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Bar Code Resource Office Overview Jonathan Bagby, MSN, MBA

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Title: Bar Code Resource Office Overview Jonathan Bagby, MSN, MBA


1
Department of Veterans Affairs, Veterans Health
Administration Session 114 August 10, 2010
330 p.m.
2
Housekeeping
  • Cell Phones
  • Please turn off or change to vibrate
  • If you must answer a call or text message, please
    leave the room

3
Housekeeping (cont.)
  • No questions during the presentation
  • Questions written on a 3x5 card will be answered
    at the conclusion of the presentation, time
    permitting
  • All questions and answers will be posted on the
    Web including those not answered during class

4
Your Faculty For Todays Session
  • Jonathan Bagby, MSN, MBA, RN-BC
  • Nurse Consultant, Bar Code Resource Office
  • Ron Schneider, MHA, RPh
  • Pharmacist Consultant, Bar Code Resource Office
  • Elizabeth Mims, BSN, MBA, RN, PMP
  • Deputy Director, Bar Code Resource Office

5
Objectives
  • Describe Bar Code Resource Offices (BCRO)
    purpose, mission and communication channels
  • Articulate BCROs work efforts in alignment with
    clinical business processes associated with the
    clinical bar code applications
  • Understand the importance the Bar Code Expansion
    Positive Patient Identification Project will
    provide

6
Headliners
Medication Errors Could Be Cut US News
Medication Errors Harming Millions The
Washington Post
Report finds a Heavy Toll from Medication
Errors The New York Times
7
Headliners
Medication Errors Could Be Cut- US News
Medication Errors Harming Millions, Report
Says- Washington Post
Nurse Charged with Felony in Medication Error
Death (November 8, 2006) www.medlaw.com
8
(No Transcript)
9
Swiss Cheese
Dr. James Reason's Swiss cheese
model http//www.ncbi.nlm.nih.gov/pmc/articles/PM
C1200687/
10
Swiss Cheese (cont.)
Dr. James Reason's Swiss cheese
model http//www.ncbi.nlm.nih.gov/pmc/articles/PM
C1200687/
11
Bar Code Resource Office Purpose
  • The Bar Code Resource Office was established
    within the Veterans Health Administration (VHA)
    to provide centralized leadership and strategic
    direction for the use and implementation of bar
    code technology within critical health care
    systems at the enterprise level

12
Issue? Cause May Not Be Easily Identifiable
12
13
VHA Office of Health Information (OHI) Alignment
14
Organizational Interfaces
15
Areas of Focus
  • Bar Code Expansion (BCE) Laboratory Specimen
    Mislabeling Data Collection Directive
  • BCE Laboratory Clinical Business Process
    Initiative
  • Bar Code Medication Administration (BCMA)
    Coordinator Orientation Guide
  • BCMA Pharmacy Web Based Training
  • BCMA Managing Scanning Failures Data Collection
    Ongoing Monitoring

Clinical
15
16
Areas of Focus (cont.)
  • Bar Code Medication Administration Coordinators
    (BCMA-Cs)
  • Bar Code Expansion Coordinators (BCE-Cs)
  • Business Owner for BCE Managing stakeholder
    expectations
  • Directive 2006-069 Purchasing Bar Code
    Scanners, Wristband Printers, and Wristband Print
    Media

16
17
Areas of Focus (cont.)
  • Closed Loop Bar Code Verification
  • Medication Cart Evaluation Purchase Guidelines
  • Wristband Scanning Bar Code Verification Testing
    Process Improvement
  • BCMA Medical Care Equipment Inventory Refresh
    Oversight

17
18
Areas of Focus (cont.)
  • Bar Code Expansion (BCE) Strategic Guide
  • BCE Procurement Integrated Product Team (IPT)
  • Bar Code Medication Administration (BCMA)
    Business Requirements Cross Functional Team (CFT)
  • BCMA Customer Satisfaction Survey
  • BCMA Coordinator Succession Planning

18
19
Support Staff
  • Bar Code Resource Offices talented team includes
  • Pharmacist Director
  • Pharmacist Consultant
  • Nurse Consultants
  • Health System Specialists
  • Management Analysts
  • Program Analyst
  • Administrative Officer
  • Administrative Assistant

