What do think about Pyxis? - page 2
Our facililty is going Live with Pyxis within the next two months and I am Nursing System manager. Our system will only be used for medications at this point. Although I have worked with Pyxis in... Read More
Feb 17, '02I like the pyxis. We have one for supplies and one for meds. Not all meds are in there but most narcs are. We still use the cassette method and MARS for routine meds. The last hospital I worked at, we had a huge med Pyxis and ALL of the meds were in there, save for some oddball drug. It was nice too cause the Pyxis was attached to the computer system so we didn't have to go back and chart that we gave the med---the pyxis did it for us. Got to be a hassle at 10 am when every patient got a pill of somesort. Had to wait in line sometimes.
If there is some narc that isn't in the pyxis like Oxycontin then that is locked in our narc cupboard and has to be counted q shift. We also have to count regular insulin too! How stupid is that! Next thing you know they'll make us count the Nitrostat!
Feb 17, '02well.........we have had pyxis as long as i can remember. they have had their share of problems. our older model, used to have the narc (pie) drawers fail quite frequently......and of course you never find this out, until your ami pt needs some mso4!! then they upgraded us to a newer version, that was supposed to be beter and help cut down, or reduce the risk of theft. the older model you had your id and your own password. the newer model you have an id and you fingerprint. we have had frequent problems with the fingerprint sensor, and that too can be a real hassle.
i have heard from someone else about something like "sure-med"? i don't know what it is........but apparently there are other options also. i'm sure they all have their faults............isn't that one of the downsides of modern technology??? :roll
Feb 17, '02Pyxis's are a life saver!! We have pyxis's for our central supplies and medications.
I love the pyxis's!!! Not all our units have pyxis's so when I get pulled to a "non-pyxis" unit it can be a pain if the patients need a lot of meds.
We rarley have troubles with our pyxis. The only thing would be the draw gets stuck mid=way between two Rx's. You have to re-shut the pyxis and re-count. That can be a pain but it RARELY occurs.
Another thing would be our Pyxis's will not respond. What we do is turn it off for 5 minutes and turn it back on after 5 minutes. ANd it's working great. Again that is RARE.
We have a number to call if we have troubles. (24 hour #)
Feb 17, '02I have used the Pyxis (P) for four years and love it. When I was in ED nearly everything was in it (except for rarely used meds or NS with KCL, which came straight up from pharm). Fluids were not actually in it, but we were expected to charge for them per pt. through P. Also, keys were in narc drawers for meds kept in locked box in 'fridge.
At our hospital the items in P vary according to each unit/floor needs (except for a couple of floors trying out the Bar Code Med Admin system). We use ID/Password system to obtain access. All narcs are in pie wedges and require a witness to return or waste. All other meds are in numbered cubbies. Can't speak for other nurses, but I, for one, have never taken out a med from a neighboring cubby. Not saying it's not possible or convenient at times, but it kind of defeats the purpose doesn't it? Pharmacy told us we don't need to physically count Tylenol each time we remove, esp. if 100 or more in the drawer. Just as long as we count it during verification count 3x a week.
I'm now in Endo and everything is still in P, but we are allowed to keep emergency reversal drugs in drawers in each procedure room. These drawers are locked at the end of the day.
Since nurses are unaware, prior to each procedure, how much Versed, Dem, Fent, etc it will take for each patient, our names are also in the P. When we start the day, each nurse takes out meds under her name, i.e. 10 vials of V, 5 of D, 3-4 vials of F. If it's a busy day we may have to restock again - if not, at the end of the day we take out the meds used and wasted under the pts. name and return under ours (with a witness, of course). We keep charge sheets on each pt we do so there is no ? about what was used and what was wasted. Also the MD docs in his notes what was given as well as writes the order for amount used. Wish our P was hooked up to a computerized charting system like kaknurse talked about. We still have to chart what was given. Seems unconventional and confusing, but it works well for us!
If the "discrepancy" icon shows up in lower left corner, NO ONE leaves until it is "fixed". We verify "count" three days a week as required by pharmacy for our unit. ED counts q shift.
Our P had a very thorough computerized training session built into it, and also gives you a chance to cancel your action if you think you have made a mistake.
Used to have "failed" drawers a lot in ED, seemed to happen a lot if too many meds were crammed into one drawer. We're pretty cautious about counting the narc drawers each time we remove - otherwise, if a count comes up short, our name shows up as the last one in the drawer, ergo, the one responsible.
We do both out and in patients. On a very busy day, the OP is sometimes taken out of the P before we get a chance to "do" our meds, and we have to re-enter them.
Via P Pharmacy has an accurate running count of our meds and we aren't having to call them to restock all the time. They just come at the end of each day (sooner, if needed) to restock. Love it!!
Feb 17, '02We keep narcotics and most commonly used meds in the pyxis; it works great. Much better than having to wait for pharmacy. I went to another unit once where all the supplies IV supplies, 4x4's were kept in a pyxis and I found it to be a real nusiance.
