As requested, here is a compilation of responses that I have gotten
relating to eMAR and BMV.
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1. What are your thoughts on implementing eMAR and BMV concurrently? We
do not currently have either system in place and need to know whether to
implement separately or concurrently. We did it together-a lot easier
than going through 2 installs
2. How long did the dictionary building/changing take once Meditech
enabled the BMV system? 4 months
3. What departments were members of your Core implementation group?
Nursing, Pharmacy, IS
4. How long did training take for the Core group? For house-wide
training?5 weeks
5. What was the time frame of implementation - for first stages of
planning to full implement? >From Meditech install of BMV to full
implementation? Dictionaries in May Live in November
6. What was the staffing requirements/allowance for building and
implementation? For going live? Implementation: we had the 3 of use.
Could have used 2 more nurses. Go Live: Should have been a super user on
for 1 week 24/7 and then week 2 on 1st and 2nd shifts
We implemented eMAR and BV concurrently with the thought that it would
be easier and more cost/time effective to train once than twice. BV
safety measures to eMAR that cannot be discounted.
Dictionary training/building/testing took us about 7 months, keeping in
mind there are three of us on the team sharing a 1.0FTE. We had
dictionary training in January and our Pilot go LIVE was October 6,
2005.
IS, Nursing, and Pharmacy
The Core group had three days of dictionary training at Meditech.
House-wide training was done in 4-hour classes. Pilot team members were
trained in advance of, and assisted in, the training of the rest of the
staff.
Planning was initiated in late 2004; full go LIVE was November 1, 2005.
Informatics team members were allotted extra hours for
building/testing/training. For go LIVE, Informatics and Pilot team
members were allotted extra hours to provide staff support 24/7 and
patient-nurse ratio was significantly decreased. We also found that
increasing the variance for med administration from 30 to 60 minutes
greatly reduced staff anxiety.
1. No secret - I'm a believer of implementing eMAR and BMV
separately, especially if Nursing is not currently documenting on-line.
The only advantage is combined training, or not having to bring nursing
back to train on how to use a scanner...more in a minute.
2. The dictionary build/edit for eMAR you can do now, independent
of the BMV enabling. We're talking about the PHA Drug Dictionary, and
specifically 5 or 6 fields. Also no secret, I'm a believer in making
some additional edits to prepare for POM...even if that's 18 months down
the road. You'll be touching every line item in that dictionary from
Acetaminophen to Zyloprim so why not do it now? The time commitment
depends on the "State-of-the-State" - I have found that sites that have
been live on MT longer typically require more edits simply because of
the years of neglect...no disrespect to anyone intended, we just usually
don't have the luxury of a dedicated resource to maintain the ever
changing PHA Dictionaries.
3. Core Team - remember (and as a Pharmacist this pains me to say)
eMAR is ALL ABOUT NURSING...and the sooner Pharmacy realizes, the
better. The output of our order entry is displayed - and in the case of
the eMAR, it's hard-coded...no customization like we can do with NPR and
the paper MAR. Pharmacy has to change many fields in THEIR dictionaries
to accomplish a clean look, (and this is the money shot) as well as
change many order entry habits. Label Comments, Dose Instructions, etc.
- it's all about display. The Core Team needs to have representation
from each discipline (Med Surg, ICU, Mother/Baby, RT, TCU, etc.) that
intends to use the eMAR. They will need to map out their workflow and
determine what needs to change with movement to the electronic world.
The Team must also have the folks empowered to make decisions with
regards to global parameter settings (Acknowledgement, unverified orders
appearing, etc.), which usually includes Nursing Administration...the
CNO is preferred. And then there's Pharmacy...
4. The training of the Core Team is usually on-the-fly, and
hopefully these folks were involved in your NUR/PCS build...since eMAR
resides in NUR/PCS. Hands on and weekly mentoring meetings get them up
to speed very quickly. As for house-wide training, I have found that a
4 hour class is ample...even some time in there for a refresher course
if need be. As I mentioned above, the BMV or scanner portion I believe
can be introduced 6 months down the road after all of your bugs are
worked out and the comport level of the staff is high. A departmental
staff meeting works great. BMV requires absolute bedside documentation,
and as much as we don't want to admit it most sites just aren't there.
5. I think Meditech now states 8 months for an Implementation
Timeline - that is supposed to cover from software delivery
(pre-planning stages) to go-live. Reality - it can takes some sites
much longer depending again on their resources. As a Consultant, I
usually get a call from a site when they're behind the eight ball, and
the conversation goes something like "...can you get us live in 60
days..." - and my answer is no, but I have accomplished the task in less
than a 4 month period with very engaged internal resources. There are a
lot of variables there.
6. The biggest reminder I have with regards to staffing
requirements is to remember this is a nursing gig - they MUST be
involved in the build, and they MUST perform the majority of the testing
to ensure the success of your implementation and to have the highest
level of buy-in...from the top down.
