Transcript Use of SuperUsers in EMAR “Go-Live”

Use of SuperUsers in EMAR
“Go-Live”
Presented by: Trina Allison, RN, MSN
Clinical Educator
Objectives
• Discuss how Memorial Hermann is committed
to excellence by their brand promise
• Describe how the organization’s behavioral
expectations of accountability, innovation,
collaboration, and competence resulted in
successful implementation of eMar
• Discuss why identifying SuperUsers are
important to the planning and implementation of
Informatics
• Identify methods used to keep SuperUsers upto-date with upcoming changes of eMar
Leadership
• “Breakthroughs Everyday”
• Vision: “Best of the Best”
• Brand Promise: “We create the best
possible clinical outcomes with
exceptional patient care experiences”
Leadership
• Behavioral Expectations
- Accountability
- Innovation
- Collaboration
- Compassion
- Competent
- Respectful
Teamwork
•
What is teamwork?
Memorial Hermann partners working
together to achieve a common goal:
“Successful implementation of eMar”
• Building your “dream team”
“The collaboration and cooperation of
Memorial Hermann partners being
accountable for the successful
implementation and innovation of
electronic documentation (eMar)”
Teamwork
• Identifying the SuperUsers
- The “go-to” person that is able to answer
questions, trouble-shoot, and problemsolve during implementation of eMar
- Those individuals with “Star Power” that
are identified in each unit to assist ISD
with implementation
- All Clinical Educators identified as
SuperUsers to provide continued
education to new partners entering the
organization
Informatics/eMar
• Preparation
- Train-the-trainer (SuperUser)
Four hours of user training combined
with ‘trouble-shooting’ techniques to
ease the transition to implementation
Hospital educators were all designated
SuperUsers in addition to unit-based
designees
Informatics/eMar
• Preparation
- Hospital-wide: Two hour sessions for
clinical staff. SuperUsers conducted
several education sessions to increase
their knowledge and confidence.
• Accountability and Competence
99% of nursing staff and 100% of
pharmacy and RT staff completed formal
training!
Informatics/eMar
• “Go-Live” is here
Saturday, February 12, 2006!
- eMar News Team Updates
Daily updates and reminders
regarding order-entry and retrieval
- SuperUsers daily de-briefings at the
command center
Collaboration with ISD and SuperUsers
to ensure implementation was going smoothly,
to receive daily updates, and answer call-in
questions
MHHS eMAR, PAL Project
Second Nurse Witness
To the left is a rev iew
of the method for
documenting the
w itnessing high risk
medications.
The current policy of
which medications
are to be w itnessed in
your units has not
changed, just the
method.
This is also in your class
booklet, and on line
in the PiL library.
1/10/2006
Nurse prepares a medication
requiring a second nurse
verification of accuracy
Second Nurse Verifies
accuracy of dose
Positive patient ID when
bracelet scanned, Medication
administered, and documented
Time Lapse
Second Nurse Prepares to
document witnessing
medication using own sign on
Right clicks on the
documented dose he/she
witnessed
Selects “add a comment”
Enters Witnessed by ...Initals
Dose will Show an * to identify a comment
has been added when viewing the eMAR
User Meetings Daily!!!! All in the Aspen/ Birch rooms:
11:00—Womens and Childrens
12:00—ICUs, IMUs
1:00—General Floors
HH & HCH eMAR News
eMAR/PAL Help -ASK Your Superuser or call 45370!
MHHS Team Update
Process Meetings:
Pediatric Bracelets – Product search in Progress
RT Wireless – in Progress – Next meeting Wednesday 2/22 @ 2:30
Plan for Adult Dialysis – in Progress
End of Shift Reminders:
-Orders to Review
-Overdue medication tasks
February 21. 2006
eMAR/PAL
DAY 11!
Using the Active Intervention
sheet
Two Main Purposes of the Active
Intervention Sheet
1. Review orders and medication times
during nursing report
2. Reconcile orders with the 24 hour chart
checks
Report Time
• Off-going nurse – With the PAL open, Report any scheduling
changes that need to be communicated to the
next shift
• Ex – Patient’s afternoon dose still needed after 3pm because
patient is in x-ray.
“Please give on eve shift.
