EMR, CPOE, BCMA & emar Implementation.. How EPIC

Transcription

1 Objectives EMR, CPOE, BCMA & emar Implementation.. How Kevin Robertson, PharmD, BCPS Jason Eakin, PharmD BHMC-NLR overview Guidelines that exists Practice model prior to implementation Preparation for implementation Implementation and aftermath Practice model subsequent to implementation What needs to happen now.. February 26, 0200 ASHP Guidelines and Statements Paper chart Electronic chart Pharmacist order entry CPOE Bar Code Medica8on Administra8on Paper MARs Electronic MARs and automa8on intergra8on BHMC-NLR Overview BHMC-NLR Overview 248 bed facility (daily census ) Services: General inpatient Surgery General & cardiac Inpatient & outpatient OB/GYN Services: Pediatrics Angiography Oncology DaVinci robot 1 st in the state (prostatectomy) 1

2 Department of Pharmacy Overview FTEs Pharmacist (Full-Time & Part-Time) Technicians Students 1.4 Services: Distributive Clinical 24 hours GREAT TEAM MEMBERS AND TEAMWORK Pharmacist Decentralized McKesson Pharmacy System Pyxis Computer Generated MARs Phamis Handheld Clinical Devices Documenation MDATA CareFusion Admission Home Med-Rec CMS Core Measures Pharmacy Paperless Documentation: Pendragon 1980s Distributive: Prior to 0200 Distributive: Prior to 0200 Procurement/Receiving Want Book / Walk the Shelves Replenishment software (M&D) No Par levels Non-bar-code receiving Storage Static shelving of product Pyxis Narcotic Vault Pyxis machine (nursing units) Floor-stock Preparation/Dispensing Pharmacist order entry (Pyxis Connect) Manual product verification (IV/UD) Signature on label Charge on dispense / Tubed first doses Non-profiled / Profiled (ER, PreOp, & PACU) Pyxis Replenishment Refill / Stock out reports Refill pull times Varied Repetitive workflows/ steps (spaghetti diagrams) Distributive: Prior to 0200 Inventory Controlled perpetual Non-controlled PRN Missing Doses Phone call Fax / Scanned Requests Computer generated paper MARS New admits - Manual House-wide - Daily Pharmacokinetics Vancomycin Aminoglycosides Intravenous Nutrition TPN PPN Anticoagulation Factor Xa inhibitors UFH/LMWH Warfarin Newer agents 2

3 Renal Dosing Antibiotics Anticoagulants Code Blue Attendance Medication information Medication preparation Electrolyte Management Magesium Potassium Sodium Core Measures PN VTE (VTE-2, VTE-1, etc) Antibiotic Stewardship Daily culture reviews Antibiotic duration screening Reserved antibiotic criteria review IV to PO CSF Management Restricted Formulary Review for approved use Appropriate criteria for use Professional Development Projects Preceptor (IPPE & APPE) Clinical Pharmacist II Tier approach Prioritization Shift specific Admission home med rec 3

4 Leadership Selection Single Formulary Meetings Sessions PB, IV, Chemo and PO Med Reviews March 2010 May 2010 June 2010 July 2010 Initial Bar-code Scans Sessions (Order Entry, Consults, simple meds, etc) Sept 2010 ChemoClave Order-Set Review Kick-off Oct 2010 Sessions (Chemo, Periop, BCMA, Complex Meds, etc) Unconfigured Med Review Nov 2010 Jan 2011 March 2011 April 2011 May 2011 June 2011 Carousel Vendor Review Standardized Clinical Intervention Willow Weekly Categories Conference Calls Sessions Wound Care (OP Chemo, Formulary Cath Lab, etc) Standardization Pyxis 4K Demo HPF Upgrade Cabling and Hardware Installation Facility Wide Renovations PhACTS Repackager Super-User Training Initial Meeting TJC Survey Central Pharmacy Renovations Pyxis 4K Conversion Clinical Repository Barcode Database And Inventory Order-set Review and Process Completed July 2011 Aug 2011 Sept 2011 Oct 2011 Nov 2011 Jan 2012 Nurse-Link SSO to MyApps Conversion Change Management Carousel PCs Install Complete Bi-Weekly Administration Meetings PGY-1 Residency Proposal to VP Employee ID Re-badging Facility Wide Renovations Complete Super-User Training Residency Planning Committee s Lawson Payroll End-User Training Mock Cutover Dress Rehearsal Meaningful Use Meetings PGY-1 Interviews 2/10/12 And 2/17/12 Last Minute Training 2/19/12-2/26/12 Command Center 2/22/12 Cutover 2/24/12-2/25/ Hgt, wgt, allergies, and PTA meds for 4 units (assist with others) Transfer all orders from AS400 to Maintain two pharmacy systems until

