LTC med pass from PYXIS?

[BrandonLPN]

My facility will shortly be doing away with med carts, and the LPNs will have to do the entire med pass from a stationary PYXIS machine next to the dinning room. That's anywhere from 35-42 residents, all from a PYXIS. The logistics boggle my mind. We've been hearing roomers about this for months, but I assumed the new PYXIS machines would simply be supplemental, a place to get meds that we ran out of in the cart. But, no, we will be doing the entire pass directly from the PYXIS. Any other LTC facilities do this? It seems impossible.

[WillyNilly]

When you make your rounds to eye ball them ask if they are having pain and if yes pull the PRN when you are doing that pt meds. We are able to "pull by time" button on Pyxis and set a range and it should pull all meds or that time. I can then quickly verify to MAR for that pt and pass it.

Good luck!

[CapeCodMermaid, RN]

It's close to impossible now staying within the hour before and hour after the scheduled time for meds in LTC where most residents take upwards of 15 meds every morning....and that's with one card of meds. How is the nurse expected to find all the individually packaged meds, open them, put them in a cup and have a prayer of being on time? I can't see this working.

[chrisrn24]

It's close to impossible now staying within the hour before and hour after the scheduled time for meds in LTC where most residents take upwards of 15 meds every morning....and that's with one card of meds. How is the nurse expected to find all the individually packaged meds open them, put them in a cup and have a prayer of being on time? I can't see this working.[/quote']

Amen. Oh and sharing the Machine!

[BrandonLPN, LPN]

Amen. Oh and sharing the Machine!

Each unit will have its own machine. And there's only one LPN scheduled per unit per shift. So, at least we won't be fighting over it.

It looks like it won't happen until June, so I'm not going to lose any sleep over it now. I'll just go with the flow and see what happens. And if it ends up being a great big hot mess.... well, hot messes can be amusing sometimes. :)

[amoLucia]

Hey Brandon - don't know how (if even they could ) if your union could speak up? At least they could go on record with a position statement re possible negative problems that might cause staff to have med pass compliance issues (and thus fodder for disciplinary action).

[morte, LPN, LVN]

the only way it could possibly work with more that 10 patients per nurse, is to have a separate cart, pull meds for 6-8 patients at a time, have assignged drawers for ea patient. deliver those and go back, do it again. They think they will be saving pharm time/money.

[withasmilelpn]

I'm thinking this move comes from the 'Culture Change' movement, making your LTC less 'institutional' by getting rid of your cart. However we now have meds in the rooms for each patient when we did away with our tradional carts. For us in the rooms has turned out to be more time consuming and definitely involves more walking. Your situation sounds impossible frankly when it comes to the amount of walking you'll have to do. You could have them bring your patients to you, but these days that's frowned on as well - nursing care must all be private - in no circumstances should anyone at any time know you are a patient lol!

One thing that may help you that we did - we also changed our med pass times to a broader time pass spanning about 4 hours. For example an am med can be given from 7-11. On our MAR the time would simply read AM. Some meds of course had to be at set times like insulins.

Honestly though, it sounds pretty awful. Best of luck.

[generalRN2008]

Um no. It is hard to get done with 5-10 med pulls in the 2 hour window. Not ideal for ltc unless you have a med aide or lpn just to help with half the meds

[dudette10, MSN, RN]

All good questions, but I don't really know the answers yet. We have a ton of inhalers. And eye gtts. And Miralax. Time will tell.

What happens when I get all of someone's pills pulled in a cup, only to find them on the bed-pain? Or in an activity? What do I do with the meds I pulled? And going from the Pyxis to a resident's room and then back to the Pyxis again 'cause they want a PRN pill.... the Pyxis works on hospital floors because they only have 7 or 8 pts. In LTC, all the back and forth will be a nightmare.

As for refills, we have an in-house pharmacy, so that will make re-stocking the machines easier.

I don't work LTC, but in acute care, if I've pulled all the meds and have to delay giving them for whatever reason, I throw them into a bag and put them in the patient's individual bin, then move onto the next pull.

[CrazyGoonRN]

Sounds like a disaster waiting to happen!

[CrazyGoonRN]

Sounds like a good idea to put them in individual bins, but LTC's don't have individual bins and with 25 or so patients it gets very hectic. There is no safe place to put the pills unless you have a cart to lock them in.

[pebbles049]

Our facility went over to an ADU machine. It dispenses pills in packets and night shift stocks the drawers. we have blister packs too of the more uncommon drugs. prns that are common come from the adu machine. meds on blister cards were being fedexed to facility and we were having trouble getting them still at times. I hate the whole system. when the adu machine is being cleaned i have to wait to get prns. meds dont come into facility in timely fashion. back up pharm sends bottles so now we have bottles packets and blister cards . the back up pharm often mislables the pill bottles so its a disaster in the making. they were trying to save a dime.