KBMA Reports:Analyzing Process and Monitoring Outcomes

Lori A. Dixon, RN

Senior Clinical Analyst

CTCA is a Four Facility Specialty Hospital

• .

• Eastern• Midwestern• Southwestern• Western

All sites use KBMA•Implementation Date: 03/2009•After a year on the system, beganintense review to improveConfiguration and Workflow

Outcomes

• Standard Eclipsys reports: Be able to verbalize what are the standard reports and what does the data provided mean

• Be able to use the Custom KBMA reports and analyze the information to improve patient outcomes

Eclipsys Standard Reports

• KBMA Drug Scan Override Report• KBMA Manual Match Report• KBA Patient Record Report• KBA Scan Auditing Report• KBA Scan Warnings Report• KBA Time Efficiency Report

KBMA Drug Scan Override Report

• This report displays information showing when, how often, and why drug scanning is being overridden when scanning for a barcode is required. The report includes a summary view of percentage of tasks being performed without the drug being scanned for a defined time period, along with detailed information about the override.

KBMA Drug Scan Override Report

The report includes the following criteria that you can define:• • The From date and time• • The To date and time• • The total number of administrations based on the search

criteria• • The percentage of administration completed without

scanning (when scanning is• required) based on the search criteria• • The generic item name• • The generic item ID• • Override reason• • The care provider name and occupation

KBMA Drug Scan Override Report

KBMA Manual Match Report

• This report lists when and for which drugs a manual match was performed. Selection criteria you can define to run this report includes: Date/Time From, Date/Time To, and location. The report header includes the location(s), Date/Time From, Date/Time To, total number of administrations, and total number of administrations performed through the use of the manual match feature. The report columns include location, patient name and visit ID, the date and time the task was performed, the drug scanned, the task occurrence details to which the drug scanned was manually matched, the care provider performing the task occurrence.

KBMA Manual Match Report

Difference between Eclipsys Standard Manual Match and CTCA Manual Match

• Eclipsys Standard report includes when they have a multiple match and have to select the correct match. There was no way on this report to exclude these. CTCA wanted to find the true manual match. This would allow us to look at areas of configuration that need fixed.

Warning used for CTCA Report

• SXAMMOrderTaskOccurrenceAdminWarningTable. If we pull data first by the IsManuallyMatched = 1 and then we can use the column WarningType. It has numeric values, but here is what they mean:

• 1 Dose Warning• 3 Drug Not Scanned

Warning• 0 Drug Warning• 5 Order Warning• 2 Time Warning• 4 Unverified Order Warning

KBA Patient Record Report

• This report provides organized information for each patient on medication administrations that have occurred for a defined period of time. The report includes detailed information such as order information, scheduled time, performed time, the provider who performed the task, warnings provided and override reasons, if applicable. The report is similar to the MAR, however, it includes KBA scan warnings and overrides.

KBA Patient Record Report

KBA Scan Auditing Report

• This report lists the scanned events over a period of defined time.

Scan Event TypesAllMultiple Visits FoundPatient Not FoundPatient Not ScannedSuccessfulVisit Not found

KBA Scan Warnings Report

• This report lists the number and kind of scan warnings that occurred during a

• defined period of time.

KBA Time Efficiency Report

• This report provides organized information regarding the timing of medication administration. The scheduled task time is listed compared to the actual performed task time. Using facility defined settings, the report lists the early, late, and on‐time administrations. The report includes a summary view in terms of percentages.

What are the custom KBMA Reports

• Exceed Daily Dose Alert• Dose Warning• Med Administration Time Warning• Manual Match • Drug Not Scanned• Order not Found• Scan code not Found• KBMA Overrides (SMM5000)

KBMA Overrides (SMM5000)

KBMA Overrides (SMM5000)

KBMA Overrides (SMM5000)

• Look for high volume of the same drug on the report: acetaminophen

• Review reason for the override: In this case, we may have to check with the nurse as to what “Barcode scanner inoperable” means to them.

• Gather packages and see if there is any issue with the package

KBMA Overrides (SMM5000)

• Nurse Scanning: Look for clinician who appears on report multiple times.

• Reason: See what the override reasons are• This could be a scanner issue, or maybe a

nurse who needs more education.• Talk to the end user to see what does the

reason they are choosing mean to them.

Custom KBMA Queries/Reports

• Exceed Daily Dosage• This is ran by environment PROD C, PROD E and

PROD M.• For SRMC and MRMC, sort by location in the

spreadsheet to find each sites alerts.• Includes: Drug, Date Entered, Patient Name and

Patient location• Additional columns: Alert Valid?, Alert Text,

Comments

Exceed Daily Dosage

Exceed Daily Dosage

• Tips: If the nurse gets the alert, but they correct their data going into the system, the alert will still be in the Database and show up on the report. But you may not see this alert on the chart.

• For Example: Nurse scans vial to match the drug. They don’t think it scanned, but the cursor is not in the dosage field and they scan again. They realize when the alert comes up what they did and correct the dose field

Exceed Daily Dosage

Sort the report by Drug A-Z

Look to see which drug has the highest volume of alerts and review those charts first.