19
20
Jonathan Bagby, MSN, MBA, RN-BC Nurse Consultant
21
Wristband Verification
  • Began in 2006
  • Each facility provided a representative wristband
    each year
  • Two verification labs to provide ANSI/ISO grades
  • Discontinued in 2009
  • Error correction in scanners improved since 2005
  • Less correlation between ANSI/ISO grades and
    scanning at point of care
  • Now performing upon request

American National Standards Institute/Internation
al Organization for Standardization
22
Wristband Verification
23
Managing Scanning Failures Data Results
  • Began as manual reporting process (April 2009)
  • Automated process in July 2009
  • VHA Support Service Center
  • Extracts data
  • Creates report templates

24
Managing Scanning Failures Data Results
25
Managing Scanning Failures Data Results
26
Bar Code Medication Administration (BCMA) New
Service Request Coordination
  • Assists facilities with submission of BCMA New
    Service Requests (NSR)
  • Fosters communication between facilities, the
    BCMA Coordinator, stakeholders, and program
    offices
  • Provides guidance, coordination and oversight of
    BCMA related NSRs
  • Supports ongoing development and enhancement of
    the BCMA Coordinators role

27
Bar Code Medication Administration New Service
Request Coordination
28
Bar Code Medication Administration New Service
Request Coordination
EXAMPLE
29
Bar Code Medication Administration Coordinator
Orientation Guide
30
Coordinator Orientation Guide (cont.)
31
Coordinator Orientation Guide (cont.)
32
Coordinator Orientation Guide (cont.)
33
Bar Code Expansion Strategic Guide
34
Clinical Business Process Bar Code Expansion
Readiness Plan
  • Goals of the Initiative
  • Identify and apply methodologies to assess
    current clinical workflow processes
  • Develop recommendations to improve workflow
    processes
  • Determine impact of results
  • Test and quantify results
  • Identify and communicate standards and best
    practices

35
Clinical Business Process- Bar Code Expansion
Readiness Plan (cont.)
https//vaww.portal.va.gov/sites/BCRO/BCROPublic/B
arCodeCoordinators/default.aspx
36
Ron Schneider, B.S. Pharmacy, MHA Pharmacist
Consultant
37
Product Effectiveness (PE) Overview
  • PE resides within the Veterans Health
    Administration Office of Health Information
    (OHI)s Service Coordination
  • PE provides independent and impartial assessments
    of Information Technology (IT) products deployed
    throughout VHA
  • Customer Satisfaction
  • Benefits Realization
  • Functional Review
  • Lessons Learned

38
Product Effectiveness(PE) Overview (cont.)
  • The PE Customer Satisfaction (CS) Team has a
    two-part mission
  • Collect and analyze customer satisfaction
    information on significant IT products and
    services within VHA
  • Provide unbiased reports on findings and
    recommendations for improving their effectiveness

39
Bar Code Medication Administration (BCMA)
Customer Satisfaction Survey Background
  • September 2008
  • Customer Satisfaction (CS) Team began working
    with the Bar Code Resource Office (BCRO)
  • Goal -design an end-user customer satisfaction
    survey for BCMA
  • CS Team worked with a Steering Committee and User
    Work Group to understand BCMA and design a
    tailored survey
  • April 2009
  • Product Effectiveness Customer Satisfaction team
    implemented a BCMA Pilot Survey at 12 sites that
    had tested Managing Scanning Failures (MSF)
  • Following the Pilot Survey, a work-stoppage
    placed the survey project on hold for seven
    months

40
Bar Code Medication Administration Customer
Satisfaction Survey Background (cont.)
  • November 2009
  • CS Team reengaged with the Bar Code Resource
    Office
  • Pilot survey data was compiled and summarized
    into a Survey Executive Summary document and a
    detailed presentation of pilot survey results
  • Pilot survey data was used to revise national
    survey questions and to refocus the national
    survey objectives
  • March 8, 2010
  • National survey released
  • Open for 30 days

41
Bar Code Medication Administration (BCMA) Survey
Overview
  • Survey designed to assess target areas
  • - BCMA Software - BCMA
    Equipment
  • - BCMA Technical Support - BCMA Training
  • BCMA is used in different capacities by a large
    end-user base
  • Survey
  • Attempted to collect and analyze satisfaction
    data from the different user groups
  • Gave end users the ability voice their opinions
    and perspectives

