Pyxis report question...being falsely accused!

Nurses Medications

Published

I am currently being accused of withdrawing medications and not wasting them in the pyxis. Everyone in our department asks a nurse to enter the pyxis first, then the "wasting" nurse completes the transaction. In effect, wasn't I "witnessing" instead of "wasting"? Are there separate pyxis activity reports for withdrawals, wastes and witnesses? I ALWAYS waste my medications and can't understand the discrepancies. They requested a drug test that should come back fine but I am on temporary leave while this gets sorted out. Any thoughts/ideas would be greatly appreciated.

It does come in pre-pilled single use syringes in the most common doses. A pyxis can only hold a specific number of controlled substances. The one where I work has 1mg and 2mg because those are the most common doses.

http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2007/sep4(3)/PublishingImages/86_fig.JPG

ok, cool, thanks!

Up Vote Up Vote ×
Specializes in Pediatrics, Emergency, Trauma.
It does come in pre-pilled single use syringes in the most common doses. A pyxis can only hold a specific number of controlled substances. The one where I work has 1mg and 2mg because those are the most common doses.

http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2007/sep4(3)/PublishingImages/86_fig.JPG

I totally forgot about those! :facepalm:

Haven't seen those in a while...well, I'm not in acute care...right now...

Up Vote Up Vote ×

money...

OK, stupid question from someone who never worked with IV push medications: Why can't IVP dilaudid come in pre-dosed syringes? Like a 0.4mg syringe, a 0.5mg one, etc? Why does it always have to be in vials and part drawn up and part wasted?
Up Vote Up Vote ×

I have never used a Pyxis before as I still have to start my nursing education, but all this waste thing sounds exactly like a waste to me. Wasting all that medication ( pretty expensive probably) seems like an extra cost for no reason. Wouldn't it be better to have a human being handling those medications and giving the Nurse the requested amount instead of wasting time on doing this whole process?

Up Vote Up Vote ×
Specializes in Pediatrics, Emergency, Trauma.
I have never used a Pyxis before as I still have to start my nursing education, but all this waste thing sounds exactly like a waste to me. Wasting all that medication ( pretty expensive probably) seems like an extra cost for no reason. Wouldn't it be better to have a human being handling those medications and giving the Nurse the requested amount instead of wasting time on doing this whole process?

Once you understand the responsibilities that nurses have, you wouldn't want another human being TOUCH the medications that YOU need for YOUR pt...I can't stress this enough. Google nursing and safe medication administration to acclimate yourself on a very important aspects of nursing, which includes medication administration.

Up Vote Up Vote ×
Once you understand the responsibilities that nurses have you wouldn't want another human being TOUCH the medications that YOU need for YOUR pt...I can't stress this enough. Google nursing and safe medication administration to acclimate yourself on a very important aspects of nursing, which includes medication administration.[/quote']

Thank you for the reply, I will look up in google what you recommended and familiarize myself with it. I though that having a pharmacy technician dispensing the medication would lead to less burden to the nurse.

Up Vote Up Vote ×
Specializes in Pediatrics, Emergency, Trauma.
Thank you for the reply, I will look up in google what you recommended and familiarize myself with it. I though that having a pharmacy technician dispensing the medication would lead to less burden to the nurse.

Not when the nurses assess for adverse reactions...I'll take the "midleman", aka pharm or med tech and give the med myself...it's been working well for me for years, and nursing for generations.

:nurse:

Up Vote Up Vote ×
Specializes in SICU, trauma, neuro.
ALL of the nurses pull the whole amount, give 1/4 or 1/2 of the med, label it, and pocket it for future use. If the pt doesn't require anymore and/or leaves for the OR, THEN the left over medication is wasted.

9-10 yrs ago, the unit I was working on routinely did this. Then we were notified by our nurse manager that per the DEA, only one dose can come out of a vial. So if the pt had 0.5 mg Dilaudid ordered, we had to waste 0.5/give 0.5 of a 1 mg syringe...every. single. time. We couldn't give 0.5 one hour, and then the remaining 0.5 an hour later. It's a pain, but it is what it is.

How are you doing with your situation? I hope it turned out ok!

Up Vote Up Vote ×
Thank you for the reply, I will look up in google what you recommended and familiarize myself with it. I though that having a pharmacy technician dispensing the medication would lead to less burden to the nurse.

That could mean up to an hour or more wait for the pt in my facility. The pt needs 4mg of morphing, which comes in 1' 2' and 5 mg doses in our pyxsis. So I would have to send a request to the pharmacy, they would have to draw it up, then, since it is a controlled substance, walk it over to me, hand deliver, have me sign for it, and then finally I could give the med.

Up Vote Up Vote ×

I have investigated discrepancies in my former position. Let me tell you, not wasting immediately but rather after the fact is a big red flag.

Up Vote Up Vote ×
Specializes in Paediatrics.

I find this subject really interesting, I'm a paediatric nurse in the UK and we seem to do meds completely different to how you do them! We have 2 meds rooms, and oral one and an iv one, all iv's (and im and sc) have to be second checked, especially as the doses are worked out by weight. We are observed making it, drawing it up, and then 2 people are supposed to go to to the patients bedside with the drug chart to check it's the correct patient, and then give the medicine. We don't get oral meds second checked unless they are a controlled drug (eg. Morphine, oxycodone, phenobarbital etc) and with a controlled drug we have to witness the whole process again, and sign it out in the cd book.

I think the differences between USA and UK are really interested, especially as there seems to be good points and bad points to each.

Sorry your being accused though, I don't know what a Pyxis is, other than what I've googled :) But it sounds like there's a few problems with them. I could be wrong though.... Plus I'm not sure if they use meds trolleys like that in adults here...

Up Vote Up Vote ×
Specializes in Leadership, Psych, HomeCare, Amb. Care.
I have never used a Pyxis before as I still have to start my nursing education, but all this waste thing sounds exactly like a waste to me. Wasting all that medication ( pretty expensive probably) seems like an extra cost for no reason. Wouldn't it be better to have a human being handling those medications and giving the Nurse the requested amount instead of wasting time on doing this whole process?

While meds may come in a variety of doses, it's cost prohibitive to stock every single combination. You not only have to buy & stock everything, but monitor the stock to avoid diversion & make sure your vast stock doesn't expire. It's more meds to keep track of, and since all the vials or per filled syringes are going to look similar, so the risk of error increases.

Up Vote Up Vote ×
+ Add a Comment