BCMA

Data visualization and dashboards

A wise colleague of mine once told me that lots of people collect data, but few people know what to do with it. I didn’t understand what he was talking about at the time, but I’ve come to have a better understanding over the years. It basically boils down to the difficulty that many of us experience when it comes to the best way to handle information. Our brains do some amazing things, but fail to “see” things when the perspective is all wrong.

Data surrounds us. It’s in everything we do, from the bank statements we receive in our personal life to the mountains of data collected by every healthcare institution. Regardless of the data collected, there are basically three things that can be done with it. Data can be ignored, it can be archived or it can be used. Unfortunately only one of those three things is truly useful; using it. Many people chose to ignore or archive data not because the information isn’t valuable, but because they are overwhelmed with the amount of information they receive and the way that the information is presented.

Presentation is everything when it comes to data. The methods we chose to present information can make the difference between the information being useful or being useless. The significance of such a problem creates a quagmire for pharmacists as theirs is a data driven environment. Pharmacists spend a great amount of time emerged in data; patient data, lab data, micro data, kinetics data, drug data, usage data, nursing data, physician data, and so on.

Data visualization and dashboards can help. They provide us with the tools to better understand the information around us, and therefore improve efficiency in the process.

Data visualization
Acording to an article by Michael Friendly in 2008 (1) data visualization is “information which has been abstracted in some schematic form, including attributes or variables for the units of information”. In other words it’s data that’s put on display in a format that’s easier for the end user to understand, i.e. the use of an image to represent tables full of data.

It’s difficult to conceptualize the benefits of data visualization until you see it in action. This was recently demonstrated to me at the unSUMMIT in the form of a poster on data visualization by Charles Boicey, MS,RN-BC, PMP, Informatics Solutions Architect from the University of California, Irvine Medical Center. The poster demonstrated the value of data visualization by utilizing several different methods to present information collected from bar-code medication administration (BCMA) override scans. The information was displayed in table format along with various types of graphs and images. The tabular information was virtually useless as it was difficult to wade through the data and make sense of it. However, the visual representation of the data created a much more powerful statement that made the data easier to understand.

According to Vitaly Friedman (2) the “main goal of data visualization is to communicate information clearly and effectively through graphical means”. While the concept is simple, the application is more difficult and requires a keen eye and the ability to think in abstract ways. If you can get it right, it’s powerful stuff.

Dashboards
Dashboards take data visualization one step further by aggregating several different pieces of visual information in a single location. Think of it as an information control panel where the end user controls what information is gathered and how it’s presented. A simple search for “dashboards” in Google Images reveals several excellent examples.

Even though the concepts are useful and commonly used in business applications, the use of data visualization and dashboards remain relatively uncommon in healthcare, which is unfortunate because they could go a long way in helping pharmacists understand what’s really going on around them.

References:
(1) Michael Friendly (2008). “Milestones in the history of thematic cartography, statistical graphics, and data visualization

(2) Vitaly Friedman (2008) “Data Visualization and Infographics” in: Graphics, Monday Inspiration, January 14th, 2008

via talyst.com - jerry fahrni

If we can understand human behaviour and understand the triggers that they go into the desired behaviour that I’m looking for and how content plays a role in providing that brand, the cultural context to drive that consumption, right, what we’re going to want, what we’re going to see is greater efficiencies, lower cost to brand, greater egality to consumer and it becomes a win-win.

Agencies need to hire behavioral economists and creative technologists as well as individuals that truly understand social interaction. This goes well beyond the “social media specialist” who claims to understand how to evoke more tweets out of a post.

—  Doug Scott, President, OgilvyEntertainment

Beyond stoked right now. Got promoted to my yellow belt. Im so blessed to be apart of a great academy with amazing mentors. Ive never wanted something so bad and it just goes to show hard work pays off. Its honestly not even about the belt rank im just glad to be apart of this life style the belt is just a reminder of all the hardwork and time ive put into this art. Huge thanks to Tamdan, Pete and Steve. And congratz to my buddy Chris! #bcma #bjj #jiujitsu #taikai #teambalance

unSUMMIT 2011 Presentation (#unSUM11)

I uploaded the presentation I gave Thursday at the unSUMMIT in Louisville, Kentucky. You can see it below, although some of the slides came out a little rough when I uploaded it to slideshare. It looks like it may have something to do with the font I used. If I find time I’ll correct it later.

The presentation focused on the often overlooked things that need to be done following implementation of something like BCMA. Healthcare systems have a bad habit of not providing enough resources, both labor and monetary, to maintain and optimize technology once implemented. I simply suggested five things that healthcare systems could do post-implementation to make sure their BCMA implementation didn’t crumble right before their eyes.

And now that the unSUMMIT presentation has been delivered I am officially retiring from the role of presenter. Unlike some people I know, it takes me a concerted effort and a fair amount of time to put one of these things together, and I just don’t feel like doing it again. Enjoy.

