Person Directed emar Use: Conversion of Traditional Medication Administration to Liberalized Medication Administration

Transcription

1 C A S E STUDY Persn Directed emar Use: Cnversin f Traditinal Medicatin Administratin t Liberalized Medicatin Administratin Categry Quality f Life/Satisfactin with Care Cntributrs: Carl Garcia Senir Manager, IT Services Stephanie Brennan IT Applicatin Analyst Dushwante Lricka Infrmatics Educatr, IT Clinical Specialist Staff Efficiencies Organizatin Name The Francis E. Parker Memrial Hme, Inc. ( Parker ) Organizatin Type The Parker System includes fur Skilled Nursing Facilities, an Assisted Living Facility, Medical and Scial Adult Day Care Prgrams, Pst-Acute Rehabilitatin Services, Outpatient Rehabilitatin Services, and Health and Wellness Prgrams. Other Partners Answers On Demand (AOD), nw part f MatrixCare Dr. David Hwarth, Medical Directr Pharmcare USA, Prescribers Cnnectin RASA Pharmacy Cnsultant Grup The LeadingAge Center fr Aging Services Technlgies (CAST) is fcused n accelerating the develpment, evaluatin and adptin f emerging technlgies that will transfrm the aging experience. As an internatinal calitin f mre than 400 technlgy cmpanies, aging-services rganizatins, businesses, research universities and gvernment representatives, CAST wrks under the auspices f LeadingAge, an assciatin f 6,000 nt-fr-prfit rganizatins dedicated t expanding the wrld f pssibilities fr aging. Fr mre infrmatin cntact: Zhra Sirat, Prject Manager, CAST zsirat@leadingage.rg (202) LeadingAge.rg/CAST Organizatin Descriptin Funded in 1907 Parker is based n the belief that peple shuld be able t live in a hme-like envirnment with the ultimate in persnalized, affrdable high-quality lng-term care services. Guided by the principles f the Eden Alternative persn-directed philsphy f care, Parker ffers a cntinuum f services, prviding scial, emtinal, medical, and physical supprt t empwer persnal chice fr ur lder adult residents. Parker is cmmitted t creating and maintaining an envirnment that enhances the lives f ur residents and their families, ur emplyees, and ur cmmunity. Prject Descriptin In supprt f Parker s persn-centered care apprach, an pprtunity was identified t empwer and engage residents thrugh a liberalized medicatin administratin prgram. The decisin t migrate frm a

2 traditinal time-stamped medicatin administratin plicy t a liberalized medicatin administratin plicy* allws medicatins t be administered in a safe and timely manner but in a way that crrespnds with residents daily activities and mre nrmal hme-like schedules. Residents receive medicatin(s) at their preferred time, enabling them t retain cntrl f their wn wake and sleep hurs, encuraging independence and enhancing quality f life. System Type Parker s clinical sftware prvider, AOD, prvided the Physician Orders and Electrnic Medicatin Administratin Recrd/Treatment Administratin Recrd (emar/etar) mdule allwing nurses and physicians t create and send rders electrnically t the pharmacy. Physicians als have capability t electrnically e-sign interim and mnthly rders. This prvides real-time updates t each resident s electrnic medicatin and treatment administratin recrds (emar/etar). Clinicians have remte access t emar/etar updates n the system and a twice-daily scheduled emar/etar pdf backup n a secured server prvides resilience in the event f any scheduled r unscheduled system dwntime. Prescribers cnnectin is the natin s largest lng term care fcused eprescribing Netwrk, with a cmprehensive netwrk cnnecting lng-term care facilities, physicians, and pharmacies. Prescribers Cnnectin is used as an interface between Parker s sftware, AOD, and pharmacy, Pharmcare USA. System Embdiment The AOD Physicians Orders emar/etar feature allws fr electrnic data entry and management fr the administratin f medicatins and treatments. The prgram can be set up t administer medicatins and/ r treatments accrding t physician s rders. Parker Hme implemented a bi-directinal cnnectin hub t the pharmacy thrugh Prescribers cnnectin that allws the pharmacy t seamlessly access data withut having t cntact Parker staff directly. The pharmacy can access infrmatin such as census data, and review medicatins fr patient diagnsis thrugh read-nly access t AOD, ensuring that residents electrnic prtected health infrmatin (PHI) recrds remain secure frm any external data manipulatin r crruptin. The bi-directinal interface between AOD, Prescribers Cnnectin, and Pharmcare USA allws messages t be sent between the three systems fr refilling f medicatin and therapeutic substitutin, facilitating rder changes, and seamless updates f census and patient diagnsis data. See diagram belw describing the eprescribing messages flw in and ut f Prescribers Cnnectin. Surce: Pharmcare USA IT Department * Mrning medicatins can be administered frm 6:00 a.m. t 11:00 a.m.; nn medicatins frm 12:00 p.m. t 4:00 p.m.; Afternn medicatins frm 4:00 p.m. t 7:00 p.m. and hurs f sleep frm 8:00 p.m. 11:00 p.m. There are sme exceptins t this plicy t facilitate best medicatin treatment utcmes as recmmended by physicians. Persn Directed emar Use: Cnversin f Traditinal Medicatin Administratin t Liberalized Medicatin Administratin 2

