Barcode Medication Administration (BCMA) Facilitator Guide

Transcription

1 (BCMA) Facilitator Guide

2 Table of Contents Table of Contents Contents Course Setup... 5 Module 1 - Welcome to Barcode Medication Administration (BCMA) Lesson 1 - Welcome, Introduction and Logistics Lesson 2 Training is Lesson 3 BCMA Learning Objectives Module 2 Introduction to BCMA Lesson 1 Overview of the BCMA Project Lesson 2 Project Background Lesson 3 In Scope and Out for Phase 1 Implementation of BCMA Module 3 Impact of BCMA on Patient Safety Lesson 1 Patient Safety and Closed Loop Medication Administration Lesson 2 Scan Administer Sign Module 4 Barcode Scanning Lesson 1 Scanner Overview and Tips Lesson 2 Hands-on Scanner Activity Lesson 3 Scanner Configuration Revision Date:

3 Table of Contents Lesson 4 Barcodes and the Patient Wristband Module 5 BCMA Overview: Instructor Led Demonstration Lesson 1 Patient Overview and emar Lesson 2 Medication Preparation Lesson 3 BCMA Overview and the Medication Administration Wizard Lesson 4 Sharing the Workstation Module 6 BCMA Participant Hands-on Practice Scenario Lesson 1 Practice Patient # Module 7 BCMA Review and Best Practices Lesson 1 BCMA Does and BCMA Does Not Lesson 2 BCMA Best Practices Lesson 3 Documentation By Proxy Lesson 4 Medication Preparation Best Practice Lesson 5 Using the emar Module 8 BCMA Participant Hands-on Practice Scenario Lesson 1 Practice Patient # Module 9 Point of Care Alerts Lesson 1 What are Point of Care Alerts? Lesson 2 - Demo POC Alerts Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 3 of 115

4 Table of Contents Module 10 Troubleshooting the Scanner and the MAW Lesson 1 Scanner Charging and Battery Replacement Lesson 2 Scanner Hygiene Lesson 3 Troubleshoot: Scanner Lesson 4 Troubleshoot: Medication Scanning Module 11 Review and Resources Lesson 1 Interactive Discussion and Review Lesson 2 Knowledge Check Lesson 3 Job Aids Lesson 4 - Class Survey BCMA Workflow Overview Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 4 of 115

5 Course Setup Course Setup Overview The course includes an introduction, overview and scenario-based, hands-on practice, focusing on functionality and documentation associated with Barcode Medication Administration (BCMA) and the Medication Administration Wizard (MAW). Participants learn how to use BCMA scanners at the point-of-care and document medication administration within the MAW. The course is presented in classroom, as Instructor Led Training (ILT) and is approximately two hours in length. Educator Supplies Tent Card includes participant s name, user ID, password, patient identifiers and barcodes. Facilitator Guide is a detailed informational guide for educators and includes: o Relevant project overview and equipment information o Support for enterprise-wide workflow and documentation o Informational support for the stated learning objectives o Provides background information for scenario-based exercises o Includes all BCMA Participant Workbook exercises o Master set of medication barcodes for all ILT PowerPlans PowerPoint (PPT) presentation provides overview information to be used in conjunction with lectures, demonstrations and exercises. o Project Introduction and Overview o Patient scenario information for exercises o Screen shots for various call outs Participant Workbook includes guided and individual exercises, medication barcodes, Clinical Adoption Readiness Checklist and Reference material. Demos and scenario-based exercises occur in Train Domain. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 5 of 115

6 Course Setup Classroom Setup Clinical Operations and ILT site educators at UWMC and HMC are responsible for all classroom materials and printing needed for BCMA ILT. Classroom setup and materials should be delivered to the classroom 30 minutes prior to class start time. All classroom materials can be found on the ehr portal: \\lapis\ehr_learn$\orca\classes Projects\BCMA. Tent Cards: Educator places one tent card at each workstation in the classroom. (BCMA_Tent Cards_UWMC and BCMA_Tent Cards_HMC). PowerPoint: BCMA ILT PPT, accessed on educator desktop (BCMA-ILT_Final). Facilitator Guide: Two per classroom, for educator and proctor reference (BCMA_Facilitator Guide_FINAL). Participant Workbook: One per participant for use and reference (BCMA_Participant Workbook_FINAL). Participant LMS Roster Sign-In sheet: One per class. Educator has dedicated computer workstation. o Workstation has one, un-corded Code scanner with base charging station o Educator configures un-corded scanner and tethers to educator workstation Scan QuickConnect barcode on the base station to tether o Access to Train Domain via icon on desktop or through Citrix icon (see p. 126 for instructions) Educator should be logged into Train Domain prior to start of class Educator has Clark (HMC) or Roberts (UWMC) patient chart open prior to start of class Educator has BCMA ILT 1 and BCMA POC Alerts PowerPlan initiated prior to start of class. (see p.127 for instructions) o Educator has all four ILT PowerPlans pending on their patient and available to initiate as needed BCMA ILT-1 (educator demo scenario) BCMA POC Alerts (educator demo POC alerts) Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 6 of 115

7 Course Setup BCMA ILT-2 (hands-on participant scenario) BCMA ILT-3 (hands-on participant scenario) Flip Chart for educator to capture parking lot type questions Projector Participant has access to their own computer workstation o Participant workstation has a corded Code scanner connected to the workstation via USB port o Access to Train Domain via icon on desktop or Citrix icon (see p. 68 for instructions) o Participant only patients with pending PowerPlans for two hands-on patient scenario exercises Patient #1 on Tent Card Adams/Porter (HMC) with PowerPlan BCMA ILT-2 pending Smith/Timmons (UWMC) with PowerPlan BCMA ILT-2 pending Patient #2 on Tent Card Madison/Baily (HMC) with PowerPlan BCMA ILT-3 pending Johnson/Nichols (UWMC) with PowerPlan BCMA ILT-3 pending PowerPoint presentation should be queued to the title Cue Slide before class begins Classroom Expectations Participants who arrive 20 minutes late should not be admitted to class per UW Medicine policy. Use your discretion to decide when to provide breaks. Information regarding class breaks and restroom facilities should be presented to the participants, at the beginning of the course. Additional details regarding organizational expectations may be found in Module 11, at the end of this document. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 7 of 115

8 Course Setup How to use this Facilitator Guide This guide uses a table format with two different types of tables: 1. The two-column table is for non-demo material. It has an column and a Script and Key Points column. a. Look in the column for what you need to do. b. Look at the Script or Key Point column for suggested wording and bullet points. Be sure to address each of the key points from this column but, there is no need to read the script verbatim. c. Content marked as Note is for educators and is intended as additional reference information. This information can be incorporated for class use, at one s discretion. 2. The three-column table is used for Demos and Exercises. The first column lists the Step. The second column is the column, and the third column contains Additional Details. a. Look in the Step column for sequential step numbers. b. Look in the column for the step you will be demonstrating or things the facilitator should say. c. Italics indicate things the facilitator should say. d. Non-italics are directions or steps for a demo. e. Look at the Additional Details column for additional information, including pictures and notes. Column Transition Information for the educator noting transition to a new lesson or content. Objectives Review the objectives with participants. Ask Ask the question(s) listed and incorporate questions related to content review. Say Read the contents of this cell to present new information to participants. Emphasize These are key concepts to review/discuss. Exercise Description of the exercise with answers. Set up the exercise by reading this cell s contents to the participants. An exercise may be a practice for one lesson/module or to discover information in the system. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 8 of 115

9 Course Setup Scenario Description of the scenario with answers. Read the cell s content to set up the exercise. A scenario is a hands-on practice session encompassing multiple lessons or modules and includes a more robust patient scenario. Debrief Used after exercises and scenarios as review. Review/Summarize Review the lesson objectives or key module takeaways. Activity Read the contents of this cell to set up the instructor-led group activity. Cue Indicates to the instructor to cue a complementary technology feature, such as a PowerPoint presentation, a Captivate video, a web page, or other. Cue Slide Cue for instructor to display PowerPoint slide. Assumption Facilitator tip informing him or her where they should be in the application, based on the last demo or follow-along. Note Information provided to educator as reference information that can be shared with participants, if needed. Note boxes are highlighted in gray. Facilitator Guide Language Unique references and abbreviations used in this guide: UWMC is written before HMC in this guide because they are going live first. This course is being taught to more than one position. Hence, all participants will be referred to as clinical staff or clinician. Un-corded cordless device Tethered connected via Wi-Fi, Bluetooth type technology RN Nurse RCP Respiratory Therapist SME Subject Matter Expert Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 9 of 115

10 Course Setup POC Point of Care, bedside BCMA Barcode Medication Administration MAW Medication Administration Wizard ILT Instructor Led Training UPS Unit Practice Session Educator Tip The educator is switching between multiple media sources: PowerPoint, Notepad, and Train Domain. In order to help provide a more seamless and timely transition between media sources: Hold down the Alt key and press the Tab key to switch between open applications on the desktop. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 10 of 115