42
Bar Code Medication Administration (BCMA)
Customer Satisfaction Survey Overview (cont.)
  • The empirical data obtained could help the Bar
    Code Resource Office, VHA and VA Office of
    Information Technology in defining the
    strategic direction of the BCMA program
  • By gathering customer satisfaction now, we will
    have a baseline on which to measure future
    changes to BCMA

43
Bar Code Medication Administration (BCMA)
Customer Satisfaction Survey Structure
  • BCMA National Survey was Web-based
  • Distributed to all Veterans Integrated Service
    Networks (VISNs) and facilities
  • Survey used branching logic to ask specific and
    relevant questions based on the respondents
    role selection
  • Questions focused on the following information
  • Satisfaction levels with BCMA software,
    equipment, support, and training
  • Aspects of BCMA software and equipment that
    warrant improvements/enhancements and technical
    support gaps
  • Common causes of scanning failures
  • Suggestions for improvement

44
Pilot Survey Results 620 Respondents (12 Test
Sites)
  • Categories
  • Categories
  • Bar Code Medication Administration (BCMA)
    software
  • Managing Scanning Failures (MSF)functionality
  • BCMA equipment
  • Pharmacy VistA BCMA
  • BCMA support
  • BCMA Procurement
  • BCMA training
  • General BCMA questions

45
Pilot Survey Results (cont.)
  • Respondents by Role
  • RN 49
  • LPN 21
  • Pharmacy 8
  • Respiratory Therapists 5
  • Coordinators 2

46
High Satisfaction Results
  • Visual display
  • Virtual Due List
  • Unable to scan reports
  • Unit dose label printers
  • Uptime and performance of VistA Bar Code
    Medication Administration (BCMA) pharmacy module

47
Areas for Improvement
  • Improve end user satisfaction with Managing
    Scanning Failures (MSF)
  • Most sites had product less than 30 days
  • Reduce software login time and steps
  • Improve wireless networks
  • Wireless Infrastructure Project
  • Entry of second verifier for high risk meds
  • New Service Request (NSR) approved

48
Results of National Survey
  • 6,280 respondents
  • Bar Code Medication Administration (BCMA)
    improves patient safety
  • 82 agreed or strongly agreed
  • BCMA should be available in all patient care
    areas
  • 72 agreed or strongly agreed
  • Major areas of concern
  • Scanners
  • Non administrative hours support
  • Wireless networks

49
Bar Code Medication Administration Cross
Function Team
  • Why do requirements 10 years later?
  • What is being done?
  • How will the results be handled?
  • What are the project timelines?

50
Scope/ Goal of Initiative
  • Document as is Bar Code Medication
    Administration (BCMA) Business Requirements
  • Review existing active New Service Requests
    (NSRs)
  • Define Business Requirements for BCMA on a mobile
    hand-held device (HHD)
  • Provide requirements to Requirements Analysis
    Reengineering Management (RAEM) team and
    Enterprise Systems Management Office (ESM)

51
Background/Summary of Initiative
  • Initial deployment provided functional
    specifications
  • Business Requirements will provide roadmap for
    future development
  • Assure that technical solution meets needs of
    customer

52
Strategic Alignment
  • Bar Code Resource Office (BCRO) strategic goal
    alignment
  • BCRO strategic goal 3 Promote interoperability
    between clinical bar code software and their
    interdependent applications
  • BCRO strategic objective alignment
  • Effectively represent customer needs during
    requirements gathering, development, and testing
    of Bar Code Medication Administration (Objective
    3.7)

53
Key Milestones Deliverables
  • Resources committed and Cross Function Team
    Charter signed
  • Kick off call held
  • Initiative Requirements Document (IRD) approved
    by Director Bar Code Resource Office
  • Bar Code Medication Administration (BCMA) as is
    business requirements delivered to Requirements
    Analysis Engineering Management (RAEM) team and
    Enterprise Systems Manager (ESM)
  • BCMA on a mobile handheld device business
    requirements delivered to RAEM team and ESM
  • Review of existing New Service Requests to
    determine impact on current BCMA business