3 Business Mdel Parker, a nt-fr-prfit rganizatin, ffers the highest quality lng-term care services at subsidized rates. Parker accepts private pay, private health insurance, and Medicaid (dependent n lcatin). Implementatin Apprach Parker s electrnic Liberalized Medicatin Administratin prgram was launched in Nvember 2015 with the Assisted Living Residence selected t G Live first, with 36 resident recrds t recncile and seven nurses t be trained. The prcess was a simple behind the scenes cnversin perfrmed by AOD and n additinal recnciliatin was necessary t implement this prject. All medicatin administered timestamps were changed t thse utlined in ur Liberalized Medicatin Administratin plicy. Training was a pririty and rle-centric task frces were created. A Champin/Buddy system was used, with three nurses, ne representing each shift, selected as Champins wh received a three-day cre training frm an AOD specialist. Each Champin was assigned a Buddy (anther nurse n the same shift) t train and supprt thrugh the three-mnth implementatin prcess. Physician buy-in was vital and supprt was gained frm the Medical Directr prir t implementatin. A Physicians Task Frce prvided an pprtunity fr review and input n develpment f electrnic frms fr use within the AOD system. Parker s Infrmatics Educatr/ IT Clinical Specialist prvided initial training and nging user supprt fr physicians. Parker als created and published an AOD Physician Binder that includes infrmatin and resurces fr system use and wrk flw, including remte desktp instructins, navigatin tls, and writing and e-signing rders guidelines. Parker IT staff wrked in tandem with AOD team specialists thrughut prject implementatin and supplied and supprted infrastructure and equipment needs. The nursing department crdinated staff schedules t allw availability fr training and cverage and senir nurses were selected t manage and review medicatin schedules fr cmpliance. Administrative staff prvided clerical supprt during reviews and training exercises. Pharmacy prvided nging trash runs and the Pharmacist Cnsultant wrked with the Parker team thrughut implementatin t ensure cmpliance with state regulatins. Surce: Pharmcare USA IT Department Persn Directed emar Use: Cnversin f Traditinal Medicatin Administratin t Liberalized Medicatin Administratin 3

