Northern Navajo Medical Center BCMA Deployment Site Visit “No Nurse Left Behind”

1. May 12 – May 23, 2014 Northern Navajo Medical Center BCMA Deployment Site Visit“No Nurse Left Behind”

2. IHS RPMS EHR Deployment

3. BCMA Inpatient Deployment

4. Northern Navajo Medical Center BCMA Team • Clint Krestel, PharmD, Inpatient Pharmacy Supervisor • Kendall Van Tyle, PharmD, BCPS, Pharmacy Informaticist • Farrah Smiley, BSN, RN, Med/Surg Nurse Supervisor, BCMA Coordinator • Harriet Jones, BSN, RN, Med/Surg Clinical Coach • Nicola Pierce, MSN, RN, Pediatric Nurse Supervisor, BCMA Coordinator • Regina Thompson, BSN, RN, ICU Nurse Supervisor, BCMA Coordinator • Gary Russell-King, Chief, Health Information Manager • Marilyn Bowman, CRT, RT Supervisor • Lilita Burton, Registration Supervisor • Neil Fischer, BS, MT(ASCP), Hospital CAC • Darlene Begay, Information Technology Specialist • Sharon Bekis, Information Technology Specialist • Arlin Bekis, Information Technology Specialist • Sam Namoki, Information Technology Specialist • Lilly Benally, Information Technology Specialist • Kathy Ray, CNM, CPCHITPro, Navajo Area CAC

5. 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, Medsphere Corporation • Chris Saddler, RN, BCMA Information Technology Consultant, IHS/OIT via Remote Adobe Connect • Mike Allen, MIS, RPh, Pharmacy Informaticist, IHS/OIT • Cecelia Rosales, BCMA Analyst, Contractor Data Networks Corporation

6. IHS OIT BCMA Team

7. VA Remote Cross Functional Team • Cathi Graves, Project Manager, BCRO, OIA, VHA • Kirk Fox, Clinical 1 Support Team, OIT, VA • Jaculyn Bloch, 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, VHA EES • Stephen Corma, BSPharm, RPh, Pharmacist Consultant, BCRO, OIA, VHA • Daphen Shum, PharmD, Pharmacist SME, VA Maryland HCS • Hugh Scott, MS, RNC, VHA Management & Program Analyst, Washington, DC, IHS/VHA Interagency Liaison • Barbara Connolly, Clinical 1 Support, OIT, VA

8. VA Cross Functional Team

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. Special Thanks To • Michael Belgarde, CIO, Navajo Area IHS • Kerri Culligan, PharmD, GIMC • Josh Valgardson, PharmD, GIMC • Andrew Ruddle, RN, BCMA Coordinator, GIMC • Anna Garcia, RN, BCMA Coordinator, GIMC • Nick Bird, RN, BCMA Lead, CCHCF • Andrew “G-Status” Gentles, PharmD, BCPS, CCHCF • Valerie Cooper, PharmD, BCPS, CCHCF • Jeanetta Fields, BSN, RN, BCMA Coordinator, CCHCF • Renee Chase, BSN, RN, BCMA Coordinator, CCHCF

11. 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 Services Staff if the Medication Administration Arm of the System is Work Optimally

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 Week One Cohort Activities • Configured Day Surgery as a Ward, will require Admission/Discharge Process Changes • Configured Inpatient Surgical Suite as Ward to Accommodate Transfers between Inpatient Wards and Surgery • Resulting in Auto Discontinue of Orders and Use of Delayed Orders Possible in Day Surgery and Inpatient Surgery • BCMA now Available for Use in Day Surgery and Inpatient Surgery, thereby Increasing Patient Medication Safety through Medication Reconciliation • Chris Saddler Facilitated Cohort Installation of RPMS Report Routines • Parallel Drug-File Cleanup & Configuration

14. BCMA Week TwoTraining & Go Live Plan • Friday & Saturday – Training Preparation and Practice Session (16 Hours) • Sunday – Morning Nursing Super User Training Sessions (4 hours), Afternoon Pharmacy Session (4 hours) • Monday – Morning Nursing Super User Training Sessions (4 hours), Afternoon Pharmacy Session (4 hours), Afternoon BCMA Coordinator (4 hours) • Tuesday – Morning Nursing Super User Training Session (4 hours), Pharmacy Afternoon Training Session (4 hours) • Wednesday – Morning Nursing Super User Training Session (4 hours each), Afternoon Pharmacy Session (4 hours) • Go Live Wednesday Evening • Troubleshooting • Thursday – Debriefing, Go Live and Troubleshooting Continues Throughout Thursday and Friday Major Medication Passes (10:00 AM, 5:00 PM, 10:00 PM) 14 hours on Wednesday and 14 hours on Thursday • A Total of – 36Training Hours, 195Training Encounters, of these 95were Unduplicated Educational Encounters for NNMC

15. Northern Navajo Medical Center Training

16. BCMA Training Statistics

17. BCMA TrainingLessons Learned • BCMA Team and HIM Review, Approve “Comments” • Identify/Delineate Pharmacy Processing of PreOp Medications for Timely Administration • Titration of Pain Medication Syringes in Day Surgery and Standardized Practices • Consider use of “Cheat Sheet” to complete steps for Special Medication Scanning Processes (insulins, ointments, etc)

18. BCMA TrainingLessons Learned • Update Policies & Procedures to Align with New BCMA Processes: • 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 (Missed Medications, PRN Effectiveness) • Impact of Multiple-use Medications on Infection Control/possible use of Hospital Supplied – Self Administered Medications – Need for Best Practice

19. Go-Live Medical Surgical Ward “The Insulin Brigade”

20. Go-LiveLessons Learned • No Training Plan for Respiratory Therapy Contractor Training • Multi-Dose Containers and Infection Control (creams & inhalers) • Need for Sufficient “At-the-elbow” Support • Immediate & Well Identified IT Support • Ensure Enough Carts/Equipment for Go-Live

21. Go Live Lessons Learned • Use of the “IV Status Report” in a Consistent Manner • Early Communication to the Staff Regarding Goals & Impact of BCMA Project • Ensuring Competency of Contract Providers • Staff Who do Not Attend Planned Trainings Require Disproportionate “At-the-elbow” Support

22. Baseline Scanning Statistics Wristbands Medications

23. Post Implementation Statistics Wristbands Medications

24. Thank You & Good Luck!