In order to save time, I will often pull meds from the Pyxis for more than one patient. For example, I'll get patient #1's meds, put them in a little zip-lock bag, put the Pyxis receipt with the patient's name into the bag and them zip it shut. Then I'll do the same for patient #2. So ultimately I have 2 or 3 ziplock bags containing meds and the related Pyxis receipt.
Several nurses have told me this is "bad" and not to do it. But I don't get what the problem is. When I get to the patient's room, I pull his ziplock and check everything against the MAR before giving the meds. The receipt is in the bag so anyone can see whose meds these are and what meds were taken from the Pyxis.
Will the meds from bag #1 jump into bag #2 by magic and change what's written on the Pyxis receipt? Seriously, am I missing something (I am pretty new)? Is there a Joint Commission ruling on this? I have never had a problem doing this, and it does save time.
Someone needs to do a study - find out how much real time is saved by doing this.
I doubt it is very much . . .my hypothesis is no significant time is saved. (Stats class - sorry;))
steph
My thoughts exactly. Many policies/interventions are not evidence based (although this is changing). Perhaps proper pre-preparation of meds. for multiple patients is safer, more efficient than one at a time; perhaps it is not. There are tons of examples where we've been doing things for years because an authority figure said we should, but research shows the authority was wrong. A prime example that I just learned is CPR. How many years were we required to find the zyphoid process, then 2 finger widths above. As of 2/06, that all changed due to empirical data indicating simply placing middle finger at mid-nipple line is most efficient; and instead of different compression/respirations ratios for infants, children, and adults, it's the same 30:2 for all.
Specializes in Emergency Medicine pre-LVN, hospital cor.
I tried pulling meds on multiple patients, I labelled the cups with the patients name and when I got to the first patient I promptly handed the wrong cup to the patient. Fortunate for me all he took was an aspirin and a multivitamin. I absolutely hate making med errors. I will pass meds to 32 patients on days I am on the med cart. To do that many patients in the 2 hour time span would mean spending 4 minutes on each patient, pulling the meds, taking vital signs, coaxing the patient to take the meds and not argue about the number of pills. I would much rather take my time to do quality work than risk losing my license over a preventable med error.
Specializes in med/surg, tele, CCU, ICU, travel nurse.
I am a nurse AND a nursing instructor. I give meds EXACTLY how I was taught. I am a pro at organization and time management, and all my coworkers know it!
Wow, I was scratching my head over this thread, but the little 15-watt bulb finally came on over my head. It boggles the mind that some appear to be talking about Pyxis thinking it's used in combination with anything as stone age as putting bare meds in open cups. The other end of an adequate setup using Pyxis (with printer for itemized receipts and nurse and pt ID per pt pull, fingerprint ID, witnessing for wasting and insulin, receipted returns, and programmable features like INR query for warfarin) is a wireless wheeled workstation blessed with a scanner (for pt ID bands and individually-packaged meds alike), an interactive MAR program with full online pharmaceutical references and instant messaging to the pharmacy, a large locking med drawer, and above all, a thinking nurse. OF COURSE you pull your 10 o'clock meds for however many pts you have all at once! Each med has its own barcode and they are all inventoried on the slip in the bag with the pt's name and your name on it. It's hard enough getting 1 witness for insulin, am I going to make myself search down 4? There's usually a line for the Pyxis, with the bottleneck there, shall I wait in line more than once and screw everyone's med runs up? And everyone who's so holy with meds for only one pt at a time, when your pt has the runs and you get back to his room and he's on the potty, do you wait outside the bathroom door for as long as it takes? I mean, being pure and by the book and all, what DO you do with those ungiven meds, and what do your other pts do to get THEIR meds on time? Arguing about multiple open med cups with unwrapped pills...GET REAL.
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
I pull multiple meds if I'm already at the pyxis and have one or two meds per pt I'll do 2 pts at that time. It just makes sense and I've never had a problem, nor do I carry more than one pts meds at a time into a room. If its a controlled narc I pull it at the same time, that pt will get her meds first, the controlled narc never leaves my posession from the pyxis to the pt .I don't stand and draw say 6 pts for a scheduled med pass,our pyxis doesn't give receipts. One or two pts yes, multiples no. Have never been told against hospital policy or JCAHO to pull mult meds We also do not have any barcode/scanning system in place[,I'm interested in how this works.].that's probably why I only pull 2 pts at a time.Our meds get automatically charted into the computer when they're pulled whether scheduled or prn/stat/etc so we have no physical charting to do
I would think the reasoning against pulling meds for multiple pts from the pyxis would be that the pyxis records the time each pt's meds are pulled and it is assumed that the patient then receives these meds as closely as possible to the recorded time. Otherwise it defeats one of the purposes for using a computerized med dispensing device, ie to be able to track the timing and frequency of meds administered to each pt.
That being said, I will pull out and "bag" two patients meds at a time as I will be able to give both within a short time of each other, and access to our single pyxis get very congested during certain hours. Virtually all our meds are in blister-packs or single-dose packaging so it this is a far cry from what was called "pre-pouring" in years past when there might be half a dozen or more med cups in close proximity each containing half a dozen or a dozen unwrapped tabs . The potential there was high for losing a med without noticing or mixing up similar appearing pills. As per our protocol no meds are removed from their individual, labeled blister packs until I am at the patient's bedside and have ID'ed the pt by their wristband. As I have checked my "Five Rights" when I removed them from the pyxis and again before entering the pt's room this is my third check.
