I cannot trust the Pyxis and its slowing me downn

[SaltySarcasticSally, LPN, RN]

New RN w/ several years of PN experience. Recently started on acute care floor, took a full patient load for first time last week. Well without writing a novel, it was a hot mess. Mainly because I am struggling with how meds are pulled in the hospital setting vs in LTC. In LTC, your cart has the computer with the MAR on top and the meds to be pulled in the drawers right beneath. In my new acute care job, the Pyxis is in the med room and there are no computers with your MAR, just the pyxis record. So for each patient, I'm writing their meds down before going to Pyxis as I have been told, even if you pull meds by time in pyxis, it may not always bring up all meds due, causing multiple trips to med room. Then, once in a patients room, I scan the patient, then go over the MAR again once I scan and accept the medications to make sure I have the right meds. Well needless to say this process is making my med passes lengthy and I've been told by my mentor that I don't need to write meds down because the pyxis and actual MAR will be my double checks. I just cannot seem to find confidence in that advice. What if you miss scanning a med and give the wrong one?! Does anyone struggle with this? I need to figure out a way to be comfortable with this because its making my med passes wayyy too long.

[oceanblue52]

I've never worked in a hospital as a nurse, but I ran into this issue in clinical. My instructor wanted us to do what you are proposing, but every nurse preceptor I worked with said no way, that will take too much time. So we just pulled all the meds that were due according to the Pyxis, then scanned them in at the bedside, double checking for discrepancies. In my 120 hours of clinical time we didn't ever find an error. I can relate to your anxiety though. To each their own, and floor nurses can probably give you better advice. My preceptors and I never would have managed our joint assignment though without trusting the Pyxis. One of many reasons I've stayed away from floor nursing.

Does your computer system have a way to print out the most recent list in the morning so you can quickly cross check when pulling? Handwriting them out just seems like it would take way too much time, unless you are willing to come in early every shift and work for free off the clock...one other suggestion is to try and make note of PRN meds for each patient and then ask them before they pull meds if they feel nauseated, pain level, etc.

[nursej22, MSN, RN]

The last time I used a Pyxis (which was last spring) there were ways to ask just for meds within a certain time frame for a certain patient, which helped. But there was also a computer next to it to check while pulling. I was working with students at the time, so they had to look all meds up (but they only had 2), then checked against the EMAR as they were pulled (1 check), checked again in the room against the computer,(second check), and then scanned (3rd check). Also, telling the patient what each med was, so that they could confirm, or ask about a new one, or report an unrecorded allergy.

I also had quite a bit of experience, and depending on the patients medical dx, I would know that if they were diabetic, they probably got insulin and or oral meds, if CHF, they would probably get a diuretic, beta blocker, ACEI, maybe potassium, and so on.

If you are new to the hospital and system, it will take a while to get a system down.

[SaltySarcasticSally, LPN, RN]

I've never worked in a hospital as a nurse, but I ran into this issue in clinical. My instructor wanted us to do what you are proposing, but every nurse preceptor I worked with said no way, that will take too much time. So we just pulled all the meds that were due according to the Pyxis, then scanned them in at the bedside, double checking for discrepancies. In my 120 hours of clinical time we didn't ever find an error. I can relate to your anxiety though. To each their own, and floor nurses can probably give you better advice. My preceptors and I never would have managed our joint assignment though without trusting the Pyxis. One of many reasons I've stayed away from floor nursing.

Does your computer system have a way to print out the most recent list in the morning so you can quickly cross check when pulling? Handwriting them out just seems like it would take way too much time, unless you are willing to come in early every shift and work for free off the clock...one other suggestion is to try and make note of PRN meds for each patient and then ask them before they pull meds if they feel nauseated, pain level, etc.

I am not sure but that is a good idea to see if I can get a recent list every shift. I think having a hard copy in front me validating the medication record in the Pyxis may help me get used to it being correct. thanks for the suggestion!

[SaltySarcasticSally, LPN, RN]

The last time I used a Pyxis (which was last spring) there were ways to ask just for meds within a certain time frame for a certain patient, which helped. But there was also a computer next to it to check while pulling. I was working with students at the time, so they had to look all meds up (but they only had 2), then checked against the EMAR as they were pulled (1 check), checked again in the room against the computer,(second check), and then scanned (3rd check). Also, telling the patient what each med was, so that they could confirm, or ask about a new one, or report an unrecorded allergy.

I also had quite a bit of experience, and depending on the patients medical dx, I would know that if they were diabetic, they probably got insulin and or oral meds, if CHF, they would probably get a diuretic, beta blocker, ACEI, maybe potassium, and so on.

If you are new to the hospital and system, it will take a while to get a system down.

I like the idea of saying the meds out loud to the patient while scanning them. And yes, I am new to the hospital system. Being in a new environment has me on edge because I know it's easier to make a mistake when I am out of my normal nursing setting that I was used to for 7 years!