11 Module 1: Welcome to Barcode Medication Administration Module 1 - Welcome to Barcode Medication Administration (BCMA) Lesson 1 - Welcome, Introduction and Logistics Duration: 2 minutes Transition Welcome your participants to the Barcode Medication Administration course, and introduce yourself. Each participant should have a Tent Card and Participant Workbook. Say Cue Slide: Welcome to BCMA Welcome to Barcode Medication Administration, Instructor Led Training. What is the purpose of this class? This course includes an introduction and overview of BCMA, including instructor led demonstrations and hands-on practice for participants. The focus is on functionality and documentation associated with BCMA and the Medication Administration Wizard (MAW). You will learn how to use BCMA scanners at the point-of-care and document medication administration within the MAW. Emphasize The purpose of this course is to address BCMA and enterprise-wide functionality. Transition Provide classroom logistics and expectations. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 11 of 115

12 Module 1: Welcome to Barcode Medication Administration Say Cue Slide: Classroom Logistics Logistics The course is approximately two hours in length. Explain when breaks will take place and the location of the restrooms. Say Please, silence phones and pagers. If you are on call and required to answer personal devices, please step out of the room to do so. Say We will be using the Train Domain for demonstrations and exercises. Do not log into the Train Domain yet. I will give you instructions about how to log in shortly. This is a short class with a lot of material to cover. Please refrain from using your computer for other purposes during class. Say Cue Slide: Parking Lot I will ask for questions at the end of each lesson. Questions I cannot answer are written down by the proctor. These are referred to as parking lot questions. Answers to your questions will be researched and posted on the ITS Clinical Applications website, under BCMA Reference, FAQ. Further questions can be sent by to caed@uw.edu. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 12 of 115

13 Module 1: Welcome to Barcode Medication Administration Lesson 2 Training is Duration: 2 minutes Transition You will be defining and discussing BCMA s training strategy. Training is multi layered. Opportunity to reinforce lessons learned during this class and continue training on-unit. Define and review ILT and UPS. Say Cue Slide: Training is Let s talk about BCMA s training approach. This course is the beginning of your education experience and will highlight enterprise-wide functionality. You will have an opportunity to see, learn and understand BCMA functionality by practicing skills in a real-time, interactive environment. We will focus on broad-spectrum workflows related to medication prep, scanning, administration and documentation associated with BCMA. Unit specific workflows involving BCMA, will not be covered during this class. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 13 of 115

14 Module 1: Welcome to Barcode Medication Administration Say When you return to your units, BCMA training opportunities are provided through Unit Practice Sessions, referred to as UPS. The focus of UPS is on unit specific workflow. UPS is designed to address unit specific situations, providing opportunities for hands-on practice, focusing on your unit workflow. The BCMA Readiness Checklist in your Participant Workbook, is designed to help you capture questions/concerns unique to your work experience. Emphasize It is understood that this class is the beginning of your BCMA Training. Transition Have participants turn their attention to the Participant Workbook. Highlight the following components in the workbook. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 14 of 115

15 Module 1: Welcome to Barcode Medication Administration Say Cue Slide: Workbook Contents Let s take a closer look at your participant workbook You will reference this workbook throughout class and can take it with you, to reference and have available during UPS. The workbook contains: BCMA Workflow Overview Scanner operation activities Scenario-based exercises Icon Reference page Job Aids associated with BCMA Website and source for BCMA FAQ Reference Course objectives check list BCMA Readiness Checklist Activity Have participants orient themselves to their workbooks and locate the BCMA Course Objectives and BCMA Readiness Checklist. Suggest having these available throughout the course. Note Address concerns with first time use of BCMA. Acknowledge transition to new workflow expectations. Provide opportunities to assimilate workflows and review policy changes. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 15 of 115

16 Module 1: Welcome to Barcode Medication Administration Lesson 3 BCMA Learning Objectives Duration: 1 minute Transition Review the following learning objectives. The course learning objectives are the recognized knowledge and skills associated with BCMA functionality. Subject Matter Experts (SMEs), educators and project leadership have identified these objectives as required to fulfill performance goals. Cue Cue Slide BCMA Objectives, have participants review. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 16 of 115

17 Module 1: Welcome to Barcode Medication Administration Objectives Cue Slide: BCMA Objectives Ask Say By the end of this course, you ll be able to: Recognize units and staff in scope at UWMC and HMC Enhance patient safety with the use of BCMA technology Launch and navigate the MAW display Scan the patient wristband Scan medications prior to administration Document medication administration within the MAW Manage BCMA medication administration warnings Support Best Practice recommendations Refresh, Sign and close the MAW Identify emar documentation opportunities Configure and maintain the scanner Troubleshoot hardware and system errors Are there any questions about the objectives? As we go through the course, you can document completion of these objectives in your workbook. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 17 of 115

18 Module 1: Welcome to Barcode Medication Administration Note * The following BCMA medication administration alerts are covered during ILT: medication documentation warnings associated with the Five Rights Point of Care (POC) Alerts medication route changes medication not found free text medications multi-dose medications early and overdue medication tasks vaccine documentation Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 18 of 115

19 Module 2: Introduction to BCMA Module 2 Introduction to BCMA Lesson 1 Overview of the BCMA Project Duration: 2 minutes Transition Say Say Cue Slide: BCMA Project Overview The following is a broad overview of BCMA and BCMA Project context. Let s talk about the BCMA Project and how we got to this point. Overview of BCMA: BCMA adds another layer of safety: To the patient identification process Medication administration Documentation of medication tasks Notifies the clinician of potential medication administration errors, through verification of the "Five Rights" (5Rs). Reduces medication errors and improves patient safety while supporting our UW Medicine, Patients are First, quality of care pillars. Also achieves Meaningful Use, Stage 2 requirements by automatically documenting the administration of medication into the patient s electronic health record. Meaningful Use metrics are achieved when: o The patient s wristband is successfully scanned. o Every dose administered for a medication order is successfully scanned. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 19 of 115

20 Module 2: Introduction to BCMA Note If UW Medicine does not meet the required percentages of patient and medication scans, fines are imposed by the federal government. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 20 of 115

21 Module 2: Introduction to BCMA Lesson 2 Project Background Duration: 2 minutes Transition These are the project team members who were involved in the decisions made and helped to make it all happen The emphasis here is how BCMA policy and procedure determinations were recommended by RNs, RTs and Project Design team members. These recommendations for Best Practice were then supported by UW Medicine leadership. Say Cue Slide: BCMA Team RNs and RCPs were directly involved: BCMA policy and procedure determinations were recommended by RNs and RCPs. They provided guidance in recommending Best Practices and defining BCMA workflow. Responsible for driving BCMA policy and procedure to leadership for approval. The recommendations for Best Practice, made by your coworkers, were supported by UW Medicine leadership. The following committees were involved in Best Practice considerations: PCS Leadership Pharmacy Ops Med Safety Committee Medication Administration Committee Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 21 of 115

22 Module 2: Introduction to BCMA Lesson 3 In Scope and Out for Phase 1 Implementation of BCMA Duration: 2 minutes Transition The following lesson will review the scope of phase 1 implementation of BCMA. Who is in scope and where. What medications are in and out of scope. Say Cue Slide: In and Out of Scope Emphasize Who is in scope: All RCPs, STAT and Float staff at UWMC and HMC. RNs working on the following units: Units In Scope at UWMC. o 4NE, 4SE, 5E/5N, 5NE, 5SE, 6NE, 6SE Units In Scope at HMC. o 2WH, 3WH, 7EH, 8EH, 9EH, 9MB Why do we need to know this? If a patient is transferred or transported to a unit or procedure area that is not in scope, BCMA cannot take place. No scanners on unit = No BCMA. Medication administration is documented in emar. Note Information regarding workflows when patient is off-unit will be discussed in more detail during BCMA Best Practices lesson. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 22 of 115

23 Module 2: Introduction to BCMA Say Cue Slide: In and Out of Scope Ask What medications are in scope? All routine medications should be scanned prior to administration, including: Bolus medications. Maintenance and bolus IV administration. Multi dose medication. Range dose medication. Crush medication. Dialysis, if delivered on a unit that is in scope. What is out of scope? NS flushes 5ml NS flushes do not need to be scanned. Document in IView. Self-Administered Medication (SAMs) Home medications IV Pumps do not communicate with ehrs and are therefore, out of scope. However, medications administered through IV Pumps should be scanned first. If a patient is transferred to a unit that is not in scope, will BCMA scanning occur? No, documentation occurs in emar, as it does now. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 23 of 115

24 Module 2: Introduction to BCMA Say Cue Slide: Go-live Dates Ask UWMC and HMC have different Go-live dates. UWMC..February 19, 2014 HMC..March 5, 2014 Any questions about scope of practice or go-live dates? Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 24 of 115