I've been to MUSE and the current thinking is to bring up BMV with eMAR.
It makes sense to develop good habits from the start. As far as building
the drug dictionary, I have scanned in all the drugs over the last 2
months working a section here and there on the slower times during
evening shift so I'm not sure exactly how long it took. Probably about 2
weeks of solid working. I know the mnemonics cold and the sections went
pretty fast and we had a COW with a wireless connection which made it go
easily. You have to go through your entire stock and scan everything.
Our buyer is scanning every new item coming in the door (with a double
check by a pharmacist) so we are well positioned now.
The big step is to have a tech bar-code all the OTCs and other
items that do not carry a barcode. I anticipate two months of project
work to go through our entire stock and make sure every item has a
barcode and that it scans correctly. (Two months seem to be what I've
heard from other sites depending on the size of your institution just to
bar code and verify stock.) I am in the process of a major overhaul of
the drug dictionary and expect about two months for that. Meditech has
recommendations on their website which seem reasonable to follow (check
the links for BMV). Currently we have nursing, IS and pharmacy
involvement. I am it for pharmacy. Another huge issue is process and
workflow redesign which we are working on right now. It is painful and
we seem not to have many nursing champions here.
The story about 5.61 is that there are numerous bugs in the eMAR
desktop. They are making daily changes. I was assured by Meditech that
this is their top priority to fix it and we could expect not to have our
implementation deadline delayed. I'll give it to the end of the month
and then we'll see. We will be among the first with the new Magic 5.61
code so it should be interesting.
For Go-LIVE, it is highly recommended to have Super-Users available
to "hand hold" people for about 2 weeks. One idea I also like it to pick
a patient and do parallel runs to work out anything you may not have
thought of. Go through a transfer from one floor to another floor, etc.
I was impressed in the evolution of the software based on our
training we had a Meditech two weeks ago. I wished that they would
employ clinical people to teach the software and put more stock in the
importance of that. I guess that is why we have the L-list.
I think implementing EMAR and BMV concurrently is a good way to go. BMV
is quite simple and easy compared to EMAR. If you give your users BMV
from the beginning, scanning is the standard. You also give them the
patient safety features of scanning from the beginning. I think it's
actually easier to teach EMAR using BMV rather than teaching them the
various verb strip routines. If you start with just EMAR, you then have
to go back later and teach them a whole new way of doing things. We've
implemented a number of units doing EMAR and BMV together and it's
worked well.
The building part for BMV is quite minimal. However, the building part
for EMAR is huge. It took a Pharmacist and a tech 3-4 months working
about 20 hours a week each to get our Pharmacy dictionaries ready for
EMAR. We have around 2,500 entries in our drug dictionary.
It took the nursing part of the team about 10 hours per week combined
for 3-4 months. Most of the nursing time was spent getting comfortable
with the routines and training the staff. The nursing and pharmacy
teams did lots of problem solving as they looked at different medication
scenarios and plugged those into TEST.
We had representatives from Med/Surg & ICU, OB, Chemical Dep unit, Long
Term Care, Pharmacy, and IS. We had mainly staff nurses with some
manager involvement as needed.
Core group - we met bi-weekly (weekly in the month before LIVE) for an
hour or two to address issues and go over various routines for several
months. Many in the core group played with EMAR during slow times in
their work day or came in extra. We did not do special training per se
for the core group, they had to get out in TEST and use the system to
learn about it. We encouraged them to set up their own scenarios and
jot down the questions they had as they went along. The nursing staff
were given access to order meds in Pharmacy and the Pharmacists were
given access to document in the EMAR in TEST so they could do the whole
process and understand what was happening on both sides.
House-wide training - we did an hour long class when we switched to the
Status Board a couple weeks/months before EMAR LIVE, then we did a two
hour EMAR beginning class with the option to repeat the class in a week
for more practice. About 3-4 weeks after LIVE, we did a two hour EMAR
intermediate class that went over more routines and more complex
situations. It was very hard to cover the complex stuff at the
beginning when the staff was clueless about how this would work in real
life with real patients. We then did a competency class about 6 months
down the road with even more complex situations.
3-4 months for the first unit (Chemical Dependency), then one month to
the next unit (OB/NSY), and another month to the next units (Med/Surg
and ICU). Our Long Term Care facility was then brought up about 9
months later as we did a major redesign of their entire workflow
surrounding Meditech.
Pharmacy - as discussed above.
Nursing - 4 hours per week per representative.
IS - consumed my entire being for the better part of a year!
GO LIVE - super user support for the first few days to week with 24 hour
coverage. We found it takes about 3 shifts for the average staff nurse
to feel like they are getting the hang of things. There are still many
questions and issues for about the first 3 months but not such that they
need 24 hour support. The key for us was getting the supervisors
involved in the process and taking responsibility for being the first
line of support for questions.
