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More thoughts on BCMA from Mike Jones at Univ Colorado Hosp

06/24/2009

Just so you do not think I am some anti-BCMA psychotic:  Below is thoughtful essay on some of the (side) benefits of BCMA and the process.

Posted with permission from Michael Jones, Pharmacy Informatics Specialist (extraordinaire) at Univ of Colorado Hospital.

John Poikonen, Pharm.D. | UMass Memorial Health Care | john.poikonen@umassmemorial.org | 508-334-1159 | 978-501-4887 mobile


From: Jones, Michael – Pharmacy

Sent: Tuesday, June 23, 2009 3:57 PM
To: Poikonen, John
Subject: RE: BCMA

Hi John,

Before we implemented BCMA I think I agreed with your current position.  In fact, I’m sure I would agreed with you half way through our two year implementation.  Now that we have completed implementation I’ve really grown to appreciate the benefits.  Interestingly, for me the benefits go beyond the “5-rights …” everybody talks about.   

Two important benefits of BCMA that seem to be missing from our discussions and the literature is:

  1. BCMA forces Pharmacy and Nursing together, as a single team.

In order for BCMA to work effectively, pharmacists really need to be decentralized, working with nurses as a team.  One of the challenges we had to overcome was several pharmacists and nurses that liked the status quo.  Some of these people learned to like the new working arrangement, some moved on.  Nurses came to appreciate what pharmacists brought to the point-of-care.  Pharmacists realized they had nothing to fear and gained significant respect for the work nurses, RTs and physicians do.  

Bill Gates said in his book Business at the Speed of Thought, “… success in a high-tech environment requires high-touch professionals”.  For pharmacists to continue to thrive with the numbers employed we currently have, in a “no more NUPOR” world we need to be close to our patients and really integrated in to a healthcare team. 

  1. The value of knowing the actual time a med is administered, and knowing it in real-time is important for real-time decision making. 

Example #1: When a patient starts to crump the first questions are “what meds have the patient gotten?”, and when were the narcs given?  If the nurse has not charted all day there is a huge information gap interfering with good decision making. 

Importance to automated CDS:

1)          Here at UCH our team is writing a medical logic module (MLM) for the medical emergency team (MET) a.k.a a rapid response team in some hospitals.  Obviously accurate and timely charting of VS, meds, labs, procedures, etc, is very important to the specificity and sensitivity of the alerts.  

2)          I have also written a MLM for our pharmacokinetics service that is triggered by a Vancomycin SDC stored in the electronic patient record.  It collects most the information they need including the actual times of the last two Vancomycin administrations.  As you know, the actual time of med admin is a major vulnerability to the success of any PK service.  This would be impossible without BCMA.  I am also a strong advocate of point-of-care barcode scanning at the time of obtaining lab samples. 

Medical Decision making (electronic or otherwise) is very dependent on accurate information, including accurate time of events.   

Example #2: Scanning medications at the time of administration provide accurate information at the time of med administration that would otherwise be lost.  Prior to BCMA nurses would gather their meds, ideally for one patient but nurses being efficient as they are will frequently gather meds for all their patients at that end of the hall.  They will administer the meds the best they can while often dealing with multiple distractions that naturally occur from patients, family, visitors, physicians, and other nurses needing assistance.  The 0900 meds he/she started passing at 0800 are not infrequently completed at 1030 or 1100.  Busy as nurses are they frequently do not chart med administrations until the end of there shift.  These days it seems the usual nursing shift is 12 hours, which means by the time the nurse finishes charting his/her shift may be 13 hours or more. Which by that time of the day they chart all their 0900 meds as administered at 0900 because they can’t remember what really happened.  An unexpected benefit the nurses tell me is they actually are getting out on time more often, because their med administrations are charted throughout the day, so they have less to chart at the end of their shift.  And this comes about because they are held accountable for their scanning rates, so scanning becomes a priority. 

I’m sure there are other import reasons.  If I think of more I’ll send them along. 

I know it is expensive and a lot of had work to get a successful BCMA system up and working, but IMHO it is well worth it.  Many of our CDS problems relate to accurate information, and I am now convinced that BCMA is an important part of the several solutions.   

Thanks,

Mike

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