25 Module 3: Impact of BCMA on Patient Safety Module 3 Impact of BCMA on Patient Safety Lesson 1 Patient Safety and Closed Loop Medication Administration Duration: 3 minutes Transition Discuss and emphasize importance of BCMA and patient safety. BCMA adds a second layer to patient safety by enhancing 5Rs safety check already performed by clinical staff. Say BCMA can enhance patient safety and reduce medication errors by providing a second safety check of the 5Rs that you already check with every administration. It also allows for standardized documentation. Say Cue Slide: Closed Loop Medication Administration Let s review the Closed Loop Medication Administration system. Potential for medication errors can occur throughout the medication administration process. This system is designed to utilize technology to reduce medication errors. For example, while CPOE uses technology to help reduce prescribing and transcribing errors. BCMA enables a closed loop system because it uses technology to: o Verify the patient s identification. o Reinforce the Five Rights verification. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 25 of 115

26 Module 3: Impact of BCMA on Patient Safety Images Cue Ask Use the following questions to reinforce BCMA and patient safety. Will BCMA protect you if a medication is entered incorrectly by the prescriber? No the purpose of CPOE, nurse and pharmacy review is to catch these errors. You are still expected to review the order and use your clinical judgment to ensure the orders accuracy. from giving a medication to the wrong patient? Yes as long as you scan the patient s wristband and medication dose prior to administration. from giving an incorrect dose or form of a medication? Yes as long as each and every medication dose barcode is scanned prior to administration. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 26 of 115

27 Module 3: Impact of BCMA on Patient Safety Say BCMA helps to ensure accuracy and enhance patient safety. Emphasize Does BCMA check the Five Rights so you don t have to? NO you should continue to self-check the Five Rights with each and every medication administration. Note 39% of medication errors occur during the prescribing phase. 23% of medication errors occur during the pharmacy phase. CPOE technology contributes to CLMA and reduces medication errors by as much as 95%. 38% of medication errors occur during the administration phase. BCMA technology contributes to CLMA by reducing medication errors by 86% Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 27 of 115

28 Module 3: Impact of BCMA on Patient Safety Lesson 2 Scan Administer Sign Duration: 2 minutes Transition In order to ensure the patient receives the benefit of BCMA safety: Medications must be scanned prior to administration and Medications must be administered prior to signing. Say The essential component to BCMA increasing the safety of medication administration S-A-S. Emphasize Cue Slide: Scan, Administer, and Sign The key to BCMA s success is to scan every medication dose before administration. This means medications must have Orders in place to scan against. Medications must have barcodes to scan. Sign after administration. Emphasize Scan, Administer, and Sign In order to receive the safety benefits associated with BCMA, every medication dose must be scanned prior to administration. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 28 of 115

29 Module 4: Barcode Scanning 101 Module 4 Barcode Scanning 101 Lesson 1 Scanner Overview and Tips Duration: 2 minutes Say Cue Slide: Scanner Overview In this module, We will provide an overview of scanner function and configuration. Review Best Practices associated with scanner usage. Participate in a hands-on scanner activity. Say Every bedside workstation and Workstation on Wheels (WOWs) will have an un-corded scanner and base station used for charging. The corded scanners used in class, work with ORCA the same way as the un-corded scanners will at your unit workstations. Say Cue Slide: Scanning Tips The scanner performs best when it is 3-4 inches from the barcode. Hold the trigger and gradually pull away until a beep is heard and/or vibrate felt. The scanner can be used at different angles to the barcode. However, scanning at extreme angles will take the scanner longer to recognize the barcode. The Code scanner does not use laser technology. If the scanner light flashes rapidly, pause until it stops and then rescan. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 29 of 115

30 Module 4: Barcode Scanning 101 Note Educator may have to review BCMA specific terminology: Un-corded = cordless Tethered = Bluetooth type connection between scanner and workstation. Information specific to the care and feeding of the scanner will be discussed later. Scanners: Do not use laser technology and therefore are uncomfortable, but not harmful to eyes. They are mini computers with a camera and light. They are programmed by simply pointing at the right barcode. They do not break easily. Play is the highest form of learning, so don t be afraid to play. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 30 of 115

31 Module 4: Barcode Scanning 101 Lesson 2 Hands-on Scanner Activity Duration: 5 minutes Transition Have participants turn to page 3 in their workbook: Exercise: Open Notepad and Scan. Have participants follow steps in their workbook to open Notepad at their workstation. Say Please turn to page 3 in your participant workbook. This exercise is an opportunity to use scanners and get a feel for how they operate. Practice scanning different types of barcodes and at different distances and angles. Note For the purposes of training, participants are using corded Code scanners. Corded scanners will function in this exercise and in the Train Domain, the same as un-corded scanners will function with ORCA on the unit. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 31 of 115

32 Module 4: Barcode Scanning 101 Activity Open Notepad and Scan Have participants open Notepad on their desktops. If needed, see Note at the end of this lesson, for alternate directions to open Notepad. 1. Go to Windows Start button. 2. In the Search field, type Notepad. 3. Select Notepad in list. 4. Have participants get creative and scan various barcodes. Barcodes on their UW ID. Barcode on scanner base station, hand sanitizers, etc. Various medication barcodes found in participant workbook and tent card. 5. Encourage participants to scan at different distances and angles. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 32 of 115

33 Module 4: Barcode Scanning 101 Note This is a short activity. Have participants scan for 5 minutes and then move on to the next lesson. Say After you are done practicing, please close out of Notepad. Select Don t Save Transition Return to PPT Note Some workstations may have an older version of Windows, open Notepad as follows: 1. Click on Windows Start button. 2. Click on Run. 3. Type Notepad. 4. Click OK. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 33 of 115

34 Module 4: Barcode Scanning 101 Lesson 3 Scanner Configuration Duration: 3 minutes Transition The following lesson and activity involves lecture points on scanner configuration followed by a participant workbook exercise. Say Cue Slide: Scanner Setting Configuration Scanner configuration: Clinicians can adjust scanner volume and vibration settings. Volume/vibration settings are changed by scanning the corresponding barcodes. Laminated cards with volume/vibration barcodes and troubleshooting steps will be located at workstations. Each unit will have policies regarding volume settings. For example: Day Mode barcode Night Mode barcode Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 34 of 115

35 Module 4: Barcode Scanning 101 Slide Image Say This is an example of what the laminated cards will look like. Say Cue Slide: Scanner Workstation Configuration When un-corded scanners are talking to workstations they are referred to as tethered. A scanner is tethered to a workstation using the same Bluetooth technology as cellphones. Scanning the QuickConnect barcode located on the base station, tethers the scanner to the workstation. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 35 of 115

36 Module 4: Barcode Scanning 101 Say The scanner may need to be reconfigured to the workstation. If it is carried more than 50 feet from the workstation. If the scanner is replaced. If the battery is replaced. Scan the QuickConnect barcode on the base station to reconfigure. Transition Have participants turn to page 4, Exercise: Scanner Configuration. Participants can practice configuring scanners to different volume and vibrate settings. Have participants scan the various configuration barcodes located in the Scanner Configuration workbook exercise. Say Please turn to page 4, Exercise: Scanner Configuration located in your workbook. This is an opportunity to configure your scanner to different settings. Scan the various barcodes and practice configuring the scanners to different volume and vibrate settings. Note The barcodes used in this exercise are for Code scanners only. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 36 of 115

37 Module 4: Barcode Scanning 101 Clinicians can adjust scanner volume and vibration settings. Exercise: Scanner configuration Volume/vibration settings are changed by scanning the corresponding barcodes. Laminated cards with volume/vibration barcodes and troubleshooting steps will be located at workstations. Step Additional Details 1. Aim scanner at barcode. 2. Aim scanner at barcode. Beep on HIGH 3. Aim scanner at barcode. Beep on Low Vibrate Only This exercise is complete. Emphasize Scanners on your unit will be configured and programmed to Vibrate ON. Volume may be adjusted from Off to High, per unit policy. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 37 of 115

38 Module 4: Barcode Scanning 101 Lesson 4 Barcodes and the Patient Wristband Duration: 2 minutes Transition Review different types of barcodes. Scanners are pre-configured to read certain types of barcodes. Say Cue Slide: Different Barcodes There are different types of barcodes. At UW Medicine, you may see linear, 2D or combination barcodes. Linear o Linear barcodes are manufacturer type barcodes. 2D o 2D stands for two dimensional. Combination o Have both types of barcodes. o If one barcode does not scan, scan the other. Emphasize When there are multiple barcodes on the medication, scan the barcode on the patient specific, pharmacy label first (yellow or blue label). Pharmacy generated medication labels, will have 2D barcodes. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 38 of 115

