my pyxis nightmare..

[annreese]

Okay so my hospital has been migrating towards taking medications out of the pyxis units more and more for about a year. It started off they took out the controlled drugs, than the expensive one,s then some other ones. It has come to the point where there are no more drugs kept in our pyxis, we order then from the pharmacy and they come up through the tube thingy. It's pretty fast, almost instantaneous, I am not sure how it works. I think the only drugs we keep on the floor are in the crash cart. So this morning I go to pyxis to grab a saline flush.....no saline flush.... I run over to the other pyxis down the hall....no saline flush. I ask a colleague of mine and apparently saline flushes are also considered a legend med now and thus will not be kept on the floor any longer. I was LIVID, you mean I have to ORDER a saline flush? Are you kidding me? That is absolutely ridiculous. I just DO NOT understand the rationale behind this. Apparently they still have them on the floor in ER, but not in the CCU? I under stand not keeping narcotics, even other drugs, but when they start taking my saline I will not sit and be quiet. What do you keep in your pyxis? Am I just crazy for thinking this is a bad idea?

[ChristineN, BSN, RN]

Wow, that's very strange. At work, they've actually been working to increase the drugs stored in the Pyxis. Besides narcs, and common pyxis drugs like Tylenol and Zofran, we now have Insulin. We also have IV fluids, saline and heparin flushes, and flavoring for meds. If they took the flushes away, I would also be upset.

[nurse grace RN, BSN]

Our pyxis is pretty much stocked with everything needed on a med/surg floor: narcotics, cardiac meds (plavix,bp meds, coumadin etc.) gi stuff(nexium,prevacid, mmalox, etc. We have bins of 2cc and 10 cc saline flushes. Individual patient drawers have the daily stock of meds. We do get rounds where pharmacy techs bring up the newly ordered meds through out the day. I would go crazy if I had to go to the tube system for every med ordered for my patients.:bowingpur

[annreese]

I actually somewhat understand the underlying logic. They are trying to integrate the pharmD into the whole process, we input the orders into the computer, they go down to pharmacy, pharmacy overlooks the order, sometimes theyll call us up if theres a problem and they send up the order, occasionally already drawn up and everything, its actually kind of nifty, however I think theyve taken it a bit too far, they took our IV bags and that was enough of an annoyance, but now this is just ridiculous. And to boot the other nurses didn't see a problem with it! other nurse: "well how often do you need to flush" me:"uh I don't know, quite often" other nurse:"and its so urgent you can't 30 seconds for it...?"...well ok maybe not but thats not the point, why should I have to wait? No one has given me a good answer to that question. I think I'll go up to nurse management tomorrow and figure out what the deal is.

[Reno1978, BSN, RN]

Working in a critical care area, I think my head would explode if I couldn't find saline flushes...

"Oh, the patient is coding?...can someone order some saline flushes from pharmacy, please?"

[fiveofpeep]

thats so wierd. so no vials, no syringes--you cant draw up your own yourself. wth?! soooo wierd. I guess it doesnt come up too often because every patient seems to be on some fluids or another so we always just flush with the bag we have...but Im just a student.

[madwife2002, BSN, RN]

No meds on the floor can I ask what the rationale is behind this?

[blondy2061h, MSN, RN]

We not only keep saline flushes on the floor, but in the patients' rooms. They DO say "RX Only" though, thus making them a legend drug. Technically. Pretty lame. We all rinse our contacts with them around hour 10 or so

[DoeRN]

Wow that is different. We keep everything in ours except the pre-filled saline and heparin flushes.

So whats next the patient can call down and ask for their medication?

[Ginger's Mom, MSN, RN]

I have seen saline flushes kept outside the pyxis, but heparin flushes within the machine, seems like a time killer.

[Dinsey]

We have heparin in the Omnicell, but saline flushes are locked in a cabinet outside the patient's room with the rest of their scheduled meds.

I generally stash several in my pocket at the start of a shift (for initial assessments) ... does the pharmacy have a rush at shift change of nurses just wanting flushes?

What do they think is going to happen if a patient gets a hold of a flush?

[FireStarterRN, BSN, RN]

I imagine it has something to do with money and micromanaging charges.