The BCMA Puzzle: The Connection Between Pharmacy and Nursing VeHU

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The BCMA Puzzle The Connection Between Pharmacy
and NursingVeHU 122

• Ron Schneider
• Pharmacist Consultant, BCRO
• Jennifer Barker-Yahnian, BSN,RN
• Pharmacy ADPAC

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HOUSE KEEPING

• This is 70 minute class
• Restrooms are located
• Cell Phones
• Please turn off or change to vibrate
• If you must answer a call, please leave the room.

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HOUSE KEEPING

• Please,
• No questions during the presentation.
• Questions written on the 3X5 card will be
  answered at the conclusion of the presentation.
• For questions not answered,
• the question and the answer will be available on
  the web.

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Objectives

• Assess and enhance BCMA competency knowledge
  for Pharmacy staff
• Demonstrate interface between CPRS, VISTA, and
  BCMA
• Learn techniques to improve patient safety
• Demonstrate common problems best practices
• Identify Local and National BCMA resources

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Why pre test pharmacy staff?

• What is knowledge base of staff?
• New staff
• Part time staff
• Full time staff
• Need to determine educational needs
• Understand pharmacy interaction with BCMA
• Train super users for evening and weekends
• Training-walk the walk not just talk

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Pre-Test
No Cheating
No Group Communication
Close all notebooks
70 or above is passing
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Actual pre test results

• Average score on pre test 66
• Average score on post test 83
• Confidence level in trouble shooting BCMA pre
  test 53
• Confidence level in trouble shooting BCMA post
  test 71
• Dart, Lindsey, Schneider, Ron. Development and
  evaluation of bar code medication administration
  (BCMA) pharmacy training at the Veterans Affairs
  Medical Center, Washington, DC.

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What is BCMA?
"BCMA"
Bar Code Medication Administration

• Relies on a multidisciplinary approach
• Providers Order Entry
• Pharmacists Order Finishing/Verification
• Nurses- Medication Administration
• Information Resource Management
  Software/hardware support
• BCMA coordinator- Overall management
• Software interface CPRS, VISTA, BCMA

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BCMA Software Overview

• What are the Primary objectives of BCMA?
• Reduce medication errors 5 Rights              
• Provide online pt medication records at the point
  care
• Increase access to information               
• Improve decision making             
• Increase efficiency in medication administration
• Multi-disciplinary approach           
• Capture drug accountability data
• Standardize medication administration processes,
  and
• Improve communication between Nursing and
  Pharmacy staff!!                 

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Pharmacys BCMA Toolbox

• Setting up users
• Understanding Pharmacys impact on BCMA
• What should a pharmacist know?
• When nursing calls to report a problem what
  should a pharmacist do?
• Best Practices

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User Access

• Pharmacy BCMA Menu and Key set up
• Allocate Menu
• PSB GUI CONTEXT - USER BCMA Client
  Context
• Allocate Key PSB READ ONLY
• This allows Pharmacy Staff BCMA Read Only Access
  and will prevent the pharmacist from
• inadvertently Marking a medication as GIVEN

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BCMA LOGIN
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Using the Toolbar
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BCMA Read-Only option

• Select File on the Main Menu bar, then Open
  (Read Only).
• Patients may be accessed by Social Security
  Number, Initial and last 4, ward list and even
  room number.

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Virtual Due List Navigation
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Last Action Column

• May display information from a previous
  admission.
• Will not display information if no data is
  available (Given, Held, Missing, etc)
• Will populate with first administration after
  refresh
• Important Note
• The data in the LAST ACTION Column is
• related to the ORDERABLE ITEM, not to the
• specific order being displayed.

