major Medication Passes (9:00 AM & 9:00 PM) 14 hours on Wednesday and 14 hours on Thursday
A Total of – 202 Training Encounters, of these 76 were Unduplicated Educational Encounters
Fifty percent (50%) Claremore Indian Hospital Pharmacy/ Nursing staff members who participated in the training will process/administer medications.

14. Claremore Indian Hospital Training Statistics
Participants
Sunday
Super User 3/2/14
1 Session
Monday
Super User
3/3/14
2 Sessions
Tuesday
Pharmacy
3/4/14
Afternoon
Morning
Wednesday
3/5/14
& 2 Sessions BCMA Coord
Total
Claremore IHS 12 25 10 44
103
Cherokee Nation 4 3 11
OKC Area 2 5 8 21
OIT 32
VHA/VA 18
I/T/U Remote 1 17 59 26 74
202

15. BCMA Training

16. BCMA Training Lessons Learned
Active engagement of House Supervisors and BCMA Coordinators is REQUIRED
Nursing Verification of Medication Orders in EHR
RN Finish Key Process and Order Verification Process in EHR must be carefully Understood and Delineated
Provide “At the Elbow” Support for Generating Reports (Due List, Missed Medication, PRN Effectiveness) Marking Medications and Adding Comments
Provide Orientation to WOWS, Battery Packs, Sign-ins

17. BCMA Training Lessons Learned
Create Policies & Procedures to Align with New BCMA Processes:
Each Nurse to View Missed Med & PRN Effectiveness Reports at Specified Shift Intervals
Timely Medication Administration
Update Omnicell Medication Override Policy/Procedure
BCMA Competency Evaluation
Policy/Procedure for RN Finish Key and RN Order Verification in EHR
Accurate Medication Order Verification Process

18. Go Live Lessons Learned
Place Generic Log-on and Comment Scan Sheet on WOWS
Nursing to Use Due List to Obtain Medications from Omnicell
Nursing to Keep Virtual Due List Time Parameters Narrow
Each Nurse and Nurse Supervisor to View Missed Medications and PRN Effectiveness Reports at Specified Shift Intervals

19. Go Live Lessons Learned
ER Medications are on Paper Resulting in Difficult Medication Reconciliation with High Risk for Errors
BCMA Requires Real Time ADT
Incorporate BCMA Reports in Medication Error Review Committee and Root Cause Analysis Meetings and other PI activities
Claremore BCMA Team to Meet Weekly to Discuss Scanning Failures/Troubleshooting and Provide Feedback to All Clinical Staff

20. Post Implementation Statistics
Wristbands
Medications
Count
Processed via Scanner
%Total Events
95%
Scanner By-Pass 4
Keyed Entry (3)
Unable to Scan Option (1) 5
3.8
1.3
Total Wristband Scan Events 80
Count
Processed via Scanner
% Total Events
97.6%
Scanner By-Pass 3
Keyed Entry (1)
BCMA Unable to Scan (0)
Vista Manual Med Entry (2)
2.4
0.8
0.0
1.6
Total Medication Label Scan Events
126

21. Thank You