Challenges and Triumphs - Launching A Large-Scale Implementation of BCMA and Navigating Surgical Clinic Variants

Just an ordinary medical center in an extraordinary world, striving to standardize medication administration across the ambulatory care enterprise, including complex surgical and wound care clinics. This poster presentation will discuss the process used to successfully implement barcode medication administration (BCMA) in the surgical ambulatory patient care centers of an academic medical center despite challenges presented by the global pandemic, decreased staffing, increased clinic volumes, and multiple medication administration variants identified for this unique patient population. This poster presentation will include strategies utilized to address hardware and workflow challenges that led to a successful implementation that reduced clicks by 31% for nurses. These areas presented medication and workflow variations not seen in previous BCMA clinic implementations. Little data existed in the literature regarding ambulatory care BCMA best practices and none specially for surgical clinics. Very few organizations have ambulatory care BCMA to serve as benchmarks and to reference. The interdisciplinary team's (analysts, pharmacists, and nursing informaticist) partnership with operational leaders was crucial to innovating a solution. This presentation will explore how existing BCMA practices and vendor processes such as therapy plans were pivoted to fit the wound care area workflows. Special challenges (medication ranges, multidose vials, compounded medications prepackaged from companies without bar codes, mixed syringes, topical medications, billing and compliance issues, recurrent ordering practices) were addressed.
Discussion will include six-month post-implementation return-on-investment metrics including scan rates, the leveraging of 340 B pricing, provider order entry accommodations, the linking of therapy to wound and healing process, nurse satisfaction, compliance, and increased reimbursement. Problems and barriers encountered will be shared to provide guidance on how to optimally design and transition to a new model of nursing informatics support. Improvements made and lessons learned will be explored.