39 Module 4: Barcode Scanning 101 Transition Detailed look at patient wristband and barcode. Emphasis is on 2D barcode for BCMA. Say Cue Slide: Patient Wristband There are two barcodes on the patient wristband. A linear barcode and 2D barcode. For BCMA patient identification and medication administration, scan the 2D barcode. The linear barcode does not contain the information needed for BCMA patient identification. It is important to target the 2D barcode. Best Practice: Cover the linear barcode with your thumb/finger when scanning the 2D barcode. Cue Slide Image Aim for this barcode Cover this barcode when scanning Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 39 of 115

40 Module 4: Barcode Scanning 101 Say Cue Slide: Best Practice BCMA is dependent on being able to scan a patient s wristband. Anticipate the need for a replacement. Best Practice: o Check wristbands during hand-off and ensure they are intact and readable. o This ensures successful scanning of the wristband, during medication administration. If the patient s wristband has become unreadable, follow your current practice to obtain a new one. Note Due to Train Domain limitations, the patient wristband barcode on the Tent Cards have linear barcodes, not 2D. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 40 of 115

41 Module 5: BCMA Overview: Instructor Led Demonstration Module 5 BCMA Overview: Instructor Led Demonstration Lesson 1 Patient Overview and emar Duration: 2 minutes Cue Educator Demo patient (Clark or Roberts) chart is open. BCMA ILT 1 PowerPlan is initiated. Transition The demonstration is divided into 4 lessons. Participants follow along as educator walks through a start-to-finish demonstration of BCMA functionality, workflow and MAW documentation. Say This is a demonstration of BCMA and the MAW. Cue We will be walking through start-to-finish, BCMA workflow. The patient is a 58yo female, admitted for hypertension. Click on Med Admin (emar) from left menu. Say Let s start by reviewing emar. Best Practice recommendation is to review emar first. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 41 of 115

42 Module 5: BCMA Overview: Instructor Led Demonstration Emphasize When reviewing emar: Reconcile overdue tasks. Review the patient s Orders. Review patient Allergies. Anticipate possible Med Requests and contact Practitioner/Pharmacy. If a different form of medication is needed (i.e. elixir vs. tab): o Pharmacy has to create a new Order to scan against. o Override is no longer an option. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 42 of 115

43 Module 5: BCMA Overview: Instructor Led Demonstration Lesson 2 Medication Preparation Duration: 2 minutes Transition Medication preparation at the point of care is the most significant change to the clinician s current practice. Med Prep is discussed further during Review of Best Practices. Say We have reviewed the patient s Orders, retrieved the medications needed from the Pyxis and brought the medications to the patient s bedside. Say The expectation is for all medication prep to occur at the patient s bedside. Best Practice: Medication is collected and brought to the bedside for prep and scan. This ensures the medication barcode is nearby and remains intact. Allows for successful scanning. There are very few exceptions. We will discuss med prep further when we review Best Practices. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 43 of 115

44 Module 5: BCMA Overview: Instructor Led Demonstration Lesson 3 BCMA Overview and the Medication Administration Wizard Duration: 10 minutes Transition The MAW display is a new display for end users. You will be providing a high level overview of the MAW display while demoing BCMA functionality. Say Let s go over what we have done: We have reviewed emar and Orders. Collected medications from the Pyxis. Entered the patient s room. Prepped medications for administration. Pleases turn to page 6 in your participant workbook where you will find an overview of BCMA workflow at the point of care. Say The first step is to open the patient s chart at the bedside workstation. Now we are ready to launch the Medication Administration Wizard display. Transition Demo How to Launch the MAW. Say Once the patient chart is open, the MAW can be launched. Clinicians who administer medication will see a new button on the Toolbar. The Medication Administration barcode button opens the MAW display. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 44 of 115

45 Module 5: BCMA Overview: Instructor Led Demonstration Cue Click the Medication Administration button on the Toolbar. Say The MAW display is where scanning of patient wristbands, medications and medication documentation will take place. Say Page 1 of the MAW opens. The display has elements you will be familiar with. Transition Highlight terms and functions found on opening page of MAW. Say Demo MAW Display Next is only used to bypass scanning patient wristband. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 45 of 115

46 Module 5: BCMA Overview: Instructor Led Demonstration Say The display title bar is labeled Medication Administration and has standard Windows buttons on the far right. The patient demographic bar contains the same information found in the patient s chart. Check patient name and MRN. The display notifies the clinician when Ready to Scan. The alert, in the center of the display, is a reminder to scan the patient wristband first. The Next button. Only used if the patient wristband cannot be scanned and medication administration is time sensitive or emergent. We ll discuss this further during the Troubleshoot lesson. Cue Scan the demo patient wristband barcode. Say The MAW displays page 2. The list of medication tasks to be administered is shown. Emphasize Overdue tasks will always display at the top. All Overdue medications will show first and persist at the top of this display. o Causing medication tasks to appear further and further down the page. Overdue tasks should be reviewed and reconciled regularly. Cue Point out gray time bar. Demo Changing Time Parameters. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 46 of 115

47 Module 5: BCMA Overview: Instructor Led Demonstration Say A time bar is displayed. Demo Changing time Parameters The medication tasks window defaults to 90 minutes before and 90 minutes after the current time. Similar to the emar, we can change the time parameters and see more medication tasks. Say Right Click in the gray time bar. Select Change Search Criteria. (Point out displays to change time) Click OK to close window. Transition Demonstrate Document Further Details Right Click on a medication. Say If you need to document further details, you can right-click on an individual medication in the MAW and select additional documentation options. The display provides similar menu options found in emar. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 47 of 115

48 Module 5: BCMA Overview: Instructor Led Demonstration View Cue Point out Nurse Review button. Emphasize Orders should continue to be reviewed on Orders page. Say Nurse Review button can be used for a quick review of current meds. It is not recommended for regular use because it only displays current medication tasks. Does not display any other type of orders/tasks. Orders should continue to be reviewed on Orders page. Have participants turn to the Icon Reference page in their workbooks. Cue Review Orders display Say This is where your medication tasks associated with this PowerPlan are displayed. Review the medication tasks. Prep your medications. Emphasize Self-check the 5Rs before every scan and administration. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 48 of 115

49 Module 5: BCMA Overview: Instructor Led Demonstration Say The first box is unchecked. As medications are scanned, a black check mark will appear in these boxes. Cue Scan Lisinopril once. Use Lisinopril to point out icons. Say Other icons appear in this area as scanning is performed. Familiar and new icons associated with BCMA display in this area. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 49 of 115

50 Module 5: BCMA Overview: Instructor Led Demonstration Ask Which icons look familiar and which are new? Answer: Familiar Icons Overdue Task. STAT Medication. Nurse Review. Pharmacy comment. Ask (cont d) Associated to a PowerPlan Answer: New Icons Underdose alert Overdose alert Icon indicating a task is unscheduled. I.e. PRN med. Inactive Order icon is displayed on a task associated to an order status: Additional charting Elements are required. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 50 of 115

51 Module 5: BCMA Overview: Instructor Led Demonstration Say The Underdose icon appears because Orders are for 20mg Lisinopril and we have scanned only one of two 10mg tabs. Cue Scan second Lisinopril. Review Best Practice Emphasize Best Practice: When you have multiple medications: o Scan each individual tab, not one tab, multiple times. o Scanning each individual tab ensures BCMA safety functionality (5Rs). Say When a medication is scanned successfully, a Blue Check mark appears. Say We have a blue check mark and have confirmed the 5Rs. Administer the medication. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 51 of 115

52 Module 5: BCMA Overview: Instructor Led Demonstration Say When giving medications: Best Practice: Scan and administer the medication before scanning the next medication task. Transition Point out Sign and Last Refresh button. Do not click on Sign button. Say Clicking on the Sign or Last Refresh button time stamps the medication administration. The Sign button automatically closes the MAW. Cue Point out Last Refresh button. Say The Last Refresh button is used to Sign for the medication, after medication has been given. It allows you to Sign without closing out of the MAW display. Updates the display of medication tasks and keeps the display open and ready for the next scan. Demo Click on Last Refresh button. Select Yes. MAW display remains open. Display is updated. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 52 of 115

53 Module 5: BCMA Overview: Instructor Led Demonstration Cue Scan Metoprolol. Use Metoprolol to point out black check and blue check. Say There are no alerts and the blue check appears, indicating Metoprolol has been scanned successfully. You have self-checked the 5Rs Administer the medication. Review Best Practice is to Scan, Administer then Sign. (SAS). Cue Call out Next vs. Sign button. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 53 of 115

54 Module 5: BCMA Overview: Instructor Led Demonstration Say Instead of the Sign button, we have a Next button. This indicates there may be further documentation associated with this medication. BCMA will not let you Sign and close the MAW until all documentation checks are complete. Click on the Next button. Say Just like in emar, Metoprolol prompts an I&O display for review. Purpose: RN can review and validate information documented in I&O is correct. Say Once display is reviewed and information is validated: Click on Sign. MAW display automatically closes. Cue Click Sign. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 54 of 115