The real work starts after implementation

View more presentations from Jerry Fahrni via jerryfahrni.com
Branded content marketers will increasingly realise that their brands are best understood as socially constructed organisms consisting of all kinds of brand meanings, brand manifestations and brand stakeholders, such as consumers, employees, competitors, suppliers, pressure groups and the media. Any of these stakeholders is able to create and disseminate brand manifestations, such as branded content, on an unprecedented magnitude – no matter if the focal organisation behind the brand (usually the legal trade mark owner) likes it or not. What’s not going to change is that content will have to be distinctive and resonate with the targeted stakeholders’ needs, interests and/or passions to be successful.
—  Bjoern Asmussen, Senior Lecturer in Marketing, Oxford Brookes University
FMEA and BCMA, two acronyms that work well together

During my time as an IT pharmacist I was fortunate enough to be part of two Failure Modes and Effects Analysis (FMEA) groups; one for CPOE and another for BCMA. The FMEA process is labor intensive and time consuming, but well worth the effort in my opinion. In both the CPOE and BCMA instances several important pieces of information were discovered that may have otherwise gone unnoticed.

I don’t often see articles that talk about using FMEAs, which is a real shame secondary to their value. So it was a pleasant surprise to see a recent article in Pharmacy Purchasing & Products on the use of an FMEA post BCMA implementation. I’m not familiar with using an FMEA after the fact, but it makes more sense to me now after reading the article.

According to the author, they “had conducted an FMEA prior to initially employing BCMA; however, we never performed any post implementation follow-up on the system.” An all too common occurrence in healthcare, i.e. implement and forget. We did something similar at Kaweah Delta when I worked there, but we referred to the process as a gap analysis rather than calling it an FMEA. Regardless of the verbiage, the results were similar.

The reason cited for the second FMEA was an increase in errors associated with the BCMA system. “Errors were primarily due to unscannable bar codes, mislabeled medications, the wrong medications being dispensed, and most commonly, nursing staff’s failure to scan.” This sounds familiar. The errors cited are simply side effects of the implement-and-forget mentality. Regardless of the system in place, humans inevitably develop bad habits and workarounds. We need to be constantly reminded to do the right thing. Implementation is only a small part of the work involved with any new system. Follow-up, maintenance and optimization is when the real work begins.

And the results of the second FMEA? “Three months after completing the FMEA, the team compared the before and after scan rates. We found significant improvements in the scanning of both the patients and the medications throughout the system. In addition, we have witnessed a culture change: nurses now become anxious if they cannot scan a product.” Not bad.

Read the article, it contains some good information.

via jerryfahrni.com

Day 7 - May 13, 2014

Today is going to be another one of those long posts. :)

Intensive Care Unit

Today I started in the intensive care unit (ICU) with nurse Brian. It was a slow day in the ICU (thank goodness!) so there were only two patients, one of them being Brian’s. This gentleman had been in the ICU since Friday, after an ATV accident where he developed serious head injuries including: subarachnoid hemorrhage (bleeding between the brain and tissues that cover the brain) and a hematoma. This is the first time I have had any experience with this type of patient care. I had done rounds at Florida Hospital, however all the patients were stable.

First, I wanted to mention something I thought was very sweet. The patient’s family brought pictures of him, and left a board listing many things about the patient. These include the names of his family members, his hobbies, favorite athletic teams, etc. I thought that this was something they did for every patient in the ICU, but I learned the family constructed it. I thought it was very sweet and helps add a personal touch to the care that he receives.

Brian showed me the med pass process using Barcode-Medication Administration (BCMA). This is where patient medications are crosschecked and verified by using the barcode on the patient’s wrist, as well as the one on the medication. We started with his 9:00 meds. He had many different medications including lorazepam (PRN for agitation, which we did administer), Lovenox, docusate, PEG, sennosides and some other high risk medications. The patient had a nasogastric tube, continuous suction, a continuous normal saline (NS) drip and a urinary catheter. The patient was unable to take medications by mouth, so we crushed all of his tablets, and mixed it with his powders and liquid medications. It was diluted with water and administered to him through his nasogastric tube.

At 10:00a, an antibiotic was administered through his IV. The IV was actually infiltrated and therefore removed (Infiltrationoccurs when IV fluid leaks into surrounding tissue) A PICC line was requested, which would last longer than the peripheral line that he had. We also monitored his blood glucose levels and administered 4 units of Novolog. Following that, Brian and I talked about the different antibiotics used intravenously, as well as protocol for disposing of controlled/non-controlled IVs. It was overall a great experience.