Pt is still in X-ray”
Report Time
• On-coming nurse
– Circle doses due for your shift by the times
indicated to help create a Pyxis pull list
Challenges of Implementation
• SuperUsers had dual roles Some were assigned to patient care in
addition to SuperUser
• Some SuperUsers were less than novice
with computer applications and navigation
• Some SuperUsers did not demonstrate
the commitment necessary to facilitate a
smooth implementation
Overcoming the Challenges
• ISD staff was visible in all units with the
assistance of the clinical educators who
were dedicated SuperUsers in the units
• ISD staff and clinical educators were on the
units to assist and answer questions for
those less than novice SuperUsers
• ISD staff and clinical educators
demonstrated the dedication and
commitment necessary by assisting those
who were less committed to the role of
SuperUser
Technical Challenges During “GoLive”
• Staggered medication administration
times – Revised staggered
medication times to achieve
standardized administration times
• Follow-up and completion of ‘PRN
response’ – All PRN medications
need a response to be documented
REHAB
HOW TO STAGGER MEDICATION ADMINISTRATION TO
ACHIEVE STANDARDIZED ADMINISTRATION TIMES
1.FIND first dose time
2. FIND administration interval standard
dose
per schedule
Once you achieve a BOLD time you are back on standardized administration times
3. INTERSECT time next
FIRST
dose
time
Q 4 hr
0400, 0800,
1200
1600, 2000,
2400
Q 6 hr
0800,1400
2000, 0200
Q 6 hr
0600, 1200
1800, 2400
Q 8 hr
0800,1600
2400
Q 12 hr
0800, 2000
0700
0700, 1200
0700, 1400
0700, 1200
0700, 1600
0700, 2000
0800
0800
0800
0800, 1200
0800
0800
0900
0900, 1300,
1600
0900, 1400
0900, 1300,
1800
0900, 1600
0900, 2000
1000
1000, 1300,
1600
1000, 1500, 2000
1000, 1400,
1800
1000, 1700, 2400
1000, 2000
1100
1100, 1600
1100, 1600, 2000
1100, 1800
1100, 1800, 2400
1100, 2000
1200
1200
1200, 2000
1200
1200, 1800, 2400
1200, 2200, 0800
1300
1300, 1700,
2000
1300, 2000
1300, 1800
1300, 1800, 2400
1300, 2200, 0800
1400
1400, 1700 ,
2000
1400
1400, 2000,
2400
1400, 2300, 0800
1400, 2300, 0800
1500
1500, 2000
1500, 2000
1500, 2000,
2400
1500, 2400
1500, 2400, 0800
Revised 02-06 Chi Peyton, Pharm D
Post “Go-Live”
• Monthly meetings with ISD and
SuperUsers
Continued collaboration with ISD and
SuperUsers to discuss eMar changes and
updates
• eMar updates to staff
ISD’s continued commitment to respond to
the concerns of the staff to improve eMar
on the end-user side
Post “Go-Live” Update
•
•
•
•
•
•
eMAR Update 5/18/2006
We heard your requests,
There are some changes you should be
seeing as you work with eMAR.
For acute MI patients Aspirin and Plavix will
be scheduled to start the day they are
ordered.
Golytely will no longer appear on eMAR as
240cc q 10 minutes. It will appear as a one
time dose with a note in the comment section
“give 240 ml every 10 minutes.”
New medication orders: if the physician or
nurse puts the time they need to give the
med the pharmacy will schedule that time.
Post “Go-Live” Reminder
We are working with units to make sure the eMAR process provides quality safe
care for our patients and is efficient for our clinicians.
I will be sending out helpful hints each week to improve our process.
TOP TEN REMINDERS for eMAR
1. Patient Safety! Patient’s armbands need to be scanned prior to giving
medications. This will decrease medication errors.
2. All PRN medications need a response to be documented.
3. Clean up all tasks and orders to review from your list by end of your shift.
4. Use the medication request on the computer for medications needed in 2-3 hours.
This allows you to not have to leave your patient and call pharmacy.
5. Enter all RT orders except vent changes in the computer and D/C them in the
computer. (Under orders)
6. Do not forget to log off your computer before leaving it. You do not want anyone
to document under your sign on.
7. Clean your COW each shift and PRN with a hospital approved disinfectant except
the screen use alcohol for the screen.
8. Reconcile your medications and orders from the original written order and the AI.
9. All problems go through the support center 45370. Contact Margie Aronowitz @
45735 or your manager with any process issues.
10. The teamwork and communication between pharmacy, nursing, RT,
physicians, and IS was and is the key to our success.
Post “Go-Live” SuperUser Update
Meeting
We want to hear from you !!
Join us for the Super Users Meeting to
improve Workflows and Processes.
Stay Updated !!
Get information on various IS initiatives
that will affect your department.
SuperUser Meeting 5/31/2006
In Conclusion
• The successful implementation of eMar
depended on the collaboration of hospital
leadership, ISD, and the clinical staff
• SuperUsers play an integral role in
implementation because they remain in
the facility post go-live to help facilitate
changes and updates and educate new
partners