55 Module 5: BCMA Overview: Instructor Led Demonstration Say If you click on Sign and close out MAW display but, more meds need to be administered. You will have to start over by clicking on Medication Administration button. Reopen the MAW display. Rescan the patient wristband and continue. Say We have completed all of our scanning, medication administration and documentation. We have signed and closed out the MAW. Since we launched the MAW from emar, we are back on emar page. Click Refresh in emar. You can check medications administered and time stamps in emar and Med Admin Summary. Note Tip: If needed, you can click on black checked box to deselect and start scanning event over. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 55 of 115

56 Module 5: BCMA Overview: Instructor Led Demonstration Lesson 4 Sharing the Workstation Duration: 2 minutes Transition Sharing the workstation between RNs and RTs is important to the success of BCMA. Say Emphasize Nurses and respiratory therapists will share the scanner and workstation located at patient bedside. The Change button, located on the Toolbar, is a fast and easy way to log in and out of a patient s chart. Allows users to switch positions while keeping the patient s chart open. Best Practice: The expectation is for RNs and RCPs to scan and document all medications at the bedside. RCPs are expected to document their own medication administration. This is accomplished by using the Change button to share the workstation and scanner. Cue Point out the Change button in the toolbar. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 56 of 115

57 Module 5: BCMA Overview: Instructor Led Demonstration Say The MAW functions are the same whether an RN or RCP position is signed in. If the Change button is dithered, there is more than one chart open. Close the chart not in use and continue. Note If clinician does not have the Medication Administration button or the Change button on their Toolbar: Job Aid is located in their workbook, under Reference, Placing Icons on the Toolbar. The UPS team can assist with Toolbar customization. Say Demonstration is complete. Ask Are there any questions? If time permits, have participants take a short break. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 57 of 115

58 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Module 6 BCMA Participant Hands-on Practice Scenario Lesson 1 Practice Patient #1 Duration: 15 minutes Transition Have the participants open their workbooks to page 8. Exercise: Practice Patient #1 Participants can work through scenarios individually. Encourage participants to help one another. Educator to go around room and offer assistance, answer questions. Cue Participant exercise is also located in this Facilitator Guide. Say Now it s your turn to experience BCMA workflow from start to finish. Your patient is a 58yo female admitted for Chest Pain. Follow the steps and complete the tasks associated with this exercise. I will be going around the room, let me know if you have any questions. Note The exercise appears in this Facilitator Guide as it appears in the Participant Workbook. Participants can scan medication barcodes located in the exercise table. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 58 of 115

59 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 BCMA Participant Hands-on Practice Scenario Scenario: Patient: 58yo female admitted for Chest Pain. History: Hypertension, A-Fib and Asthma. Medications: Albuterol, Lisinopril and Coumadin. Allergies: Penicillin. Exercise: Practice Patient #1 Instructions: Follow the steps below to complete tasks associated with opening the MAW display, scanning the patient wristband, scanning medications, managing alerts and documenting medication administration. Step Additional Details & Hints 1. Log onto Train Domain. 1. Click on Train PowerChart icon on desktop and go to step #3 or 2. Click on Citrix icon in lower right corner of desktop. a. Hover over ORCA. b. Hover over TRAIN. c. Click TRAIN Powerchart. 3. User Name and Password is located on your Tent Card. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 59 of 115

60 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 2. Search for and Open: Type Practice Patient #1 MRN in Search box. Point out Search box and have participants search for patient chart using MRN. Practice Patient #1 s name, barcode and MRN is located on your Tent Card. 3. Initiate PowerPlan BCMA ILT 2. Please assist RCPs with Initiate. Steps to Initiate orders: 1. Click on Orders 2. Right click on BCMA ILT 2 PowerPlan. 3. Click Initiate. 4. Select Written No Cosign. 5. Click OK. 6. Click Orders for Signature. 7. Click Sign. 8. Click Refresh. Initiating orders may take a few minutes. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 60 of 115

61 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 4. Best Practice. Review emar. Reconcile Overdue tasks Anticipate possible Med Request Reminder: You can launch the MAW from anywhere in the patient s chart. Best Practice recommendation is to launch the MAW from emar, after chart review. 5. Open the MAW display. Click the Medication Administration barcode button in the toolbar. 6. Scan Practice Patient #1 barcode to identify the patient. MAW display opens page The patient is wheezing. Scan Albuterol 2.5mg Nebulized barcode. Patient name, barcode and MRN is located on Tent Card. Albuterol 2.5mg/3mL 0.83% inhalation Blue check = med task scan complete. Administer medication Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 61 of 115

62 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 8. The patient is complaining of chest pain. Scan Aspirin 325mg barcode. Aspirin 325mg tab The patient continues to have chest pain. 1. Scan Nitroglycerin.4mg SL barcode. 2. See Additional Details & Hints Blue check = med task scan complete. 3. Click OK. Warning displays medication is not within the MAW task list. Nitroglycerine 0.4mg sublingual tab Initial Order was for NTG SL, order was dc d sometime between Pyxis and bedside. Now, Order is for Nitroglycerine paste. Secure or administer other medications, return to Pyxis and retrieve medication in the correct form/route (paste). Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 62 of 115

63 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 10. Scan Nitroglycerin paste barcode. Nitroglycerin 2% oint 30g Blue check = med task scan complete. 11. The patient has orders for Lisinopril 30mg. You return to bedside with Lisinopril 10mg x3 tabs. 1. Scan Lisinopril 10mg tab barcode. 2. See Additional Details. Review: Best Practice Scan each individual tab to ensure BCMA safety functionality (5Rs). Do not scan one tab multiple times. Lisinopril 10mg tab Underdose alert icon noted. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 63 of 115

64 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints Scan next Lisinopril 10mg tab. 2. See Additional Details. Lisinopril 10mg tab Why is underdose alert icon still present? Orders are for 30mg and only two 10mg tabs have been scanned. Underdose alert icon still noted. 13. Scan last Lisinopril 10mg tab. Lisinopril 10mg tab Blue check = med task scan complete. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 64 of 115

65 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 14. The patient has orders for Sodium Chloride IV infusion at 100ml/hr. 1. Scan Sodium Chloride 0.9% 1000ml barcode. 2. A Qualified Task display appears. a. Select continuous 100ml/hr task. b. Verify correct task is in bold type. 3. Click OK. 4. Blue X icon indicates need for further documentation. Best Practice for IV maintenance and blous documentation: Sodium chloride 0.9% 1000mL New begin bag is scanned in the MAW. Subsequent bolus from the same bag is documented in emar Click the yellow Results field. Display for Sodium Chloride appears. 2. Complete the required field: Site: Antecubutial LEFT. 3. Click OK. All yellow fields require documentation. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 65 of 115

66 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 16. The patient continues to have of chest pain. There is an order for Morphine 2-4mg IV PRN. 1. Scan Morphine Sulfate barcode. 2. See Additional Details. 3. Click OK. 17. Display for Morphine appears. Yellow fields require documentation. You administered 2mg of Morphine. 1. Type 2 in the first yellow box. 2. Press Tab on keyboard for second yellow box. 3. Type mg (milligrams). 4. Press Enter on keyboard or 5. Click OK. Warning free text dose alert appears because order is written as a range dose. PRN Med Response is documented in emar. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 66 of 115

67 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 18. The patient has orders for Warfarin 7.5mg. You return to the bedside with Warfarin 5mg tab and Warfarin 2.5mg tab. 1. Scan Warfarin 2.5mg tab. 2. See Additional Details. 3. Scan Warfarin 5mg tab. Why is it important to scan each individual tab? Ensure BCMA safety functionality. For example, these tabs are different doses. Warfarin 2.5mg tab Underdose alert icon appears. Warfarin 5mg tab The patient has orders for Hydrochlorothiazide 12.5mg. You return to bedside with HCTZ 25mg tab. 1. Scan HCTZ 25mg tab barcode. 2. See Additional Details. 3. Click OK. Hydrochlorothiazide 25 mg tab Warning display indicates wrong dose. Overdose alert icon appears and med task is red. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 67 of 115

68 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints Click on HCTZ Results field of med task to enter the correct dose a. HCTZ display appears. 2. Click in dose field and change 25 to Click OK. 4. Split medication and administer. 21. An Influenza screening for vaccine PowerForm has been completed. The patient has an order for Influenza vaccine. 1. Scan Influenza Virus Vaccine barcode. 2. Click yellow Results field to document further. Results field is in the far right column on the medication task. Best Practice: Split and administer before scanning next medication. Blue X icon indicates need for further documentation. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 68 of 115

69 Module 6: BCMA Participant Hands-on Scenario Practice Patient #1 Step Additional Details & Hints 22. Influenza virus vaccine display appears. Yellow fields are required documentation. Complete the required fields. 1. Manufacturer GlaxoSmithKline. 2. Lot Number Expiration Date One year from today. 4. Site - Deltoid LEFT. 5. Click OK. 23. Medication tasks are complete. 1. Click Sign. 2. MAW closes automatically. 3. Click Refresh. 4. Review emar. 5. Close the patient s chart. Exercise is complete. Ask if there are any questions. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 69 of 115