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BCMA Coversheet
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FYI Keyboard Shortcuts

• F5- Refresh
• F9 - Coversheet tab
• F10 - Unit Dose tab
• F11 - IVP/IVPB tab
• F12 - IV tab
•  
• Shift-F9 - expand and collapse the first group in
  a view
• Shift-F10 - expand and collapse the second group
  in a view
• Shift-F11 - expand and collapse the third group
  in a view
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• Ctrl-Alt-V - available bags for highlighted item
• Ctrl-Alt-O - Display Order for highlighted item
• Ctrl-O Will prompt you with the scan wristband
  prompt for the next pt
• Ctrl-Alt-E - Med History for highlighted item
• Tab - The tab key will move focus from one group
  to the next on the coversheet.
• Up/Down Arrow - Allows focus to shift from one
  row to the next on a table
• Right/Left Arrow - Expands or collapses a row if
  expandable
• Alt-Up/Down Arrow - Scrolls the entire Coversheet
  up and down

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Pharmacy ADPACs Role

• Drug File (File 50) Management
• Synonym Entry/Removal
• Pharmacy Data Management Standard Schedule set
  up, Dosage form, route, Orderable item, etc
• Trouble shooting
• Training
• Collaboration with the BCMA-C

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Orderable Item Set-up

• Pharmacy Orderable Item set-up
• Orderable Item - PEGINTERFERON ALFA-2B
• Dosage Form - INJ,PWDR
• Dispense Drugs
• ---------------
• PEGINTERFERON ALFA-2B 150MCG/0.5ML,VIAL
• PEGINTERFERON ALFA-2B 120MCG/0.5ML,VIAL
• Select OI-DRUG TEXT ENTRY FOR SUBCUTANEOUS USE
  ONLY !! //
• INACTIVE DATE
• DAY (nD) or DOSE (nL) LIMIT ?
• MED ROUTE SUBCUTANEOUS//
• SCHEDULE TYPE
• SCHEDULE WEEKLY//
• PATIENT INSTRUCTIONS FOR INFECTION.//

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CPRS GUI- Provider Options
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Pharmacy View in VISTA

• (1)Orderable Item NEOMYCIN TAB
• Instructions 1000MG
• (2)Dosage Ordered 1000MG
• Duration
  (3)Start 05/15/08 2300
• (4) Med Route ORAL
  REQUESTED START 05/15/08 2300
• 
  (5) Stop 06/29/08 2359
• (6) Schedule Type CONTINUOUS
• (8) Schedule Q6H
• (9) Admin Times 0500-1100-1700-2300
• (10) Provider BARKER,JENNIFER L es
• (11) Special Instructions
• (12) Dispense Drug
  U/D Inactive Date
• NEOMYCIN SULFATE 500MG TAB
  2

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To flag or not to flag

• PROVIDER COMMENTS
• FOR 5 DAYS
• Select one of the following
• Y Yes
• N No
• ! Copy and flag for display in
  a BCMA Message Box
• Copy the Provider Comments into Special
  Instructions (Yes/No/!)
• A Pharmacist must READ these comments Carefully.

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• Select Item(s) Next Screen// 3
• START DATE/TIME MAY 15,2008_at_2300// N (MAY 15,
  2008_at_2020)
• Expected First Dose MAY 15,2008_at_2300
• Fields
• Stop 05/20/08 2023 (now 5)
• SPECIAL INSTRUCTIONS FOR 5 DAYS// FOR 5 DAYS
  (STARTED 5/15)

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• Would you like to flag the Special
  Instructions field for display in a BCMA Message
  box?
• Select one of the following
• Y Yes
• N No
• Flag the Special Instructions (Yes/No)

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• (1)Orderable Item NEOMYCIN TAB
• Instructions 1000MG
• (2)Dosage Ordered 1000MG
• Duration
  (3)Start 05/15/08 2023
• (4) Med Route ORAL
  REQUESTED START 05/15/08 2300
• (5)
  Stop 05/20/08 2023
• (6) Schedule Type CONTINUOUS
• (8) Schedule Q6H
• (9) Admin Times 0500-1100-1700-2300
• (10) Provider
• (11) Special Instructions! FOR 5 DAYS (STARTED
  5/15)
• (12) Dispense Drug
  U/D Inactive Date
• NEOMYCIN SULFATE 500MG TAB
  2

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Multiple tablets
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Scanning Circumvention

• How can a nurse administer a medication
• even though the barcode will not scan?

