Project Charter for Hospital System - PDF by zjw21222

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									                                                         * CE accredited

                                           for BEDSIDE

       BPOC, Implementation Overview for a
       Multi-Hospital Health System
       Christopher A. Woodruff, R.Ph.
       Enterprise Application Services –
       Clinical Information Systems & Project Director
       Bon Secours Health System, Inc


•  Describe Project Management practices used by a multi-facility
   health system for installation of a BCMA Program
•  Describe the preparation and implementation process required
   for installation of a BCMA Program in the Pharmacy, Nursing and
   Information Technology Departments
•  Outline lessons learned from the installation of a BCMA Program
•  Describe internal and external marketing techniques employed to
   inform employees and patients of Bedside BCMA

Bon Secours Health System, Inc.


What is a Bedside Barccode Medication Administration

Least understood about this system/project:
     “Oh, you are just having nurses do the same thing as a cashier at the
        grocery store…”

Use of barcode labeled clinicians, patients and medications for ensuring the 5 rights of
   medication administration
Automated dose and allergy checking.
Computer documentation of medication administration
User reports of occurrences, compliance and potential errors

What is a Bedside Barcode Medication Administration
Five Rights Checking
     Right patient, right drug, right dose, right time, right route
Going beyond the five rights with:
     Formulary comments
     Alerts and reminders help avoid errors
     ISMP alerts built into Bridge Comments
          •  Look alike/sound alike drug alerts
          •  High risk medication alerts
     Maximum daily dose warnings
     Allergy alerts
     Order confirmation feature
     Accurate, legible, real-time, complete documentation
     Accurate charging
     Medical-legal: MAR and reports capture greater detail
     Drug References/Patient education

BPOC Screen


Where we are today – smooth sailing


Bon Secours Health System – BPOC Project
Four hospitals are now live on MedAdmin
        - Memorial Regional Medical Center Mechanicsville, VA
        Live since 4/17/06
            •  All 225 inpatient beds live
            •  All 40 rehab beds at Sheltering Arms In-patient Rehab live
            •  All other patient care areas live (with the exception of ER & OR)
        - Good Samaritan Hospital Suffern, New York
        Live since 2/20/07
            •    All 270 inpatient beds live
            •    PACU, Endo, Pre/Post Cath Lab & Wound Center are live
            •    Radiology (meds only)
            •    ED (Hold patients only)
            •    2 Specialty care areas or departments remaining (Out-pt Oncology, 2 out-patient Renal Dialysis centers)
        - Bon Secours Community Hospital Port Jervis, New York
        Live since 6/07/07
            •  All 137 inpatient beds live
            •  Emergency Room, Same Day Surgery, PACU and Radiology are live
        - Saint Anthony Community Hospital Warwick, New York
        Live since 11/06/07
            •  All 73 inpatient beds live
            •  Emergency Room, Same Day Surgery, PACU and Radiology are live

Bon Secours Health System – CIS/HER Connect Care

Two hospitals are now live on CIS/EHR
     -St. Francis Downtown Medical Center Greenville, SC
     Live since June 2008
            •  All 245 inpatient beds live
            •  All out-patient areas live
            •  Epic RX, BPOC, CPOE, nurse charting, charge on admin
      -  St. Francis Eastside Medical Center Greenville, SC
         Live since June 2008
            •  All 97 inpatient beds live
            •  All out-patient areas live
            •  Epic RX, BPOC, CPOE, nurse charting, charge on admin


  Where we have been – building the vessel


  BSHSI BPOC Project

  -    2004, after 3 years BPOC vendor chosen
  -    Spring 2005 Corporate Kickoff
  -    Fall 2005 Corporate team created
  -    September 2005 Pilot site kickoff at MRMC
  -    May 2006, first unit go-live at MRMC
  -    Project change in scope due to CEO change
  -    June 2006, Pilot evaluation
  -    August 2006, 2nd site kickoff at GSH
  -    February 2007 first unit go-live at GSH
  -    March 2007 3rd site kickoff at BSCH
  -    June 2007 first unit go-live at BSCH
  -    July 2007 4th site kickoff at SACH
  -    November first two units live at SACH