70 Module 7: Review and BCMA Best Practices Module 7 BCMA Review and Best Practices Lesson 1 BCMA Does and BCMA Does Not Duration: 3 minutes Transition Cue Say Cue Slide BCMA Does Say Cue Slide: BCMA Does Not Review BCMA Best Practice recommendations. Your desktop should be back on PPT presentation. BCMA does Help verify patient identification. Confirm medication administration. Notifies the clinician of possible medication administration safety hazards. Enable a Closed Loop Medication Administration system Standardize documentation. BCMA does not Take the place of clinical judgment. If the order or medication task does not coincide with your clinical judgment, verify using the same workflow you currently use. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 70 of 115

71 Module 7: Review and BCMA Best Practices Say Say BCMA does not Check the Five Rights so you don t have to. Clinicians are still expected to verify the 5Rs with every medication administration. BCMA does not Slow down or stop you from administering medication. The expectation is every medication should be scanned before administration because o Order should be in place for the medication task. o Medication will have an associated barcode to scan. Anticipate and complete Med Requests to ensure timely med administration and BCMA patient safety success. Say If medication does not scan and giving the med is time sensitive or emergent, what steps should you take? Confirm the 5Rs and administer medication. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 71 of 115

72 Module 7: Review and BCMA Best Practices Say Cue Slide Medication does not scan If a medication does not scan and administration is emergent: You can bypass the medication scan. Select the check box next to the medication. Message box will appear: Task has not been verified by a scan Click Yes. Check the 5Rs. Administer medication. Images Cue Slide builds showing screenshots. Hit Enter key to show images. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 72 of 115

73 Module 7: Review and BCMA Best Practices Ask Cue Slide: Patient Wristband Does Not Scan If patient wristband does not scan and medication administration is time sensitive or emergent what should be done? Say Click Next. Select YES. Images Next is only used to bypass Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 73 of 115

74 Module 7: Review and BCMA Best Practices Emphasize Bypass of medication scan or patient wristband scan also bypasses BCMA safety check. Does not meet Meaningful Use requirements. Therefore, bypass should only be done when scan fails and med administration is time sensitive or emergent. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 74 of 115

75 Module 7: Review and BCMA Best Practices Lesson 2 BCMA Best Practices Duration: 3 minutes Transition Certain recommendations for Best Practice may still be in progress. The intent is to deliver up to date recommendations for Best Practice. Say Cue Slide: Best Practices Say Cue Slide: IV Bags and Bolus Let s take a moment to review Best Practice recommendations: Review emar, and then open the MAW. Reconcile overdue tasks. Anticipate Med Requests. Anticipate the need to replace patient wristbands. Always verify the 5Rs with each medication administration. Scan each individual medication tab, capsule, blister pack, etc. Do not scan the same medication multiple times. IV bag and bolus infusion: If it is a new begin bag from Pharmacy, it can be scanned and documented in MAW. New bag = scan. Documentation of subsequent boluses, from the same bag, is done in emar. You cannot scan the same bag repeatedly; it will prompt an overdose alert. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 75 of 115

76 Module 7: Review and BCMA Best Practices Say What happens when a patient returns to your unit with an on-going IV infusion: If there is a patient label, scan on-going infusion to allow for BCMA safety check. If there is not a patient label, (i.e. from OR) make sure current infusion is documented, if not document by proxy in emar. The next bag or new bag from Pharmacy can be scanned in the MAW. Say What happens if your patient returns to your unit and medications were given elsewhere? Make sure meds are documented in emar, if not document by proxy. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 76 of 115

77 Module 7: Review and BCMA Best Practices Lesson 3 Documentation By Proxy Duration: 2 minutes Say Cue Slide: Document by Proxy What does documenting By Proxy mean: Documenting a medication task performed by someone else that can be confirmed (verbally or written). When can you Document By Proxy If medications are administered by someone else on another unit or patient care area and it was not documented in emar. Can you confirm medication was given? Document medication administration in emar as by proxy. During urgent episodes of care. If medication is scanned by one nurse but administered by another. Document by proxy in MAW. If clinician is gowned and gloved, another clinician can scan and document as by proxy in MAW. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 77 of 115

78 Module 7: Review and BCMA Best Practices Say Cue Slide: Document By Proxy in MAW How to document by proxy in MAW: Click on medication field in MAW display. Select Chart Details, window displays. Choose Medication performed by from drop down menu. FYI: New drop down menu choice for meds given in OR. OR, see Anesthesia Say You can also continue to document by proxy in emar. Click on medication or dose and document in Chart Details or Additional Details. Emphasize If a medication is given elsewhere or by someone else and the administration can be confirmed (verbally or written), the medication administration should be documented in emar or MAW, as by proxy. The emar needs to reflect all medications administered. Say Anticipate medication administration needs before patient leaves unit. If clinically appropriate, administer meds prior to patient leaving unit so patient benefits from BCMA safety check. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 78 of 115

79 Module 7: Review and BCMA Best Practices Lesson 4 Medication Preparation Best Practice Duration: 2 minutes Transition Medication preparation at the point of care is the most significant change to the clinician s current practice. Say Best Practice recommendation is for all medication preparation to occur at the bedside. Medication is collected and brought to the bedside for prep and scan. Emphasize There are a few exceptions to bedside preparation: Crushed meds Multi-dose medications Say Cue Slide: Crushed Meds Crushed meds will continue to be prepped in medication area. Crush the meds in their package. Ensure the barcode stays intact. Keep crushed medication in package and bring it to the bedside for scanning and administration. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 79 of 115

80 Module 7: Review and BCMA Best Practices Say Cue Slide: Multi-dose Medication Multi-dose medications Patient specific meds (i.e. inhalers, creams, etc.) Bring medication and packaging to the bedside. Leave packaging near workstation for future scanning. Insulin (shared vial) Do not take entire vial/bottle to the bedside. Insulin pulled from a shared vial will continue to be prepped in the medication area. Prepped Insulin syringe and the medication barcode label system (TBD) is brought to the bedside and scanned. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 80 of 115

81 Module 7: Review and BCMA Best Practices Lesson 5 Using the emar Duration: 2 minutes Transition Using BCMA and the MAW does not entirely replace the use of emar. Certain documentation will continue to take place in emar. Say Cue Slide: emar is Still There There are occasions where documentation will still occur in emar. Reconcile overdue tasks. Document Med Requests. Document PRN Med Response. Document subsequent IV boluses. Document a patch removal. Emphasize Consider emar as the source of truth. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 81 of 115

82 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Module 8 BCMA Participant Hands-on Practice Scenario Lesson 1 Practice Patient #2 Duration: 10 minutes Transition Have the participants open their workbooks to page 14. Exercise: Practice Patient #2 Participants can work through scenarios individually. Encourage participants to help one another. Educator to go around room and offer assistance, answer questions. Cue Participant exercise is also located in this Facilitator Guide. Say Your patient is a 58yo female admitted for uncontrolled Diabetes, COPD and Sepsis. This exercise will provide some additional practice and introduce additional concepts for BCMA documentation. Follow the steps and complete the tasks associated with this exercise. I will be going around the room, let me know if you have any questions. Note The exercise appears in this Facilitator Guide as it appears in the Participant Workbook. Participants can scan medication barcodes located in the exercise table. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 82 of 115

83 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 BCMA Participant Hands-on Practice Scenario Exercise: Practice Patient #2 Scenario: Patient: 55yo female admitted for uncontrolled Diabetes, COPD and Sepsis. History: Diabetes, Hypertension, COPD, and Decubitus Ulcers. Medications: Albuterol, Lisinopril and Insulin. Allergies: Penicillin. Instructions: Follow the steps below to complete tasks associated with opening the MAW display, scanning the patient wristband, scanning medications, manage warnings and documenting medication administration. Step Additional Details & Hints 1. Participants should still be logged into the Train Domain. 2. Open Practice Patient #2. Practice Patient #2. Type the MRN into the Search box Patient name, barcode and MRN is located on Tent Card. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 83 of 115

84 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints 3. Initiate PowerPlan BCMA ILT 3. Best Practice Reminders: Chart Review in emar. Reconcile overdue tasks. Anticipate possible Med Requests. 4. Open the MAW display. Click the Medication Administration barcode button. Please assist RCPs with Initiate. Steps to Initiate orders: 1. Click on Orders. 2. Right click on BCMA ILT 3 PowerPlan. 3. Click Initiate. 4. Select Written No Cosign. 5. Click OK. 6. Click Orders for Signature. 7. Click Sign. 8. Click Refresh. Reminder: You can launch the MAW from anywhere in the patient s chart. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 84 of 115