I recently saw some comments that the new eMAR format being used in 5.61
has numerous problems. Has anyone had experinece with eMAR and 5.61?
Not yet - looking forward to it!
absolutely concurrently - BMV takes less time to document than eMAR
alone; if you bring up eMAR first, and then go to BMV, the users think
they died and went to heaven; but eMAR alone is a LOT more training and
effort than BMV (which includes eMAR).
-depends how bad your PHA dictionaries were; typically you have to
rebuild drops, topicals, etc so they appear correctly on eMAR.
-PHA, Patient Care Services (Nursing), IS, Respiratory, and
representatives of the units doing the pilot
- 4 hours training per person including proficiency testing for users,
double that for superusers
-again, depends on condition of your drug dictionary and resources
allotted. We went up with pilot units in 4 - 6 months from kickoff
meeting
-.5 FTE dedicated RPh, .5 FTE dedicated IS analyst, .5 FTE dedicated RN
- MT has pulled it back. We went live w/BMV w/5.4 and upgraded to 5.5
easily. 5.6 is supposed to be major changes.
1. What are your thoughts on implementing eMAR and BMV concurrently? We
do not currently have either system in place and need to know whether to
implement separately or concurrently. We implemented EMAR/EMV
concurrently, we felt there would be a learning curve no matter how we
implemented and we did not want to have the pain of a new process twice.
Plus are staff REALLY wanted to stop using the printed MAR and the
climate was right to do both.
2. How long did the dictionary building/changing take once Meditech
enabled the BMV system? The initial dictionary building took us about a
month but we had a really dedicated pharmacy supervisor who was in IT
everyday to help us. We are still "tweaking" every now and then.
3. What departments were members of your Core implementation group? 1
Pharmacist, 2 IT, 1 RN. We did bring in backup later on and had another
IT person helping us out.
4. How long did training take for the Core group? For house-wide
training? Our core group went to Meditech for training and then once we
had everything set up here it was learn as you go/test. Training for the
end-user takes about 3 hours. We are currently live on our OB and
Pediatric units.
5. What was the time frame of implementation - for first stages of
planning to full implement? >From Meditech install of BMV to full
implementation? 6months from Meditech training to first implementation.
We started with very contained units (very little transferring in/out)
we are also planning on moving to our inpatient rehab unit next (another
contained unit) then we are considering the "big bang theory" for the
rest of the hospital.
6. What was the staffing requirements/allowance for building and
implementation? For going live? 1 Pharmacy and 2 IT for building and
implementation we had two RN's that tested.
I recently saw some comments that the new eMAR format being used in
5.61 has numerous problems. Has anyone had experinece with eMAR and
5.61? We were considered waiting for 5.6 because the EMAR would like
just like our current printed MAR. Thankfully we did not wait especially
seeing all of the comments that EMAR is not ready in 5.6 We are
currently 5.5.3 and we have had few issues with that.
Any other thoughts/recommendations? Training was difficult for us and
we are really going to need a lot more support when we implement house
wide.
1. What are your thoughts on implementing eMAR and BMV concurrently?
We do not currently have either system in place and need to know whether
to implement separately or concurrently. I am a consultant and am on
my 4th implementation. I have always brought eMAR and BMV up together.
Why teach it twice, when you can do it once!
2. How long did the dictionary building/changing take once Meditech
enabled the BMV system? Totally depends on your pharmacy person and how
much time they can devote to the project. Normally 4 months time is
given for dictionary building/revising.
3. What departments were members of your Core implementation group? It
is good to have adequate representation from the nursing group - - and
not managers, though they can be on the team, you need end users. Also
it's good to have your education people involved. Later you can include
a risk person/quality management and medical records.
4. How long did training take for the Core group? For house-wide
training? Training of the core group is ongoing as you go through
building, but basically if you can give them "play time" several times
(maybe equally 16 hours) that would be good. The more they play with
the screens, the better they will be at troubleshooting. Nurses
normally have a 3-4 hour class, RT 1-2 hours and anyone who wants to
view mar information <1 hour.
5. What was the time frame of implementation - for first stages of
planning to full implement? >From Meditech install of BMV to full
implementation? I would say 4-6 months depending on the involvement of
your core team.
6. What was the staffing requirements/allowance for building and
implementation? For going live? Most of the building is in Pharmacy
module, but Nursing also gives them alot of information to put
there.(lab view groups, cds's) If someone from IS can help pharmacy, it
obviously would take less time.
I hope this helps a little. Tristan
Roger
Roger Beverly, PharmD
Clinical Pharmacy Coordinator
Conway Medical Center, Inc.
[EMAIL PROTECTED]
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