implementation of the epic rover app® to improve barcode
TRANSCRIPT
Implementation of the Epic Rover App® to improve Barcode-
Assisted Medication Administration (BCMA) Compliance
among nurses in the Adult Emergency Department
Heather Gardner, MS, RN, CEN & Mathew Waweru, RN, BSN, CEN
December 4, 2017 1
Presented by: Mathew Waweru RN, BSN, CEN
Objective:
• Identify challenges of executing the new BCMA
workflow
• Implement strategies for improving nursing
compliance by using Barcode-Assisted Medication
Administration systems
• Use of multidisciplinary team approach to improve on
safe medication administration
• Increase patient ID band scanning compliance at or
above 95%
December 4, 2017 2
Background:
• Barcode-assisted medication administration systems are integrated in
the hospital’s electronic health record (EHR), to promote safe and
accurate medication administration.
• Approximately 500,000 medications are administered monthly in JHH
and emergency department averages 20,000 medications
administration.
• Epic EHR Implemented in July 1, 2016, barcode medication
administration (BCMA) became a new workflow for the staff in the
Emergency Department (ED).
• Initial BCMA compliance among nurses in the ED was at 77%, well
below the overall hospital average and had not met the 95%
benchmark.
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Purpose:
• Quality Improvement Project
– To achieve the desired benchmark of 95% or
greater compliance with using the BCMA system
for administering medications in the Emergency
Department.
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Measures:
• Project was conducted in two phases over an 8-month period
• Phase 1:– Evaluated nurses’ compliance with using BCMA (January
2017 – May 2017)
– Identify barriers and challenges faced by nurses
– Pre and post Implementation
– Identify clinical area with most medication administration
• Phase 2:– Piloting the Epic Rover App® (June 2017 – August 2017)
– Review overall compliance and end pilot program
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Key Metrics:
• Monthly Reports with individual performance ( BCMA reports)
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Phase 1: January – May 2017
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Graphs displaying department and Nurses compliance details.
Phase 1: January – May 2017
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Graphs displaying department and Nurses compliance details.
Analysis
Identifying root causes of poor performance during Phrase 1
• Workflow barriers
– Medication handoff to providers i.e. Lidocaine
– Unconventional patient care areas: hallway
– Medication mapping in Epic - Pyxis or pharmacy i.e. Nicardipine
– Faded barcodes
• Equipment
– Missing Scanners- lost vs misplaced
– Computer on wheels- cumbersome and difficult to maneuver (Screening area)
• Computers in room not available – used by Registration or Providers
• Practice habits
– RN discard medication bottles after mixing medication
• Others challenges
– Damaged or Torn barcodes
– Tethered scanner limited reach
– Treatment room layout – Scanners unreachable when families in the room or other
discipline are using computer
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Phase 1: E.D Monthly Data
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Resolutions:
• Communication
– Held one-on-one discussions with nurses both high and low compliance
– obtain feedback from staff with low and high scanning percentages
– Nursing education and reinforcement on appropriate use of BCMA
– Send out email updates regarding scanning issues and resolution
– Monthly reports to track individual progress
• Multidisciplinary team to resolve issues with BCMA
– Team leader to follow up with staff and discussion incentives, remediation
– The ED leadership team
– Meeting with clinical pharmacists, Epic pharmacists
– Joint meetings with Comprehensive Unit-based Safety Program (CUSP) and
ED informatics committee to discuss BCMA issues.
December 4, 2017 11
Resolutions:
• Practice habits
– Intentional and conscious effort to scan medication/self accountability
– Adapt to the new practices and get accustomed to scanning patient ID
bands and medications
– Incentive program- “Starbucks” reward program for nurses scanning above
monthly goal. Redeem various department gift Items
• Workflow
– Using “Document for another user” Feature in Epic-allow RN be able to
document medication administered by provider
– Pharmacy dept fixed printers
– Epic medication Mapping
– Piloted use of rover in the Upfront Screening area current workflow affected
compliance to increase portability
December 4, 2017 12
Staff comments:
• “The Bluetooth scanners are great but they go missing”
• “ for hallway patients computer on wheels, that thing is
huge…………. They steer terribly”
• “Can we get mobile apps. Like if you go to DSW they can check
you on the floor because of handheld devices”
December 4, 2017 13
Phase 2 - Epic Rover ®
December 4, 2017 14
Phase 2 - Epic Rover ®
•Goal of using the Epic Rover App®:
– Provide nurses with a more portable, feasible, and convenient
method for accessing the BCMA system.
– Timely medication administration - decrease time from Medication
order to Medication administration in ED screening area
•Training:
– Face to Face education, with hands on demonstration to users
– Power Point education material
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Epic Rover 3 Month Pilot Results
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• Increase in Departmental compliance was observed
Phase 2 Trend
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. December July August
Total Meds given in E.D 19,954 19,862
Meds scanned 18,939 18,978
Total Meds not scanned 1,015 884
ED Medication Compliance 94.9 95.5
Total Rns with less than 70% compliance 2 2
Total Meds of RNs with less than 70% compliance 42 40
Survey Results 1:
Qualtrics survey:
–How successful was the software in performing its intended task? i.e.
Medication administration, entering vital signs
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Question Total
Very successful 42
Moderately successful 8
Neutral 1
Somewhat successful 1
Not at all successful 0
Survey Results 2:
December 4, 2017 19
Question Total
Strongly agree 47
Somewhat agree 5
Neither agree nor
disagree0
Somewhat disagree 0
Strongly disagree 0
Do you recommend continued use of the rover app for our
emergency department staff?
Results:
• BCMA compliance increased to 82%,
reaching to 95% by the end of initial
evaluation period. In Phase II, the compliance
rates augmented compliance to 95%,
successfully meeting the desired hospital-
based benchmark.
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BCMA Percentage Distribution
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Conclusion:
• BCMA usage among nurses in the ED improved after
initiation of the education program and the Epic
Rover App®.
• The Epic Rover App® serves as a sustainable
solution to improving nurses’ compliance with using
BCMA systems in most clinical setting especially
area with high patients volumes and medications
administration.
December 4, 2017 22
References:
• Aspden, P., Wolcott, J. A., & Bootman, J. L. (2007). Institute of Medicine (US).
Committee on identifying and preventing medication errors. Preventing
medication errors. Washington, DC: National Academies Press, 16, 463.
• Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J., Prier, B., Reichert, E., ... &
Weber, R. (2013). Effect of barcode‐assisted medication administration on
emergency department medication errors. Academic Emergency
Medicine, 20(8), 801-806.
• Cabilan, C. J., Hughes, J. A., & Shannon, C. (2017). The use of a contextual,
modal and psychological classification of medication errors in the emergency
department: a retrospective descriptive study. Journal of Clinical Nursing.
• Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-
Korach, O., ... & Churchill, W. W. (2010). Effect of bar-code technology on the
safety of medication administration. New England Journal of Medicine, 362(18),
1698-1707.
December 4, 2017 23