  Systematic Approaches and Tools for Project
  Management and Communication
Project Management Life Cycle                 Necessary Elements for
Create vision                                    Project Success
Create team                                Communication
Create budget
Create schedule & workplan                 Conflict resolution
Implementation                             Contingency planning
Go-Live/completion                         Risk mitigation/ risk
Evaluation/monitoring                     management
                                           Strong dynamic leadership
                                           Functioning team(s)


                                     Vision Example

                                                  The Vision
                             By 2007, Bon Secours Charity Health System will be
                                distinguished as a leading provider of quality,
                            community based healthcare services in the Hudson -
                           Delaware Valley. As a local Catholic health system, Bon
                           Secours Charity will be the provider of choice, offering
                              a collaborative network of dedicated health care
                             providers who assure those we serve, access to care
                                 that will meet the needs of the community.


Constructing a Charter
   –  Purpose
   –  Objectives/Goals
   –  Scope
   –  Responsibilities
   –  Deliverables
           –  Pilot
           –  Post pilot
     –    Duration and Frequency
     –    Membership
     –    Ad Hoc Membership
     –    Reporting Relationships

BSHSI Project Team Charter
    “The BSHSI Project Team was developed to establish the Bon Secours Health System’s Enterprise Model
    for medication management during the pilot phase and to assume the responsibility for rolling out the
    implementation to the other BSHSI sites/systems. The team will also participate in an expanded roll with the
    Clinical Information Systems planning and strategies development and implementations.”

BSHSI Medication Administration/Barcoding Oversight Committee Charter
    –  Develop BSHSI Model (i.e., Enterprise Operating Model) for implementing medication
          administration barcoding system-wide to support best clinical practice and software/
          equipment configuration
    –  Support all sites to ensure successful implementation of medication administration barcoding
    –  Monitor ongoing utilization of the system, outcomes data and make recommendations
    –  Committee will merge into a broader oversight group for the CIS
    Provide direction and oversight so that the Pharmacy & Nursing Collaborative Groups can review all
    management decisions around model and determine if there are any unforeseen implications. Thus,
    creating buy-in for decisions, allowing for more rapid and effective implementations of barcoding throughout


Medication Administration/Barcoding Core Team Charter
     –  Champion medication administration/barcoding at the local facility level, creating buy-in
           across all departments and ensuring a successful implementation
     –  Understand and operationalize the vision of the BSHSI Medication Administration/Barcoding
           Oversight Committee
     –  Monitor ongoing utilization of the system at a local facility through outcomes data and
           continuous quality improvements, providing feedback to the BSHSI Oversight Committee
     Post implementation the team will assist other sites within market region

BSHSI Medication Administration/Barcoding Design Team Charter
     –  Champion medication administration/barcoding at the local facility level, creating buy-in
           across all departments and ensuring a successful implementation
     –  Understand and operationalize the vision of the Core Team as well as the BSHIS Medication
           Administration/Barcoding Oversight Committee
     –  Team will assist with the implementation throughout the site post “pilot unit” implementation

Organization Chart – Corporate Team

Organization Chart – Local System


Budget Planning

Project Budget models - Predecessors
   High level equipment/computing plan
     I.T. Model
             –  Infrastructure
             –  Remote Server vs. Local
             –  Wired vs. Wireless
         –  COWs, Wall Mounts, Tablets, etc
         –  Wireless vs. Tethered Scanners
     Use of I.T. selection vendor

Budget models/tracking

•    PC/COW per Nurse (Use max staffing/floor)
•    PC/COW per in-patient
•    PC/COW per in-patient room
•    Add ins (RT, Out-Patient areas, clinics, centers)

Managing the Budget

CIP Account set up to track expenses
    Overall project expenses
    By Facility
    By Fiscal Year
    –  Resource and Productivity tracking
         •  Non-enterprise staff hours devoted to project tracked under CIP account
         •  Productivity not counted against their cost center
         •  Departments not penalized for supplying staff but positions not freed up for full time
            back fill of staff
Budget Forecast Tool
    Tracks projected equipment purchases and project expenses
Monthly Meetings
    With Exec Sponsor, Director of I.T. & Capital Projects Director