54
Elizabeth Mims, RN, BSN, MBA, PMP Deputy Director
55
A World Free from Error
  • Imagine a world free from repeated lab tests,
    incorrect lab results or incorrect blood
    transfusion
  • The Bar Code Expansion- Positive Patient
    Identification (BCE-PPI) Project expands the use
    of scanning technology to associate the Veteran
    with an order and a specimen or blood product

56
  • died about 16 hours after he was transfused
    with six units of type O positive plasma. The
    Veterans blood type was B negative.
  • A sample of XXXs blood was mixed up with another
    patient's, and the plasma was transfused before a
    routine confirmation test could be completed,
    which is a violation of standard procedure
    (labels were switched)
  • the mismatched transfusion did not have
    significant impact on the patient's final outcome

57
A World Free from Error
46-year-old undergoes Total Prostatectomy
5 patients undergo DNA testing to determine
positive cancer screening
58
Swiss Cheese
Dr. James Reason's Swiss cheese
model http//www.ncbi.nlm.nih.gov/pmc/articles/PM
C1200687/
59
Anticipated Functionality of Bar Code Expansion
  • Deploys a Commercial Off The Shelf (COTS) product
  • Provides positive patient identification
  • Generates labels at the point of specimen
    collection
  • Matches patient to blood product
  • Provides safer clinical environment for the
    Veteran
  • Is applicable to various care settings

60
Anticipated Benefits of Bar Code Expansion
  • Reduction/prevention of patient misidentification
    due to laboratory specimen mislabeling for
    clinical laboratory and anatomic pathology
  • Reduction/prevention of wrong blood product
    administration
  • Increased patient safety (decreased morbidity and
    mortality)
  • Compliance with regulatory agencies
  • Reduction in costs

61
Bar Code Medication Administration (BCMA) vs. Bar
Code Expansion (BCE)
  • BCE
  • Specimens/ blood product transfusion
  • Inpatient, Outpatient
  • Matches patient to order
  • End users specimen collectors, blood
    administrators
  • BCMA
  • Medications
  • Inpatient only
  • Matches patient to medication order
  • Order finished and verified in Inpatient
    Medications Package
  • End users

62
Five Rights to Laboratory Testing
  • Ensure the right patient has the right test
    performed at the right time for the right
    indicators leading to a right diagnosis and care
    plan
  • Borrowed from www.sunquestinformationsystems.com

63
Irretrievable Mislabeled Specimens
  • Not all specimens can be retrieved or
    recollected
  • Invasive procedures
  • Cerebral Spinal Fluids (CSF) or other body fluids
  • Blood cultures
  • Antibiotics

64
Bar Code Expansion
  • Pre-analytic phase of Specimen Collection
    (Clinical Laboratory and Anatomic Pathology)
  • Need VistA interfaces for Clinical Laboratory,
    Anatomic Pathology, and Blood Administration
  • Dependency CPRS order dialog for Anatomic
    Pathology

65
Bar Code Expansion Clinical Laboratory
  • Positive Patient Identification (PPI) at the
    point of collection
  • Associate patient, order, and specimen
  • Select order types to collect
  • Generate only those specimen labels at the point
    and time of collecting the specimens
  • Authenticate user

66
Bar Code Expansion Anatomic Pathology
  • CPRS order dialog (planned for CPRS version 29)
  • Associate patient to order and tissue specimen
  • Automate the VA Form SF-515 (planned)
  • Consider areas within your medical center where
    tissue specimens are collected. What types of
    unique considerations will need discussion early
    in the planning process to ensure success

67
Getting the Right Blood to the Right Patient
  • Transfusions are risky business
  • Not enough to use Positive Patient Identification
    (PPI) to connect patient with blood product
  • Prevent pre-transfusion specimen labeling errors
  • 5 specimens for type cross-match lack complete
    information on the label (California Blood Bank
    Society)
  • Satisfies 2010 National Patient Safety Goals
  • 01.01.01 Use at least 2 identifiers when
    providing care, treatment or services
  • 01.03.01 Eliminate transfusion errors related
    to patient identification

