Pxyis Medication Administration - page 3
I am an RN and work in a rural 72-bed acute care facility. Presently, we use the cart system to administer routine medications and the pyxis medistation for PRN'S and STAT orders. We will be... Read More
Jun 19, '04Occupation: physical medicine and rehabilitation,renal dialysis, diabetes Specialty: 37 year(s) of experience in most of them ; Joined: Dec '03; Posts: 56; Likes: 32I have used pyxis for narcs and some stats, but I wonder if the same problems we had with getting the new narcs entered by the pharmacy would continue to be a problem? also, the pharmacy was /is famous for not putting all the right meds in the drawers so how would it be different for pyxis filled med drawers. We are only as good as the cogs in the rest of the wheel! :hatparty:
Jun 20, '04Joined: Jun '01; Posts: 10,072; Likes: 8,412I have decidely mixed feelings about Pyxis. In the PICU where I worked before this one, we had a pharmacist in the unit 24/7. They brought all the meds to the bedside as unit doses, mixed all the drips and kept track of every patient's medication profile. They knew when a drip was due to run out or be changed, how many days an antibiotic had been in use, what the levels were and when the doses were adjusted. It was THE BEST! Then I moved here.
We have unlimited access to all the drugs in the machine, which is necessary in an ICU. Pharmacy only sees a fraction of our orders, usually for those drugs not in the Pyxis. When we do send them an order, say for pip-tazo (our intensivists' flavour of the month), it may take hours to get that first dose up; if it should be after hours, we have to get it from the night cupboard. Accessing the machine is often a problem because several of the keys stick causing password errors and having to restart the whole process. This can be a problem in a code situation. Another thing that fouls up my day is having to "recover the drawer"... you gotta know it'll be the drawer with the most in-demand drugs and the most tiny little vials to count... while your patient arrests. I find that people are keeping a lot of drugs at their bedsides "just in case". Things like epi, bicarb, calcium chloride, lorazepam, midazolam, chloral hydrate and propofol. Kinda negates the whole purpose, don't you think? Of course, all those unused meds have to be returned to Pyxis whan the patient is transfered. And we're always running out of "fridge meds", a) because pharmacy never accounts for the inevitable wastage that occurs when drawing up those sticky peds suspensions, and b) people don't bother to take it out of Pyxis because it's in the fridge and they just have to grab it. So I guess I'm saying I'm not a fan.
Jun 20, '04Joined: Mar '99; Posts: 13,361; Likes: 1,376We had a problem with EXTRA narcotics in the drawer with the Ativan. Every shift as charge nurse I called and Faxed the ONE pharmacist on at night, filled out an incident report and wrote e-mails to my manager. A tech would come to the unit and do something telling us it was fixed.
The next shift the SAME TABLETS were in that drawer. This went on for weeks.
Then at the staff meeting we were told tablets were missing and everyone using the Pyxis would be written up! It was clearly implied that someone was diverting narcotics.
As my coworkers started explaining to the manager, who had gotten all the reports, I copied the e-mails I had sent.
We then went to the machine as a group. When the manager used her code to open the drawer that was to ONLY contain injectable Ativan the tablets were still there!
Jul 4, '04Occupation: Care coordinater & prn ICU Joined: Mar '04; Posts: 195; Likes: 26The Pyxis rules! especially at one hospital that puts almost all the available meds most commonly used in it. It was a godsend when I had students on the Medical floor taking 5-6 patients and I had to get into it to pull their meds. Saved beaucoup time, esp. after they upgraded the machine and you had the ability to make your own patient list, and pull meds by times due. It really is a time saver and increases accuracey..most times it tells you how many to take out, and trade + generic name. Ours even had a drug-book function you could use for information.
Jul 4, '04Joined: Jun '01; Posts: 10,072; Likes: 8,412We had another example of how Pyxis is not the greatest thing since sliced bread just yesterday. Due to a highly publicized med error in another city, all of our potassium was removed from our Pyxis and the pharmacy started drawing it up into 2 mL doses (1 ml=2mmol) and 10 mL doses (1 mL=1 mmol) and storing them in a locked fridge. To take potassium out of the fridge, one must go through Pyxis, get the key out of the drawer, take out what you need and return the key.. We use A LOT of potassium in our unit, since most of our patients are getting furosemide and some are even on infusions, so their K+s fluctuate quite radically from check to check. Many patients have as much as 80 mmol/L in their IV fluids and some are also on a 1:1 infusions to maintain their K+s >3.0. Anyway, the Pyxis indicated that there were 14 of the 2 mL doses in the fridge. There were actually none. And several of the syringes containing the 1:1 concentration had cracks in them from falling on the floor when the fridge door is opened. Since it was Saturday and the hospital is on skeleton staffing outside of the patient care units, it was quite awhile before anyone could come up and fix the problem. Obviously what is happening is that people are telling the machine they're taking one dose and then are taking three or four... to save themselves from having to run back every couple of hours to get more. We will have to address the issue with more signs on the machine and more notes in the communication book. Unit dose would be so much simpler... Sigh.