The BSHSI Team/Oversight Committee Participants
   •    Skip Hubbard, VP Information Services & CIO
   •    Ronnie Oestreicher, Director Clinical Information Strategies
   •    Bill Varani, MD, VP Quality Improvement – Executive Sponsor
   •    Jeff Burke, CIO – BSHSI – South Region
   •    Len Ptak, CIO – BSHSI - North Region
   •    Maureen Price, CIO – Charity Health System
   •    Laishy Williams-Carlson, CIO
   •    Jeff Pearson, Director, IS Architecture
   •    Kathleen Lynam, CNO, GSH – Charity Health System
   •    Charlie Johnston, RPh, Administrative Director Pharmacy BSR
   •    Amey Harvey – Performance Engineer
   •    Chris Woodruff, Project Director & RPh Lead – Enterprise Team
   •    Tracy Singer, Technical Project Lead – Enterprise Team
   •    Armen Mzrakian, Pharmacy Informatics – Charity Health System
   •    Kathy McDonough, Nursing Informatics – Charity Health System
   •    MRMC, GSH, BSCH and SACH Pharmacy Directors, Nursing Directors, Nurse Leads,
        Project Leads

                Local System Support Model Example

Bon Secours Charity Health System
•  Maureen Price, Nancy Drumgoole, & David Kurilla - CHS IT Project Leads
•  Armen Mzrakian – CHS Pharmacy Informatics Lead
•  Kathy McDonough – CHS Nursing Informatics Lead
•  Luis Perez – Desktop Support


    Hospital Project Team Example
    Bon Secours Community Hospital Core Team
    • Judy Lindberg – Project Lead, Executive    • Fred Salamone – IT
    Sponsor                                      • Angie Raines – nursing administrative assistant
    • Bob Flisikowski – Pharmacy Lead            • Diane DeFreest – OB/GYN nurse manager
    • Anita Sultana - Nurse Lead                 • Tom Flynn – ED nurse manager
    • Marlene Salowitz – Resp. Therapy Lead      • Janet Lendzian – OR manager
                                                 • Nancy Folino – OR nurse manager
    • Barbara Hansen – Education Lead
                                                 • Jeff Reilly – VP operations****
    • Debbie Thomas - Performance
                                                 • Leah Cerkvenik – EVP****
    Improvement Lead, PI Director
    • Laurie Motejl – Nursing Care Coordinator
    • Sharon Geidel – Staff Educator
    • Barbara Hansen - Staff Development

                                   BPOC Vendor Team
      Project Manager
      Clinical Consultant / Nursing
      Clinical Consultant / Pharmacy
      Technology Consultant
      Interface Engineer
      Executive Management

    External Resources for Project
Vendors and what worked well and not so well:
•  Out-sourced tech consultant allowed us to have a key focus on PM principles and
   the hundreds of technical changes occurring
•  Hardware selection vendor was key in thinning the field and providing experienced
   opinions and outside knowledge
•  BPOC vendor provided outstanding documentation, test plans and implementation
•  Barcode scanners with different version of firmware posed repeated challenges
•  Retrofitting medication Carts was a time consuming, costly and unpleasant


  Enterprise Model/Enterprise Pilot

  –  Pilot Site DBV (Design, Build, Validate) Sessions
      Color Coding of responses
      –  Enterprise Wide Standards
      –  Local System Standards
      –  Facility Decisions
  –  Pilot Site post live evaluation
  –  Bon Secours Charity DBVs
      –  Pharmacy System standardization
      –  24 hours pharmacy model
      –  Nursing Standards
      –  Downtime Policies

Implementation Methodology Overview
   Implementation Phases
        Vision / Scope
        Project Kick-off
        System Set-up
        Design & Build
        System Validation & Final Training
        Deployment – Go-Live
        Post Implementation
   Preliminary Assessment / Project Planning
   System Design
   Change Management
   Issues Management / Escalation – Risk Mitigation

  Project Management Tools

      Project Plan
      Work Plan
      –  Visio
      –  Power Point
      Project Team Status reports
      –  Dashboard
      –  Issues
      –  Frequency of reports
      Oversight Committee Status Reports
      Issue Logs