85 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints 5. Wrong Patient 1. Intentionally scan your neighbor s patient barcode. 2. Review Warning 3. Click OK. Note: Warning indicates scanning in wrong patient chart or scanning wrong patient. Warning display indicating patient could not be identified. 6. Scan correct Practice Patient #2 barcode from your Tent Card. MAW display opens page 2. Patient name, barcode and MRN is located on Tent Card. 7. Your patient is wheezing and has orders for Albuterol MDI 4-8 puffs. 1. Scan Albuterol MDI. 2. Review the Warning. 3. Click OK. Why does the warning appear? Order is written as a range dose, further dose documentation is required. Albuterol cfc free (HFA) 90 mcg/inh aerosol Warning free text dose alert appears. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 85 of 115

86 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints 8. Albuterol display appears. Your patient will receive 4 puffs. Complete the required fields. 1. Type Choose puff(s). 3. Click OK. 9. Your patient s has orders for Chlorhexidine swish and spit. Scan Chlorhexidine 0.12 % 10mL.l Chlorhexidine 0.12% oral top liq 10 ml Patient has a diabetic history and has orders for 10 units of Insulin. 1. Scan Insulin. 2. Yellow fields require further documentation. Note: With certain types of Insulin, the barcode profile is programed to 1 Unit. This will require Dose field to be updated to reflect dose administered. Blue X icon indicates need for further documentation. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 86 of 115

87 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints Click on yellow Results field. 2. The dose field will need to be updated. What will happen if you don t update dose field? Underdose alert. 3. Enter the correct dose administered. 4. Fill in Site information. 5. Click OK. 12. You have received an order to place a Fentanyl patch on your patient. Scan Fentanyl 50mcg/hr. Reminder: Always self-check 5Rs, Insulin expiration date is hand written on bottle and not included in barcode profile. Fentanyl 50mcg/ hr patch Patient has infected decubitus ulcer and orders for Bacitracin. Scan Bacitracin ointment. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 87 of 115

88 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints 14. Sodium Chloride IV infusion at 100ml/hr is ordered. 1. Scan Sodium Chloride 0.9% 1000ml barcode. 2. A Qualified Task display appears. a. Select continuous 100ml/hr task. b. Verify correct task is in bold type. 3. Click OK. What does the blue X mean? Further documentation needed. Reminder: Sodium chloride 0.9% 1000mL New begin bag is scanned in the MAW. Subsequent bolus from the same bag is documented in emar. 15. Your patient is running a fever and has orders for Tylenol 650mg. Tylenol, is dispensed as 325mg tab from Pyxis. Scan Tylenol 325mg tab. Which alert icon appears? Underdose. Acetaminophen 325 mg tab Underdose alert icon appears. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 88 of 115

89 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints 16. Scan second Tylenol 325mg tab. What if this patient needed Tylenol elixir? Best Practice Anticipate route/form changes (i.e. tablet to elixir). Send Med Request to Pharmacy or call Practitioner/Pharmacy RN can no longer obtain new form from Pyxis without Order. 17. Patient requires wound care and has orders for Fentanyl mcg. 1. Scan Fentanyl 100mcg/2ml amp 2. Click OK. Acetaminophen 325 mg tab Fentanyl 100mcg/ 2mL amp Warning free text dose alert appears. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 89 of 115

90 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints 18. Fentanyl display opens. Yellow fields require documentation. You are giving 25 mcg. 1. Fill in required fields. 2. Click OK. 3. Administer medication 4. Click on Refresh. 5. Select Yes. 19. Wound care continues and patient requires another 50 mcg bolus of Fentanyl. 1. Scan Fentanyl 100mcg/2ml amp 2. Click OK. Fentanyl 100mcg/ 2mL amp Warning free text dose alert appears. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 90 of 115

91 Module 8: BCMA Participant Hands-on Scenario Practice Patient #2 Step Additional Details & Hints 20. Fentanyl display opens. Yellow fields require documentation. 1. Fill in required fields. 2. Click OK. 3. Administer medication. 4. Click Sign. What is the difference between Refresh and Sign? Sign closes MAW display. Best Practice: Multi bolus medication from the same vial: Scan vial before each administration, document and give medication. Note: PRN Med Response is documented in emar. 21. Medication tasks are complete. 1. MAW display is closed. 2. Click Refresh in patient s chart. 3. Review emar 4. Review Med Admin Summary. 5. Close the patient s chart. This exercise is complete. Please capture any unit specific workflow questions on your Readiness Checklist. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 91 of 115

92 Module 9: Point of Care Alerts Module 9 Point of Care Alerts Lesson 1 What are Point of Care Alerts? Duration: 2 minutes Transition This is a demo. Scan medications associated with POC Alert PowerPlan. Say POC Alerts are unique alerts that require your review before scan and administration. Defined by UW Medicine, Pharmacy Ops. Can be changed or added to any medication Pharmacy Ops chooses. Require chart review to ensure alert is/is not applicable before medication scan and administration can take place. Provide access to medication reference and administration information. Emphasize The point of these alerts is to warn the clinician of a potential hazardous side effect. Be sure to review the alert before continuing medication administration. Cue Open educator demo patient and initiate POC Alert PowerPlan. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 92 of 115

93 Module 9: Point of Care Alerts Lesson 2 - Demo POC Alerts Duration: 3 minutes Step Additional Details 1. Open the MAW display. Click the Medication Administration barcode button. Currently, there are three POC alerts that have been created by Pharmacy Ops. Reminder: You can launch the MAW from anywhere in the patient s chart. 2. Scan Insulin Review content of alert. 3. Select OK to Administer. Click OK. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 93 of 115

94 Module 9: Point of Care Alerts Step Additional Details 4. Scan Naloxone. Note: Naloxone alert is site specicfic. Scan medication for your location. HMC UWMC Review content of alert. 5. Click OK. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 94 of 115

95 Module 9: Point of Care Alerts Step Additional Details 6. Scan Vecuronium. 7. Click OK. Review content of alert. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 95 of 115

96 Module 10: Troubleshooting BCMA and the MAW Module 10 Troubleshooting the Scanner and the MAW Lesson 1 Scanner Charging and Battery Replacement Duration: 3 minutes Note There will be 3 un-corded scanners per classroom. One for the educator workstation and two additional for participants to rotate use of. Say Cue Slide Scanner Charging Image Let s take a closer look at the un-corded scanners we have available. Un-corded scanners use rechargeable batteries. The scanner charges every time it is placed in the base station. A green light will glow steadily on the base station when the scanner is charging. Battery Gauge Indicators on the scanner will show the scanner s charge level. Charging Battery Gauge Indicators Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 96 of 115

97 Module 10: Troubleshooting BCMA and the MAW Say Cue Slide Replacing Battery Cue Slide Image Replacing the Battery If the scanner is in the base station and there are no lights on, the battery needs to be replaced. Remove the battery by sliding the battery latch located under the scanner. Replacement scanners, base stations and batteries are available on-unit. Latch Say The Blue LED will flash on the base station when battery is removed. Indicates the two devices are not communicating. Cue Demonstrate the steps for removing and replacing battery. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 97 of 115

98 Module 10: Troubleshooting BCMA and the MAW Say Cue Slide Powering on the Scanner Cue Slide Images After the battery is replaced, the scanner needs to be turned on. Press either of the buttons on top of the scanner. The scanner will beep, vibrate and the LEDs on the scanner will flash. The green LED on the scanner will glow steady to indicate it is on and ready for use. The Blue LED on the base station will glow steady, indicating the scanner and base station are tethered and communicating. Charging Light Blue LED QuickConnect Code Say Powering the scanner Off and On is a troubleshooting step if scanner is not functioning or scanning. Ask Are there any questions about charging or battery replacement? Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 98 of 115

99 Module 10: Troubleshooting BCMA and the MAW Lesson 2 Scanner Hygiene Duration: 2 minutes Transition Cleaning the Code scanner is similar to glucometer decon workflow. Say Cue Slide: Scanner Hygiene Cleaning and decontamination of scanners is similar to decon of other medical devices in the patient s room. Use sani-wipes to clean and decontaminate. Avoid using bleach. Bleach will cause the lens to become cloudy. Scanner will no longer function properly. Do not submerge the scanner. In the event of gross contamination. Contain and contact the HelpDesk. Replace scanner from on-unit stock. Cue Point to the scanner lens when discussing not to use bleach on the lens. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 99 of 115

100 Module 10: Troubleshooting BCMA and the MAW Lesson 3 Troubleshoot: Scanner Duration: 2 minutes Say For BCMA to succeed all the parts need to be functioning when medication is administered. There are some basic troubleshooting steps the HelpDesk would like clinicians to try before calling. Say If the scanner is not functioning Turn the device off and back on. Check the cable from base station to USB port. Check the battery indicator light. Remove and reset the battery. Replace the battery. Check Bluetooth switch is turned on (located on back of base charging station). Reconfigure the device. Ask How do you configure the scanner to the workstation? Scan the QuickConnect barcode on the base station. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 100 of 115

