"Cancel Remove" function on PYXIS Machine

Nurses General Nursing

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Have you ever used or are familiar with the "Cancel Remove" function on the electronic Pyxis medication dispenser?

Sometimes, one may be tempted to use this function to access something not otherwise profiled, Say for example to "Cancel Remove" an unwanted but profiled medication to access something else known to be in the same drawer. In my unit Lubrifax Packets come to mind.

If an individual nurse (one of many on the floor) were to use this function say 15 times within a month's time, and there were to be a discrepancy of say 15 Tylenol tabs and 6 Flexeril tabs within the same time period, could the nurse be found to be guilty of diversion of medications when the only witness is a machine?

If so, then what would you suspect the maximum disciplinary action to be?

A) A letter of reprimand from the employer

B) Termination by the employer

C) A letter of reprimand from the state B.O.N.

D) A suspension of licensure

E) A revocation of licensure

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Diversion normaly only pertains to narcotics, tylenol and flexaril are not narcotics.

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Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.

While one usually thinks of diverting drugs pertains to narcs only, diverting is diverting. If it's not on the pt profile/order, and you're pulling meds to give to a pt, you're practicing medicine/outside the scope of your practice. Even something as minor as Tylenol is not worth losing my job/income/license/respect.

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Specializes in Progressive Care.
While one usually thinks of diverting drugs pertains to narcs only, diverting is diverting. If it's not on the pt profile/order, and you're pulling meds to give to a pt, you're practicing medicine/outside the scope of your practice. Even something as minor as Tylenol is not worth losing my job/income/license/respect.

Just because you are pulling the medication and it's not on the profile doesn't mean there isn't an ORDER for the drug. It just means that the pharmacy hasn't yet put the medication on the patient's profile. The problem with this is that the pharmacist hasn't yet reviewed the dosage, interactions, lab values, et cetera pertaining to the order to make sure it's safe, as is done in my facility and I am sure is done elsewhere before it's allowed to be dispensed from the Pyxis.

For common STAT medications, we have an override list that is approved by our unit manager and can be pulled from the Pyxis using the override function.

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Specializes in med surg ltc psych.

Talk about "a machine being the only witness", I had several go arounds with it and had me sobbing in the corner of a med room. On several shifts I was the oncoming 11p-7a med nurse, and the discrepancy icon was not displayed prior to me logging in. I pulled up some meds, did beginning count, removed and closed the lid. It did not warn me that the count was off prior to me opening the pocket. The next time I pulled the same med for different patient, THEN the discrepancy shows up on the screen on my watch under my name. Going back to the previous shift to see who was previously removing such meds (under a global search) it was two nurses who had screwed up the count on prior shift and now the red icon is down in the corner attached to my name and time. I couldn't leave the building the next morning until those discrepancies were reconciled. They brought in the house supervisor, the pharmacist, and an IT guy. They were convinced I diverted. There were no options on the screen for me to clear it up at first and I was told my license would be sent down river. Until one last effort and one last option screen came up for me to put in a "naritive" of the events that lead up to all these off counts being dumped on me. It was the only way the screen was cleared of the discrepancies. Previous shift nurses need to be careful and at least tell the oncoming what happened or at least make all attempts to rectify their problem so it doesn't roll onto the other nurse. I said to the house super "so this machine is going to put my license in Sing Sing if I can't clear this" he said "Yeah it's your ass because your name is on this screen and this machine doesn't lie." Nice huh?

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Specializes in adult ICU.

I use that function all the time. We have bar-code scanning, and sometimes the barcode won't scan. If that happens, I take the scanner into the med room, scan a different package (same med), and then do the "cancel remove" and put it back. I don't use it if I actually remove a med like you have stated, however.

As far as what you asked specifically, I don't know how the employer would pin that on you unless you happened to be the only person on the entire unit that used that function for that drawer, and honestly, do they even track that stuff if it's not a narcotic? At my facility, they don't. We don't have to count/inventory non-narcotic medications, and the pharmacy doesn't either. If the drawer is empty but the Pyxis still says we have pills in there, we just call the pharmacy to have them refill. Nobody cares if a couple of tylenol are missing (or for that matter, prefilled saline flushes, bags of NS, etc...those are all connected to our Pyxis in a big cupboard style thingy as well. God knows we don't count all of that stuff that we go through.)

Did some event happen or is this a hypothetical question? I can't see anyone ever getting reprimanded or worse for the situation you described.

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Did some event happen or is this a hypothetical question? I can't see anyone ever getting reprimanded or worse for the situation you described.

As a pilot, I often review NTSB accident reports to hopefully make me a better pilot. I also do the same with Nursing disciplinary actions to see where it is that people do go wrong, and to again hopefully avoid the same pitfalls.

This one caught my eye due to the "Cancel Remove" function, as I myself have quite often found myself doing this as I described, to access something as innocuous as lubricant or iodine swabs. In this case, there were gross inconsistencies with this nurses MAR and Narcotic documentation as well. As this nurse had no doubt counted on, no hard evidence of criminal activity was uncovered, and a urine tox screen was negative.

So there was no finding of fact of diversion but a whole host of "suspicious activity."

Here's the specific conclusion of law where the B.O.N. suspends the license based on violations of statute 36-9-49 sub-paragraphs (5), (7), and (10).

36-9-49. Grounds for denial, revocation, or suspension of license, certification, or application. In compliance with chapter 1-26, the Board of Nursing may deny an application for licensure or certification or may deny, revoke, or suspend a license or certificate and may take other disciplinary or corrective action it considers appropriate in addition to or in lieu of such an action upon proof that the applicant, licensee, or certificate holder has:

(5) Negligently, willfully, or intentionally acted in a manner inconsistent with the health or safety of persons entrusted to his or her care;

(7) Violated any provisions of this chapter or the rules promulgated under it;

(10) Been guilty of incompetence or unprofessional or dishonorable conduct;

As a result of this case, I submitted a memo requesting that a number of items frequently accessed in a non-standard manner, be stored and accessed in a different manner so as to keep a "cleaner" electronic record.

I would say then, under normal circumstances with no other inconsistencies, the answer as I proposed the scenario should be "A"

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