     Work Plan

•      Provides the step-by-step instructions for constructing project deliverables
•      A way to manage and monitor the project
•      Creating a work plan
        –  Use a prior work plan from a similar project as a model, if one exists
        –  If not, build one by utilizing a work-breakdown structure
        –  Estimate work out as far as possible with as many needs and details as understood
        –  Create it at a level the project leads can understand and utilize
        –  Should include:
                    •    Implementation Phase
                    •    Deliverable/milestone
                    •    Task / Subtasks
                    •    Predecessors
                    •    Deliverable dates
                    •    Length of duration
                    •    Status monitor (percent complete)
                    •    assigned resources

     Work Plan

                                                                                                                  Enter %         Lead;
                                                                                       Actual                    complete     PL=Pharmacy
                                                      Activity,                                                                                Notes &
                                                                                     Date(s) to                  for each     Lead; ISL=IS
                                                     Milestone,     Workplan                                                                 documents
                                                                                   complete an       Number      task and         Lead;
Medication Adminsitration/Barcoding Work Plan        Deliverable   is set at 21                                                               to refer to
                                                                                      activity,     of days to      auto      PIL=Process
Bon Secours Community Hospital
                         to be       weeks for                                                                for specific
                                                                                    milestone,      complete 
    updates     Improvement
                                                     completed     completion  
                                                              tasks are
                                                                                    deliverable                   activity,       Lead;

                                                                                      and task  
                milestone    EL=Education
                                                                                                                   & deliv.
   Lead; System
                                                                                                                              Design Team,

0    Phase                     Activity/     TASK
   Predecessor   Week(s) To      Associated       Estimate       %            Resource     Document
        (and/or             Milestone/                  Row #
     Be              Date(s) To Be       d         Complete
    Name           Checklist
         Deliverable                              Completed
     or Note

                           (and/or Module)

     Work Plan

     Work Plan Implementation Phases
     •  Assessment/Pre-planning
     •  Detailed Design
     •  Development / Testing
     •  General Design
     •  Implementation
     •  Project Management


       Work Plan – Milestone and Task Example


                                 Milestone      Task

 37        Development /         Finalize
         Employee IDs
                                weeks 3-9
   Feb 19 - April 6
   35 days

                                                Confirm Employee
 38        Development /         Finalize       IDs are functioning
         Employee IDs
    in Bridge Test
             week 3
      Feb 19 - Feb 23
    2 days

 38        Development /         Finalize       Employee IDs in
         Employee IDs
                 week 8
      Mar 26 - Mar 30
    2 days

                                                Produce New
                                                Employee IDs for
                                                Pilot Unit and
 38        Development /         Finalize       Additional Super
         Employee IDs
                      week 8
      Mar 26 - Mar 30
    2 days

                                                Producing New
 38        Development /         Finalize       Employee IDs for
         Employee IDs
                   weeks 8-9
   Mar 26 - April 2
   8 days

       Project Management and Communication Tools

       Established Corporate Vision
       Established Oversight Council and charter
       Established routine meetings
            Executive status call
            Oversight Council call
            Team call
            System Design team
            Discipline calls
                   •  Nursing
                   •  Pharmacy
                   •  Technology
       Ad hoc meetings and work groups
       Creation of Health System wide safety standards and policies
       Creation of a customized work plan
       Use of issues tracking logs

       To make a 6 month install beginning at Kickoff through Post Go Live Support
       •  Full time Clinical Informatics resource in place
       •  Full time Pharmacy Informatics resource in place (Pharmacy Lead)
       •  Begin project predecessors and (complete?) before kickoff
       “Little things don’t mean a lot; they mean everything”1
              –    Resources
              –    Server Setups complete
              –    Interface(s) connectivity
              –    Formulary, Frequency and Routes Files
              –    Wireless Infrastructure**
              –    Evaluate medication distribution plan
              –    Architectural Review
              –    Employee Badges**
              –    Patient Wristbands**
              –    Automed setups and training
              –    Pharmacy IS System upgrade complete**
       1 “How to Swim with the Sharks without Being Eaten Alive,” Harvey Mackay


One Facility Estimated Project Hours

   Preparation and Implementation of a BCMA Program

   Departments affected
       Unit Secretaries
       Resp. Therapy
       Care Management

   Hold on, here we go!



