Use of SuperUsers in EMAR “Go-Live”

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 • Behavioral Expectations - Accountability - Innovation - Collaboration - Compassion - Competent - Respectful

5. Teamwork • 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. Day 10 • Process Meetings: • Pediatric Bracelets – Product search in Progress • RT Wireless – in Progress – Next meeting Wednesday 2/22 @ 2:30 • Plan for Adult Dialysis – in Progress • End of Shift Reminders: • Orders to Review • Overdue medication tasks HH & HCH eMAR News eMAR/PAL Help -ASK Your Superuser or call 45370! February 21. 2006 MHHS Team Update

12. eMAR/PALDAY 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. 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. Revised 02-06 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 • 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 45370. Contact Margie Aronowitz @ 45735 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