4 Advantages t the Apprach Rles and expectatins were clearly defined and staff received extensive training befre G Live, with cntinued training as needed. Clinical staff had prper cverage t attend all training sessins. Clinical staff had several layers f supprt prvided by Buddy partners, IT Helpdesk Specialists, Infrmatics Educatr, I.T. Applicatins Analyst and EHR vendr supprt. 1:1 supprt was prvided via walk-in hurs during the nrmal business day and after-hurs supprt (including weekends and hlidays) frm an external Helpdesk vendr. Parker s Staff Infrmatics Educatr/IT Clinical Specialist prvided super-user level n-site supprt. The Clinical and IT supprt Mdel is illustrated in the diagram belw. Outcmes Parker s cnversin t a liberalized Medicatin Administratin System empwers resident lder adults t make their wn decisins regarding when t take their medicatin. As a result, there has been an verall imprvement in persn-centered Quality f Care and resident satisfactin. Thrugh the Physician Orders emar/etar and Prescribers cnnectin hub interface, residents medicatins are rdered n-time and securely by nursing staff. This has resulted in significant quality assurance prcess imprvements (QAPI) and reduced medicatin errrs as cmpared t traditinal paper methds. Parker physicians electrnically e-sign Physician Orders with ease instead f using redundant manual prcedures that are labr intensive and time cnsuming, while maintaining an accurate electrnic audit trail fr each resident in AOD. Preimplementatin review and signing f rders tk apprximately fur hurs and pst-implementatin time was reduced t minutes. Pharmcare USA staff benefit frm having read-nly access t resident PHI recrds, enabling them t make medicatin substitutins, refill and change rders in real-time at the pint f dispensing. Imprved efficiency as nurses nw cmplete ntes with their med pass. Challenges and Pitfalls t Avid One f the mst critical aspects f implementatin was t streamline and maximize user adptin. Clinical staff were very cmfrtable using a paperbased traditinal medicatin administratin and reluctant t migrate t a Liberalized Medicatin Administratin. T maximize user adptin, Parker tk the fllwing steps: We vercame this barrier by systematic planning and scheduling f small grup rle-centered training sessins that addressed all classificatins f clinical staff. We adpted a site-wide prcess f cntinuus training, nt a ne-time nly training apprach. Training was priritized, with managers facilitating cverage t supprt attendance at nging training sessins while ensuring care and service fr residents was nt cmprmised. By using the Champin/Buddy prcess, with ne nurse frm each shift assigned t ther emplyees as their buddies, this allwed educatin t reach all nurses in a 1:1 frmat. It allwed fr persnalized training and supprt and staff were mre cmfrtable asking questins in an individualized setting. Parker develped an implementatin strategy fr emar/etar and Physician Orders that allws flexibility t facilitate any changes in the rdering prcess as needed acrss ur varied campuses. Onging cmmunicatin between Parker and Pharmcare USA Pharmacy was critical prir t implementatin and after g-live when the system was up and running. Lessns Learned The Clinical Management Team must fully supprt the prject and psitively reinfrce the benefits f the electrnic system ver the traditinal paperbased system. Timing is everything! Summer mnths may nt be the best time t implement majr prjects due t increased staff time ff. Cntinuus rle-centered training shuld be fcused n small grups and supprted by the n-site champins as needed in ne-n-ne sessins. In additin: Persn Directed emar Use: Cnversin f Traditinal Medicatin Administratin t Liberalized Medicatin Administratin 4

5 Training must be priritized by Management and n a cntinual basis as system prcesses change and future enhancements are implemented. Management must prvide staff with adequate cverage t attend nging training sessins. Physicians must buy-int the prject and be adequately trained n hw t use the system. Advice t Share with Others Parker s Staff Infrmatics Educatr/IT Clinical Specialist prvided super-user level supprt nsite t all staff members, prviding exceptinal levels f enduser training and assistance. Whether a dedicated psitin, r an expansin f an existing ne, this rle was instrumental in the success f the prject. Be sure t cnfirm with yur sftware prvider the ptin t mdify electrnic medicatin administratin frequency cdes accrding t yur rganizatin s determined schedule. Create an rganizatin-wide implementatin plan that allws enugh lead time t thrughly test the system and train users befre the G-Live Date. Cnsider all budget ramificatins, including sftware, certificatin prgram, training, and staff supprt. D nt allw yur sftware vendr t dictate the G- Live Date. Get buy-in frm senir clinical and management staff early. Define clear expectatins fr all vendrs and staff invlved. Ensure supprt is available t cver all shifts, including nights and weekends. Cntinuus training is required in rder t maintain a successful system. Keep training sessins rle-specific and tailred tward the end-users needs. Plicies must be develped and fllwed t supprt nging cmpliance. Persn Directed emar Use: Cnversin f Traditinal Medicatin Administratin t Liberalized Medicatin Administratin 5