  Preparation and Implementation of a BCMA Program
      Server Architecture
            •  Wireless
            •  Wired network ports
            •  Power Outlets
      Device and Cart Selection/Set-up
            •  Laptops vs Tablets vs PDAs
            •  COWs vs wall mounts
            •  Scanner type
                   –  1D vs 2D readable
            •  C.O.W. Coral
            •  Hallways
      Patient Wristbands
            •    Adult                                      Patient Identification?
            •    Child
            •    Neonate
            •    Psych

Network Architecture
Bridge Medication Administration/Barcoding Testing/Interface Infrastructure


                                                  Barcode                    Barcode
 ADT Test                                         Test                       Production

                                                                           Copy test into production and
                                                                           clear out patient specific
ADT                      Pharmacy                                          information – usually done a
Production               Production                                        week before system validation

                                                                                          Digital phys.
                                                                                          orders imaging/
          Test Interfaces (i.e., provides data from a test environment)                   Pharmacy
                                                                                          Messaging Printer
            Production Interfaces (i.e., provides data from a production environment)

  Network Architecture
 Automed Packager Interface Infrastructure
 Automed Server is interfaced with:
     Pharmacy Information System (2) &


 Patient Identification
 Wristband contents?

       • Name              • Picture
       • MR #              • Facility
       • Visit ID #        • Barcode (for BCMA, HIM, Glucometer)
       • Age               • Physician
       • DOB               • Physician ID
       • Gender            • Service Type
       • Admit Date        • Colored banding (DNR, Latex allergy, etc.)
       • Other

 Patient Identification
Wristband Samples

 Preparation and Implementation of a BCMA Program
   Barcode packaging solution
       •  Oral solids
           –  Automated Packager
           –  Non-automated
               Medi-dose type
               Euclid type
               Receiving Station
       •  Liquids
       •  IV’s
       •  Patient specific/Pharmacy IS system labels
   Verify stability of pharmacy IS system
       •  Determine if upgrade is needed
   Entry and transmission of Ht/Wt and Allergies


 Preparation and Implementation of a BCMA Program
  Patient specific/Pharmacy IS system labels

 Preparation and Implementation of a BCMA Program
     Pharmacy entry of orders/profiling
         •  In all areas 24/7
         •  Adopting changes that are identified thru testing
     Medication delivery method
         •  ADM’s vs Cart Fill vs COW Fill
         •  Delivery of first dose
     Timing of first dose
     File clean up of Pharmacy IS system
     Build and testing
         •  File build
         •  Interface testing
         •  Order testing
     Staff Training
     System Design

 Medication Packaging
Brief Overview of automated packaging solution
    –  320 medication canisters can be stored in the device, unlimited amount
    of Smart Canisters (current configuration 256 canister slots, and 64
    Smart Canister slots)
    –  Automated packaging solution
         –  Replenishment       of automated dispensing devices
         –  Can also perform cart fill and patient specific medication packaging (first


Barcoding Equipment

Automated Packager
             – Top 300 medication list sent to Automed to set up Canisters
             – Two Pharmacy employees from each hospital sent to Automed Training
             – Now operational performing ADM cabinet replenishment, First Dose and
             Cart Fill

Labeling Software and Printer
             – Produces Barcoded label for medications not stored in automated
             – As medications received from wholesaler barcode labels are applied

Preparation and Implementation of a BCMA Program

Human Resources
    Employee badges
    New positions
        •  Informatics roles
             –  Pharmacy
             –  Nursing
        •  Designated positions
             –  Nursing
             –  Pharmacy
             –  Educators
             –  IT
                                                Clinician Identification??
    Employee Badges
        •  Change existing badge vs. secondary badge vs. affixed barcode
        •  Barcode orientation on badge based on scanner selection
    Equipment security

Clinician Identification
Badge sample


Preparation and Implementation of a BCMA Program

   Cart and Device selection
          •  Ergonomics
          •  Vendor fair
   System Design / Decision Input Tools (DITS)
   MAR Set-up / MAR checks
   User entry /Maintenance
   Form selection

Device types - COWs

Device types - COWs


Device Types – Wall Mounts

Preparation and Implementation of a BCMA Program

Nursing (continued)
   Entry and maintenance of allergy, height and weight
   Super Users
   Workflow Changes


