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rx3500

rx3500

Pharmacy, ADC ( automated dispensing cabinet)

Experienced in pharmacy and medication automation systems

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Experience in medication automation, operation, requirements, maintenance, SOP, and law. Experienced in Narcotic DEA laws for controlled substances in a hospital and retail setting. Pyxis systems Manager in a major military treatment facility (MTF). 

15 years experience in pharmacy operations and SOP. 

rx3500's Latest Activity

  1. Pharmacy per say doesn't run audits, it's done by the PSM or persons allocated to do so. It is fact that not every transaction will be audited, and in this case unless they talk to the patient nothing will show proof of anything because the med scan to the chart shows the narcotic trail. But believe me when I say, processes of verifying patient administration are in the works, including witness verification of administered narcotics to patients. Especially because of the opioid problem . It is to easy for nursing/providers to divert pain meds and chart them accordingly, and assume because they are charted they were given. In the end the person will be caught. I found a nurse whom was stealing antidepressants, a med that is not generally on any radar, but was found and the nurse reprimanded nonetheless. Never assume anything.
  2. I'd like to add that her not seeming impaired does not equate to her not taking the meds for personal use. There are functional alcoholics as well as drug users, and they show no signs at all, especially with long term use.
  3. Hello, I am a pyxis manager at a major facility, and manage and monitor 80+ stations and over 3,000 users. I work with the hospitals narcotic investigation team and continually run reports to assess signs of diversion. Your story seems classic to what I see often. Wether it be late charting or no charting at all and no trail of were the pulled meds have disappeared to. I definitely understand the fear of reprisal, but you should consider the harm she could be causing herself or someone else. As a nurse you are responsible for the patients, and if you are having such strong suspicions about this, your assumptions could be true. I conduct audits with the controlled substance board every month and we are constantly finding suspicious activity. If the nurse is doing what she is supposed to, she has nothing to worry about. I guess what I'm getting to is that the percentage of nurse/provider diversion is significant in my experience because it is to easy to do so. I think you have a responsibility to report your suspicions.
  4. rx3500

    Pyxis questions

    Thank you
  5. rx3500

    Pyxis questions

    Hello, my first question is, at the facility you work in, was waste not required to have a witness before your upgrade? All waste should be witnessed, to assure there is no diversion of the balance. In your case I can see where it would be annoying to have to get a witness if you are using the whole vial for two doses. Unfortunately, because the dose is set in pyxis at 50mcg the system is going to assume there should be a waste of the other 50mcg. A variable dosing prescribed of 50-100mcg would prevent the system from flagging for waste, but precise documentation in the patient chart is suggested to cover yourself. It creates more work no matter how it's sliced. The other option is to waste the other 50mcg and just pull another vial, but either way you will still need to get a witness. I don't recommend using both doses from the same vial unless you are very diligent on documenting the usage in the patient charts. This creates confusion with any controlled substance audits. There is also a function in the system that allows you to forward a balance, assuming it is turned on by your system administrator. This may work, keeping you from having to document the waste is pyxis. I always like to stress the need for clear and concise documentation of any controlled substance.
  6. rx3500

    Pyxis questions

    Pyxis questions I've read several comments, complaints and questions regarding Pyxis systems and how it's run. As one who's managed 36 stations over multiple years, I may be able to answer questions, concerns or complaints in regards to the ADC. I welcome all questions, concerns, complaints, or suggestions that may streamline the process of medication automation process. Maybe even shed some light on why systems are put in place, as well as real situations in which may clarify the need for medication automation in an inpatient setting. Our facility even uses ADC's in an out patient setting as well. The understanding of ADC's ( automated dispensing cabinets) may make using these devices more tolerable with nursing.
  7. Pyxis questions

     

    I've read several comments, complaints and questions regarding Pyxis systems and how it's run. As one who's managed 36 stations over multiple years, I may be able to answer questions, concerns or complaints in regards to the ADC. 

    I welcome all questions, concerns, complaints, or suggestions that may streamline the process of medication automation process. 

    Maybe even shed some light on why systems are put in place, as well as real situations in which may clarify the need for medication automation in an inpatient setting. 

    Our facility even uses ADC's in an out patient setting as well. 

    The understanding of ADC's ( automated dispensing cabinets) may make using these devices more tolerable with nursing. 

  8. I've read several comments, complaints and questions regarding Pyxis systems and how it's run. As one who's managed 36 stations over multiple years, I may be able to answer questions, concerns or complaints in regards to the ADC. 

    I welcome all questions, concerns, complaints, or suggestions that may streamline the process of medication automation process. 

    Maybe even shed some light on why systems are put in place, as well as real situations in which may clarify the need for medication automation in an inpatient setting. 

    Our facility even uses ADC's in an out patient setting as well. 

    The understanding of ADC's ( automated dispensing cabinets) may make using these devices more tolerable with nursing. 

  9. rx3500

    Pyxis undocumented waste

    You are correct, there is no fool proof way to prove any transaction, that is until there is an audit. I'm only suggesting that each individual cover themselves, especially in the midst of a huge opioid crisis. The few extra moments could be there difference between employed and jobless. Point is to document somewhere, if you are one whom is somewhat forgetful. People are always watching, keeping record.
  10. rx3500

    Pyxis undocumented waste

    I am unsure if you read the initial issue. She forgot to waste in pyxis. So months later she is concerned that in an audit she may have to explain where the remaining drug not utilized went. My suggestion was for future transactions. Audits are usually done monthly, and if she has not been audited yet, the likelyhood is slim. I work with NCIS and controlled substance inventory boards often to resolve possible cases of diversion. It's always better to disclose and annotate in memos the situation. One occurance is not enough to terminate. It's the trend we look for. I see these situations all the time and I keep precise records of questionable transactions. Documenting things as soon as possible and corresponding with the appropriate channels is more likely to justify an honest mistake.
  11. rx3500

    Pyxis undocumented waste

    Hi, I am a pyxis manager and get this question often. Once a patient has been discharged, you can add the patient back into the system, and use this to return meds to the return bin , but the documenting the waste may not be an option because the initial transaction under the patient was under a different profile. The return will show up in the reports if audited. Documenting your waste in the medical record is an important step because it will show the path of the narcotics use. Make sure that you have a witness and have them document witnessing the actual waste. In this situation I would have the charge nurse or supervisor be your witness. Writing a memo on the situation, and having the witnessing party sign as well is a good way to prove the transaction. Keep a copy. In pyxis the option is there to document waste when pulling the med to avoid having to remember it later. Definitely remember to document this in the patient chart for tracking purposes. Additionally reach out to your pyxis administrator for guidance. They will be able to help. Never be afraid to admit the mistake, supervisory awareness, self volunteered looks better than not mentioning it at all.
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