5 Post : Issues Post : Issues Pharmacy Pyxis Connect scanners Med list maintenance Bar-coding scanning Interface (, etc) Pyxis Variable dosing All Disciplines Different charts presentation for all disciplines Navigators Physicians MD super-users Multiple orders (same thing) Warnings ignored LMAs ignored Phase of Care Sign and Hold SureScripts Order-sets (where is mine?) : Post Issues Post : Successes Medications involved? Call pharmacy.. MD Warnings SureScripts Med Rec issues (all) Nurses emar problems Newly Pyxis profiled units CPOE - 66% Meaningful Use: Hitting all threshold targets BCMA - > 90% Medical Transcription Reduction: NLR ER - 99% NLR Medical % Post : How We Made It BHMC-NLR: Implementation Positive attitude Change management Realistic expectations Quick resolution of critical issues Teamwork Leadership (all levels) Congratulations on what will almost certainly go down in Epic history as one of the most successful initial go-lives ever. It was incredibly wellprepared for and well-executed. Your cutover alone serves as a model to be replicated. Matthew Gercz, Epic Implementation Services Our congratulations on your smooth and successful go-live at North Little Rock. I d love to bottle the Baptist approach, but it s really the great people and great can-do culture that makes the difference. Pat Thompson, Epic 5

6 Distributive: After 0200 Distributive: After 0200 Preparation/Dispensing Order verification (complete chart available) Bar-code scanning of product (in addition to visual ID) Bar-code documentation of pharmacist check Charge on administration Charge of dispense (Cath Lab, OR, etc) IV room Dispense Prep/Check New orders Carousel / Narcotic vault Pyxis Replenishment Refill / Stock-outs Auto drop to carousel Refill times Automated by software Streamline pull process Bar-code scanning and less time Distributive: After 0200 Inventory Controlled substances perpetual Non-controlled substances perpetual emars Missing Doses MAR messages Phone calls Clinical: After 0200 Clinical Duties Consults etc MDATA Home Med Rec Process RX Acuity Scoring process Preceptor (PGY-1) ADR Reporting/Intervention Documentation (virtual chart, ease of ordering, emar, etc) ivents Pendragon Data.. Data.. Data.. Data.. Data.. Data.. 6

7 What are the next steps?? Distributive Organization/Efficiency of central pharmacy / IV Room Space Streamline Workflows ADS machine optimization - Adjust Max/Min levels Ordering Package sharing Standardization across system Clinical Re-evaluate clinical workflows and assigned responsibilities Documentation ( ivent vs. Pendragon) Productive/Efficiency reports (standardize across system) Next clinical initiatives... ER? DC Med Rec? Summary Pre-: Distributive / Clinical Duties Post : Distributive / Clinical Duties Data Data Data Next steps / Plans for the future Contact Information Jason Eakin, PharmD Supervisor Pharmacy BHMC-NLR [email protected] Kevin Robertson, PharmD, BCPS Clinical Coordinator Pharmacy BHMC-NLR [email protected] References American Society of Health-System Pharmacists. ASHP guidelines on pharmacy planning for implementation of computerized provider-order-entry systems in hospitals and health systems. Am J Health-Syst Pharm. 2011; 68:e9-31 American Society of Health-System Pharmacists. ASHP statement on barcode verification during inventory, preparation, and dispensing of medications. Am J Health-Syst Pharm. 2011; 68:442-5 American Society of Health-System Pharmacists. ASHP statement on barcode-enabled medication administration technology. Am J Health-Syst Pharm. 2009; 66: American Society of Health-System Pharmacists. ASHP guidelines on the safe use of automated dispensing devices. Am J Health-Syst Pharm. 2010; 67: Witkowski, P. Case study: Novel ways automation enhances medication safety. Am J Health-Syst Pharm. 2007; 64(Suppl 9): S21-3 7