KBMA Reports:

Analyzing Process and

Monitoring Outcomes
Lori A. Dixon, RN
Senior Clinical Analyst
 CTCA is a Four Facility
Specialty Hospital
• .

All sites use KBMA

•Implementation Date: 03/2009
•After a year on the system, began
intense review to improve
• Eastern Configuration and Workflow
• Midwestern
• Southwestern
• Western
 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
• SXAMMOrderTaskOccurrenceAdmi
nWarningTable. 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 Types
All
Multiple Visits Found
Patient Not Found
Patient Not Scanned
Successful
Visit 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