Student/Resident Discussion Hour

Following the ICU, I attended a “student/resident” discussion hour. Abby, a 4th year UNC student who is doing her ambulatory care rotation at the VA, led a discussion on the “Management of Oral Anticoagulation During Invasive Procedures.” She presented a patient case, and talked about how to assess the patient’s risk of thromboembolism with cessation of warfarin in patients with Atrial Fibrillation as well as the risk of bleeding. I learned about the CHADS2 scoring used to determine risk of thromboembolism as well as the HAS-BLED score used to assess the risk of bleeding.  We talked about how to bridge warfarin therapy before and after a surgical procedure using Lovenox (Enoxaparin). In the next two weeks, each of us are expected to prepare and lead a discussion on a topic of our choice. Although of course that makes me nervous, I am looking forward to this learning opportunity. The residents (aka Pharmacists!), Alli, Gina and Stephanie were super sweet and explained everything they thought we wouldn’t understand and asked us questions to challenge ourselves as well.

Pharmaceutical Cache Program

Probably one of the coolest parts of my day today was going to, and learning about the Pharmaceutical Cache Program. I don’t want to disclose information, so I will say what is listed on the web:

“The VA Pharmaceutical Cache is designed to treat Veterans, staff, and other victims that may present to local VA Medical Centers (VAMC) in a local mass casualty event, primarily one resulting from the deployment of a Weapon of Mass Destruction (WMD).  The caches are intended to provide pharmaceuticals and some equipment for short-term care until other resources could be made available in the immediate area and to support and augment a VA facility’s involvement in the local community disaster plan.”

Let me just say it is amazing! It is incredible what they have prepared for any type of emergency; these include anthrax, hurricanes, tornadoes, or any other event.

Infection Prevention & Control Committee

Next, I attended the Infection Prevention & Control Committee meeting. As indicated by the name, this committee works to prevent the transmission of communicable diseases in the medical center. Something cool that I learned was the hospital’s use of the “GoJo Smartlink” system to prevent Healthcare acquired infections (HAIs). Hand hygiene compliance is less than 50% nationally in hospitals. This system has advanced Purell dispensers and communication devices, measurement tools, and clinician support. The system will count the number of a person washes their hands or uses the Purell dispenser. For those who don’t know, every hospital has some type of hand sanitizer system outside almost every door and in every hallway. In a lot of hospitals, it is required for a clinician to use it upon entering and exiting a patient’s room—no matter what. But of course not everyone does it. I actually helped with a study of this at Florida Hospital when I volunteered in undergrad.. It will count it against every time a person walks in or out of that room, which equals an “opportunity” to use it. This will create a “compliance rate” for administrators to use. They also discussed other important new implementations for the hospital including a program to reduce “CAUTIs” (catheter associated UTIs).

VA Charlotte Health Care Center

The VA Charlotte Health Care Center (HCC) is going to be an extension of the Salisbury VA Medical center. It is projected to open in late 2016, and will help provide easier access to care for veterans in the area. Alyssa and I attended a meeting with Glenn today where he finalized the floor plans with the contractor and another pharmacist administrator. It was interesting to witness this planning process and see the blueprints for the new center. After looking at that, and the virtual tour, I can already tell it is going to be beautiful! Not only will it provide better access to care for veterans but it will also open up so many job opportunities for pharmacy technicians, physicians, pharmacists and nurses.

Oncology

Although I will be spending the day with the oncology pharmacists tomorrow, I got a little sneak preview of it at the end of the day today. I attended a short meeting between Glen, another pharmacist, and two oncologists regarding treatment for a patient. He was diagnosed with colorectal cancer and has already surpassed the average survival rate. He has failed/not tolerated all of the cancer therapies given to him thus far including FOLFOX, Avastin, cetuximab, and irinotecan (caused excessive diarrhea). He is otherwise healthy and lives a normal, asymptomatic life. The pharmacists and physicians approved the trial of a new therapy for him: Regorafenib. It is in stage 3 clinical trials. These consultations are typically done on an individual patient basis after evaluating all circumstances and the prognosis of the disease. I hope that this new therapy will improve the prognosis of this patient.

iBook Version of Best of Branded Content Marketing now available

The free enhanced multimedia iBook version of Best of Branded Content Marketing – 10th Anniversary is now available on iTunes. The ebook is an international collaboration containing 13 of the best recent branded content marketing campaigns from cutting-edge brands and award-winning agencies, as well as “what is,” “how to” and “what’s next” features from leading practitioners:

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I believe in five years time we are going to see number of new media and platforms that will enable brands to connect with customers via content in an even more exiting and creative way. What we can expect also is companies putting more emphasis on branded content in their marketing strategy. While on the other hand a lot of effort will be put in developing the right set of tools to measure the efficiency of content strategies.

What will probably remain the same are the two basic challenges: how to develop a content strategy that is truly aligned with the essence of the brand and how to maintain a fil-rouge across all possible platforms/media when creating the content.

—  Uroš Goričan, Creative director at Publicis Slovenija