Friday, March 19, 2010

The Importance of Doing BCMA Right

Neither Jamie nor I are aware of any hospitals who have implemented BCMA and then stopped using it. There have been many who have de-installed one system to install one from another vendor, but we don’t know of any that have stopped going forward with bar-code verification.

So, if “failed” implementations don’t result in de-installs, what are the negative consequences of failed implementations, and what are the motivators for doing it right?

The negative consequences could include a number of outcomes:
  • Failing to design process well results in workarounds because the process wasn’t designed to proactively prevent the need for workarounds
  • If the system isn’t used in practice, it certainly can’t help prevent errors
  • Poor implementation of technology (computers, wireless networks and barcode scanners) can frustrate nurses and add yet more stress to their stressful days
  • technology isn’t utilized, wasting investment (workstation on wheels parked and not used)
  • If extensive process exceptions are discovered after going live, lengthy project stabilization periods are almost guaranteed, which cause problems with other projects down the road, cause re-work, and postpone the benefits of the technology
  • At worst, poor implementation can lead to unintended consequences and potentially negatively impact patient safety

By “doing it right,” hospitals can achieve several benefits:
  • Decrease the timeline and expense of implementation
  • Build a culture of safety that continues after the installation, with multidisciplinary teams convened to continuously improve process
  • Improve Nursing/Pharmacy collaboration and improve efficiencies (this is only if the broader medication-use process is considered)

Some organizational barriers to success I’ve encountered as a hospital begins its BCMA process:
  • Lack of clinical system implementation experience, or lack of working through significant change management as a team
  • Lack of “street” knowledge of what’s happening at the bedside, or redesigning workflow with a “conference room” knowledge of their process
  • Unrealistic schedules that cause strain on the bandwidth of key people
  • Often schedules don’t build in “process design or change management,” or “stabilization” time
  • Jumping into implementation prematurely, such as purchasing devices before the desired process is understood

I understand that many hospital leaders are unwilling to absorb the need for process introspection and culture change, but some amount of targeted planning actually reduces overall project timelines and expense, by avoiding re-work and extensive stabilization.BCMA completely changes the way nurses deal with medications, even in scenarios where nursing documentation and an eMAR is in place. Assuming safe use, BCMA forces the computer/scanner to be used at the bedside immediately prior to administration. Before BCMA, nurses could document in a variety of locations. BCMA is not nearly as complicated than CPOE to implement, but it is a process that touches on a lot of different disciplines and processes.

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