1. Look up patient

2. Go to Patient Info Tab

3. Alerts

4. Select Alert and review alert text.

5. Look for ‘Total Daily Dose could not be determined’. This means the drug is configured with mixed units of measure (UOM). This is a configuration issue and a ticket can be opened for IT to correct.

Exceed Daily Dosage

• Drug: Calcitonin • Alert Text: Total Daily Dose Exceeded for calcitonin

injection• Based on this patient's age, the Total Daily Dose for a

patient fitting this profile and route is: 100.1 International Unit(s). With this dose, in the past 24 hours this patient will have received : Dose Total(in 24 hours): 460 International Unit(s)

• This is a valid alert. Why?• Dose range is up to 100.1 but the patient will have

received with this dose 460 IU.

What next

• Review the patient’s order: Dose is 230 IU every 12 hours. This is what is causing it to exceed the total daily dose range.

• Next Question: Should the nurse question the physician or pharmacist about a dose so far over the range?

• Next Question: If everyone agrees this is a valid dose, find out from Pharmacy if the dose range should be increased.

Steps to review

• Check Alert to see if it is valid – Quick – Patient info tab

• Check the order to see if it exceeds the total daily dose range.

• Review the eMar for when the dosages were given.

Reviewing the emar – Change the range to fit the date entered.

Find the task for that date and right click for view: Order/Task Summary

The Order/Task Summary View gives the order and all the task

information

• This will show when each task was performed or not performed.

• The time performed so you can see were they marked as done closer than 22 hours

Medication Administration Time Warning Report – Early and Late

Warning• We allow medication administration one

hour early or one hour late as a policy.• This looks at the individual administration

opposed to the Exceed Daily Dose which is all the doses over 22 hours.

• This looks at the schedule time vs the actual administered time.

Med Admin Time Warning

Use for Med Admin Time Warnings – Look for Trends

• Sort by Scanned By – Is one clinician showing up more than others?

• Sort by Location – Is there one location showing up more, for example infusion VS inpatient

• Sort by Drug – Are there certain drugs on the list more than others and is there a need for a schedule change?

Dose Warning Report – Partial and Dose More

• Administer More: They have given more than the ordered dose.

• Partial Dose: If the dose is a range order and only part of the possible dose is scanned a warning will appear. If a dose is for ‘two tablets’, if only one tablet is scanned it will get a partial dose warning.

Dose Warning

Dose Warning

• Variable Dose: When the actual dose is entered, the partial dose warning will go away.

• This can be a good reminder to staff of the actual dose that should be given.

Drug Not Scanned

• These are drugs that the nurse did an override on because they did not scan.

• Sort by drug to see if there is a trend of certain drugs not scanning.

• Sort by Scanned by to look for a end user who may need assistance.

Drug Not Scanned

Order Not Found

• The drug scanned is not due within the window on the KBMA Worklist.

• IF the window is expanded, then the order can be found sometimes if it not beyond the 12 hours.

Order Not Found

Order Warning Report

• This will warn the nurse that this order has been discontinued. It will allow them to administer the order because they may be entering the data for a early time it was given.

Order Warning Report

Scan Code Not Found

• This report is pulled from a warning in the database. This alert can show us either a package that may need reconfigured, a package that may be wrinkled, or maybe the nurse had issues scanning originally and then they were able to scan.

Scan Code Not found

At MRMC we found that the package from the manufacturer for acetaminophen is delivered wrinkled. This was causing an issue with scanning.

Manual Match Report

• Manual match may be a drug that is not verified by Pharmacy and override is done to administer the task.

• OR it could be a drug that did not match and the clinician manual matched to a drug, on the CTCA Report this is not a multiple match. This may because they pulled a different product than the one that was verified.

Multiple Match

Multiple Match Unverified

Monitoring Reports: What has it done for us?

• Exceed Daily Dose: Configuration for mixed UOM fixed. Inaccurate dose ranges fixed. Currently we have gone from 4000 alerts for SRMC and MRMC in the month of March, to approximately 200 alerts. These alerts at times have been valid and nursing has reported that it helps them.

• Propofol: Mixed UOM that still come up on the report. Can pharmacy and physicians come up with one UOM to use.

Monitoring Reports: What has it done for us?

• The data on the reports now is information that needs audited to see can we make further improvements or is education needed.

• Data provides feedback to show improvements made since February.

What is next: Defining Outcomes

• CTCA is forming a Report Subcommittee including Quality, Pharmacy, Nursing and IT to refine the reports and to create Outcomes that can be monitored.

• Nationally what are other facilities monitoring, especially other Eclipsys clients

Reporting Needs

• Ability to pull bar code that was scanned and link to a specific stock item. On the report show the verified stock item bar code vs the scanned bar code.

• Ability on a report to show if an alert was received, how the nurse corrected it or what action was taken. This could show of the total warnings received, how many of these warning caused the nurse to correct the administration.

Questions