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Circumvention Prevention

• Barcode Quality Directive
• Ensure barcode scanning success BEFORE products
  leave the pharmacy
• BCMA Managing Scanning Failures (coming soon)
• All barcodes that will not scan should be
  reported to Pharmacy and the BCMA Coordinator
• Manufacturer barcode problems should be sent to
  the Bar Code Resource office for evaluation.

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What happens if Nurse scans wrong med?
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Med History RIGHT CLICK
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Fractional Dose
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Fractional Dosing

• Note For sites still using Fractional Dosing for
  tablets (dispense Unit 0.5 or ½)
• JCAHO is now requiring the dispensing of
• doses as ordered, so Pharmacy will have to
• split and repackage tablets. Also, some
• states do not allow the nurse to split tablets.
• This may require a split tab entry in the drug
  file

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IV Tab on VDL
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Adding Comments
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Taking Action on IV
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Nurse Verification

• What does it mean when the nurse
• verifies an order?
• Performed in CPRS
• The order has been acknowledged as received and
  reviewed
• The nurse agrees that the order is accurate and
  appropriate for the plan of care
• Made sure the VDL display in BCMA is correct
  (route, start/stop date, admin time, etc)
• It is NOT a hard stop for med administration

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Administration time
What happens if the Nurse tries to administer a
medication BEFORE it is due?
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Troubleshooting

• What happens if you need to edit an order and the
  nurse is already at the VDL to administer to the
  patient?

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Trouble Shooting

• What if the nurse calls and reports that the
  order
• is not displaying on the VDL? How can the
• Pharmacist help?
• Determine first
• - Is the Order Verified by Pharmacy?
• - What are the VDL Time parameters
• - Is the right schedule type checked
• - Need to perform a Refresh?

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Using the Pop-ups wisely!!
Other Examples of Communication Musts - Give
with Food, - X3 Days only (start Date) -
Remove at 2000 - Hold if Accucheck is Hold if pulse putting extraneous information in such as start
dates of the order if it does not apply
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A New View!

• Refresh!

Refresh!
Refresh!
Common reasons to refresh - A Pharmacy Edit has
been made -After a action has been taken on a
medication -Everything is RIGHT but you
cant SEE the medication
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Best Practices

• Purchase and send all products in the unit of use
• Eliminate fractional doses
• Randomly test all products to be sure they scan
• Bar Code Quality Directive
• IV bar code on outer wrap different than inner
  bag
• Train Pharmacy Super Users on all shifts
• Involve your staff in successes
• Check pick list for errors

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Best practices Cont.

• IEN number issues
• RN knows the number
• Duplicate numbers
• Inactive drugs
• Drug Products with 2 NDC numbers on product
• Available bags
• Duplicate synonyms
• Policy for RN returning non scan products
• What happens in pharmacy?
• Managing Scanning Failures
• Create a spread sheet with Schedules and standard
  times associated (may be specific to wards)

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What are the BCMA Resources?

• BCMA Coordinator
• Specific to each site
• Do you know who yours is?
• Pharmacy APAC
• Nursing ADPAC
• Clinical Applications Coordinator (CAC)
• Your Peers!
• Bar Code Resource Office (BCRO)
• Do you know we have an office for bar code
  issues?
• Staff
• Web site
• http//vaww1.va.gov/bcmapmo/

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BCMA Coordinator Information Sharing

• Website http//vhacmnapp3/bcma/bcmac

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Bar Code Resource Office
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BCMA Training website (NTEO)
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BCMA Web-based Training for WHO?

• Addresses Nursing Pharmacy processes and issues
  
• Improves collaborative efforts
• Target Audience BCMA-C, Pharmacy ADPAC, IP
  Pharmacy supervisor, Nursing Educators, Trainers,
  Nurses and/or Clinicians passing medications,
  IRM,
• CACs, etc.

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Help!!
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Summary

• Need to train your staff
• annually
• There are best practice guidelines
• Define pharmacy practices for order verification
• Everyone finishes an order the same
• THERE IS HELP !
• New BCMA C utilize the expert BCMA C
• Bar Code Resource Office

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Questions

• ??????????