We had an incident on my unit before I came to work there, in which someone watched another nurse enter her password, took note of it and then used the other nurse's password to stockpile percocet for her own use. It took a while, but the person was caught and the nurse with the stolen pyxis password was cleared, and now it is considered the proper thing to do to look the other way when a coworker is entering her password.
Feb 17, '02When I worked as a traveling nurse at Ohio State University hospital some years ago, all regularly scheduled meds, including non narcotic meds, were kept locked in the patient server to each patient's room. The patient chart - which was kept in the patient server - had the medication sheets in it along with the nursing notes, etc. When it came time for a patient's regularly scheduled meds, they were right there near the patient...no need to run back and forth to one or two med carts at the nurses station. I loved that system! It worked out great and saved a lot of time and steps for the nurse. When the patient needed a narcotic for pain, it was a lot easier to get that from the narcotic cart because nurses didn't have to stand around waiting to pull the regularly scheduled meds and/or "non narcotic" meds, etc. from those carts.
Maybe it's time for a robot who is trained to be a "voice activated" mobile pharmacist on each unit. The nurse would tell the robot what narcotic med she/he needs, and it would obey the nurse's command. A robot should be assigned to each hall of patients. One won't do the trick. The robot would keep track of the drugs, etc. and give the nurse a computerized copy of the transaction with the time, drug, dose, med given, and who the med is prescribed for so she/he can document it as she gets around to it. NO need for keys, pyxis, waiting around the medcart to get what meds you need, etc. Expensive? heck yes! But, aren't we worth it!
All patient rooms should have a patient server for each patient stocked by pharm techs assigned to each shift. They would go around and replace any IVFs that are needed, prn non-narcotic meds (Tylenol, aspirin, MOM, lozenges, and so forth). They would also be responsible for keeping wound care supplies where needed (depending on what the patients needs are ordered by their doctor). CNAs should keep urinals, bedpans, I/O sheet, water pitchers, cups, spoons, kleenex, lotion, soap, extra linen, pillows, etc. stocked in the patient server.
As for patient care: Bring back the good ol' LPNs! Let them do bedside patient care, and the RNs can focus on the bull crap paper work that is so politically incorrect anyway, administer medications, IVFs, start IV sites (unless an IV team is present at your hospital), hang blood when needed, check patient vital signs on critical patients (letting the LPNs do the vital signs on the patients who are on routine vitals anyway). RNs should take off the doctor's orders only IF the LPNs are doing all the patient care leaving the RNs to do all the paperwork required on each patient assigned to them. Any admits/discharge should be done by the RN, and any patient teaching upon admission/discharge.Last edit by live4today on Feb 17, '02
Feb 17, '02Well, sounds like our hospital isn't that bad. I just talked to one of my mom's friends that is a CRNA and she said that at her facility they keep everything locked in a pyxis. Meds, fluids, IV materials, Syringes, and needles on all of the floors and units except the ICU and the ER. I'm not a nurse, but my mom is and it sounds kind of crazy to me to have the neeclles and syringes locked in a pyxis. I can see the meds but the Syringes?
Feb 17, '02L-O-V-E the pyxis. Rarely have problems. Especially love the ones that hold supplies....cuts down on missed charges.
Heard folks complain about the fingerprint one...they don't like it at all. Lots of probs.
We used the regular drawers for narcs, have the occasional drawer fail, but not too difficult to recover it if you know what you're doing.
Have used the Sure-Med, HATED IT. Never again.
People are gonna *#@!! about it at first, but don't they ALWAYS do that when it comes to new technology? By the end of the first month, even the most curmudgeonly, crusty, battle-ax nurses on the unit loved the thing.
Feb 17, '02meandragonbrett
I entered our supply room once because the light was out. I thought that a tube had blown and I turned around to go back out the door. Out of the corner of my eye I caught a glimpse of a plaid work shirt and then the other door opening and closing.
Seems like a Sneaky Sam had decided he and his buddies needed new syringes, so he just helped himself to a couple of boxes. Last I saw Security was chasing him across the parking lot. After that, I no longer thought it was silly to lock up the needles and syringes.
Feb 17, '02We counted all the drawers on a schedule. Each med that was withdrawn got counted, the whole narc drawers got counted Friday night.
Feb 18, '02P_RN,
Ha! my mom's friend sent me another mail explaining why they started locking everything up! They had an employee that was stealing bottles of NS and selling it on the streets as Diluaded and Oxycontin
Feb 18, '02I love pyxis it makes your life so much easier. Mainly we keep emergency and narcotics in there. Our prn were floor stock and regular meds for our little ones were in their cassettes. It worked out well for our unit. I guess it depends on how your unit is set up and med passes are done. For the most part I like it.
Feb 18, '02I hate it, my last hospital it was nicknamed the prickis system. Make sure that everybody has an acceptable time to learn the system and try and put the advantages accross, maybe trying to reinforce that it is a new system but you are open to staff feedback. We also had problems becasue everything was in the machine so it was time consuming. I would suggest putting narcotics and those type of drugs in there and leaving PRN's out. But most of all GOOD LUCK, remeber there will always be gloomy gus's everywhere and you can't please everybody.