68
Bar Code Expansion Blood Administration
  • Begins at blood administration
  • Scans patient wristband to retrieve patient
    information (transfusion order, associated lab
    results)
  • Documents 2nd verifier, intravenous fluid,
    tubing, vital signs, transfusion activities
  • Could replace VA Standard Form-518 through
    electronic documentation
  • Will replace scanning into the Surgery Package

69
Bar Code Expansion Equipment
  • Will operate on multiple platforms - not device
    independent
  • Provided as part of the project implementation
  • handheld device
  • portable label printer
  • scanner
  • Consider transport, storage, security and
    charging

70
Business Owners
  • Patient Care Services
  • Pathology Laboratory Medicine Service
  • Dr. William Triest, National Director
  • Office of Nursing Service
  • Pam Pickett, Nurse Informaticist
  • National Center for Patient Safety
  • Dr. Danielle Hoover, Patient Safety Physician
  • Bar Code Resource Office
  • Chris Tucker, Director

71
Project Development Implementation Schedule
  • Based on vendor contract award July 9, 2010
  • Contingent on Program Management Accountability
    System (PMAS) compliant schedule
  • 6 month increment VA Office of Information and
    Technology (OIT) release of functionality
  • Must receive approval to move forward with
    subsequent increments
  • Various scenarios to review and discuss
  • Increment consensus will impact release and
    implementation of functionality
  • Customer acceptance critical at the end of each
    increment- OIT must deliver something the
    customer can manipulate

72
Deliverables Increment 1
73
Deliverables Increment 2
74
Deliverables Increments 3, 4, 5, 6
75
Overall Project Schedule
76
What Can You Do Now?
  • Nursing, Lab, and others begin talking with each
    other
  • Mislabeled Specimens data collection (VHA
    Directive 2009-035)
  • https//vaww.portal.va.gov/sites/BCRO/SpecimenMisl
    abelData/Wiki20Pages/Home.aspx
  • Look at current workflow
  • Practice Improvement Recommendations for Specimen
    Collection and Blood Administration
  • Eliminate not-best practices

77
Courtesy of Lexington VAMC
78
Summary Conclusions
  • Bar Code Resource Office (BCRO) is committed to
    quality and safety of Veteran-centric care
  • BCRO Resources available to assist facilities
    with clinical business processes
  • http//vaww1.va.gov/barcode/
  • https//vaww.portal.va.gov/sites/BCRO/BCROPublic/W
    iki20Pages/Home.aspx

79
Lastlya Mims-ism
Technology is only as reliable/effective as the
process it is intended to support
80
(No Transcript)
81
References
  • Reinberg, Steven. (April 27, 2009).Medication
    errors could be cut. US News. http//health.usnews
    .com/health-news/managing-your-healthcare/healthca
    re/articles/2009/04/27/medication-errors-could-be-
    cut-experts.html
  • Kaufman, Mark.(July 21, 2006). Medication errors
    harming millions. The Washington Post.
    http//www.washingtonpost.com/wp-dyn/content/artic
    le/2006/07/20/AR2006072000754.html
  • Harris, Gardiner. (July 21, 2006). Report finds a
    heavy toll from medication errors. The New York
    Times. http//www.nytimes.com/2006/07/21/health/21
    drugerrors.html
  • Frew, Stephen. (November 8, 2006). Nurse charged
    with felony in medication error death.
    http//www.medlaw.com/healthlaw/MEDMAL/nurse-charg
    ed-with-felony.shtml
  • Wahlberg, David. (March 10, 2010), Report
    Systemic problems at St. Marys set stage for
    nurses fatal drug error. http//host.madison.com/
    wsj/news/local/health_med_fit/article_73b1055e-2fe
    e-11df-9f7a-001cc4c002e0.html?modestory
  • Wahlberg, David. (June 24, 2007). Living, or
    wanting to die, after a mistake.
    http//host.madison.com/news/article_446d8639-9b0a
    -5161-945c-ccaf67d261af.html?modestory
  • Miller, M, Weier, A. (December 16, 2006). It
    should have been my life, not hers.
    http//www.encyclopedia.com/doc/1G1-156022583.html

82
Contact Information
  • Jonathan Bagby
  • Email address jonathan.bagby_at_va.gov
  • Elizabeth Mims
  • Email address elizabeth.mims_at_va.gov
  • Ron Schneider
  • Email address ron.schneider_at_va.gov
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