101 Module 10: Troubleshooting BCMA and the MAW Emphasize If scanner is still not functioning: Contact the HelpDesk. Replace it with on-unit spare. Tether replacement scanner to workstation. Say Cue Slide: Scanner Loss Best Practice recommendations to reduce scanner loss: Return scanner to charger before leaving room. Check scanner is in room before end of shift. Check scanner is not on your person before leaving unit. The most common occurrence of scanner loss. Scanner gets mixed in with patient bedding and sent to laundry. If the scanner is misplaced, press the Blue LED button on the charging station. Scanner starts beeping until it is retrieved and the scanner trigger is pulled. If scanner walks away from its tethered workstation it will start to beep. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 101 of 115

102 Module 10: Troubleshooting BCMA and the MAW Lesson 4 Troubleshoot: Medication Scanning Duration: 3 minutes Transition Medication barcodes need to be scanned for BCMA to work. Say Cue Slide: Medication Scanning The medication does not scan: If there is more than one barcode on a medication, try the other barcode. If scanning an IV bag, try putting a hand behind the bag and rescan. Emphasize Medication should not be removed from package before scanning. Check for medication barcode when pulling from Pyxis. Say Cue Slide: If Med Does not Scan Some packages have reflective surfaces. Try changing the angle or distance and scan again. Try 2 RN Rule. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 102 of 115

103 Module 10: Troubleshooting BCMA and the MAW Say Say Cue Slide Med Request If time permits, you can try to scan another package of the same medication. Administer medication from package that did not scan. Return the package that did not scan to Pharmacy. Place the package in the Pharmacy return envelope. Put envelope in the pharmacy bin. Submit a Med Request through emar. There is a new field and workflow added to Med Request option in emar. From emar, Right-click on the medication name and select Med Request. In Reason field select Barcode Info Med Unable to Scan. Scan the barcode of the medication into the open text field. The barcode may scan into this field even though it did not scan in the MAW. Type in the barcode number, if it does not scan. Include any information you think Pharmacy should know. Pharmacy is very interested in making sure all medications can be scanned. Click the OK button. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 103 of 115

104 Module 10: Troubleshooting BCMA and the MAW Images Select from menu list Scan barcode into field or type in medication number Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 104 of 115

105 Module 11: Review and Resources Module 11 Review and Resources Lesson 1 Interactive Discussion and Review Duration: 2 minutes Transition Review Parking Lot Questions and associated material. Ask for any questions that have been saved by the students. Say UPS is designed to address unit specific settings. Please try to attend one of these sessions. Please make sure you take your BCMA Readiness Checklist to help UPS answer your unit specific questions/concerns. Cue Review the BCMA Readiness Checklist with the class. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 105 of 115

106 Module 11: Review and Resources Lesson 2 Knowledge Check Duration: 5 minutes Transition Take the opportunity to review through rapid fire Q&A. Say Starting on page 21 you can follow along and write in the answers to the following questions. Ask Where should medication preparation take place? At bedside. Why is BCMA important to the clinician? Safeguard accuracy in patient identification, medication administration and documentation. Continue to ensure patient safety and provide quality healthcare. Name the different warnings that can fire when medications are scanned. Early/Late Discontinued/Cancelled Order Overdose Medication unable to scan Underdose Medication not in formulary Missing Details Medication Not in Time Range Route-Form Medication Not On Profile Form-Form Medication not Identified Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 106 of 115

107 Module 11: Review and Resources How do you ask Pharmacy for a different form of medication that has been ordered? Submit Med Request through the emar or contact Pharmacy/Practitioner.. Name two important things to check at patient hand-off? Check for Overdue tasks and check patient wristband for readability. What is the recommended method to clean the scanner? Use disinfecting Sani-wipe What is the optimal distance the scanner should be from the barcode? 3-4 inches What barcode do you need to cover on the patient wristband when scanning? Linear barcode What colored light confirms that the scanner is seated in the charging station? Green light = scanner charging (it has the Code label on it) If a patient is off unit when medication needs to be administered how should it be documented? By Proxy in emar. Use clinical judgment to decide if BCMA can be done before patient goes off unit. How do you tether the scanner to the workstation? Scan the QuickConnect 2D barcode on the base station Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 107 of 115

108 Module 11: Review and Resources Ask Should Self-Administered Medications be scanned? No, SAMs are out of scope for Phase 1. When should IV bags be scanned? Scan new bag. Should dialysis meds be scanned? Yes, if they are on a unit that is in scope. Ask If a scanner has a full charge and the wireless icon is glowing but, it does not scan, what should a clinician try next? Point scanner at the QuickConnect Code and scan to tether. Check the cables. If the patient is off unit and a medication has been administered by someone else and you have confirmed the administration. How and where should the administration be documented? Document By Proxy, in emar. When is it acceptable to bypass patient wristband scanning? Only if meds are needed for urgent episodes of care. Otherwise replace patient wristband and rescan. Anticipate if a replacement wristband is needed before medication administration. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 108 of 115

109 Module 11: Review and Resources Question What button in the task bar allows nurses and respiratory therapists to share a patient chart and workstation? Change button. How does a clinician communicate with the Pharmacy when a medication barcode does not scan? Complete Med Request in the emar. Put the package in a Medication Return envelope. If the clinician has scanned a medication that the patient has refused what should be done? Un-check the black check in the MAW. Right-click on the medication. Select Chart Not Done. Select the Reason. If a patient needs an elixir rather than a tab, what should be done? Anticipate and submit a Med Request through emar or contact Pharmacy. If the clinician has scanned a medication and the patient has refused, what should be done? Deselect the medication, click on medication and select appropriate menu item. What are the three key steps to BCMA? Scan Administer Sign. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 109 of 115

110 Module 11: Review and Resources Lesson 3 Job Aids Duration: 1 minutes Transition Included with the Participant workbook are several job aids. Medication Administration Wizard Icons. Placing Icons on the Toolbar. Med Request Medication Barcode Failure. Emphasize Job aids are available for downloading at: The Job Aids are also available through the ITS Clinical Application web page. Say Clinicians should use the BCMA Readiness Checklist and continue to document skills they learn during the Unit Practice Sessions. Participants can check with their mangers for scheduled UPS times. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 110 of 115

111 Module 11: Review and Resources Lesson 4 - Class Survey Duration: 2 minutes Say Please take a moment and complete the class survey. Directions are in the workbook (p 24). Activity Class Survey 1. Click on Links and Reports in the task bar. 2. Under Support Links, click Clinical Applications Education. 3. Under EHR Home, click on Resource Library. 4. Click on Classroom Resources on the right. 5. Choose BCMA Classes Survey from the list below Classroom Surveys. 6. Choose BCMA Classes from the list by class name. 7. After completing the survey, close the Clinical Applications Education window and log out of the training application using the Exit Door. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 111 of 115

112 Reference BCMA Workflow Overview Instructions: Use this diagram when watching the instructor led demonstration. You have reviewed the patient s orders, retrieved medications from the Pyxis and have returned to the bedside workstation. BCMA start-to-finish workflow can be simplified into TEN easy steps. 1. You are at the patient s bedside. From the workstation, open the emar and review the patient s chart. 2. Click on the Medication Administration button located on the toolbar to open the MAW. 3. Scan the patient s wristband. 4. Review MAW and self-check the 5Rs. 5. Prep all medications at the patient s bedside. 6. Scan medication prior to administration. 7. Administer medication to patient. 8. Click Sign or Refresh in the MAW. 9. Click Refresh in emar. 10. Review emar. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 112 of 115

113 Reference Medication Administration Wizard Icons Icon Definition Medication is ready to be signed off STAT Medication Overdue Task Pharmacy Comment Missing Detail Icon. There is a required box that has not been completed on the medication task. Underdose Warning Overdose Warning Nurse Review Indicates that the order has not been verified by the pharmacy The pharmacy has reviewed and rejected the order. View Alert History Indicates that one order is linked to another order. Task is not associated to the current encounter. Indicates that this task is unscheduled Additional Charting Elements are available for documentation. The Inactive Order icon is displayed on a task associated to an order that is in one of the following statuses: Cancelled Pending Completed Discontinued Transfer/cancelled Suspended Associated to an order that was generated as part of a PowerPlan if the preference is set to 1 = on This icon display on the medication charting window if the system, for any reason cannot evaluate the medication interval for the warning. Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 113 of 115

114 Reference CONTINGENCY: LOGGING INTO ORCA TRNA/TRNB In the event the ORCA TRN desktop icon doesn t work or appear on desktop, you can access the Train Domain by logging into Citrix. 1. Left-click on the Citrix icon in the Windows system tray. 2. Select Orca from the menu. 3. Select the train domain: TRNA or TRNB 4. Select TRNA Apps or TRNB Apps 5. In the Search field, type powerchart. Press Enter. 6. Double-click on powerchart.exe or cernerapps (D:). Location: \\lapis\ehr_learn$\orca\classes Projects\BCMA Page 114 of 115