Pyxis report question...being falsely accused!

[Jasper676]

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.

[danggirl]

When I was a new nurse, we signed every narcotic out on a paper log and we could use a vial more than once. I found out the hard way that the laws had changed (as well as that Pyxis machines existed!) when I had a patient who required a dose of pain medication (exactly half the available vial) every 30 minutes (why they didn't have a PCA is beyond me). Luckily, every single dose I gave I documented diligently every 30 minutes and was educated that vials are now for single use only. It seems every place I have ever worked has had a different method of accessing and wasting in the Pyxis but I get the feeling that policies are going to be fairly the same almost everywhere. You pull a med, you draw it up and waste it right then and there with a witness, then go on your merry way to the patient bedside. To the OP, your facility is definitely doing it backwards in terms of who signs in and who documents waste vs witness. It looks like you pulled a bunch of meds and never wasted them (pharmacy audit reports are pretty specific about the actions taken in a Pyxis) then there are random nurses who have these phantom wastes on their reports because there is no record THEY ever pulled a med!! Would be nice if all this was a nationwide standardized protocol that is enforced so there is no confusion and/or false accusations.

[Been there,done that, ASN, RN]

Wow, thanks SouthernPoint for the information. I was working in a pre surgical area and 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. An RN is asked to sign in, then the "wasting" RN chooses the pt names and completes the waste. The way we have been doing this, the RN originally pulling the med isn't getting credit for "wasting" the unused portion. They are actually witnessing it, not wasting it after the fact. Sounds like much education is needed there.

Holy chit!

Most facilities have implemented the policy that..... putting a controlled substance in your pocket is cause for immediate dismissal.

Why isn't the entire unit on leave?

[dearing 1983]

So I have a related question. New nurse here working in a CTICU. I noticed that our pyxis will ask whether or not we plan to administer the full dose when pulling medications ike fentanyl, benzos etc... but certain medications require an initial count without further dose clarifications. For example, I had a patient with 25mg of Tramadol ordered, and the pyxis stores 50mg tablets. The machine prompted me to provide a count, but never asked if I planned to administer the full dose of 50mg? I pulled the med, administered 25mg, and because I was so used to wasting unused portions before ever leaving the med room, I never returned to waste the other half. Haven't gotten in trouble for it yet, but wondering if certain medications like tramadol might be tracked for inventory purposes but not require a precise tally of every milligram reconciled with the MAR? Anyone have some insight on this? Thanks!!

[Renee N, RN]

I am being accused of not wasting Percocet back in 2014 via a Pyxis machine. Not sure of the model. It was an ordered every 4 hour 2.5mg dose, not a PRN. The Pyxis dispensed a 5 mg tab each time without asking me, if I was giving whole dose. Has anyone had this same accurance in 2014? I scanned the med into Epic and was never notified by pharmacy, that the 2.5mg remainder was not wasted in the Pyxis. I wasn't given this option when I dispensed it from the Pyxis.

[_firefly, BSN, RN, EMT-B]

I know this is an old question. Here's the answer anyway. On the Pyxis server there are settings for each medication indicating if it should be on blind count (ask the nurse to count first) and whether to require a witness for any of the following: removal, waste, return, inventory. For narcotics, typically blind count and witness on waste are turned on. It sounds like the witness flag was not set. The other possibility is your user role permission was set up with the flag that says independent of witness on waste, so you aren't asked for a witness. In the end, if you notice this, you should call pharmacy to let them know. They should have these settings on for narcotics.

Also, to be clear, the nurse removing the medication is the one that administers it. The witness is the second nurse who is simply observing that the extra medication that's not needed is properly disposed of and not being taken home by anyone. It is generally expected that wasting happens before administration or in other words, waste immediately and don't use 'waste later'.

[Renee N, RN]

Thank you so much. I need to get this information you provided in print. Do you know where I can acquire it?