The Veterans Health Administration (VHA) combined its Computerized Patient Record System (CPRS) with Bar Code Medication Administration (BCMA) technology to increase its medication management processes. Physicians insert their orders into the CPRS, which sends the order to the pharmacy where it's finished and entered into the BCMA system. When completed, nurses use the BCMA for the administration of scheduled PRN and one-time medications.
Partnering by the Veterans Affairs (VA) National Center for Patient Safety, Patient Safety Reporting System, the National Aeronautics and Space Administration (NASA)/Federal Aviation Administration (FAA), and the National BCMA Program Office was central to VHA's success in this initiative. Initially open to more than 170 VHA medical facilities, only 30 teams of three members were invited to participate. The VA Tennessee Valley Healthcare System (TVHS) team consisted of a registered nurse, a licensed practical nurse, and a pharmacist.
A collaborative focus
The TVHS team proposed an educational initiative designed to improve the documentation of PRN effectiveness. That included the PRN Effectiveness List and the Medication Variance Log. The team provided training on retrieving PRN effectiveness reports for their units, and changed the allowable time for documentation from 60 minutes to 240 minutes.
Data were collected monthly from all units. National BCMA software changes were proposed to ensure assessment documentation was completed. An additional proposal involved creating a dialog box that reminded nurses of any outstanding PRN orders when exiting the BCMA application. These proposals are still under consideration.
Tool time
To further enhance PRN documentation efforts, a tool, titled "BCMA PRN Report by Ward," was constructed that enabled nurses to enter documentation of outstanding PRN orders at the end of their shift and follow-up on PRN medications administered by nurses on previous shifts. Feedback from involved staff and data analysis were used to enhance the program prior to system-wide implementation.
The team provided education to staff on this project and the use of the tool, and met with senior managers monthly to ensure their support. An educational storyboard was employed in each unit to train key support personnel. In conjunction with implementation of the tool, the team assisted in the development and distribution of a policy on documentation of PRN effectiveness.
Positive results
A 93% increase in documentation took place within the first 2 months of implementation, with an average plateau of 98% occurring since then. The CPRS with the BCMA component significantly increased the capability of providers to ensure timely, unduplicated patient care across the nation.
The TVHS team continues to monitor the documentation of PRN effectiveness and provide reports on deficiencies and outliers to nursing and facility leadership. Additionally, nurse managers continue to monitor their units and share results with their staff. In the future, the team will continue to look for ways nurses can increase the quality of effectiveness documentation in medication administration using the CPRS and BCMA union.