Support – Super Users, Vendors, Enterprise Team,
Staffing – 24/7, length of time in place?
Command Center – location, staffing
Communication Plan – who, how often, by what means
Bad Barcode collection – bad barcodes
Issues tracking
Status Reports
Dual Process
Moving from Vendor Implementation Support


External Marketing
     To Patient community
           •  Radio
           •  TV
               –  News
           •  Newspapers
           •  Flyers/direct mailing
Internal Marketing
      Before and during Implementation
      At Go-live
      At completion of roll-out
           •  To Patients
           •  To Staff – all departments
           •  To Physicians
       Beyond Blame Video
       BSHSI Video – Raising the Bar
           •  Inclusion of BSHSI CEO
           •  Inclusion of Local System CEO’s

     Internal Marketing (continued)

         Have Fun with it
             •  Use of Cow theme
                 –  Dancing cows
             •  MRMC Cow Tails
             •  Mount Carmel Angel Pins
             •  Shirts
             •  buttons
             •  Mouse pads
             •  Naming and decorating of the COWs

Project Accomplishments
•  MedAdmin now live at four BSHSI facilities, on time and below budget!
•  Thousands of med passes each day now have the 5 rights verified via MedAdmin
•  Reduction in Medication Errors
•  Improvements in pharmacy, nursing and IT relations
•  Efficiency improvements in the Medication distribution and Medication Use Process
    –  Automed
    –  COWs for med storage
•  Efficiency improvements in communication
    –  Pharmacy Messaging
    –  Co-residency of applications on COWs
•  BSHSI Standard Model created for Medication Safety
•  Citrix reduced need to install and maintain application on each laptop/PC


  BPOC Legacy

  “This system is used anytime a patient receives a medication, every
     nurse uses it and every patient that receives medication is exposed
     to it. The level of safety that the system provides far outreaches any
     endeavor we have taken on before. Patients are safer because of
     what we have done. Staff are more efficient and have better
     information available than anytime before.”

Lessons Learned

  BPOC vendor methodology was validated and proved successful
  The System Design team must be composed of a group of cross-functional clinical stakeholders
  Must have dedicated off-line people in project lead roles, at least for pharmacy lead and nurse
  Start predecessor work early before project kickoff
  Hours estimated by barcode vendors do not count predecessor activities
  Vendor provides an abundance of reports, that require analysis and work to identify root cause
        and resolution.
  Work-arounds must be identified early and stopped.
  Internal and external marketing are essential to project success

Lessons Learned (continued)

  The speed at which BCMA is rolled out throughout the facility is controlled by 2 overwhelming
         factors, training and devices
  The longer you take to roll out BCMA in the facility the longer you live in two worlds, digital and
  IT support must be 24/7 and timely
  Changes in nursing practice does not add time to the med admin process
  The biggest impact on Nursing and Pharmacy are the operational changes the application brings
           Physical space and layout
           Medication order Turn-around times
  It only takes 4-5 med passes to “get it”
  Beware of scope creep
  Pharmacy, Nursing and I.S. relationships were strengthened during the project.


Barcoding Project
    Health System Wide approach to Model Development
       •  Use of Collaboratives
           –  Pharmacy
           –  Nursing
    Local System Approach to System Design Modules
    Interdisciplinary approach at each hospital toward System Design modules
    Effective communication and good rapport allowed us to dig deeper and
       having greater understanding of process and issues
       “You’ll always get the good news; it’s how quickly you get the bad news that counts”
    Relationships with Vendors
    Use of Issues Logs/Issue Tracking
    Use of IRIS

Challenges – what lies beneath…

Barcoding Project
    Information overload
       •    Number of emails
       •    Terminology and strange new processes
       •    Location of documents
       •    Version control of documents


Barcoding Project

      •  Project work added to existing roles and responsibilities on team members
      •  Each Hospital and department has unique corporate cultures, acuity levels,
         size of institution, etc
      •  Cart Selection and delivery and receipt challenges
      •  Automated Packager inventory function
      •  Barcode Scanners
      •  Vendor abilities to deliver 2D barcodes on pharmacy labels

Thank You

                Christopher A. Woodruff, R.Ph.
                    Enterprise Application Services –
             Clinical Information Systems & Project Director
                    Bon Secours Health System, Inc.
                            Tel: 757-686-3127


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