Navigating Unknown Terrain: Launching a Large-Scale Implementation of BCMA during a Global Pandemic

Barcode medication administration (BCMA) has been the standard practice in the inpatient and infusion environments for many years, but implementation in the ambulatory care and procedural realms has lagged due to a lack of realized value. With the challenges of a global pandemic, increased clinic volumes, clinic expansions, and staffing shortages, the vison to tackle such a large-scale project like BCMA seemed bleak. With the support of nursing leadership and unwavering determination- BCMA has now successfully been implemented in all pediatric and adult clinics and two newly acquired regional practices at Vanderbilt University Medical Center (VUMC). This presentation will share some of the challenges, triumphs, and lessons learned throughout the implementation process. Extensive workflow analysis occurred as areas were implemented to identify the roles that administered meds and adjust processes to incorporate the guiding principles of BCMA. Mid-implementation, the medical assistant role was expanded to include administration of vaccines (COVID and flu) to reduce burden on nursing staff. This added further complexity to the roll-out. Resources for managers to utilize, such as a hardware toolkit, BCMA end user toolkit, and BCMA leader toolkit were created to keep managers, nurses, and front desk staff in alignment. Virtual support structure of go-live was staggered by grouping similar areas (with input from operational leaders) and considering hardware readiness, medication administration practices (volume, high risk, high cost), and other constraints. Go live support consisted of both onsite support deployed to help high-volume or high-risk areas and virtual support using an open Teams line to field questions. These topics cover just a few of the important lessons learned during the implementation of BCMA in the ambulatory care setting at VUMC. Ambulatory care BCMA is a multifaceted project that requires cooperation from many departments and can improve administration safety, patient safety, and nurse satisfaction. This is an important innovation for the ambulatory care space that we recommend to other organizations.