Wow, I was scratching my head over this thread, but the little 15-watt bulb finally came on over my head. It boggles the mind that some appear to be talking about Pyxis thinking it's used in combination with anything as stone age as putting bare meds in open cups. .
Exactly...pulling meds from the pyxis does not equal pre pouring meds, or taking the meds out of their individually labelled blister packs. Heck I don't even crush meds until I check the pt's armband, compare the med to the MAR at the bedside, state the name and dosage of the med to the pt, and then crush any meds that can and need to be crushed while I am still at the bedside.
Pyxis or not, barcode scanning with electronic MAR's, or paper charting, the best way to prevent med errors is to follow the Rights of Med administration. Which include verifying pt identity and comparing the med to the MAR at the bedside.
I haven't seen anyone say that they are for prepouring meds and against checking the MAR at the bedside.
I pull all my meds from the pyxis at the same time, one patient at a time of course, and place them in zip lock (lab) bags labeled with name and room#. Many nurses do this. Some floors have e-mar carts with drawers labeled by room and meds are pulled and placed in the drawers for rounds.
We utilize computer charting and all meds and the patient are scanned at the bedside so this is another safety check.
Returning to the pyxis between each patient would be a nightmare as I hardly have time pee each day.
Where do you keep the bags of meds? I work in LTC and we stil have carts we push. We used to have a pixas just for emergency drugs, so I am familliar with how they work.
It sounds to me as if you are just doing the gathering of all the meds, if you are keeping them in their packages and checking them against the orders before you give them. My worry would be if you were filling more than one bag at the same time, ie: both get the same medication so you pull 2 say Lopressors and put one in each bag at the same time. It is concievable that you could get distracted and think that you did it or put both pills in the same bag by mistake.
As I said, I work in long term care. Once I almost made a mistake giving too much Tylenol. We use a multidose vial and I had three patients that took it routinely so I poured a cup for each thinking I would save time. This particular patients routine was to have 3 med cups, one with most of her pills, one with applesauce, one with potassium pill (she would take her potassium with the applesauce as she had trouble swallowing it, but disliked it being premixed together as she said it tasted horribly. She would mix it her self and yes, it did drive me crazy.) Distracted and tired, I gave her a med cup with the Tylenol in it as well, not realizing I had already on auto pilot put Tylenol in her med cup with the rest of her pills. She was alert and oriented and caught it for which I was thankful and more than a little embarrassed about. Taught me a good lesson though.
First as far as Joint Commission goes they do not post was is not the standard of care. Instead they list what is standard of care. Any nurse at my hospital can tell you Joint Commission will cite you the state will cite you. We are in serious danger of loosing our acreditation. Believe me we know.
Lets think this Pyxis thing through. Why do we even have Pyxis and why is set up so that you can only pull meds for one pt at a time. There is a reason. Just as one poster suggested there is a reason management would tell you not to do as you are doing.
Before Pyxis we locked meds up on the floor. Now some of us have Pyxis. which locks and despenses meds one pt at a time. A very expensive system.
We turned to this expensive system not because hospitals love to spend $ or love to make nurses' jobs harder.
We have pyxis because there were inherent dangers in the old system. Pyxis provides certain safe guards that were not present in the old system.
Yes it is very illegal to have the meds on you or to be carrying meds for more than one pt into a room. You are not likely to find this on Joint Commission's site or your state's site either but I can assure you it is illegal. If you dispute that then Contact your state's surveyers and ask them specifically.
Let me tell you about a system that was even older. One that most (maybe all of you never saw let alone heard of because it is now so old.
We used to do this. We had these little cards with pt name and meds listed on it. We would lay out the cards for all the pts on the floor. Place a little med cup on top of each card with the meds poured (we did not have blister packs in those days).
So now you have all these little cups of pills that you can no longer ID positively because they are out of their packages, laying in seperate open little cups with the only thing to identify them or the pt they belong to is a little card sitting under the cup. Now you carry the whole mess down the hall on a tray and distribute them to the patients.
Why to I mention this antiquated system. Because it is what we did at the time and we found a safer way.
Namely pour and give meds to only one pt at a time, use individually pkted meds and do not open them until you are at the bedside, take MAR to bedside etc.
Pyxis takes these things even farther.
First it is illegal to have meds on your person. So if you are carrying around a lot of ziplock bags you are just asking for trouble. If you lock them where are you doing it? Has it been approved for meds.
If you are locking them on the floor don't you think the pyxis might be a waste? Or maybe the locked area is a waste? We have duplication here. Unlock from Pyxis and lock some place else. Something is very wrong with this picture.
If you are afraid to tell management then just maybe there is some thing wrong with what you are doing. If you are doing nothing wrong you have nothing to fear. What is wrong with this is you are short circuiting safty measures. Just because you do not under stand the safty measure does not mean it is not existant. Yes there are flaws in pyxis there are flaws in every system. But it certainly is better than what we had.
i think the better system is to have the pharm deliver to the patients rooms....to me the pyxis should only be for controlled or prn meds...the use of pyxis for routine meds is all about the hospital bottom line, they are saving money on pharmacy help....
i think the better system is to have the pharm deliver to the patients rooms....to me the pyxis should only be for controlled or prn meds...the use of pyxis for routine meds is all about the hospital bottom line, they are saving money on pharmacy help....
Best hospital system I ever worked delivered all patient meds (minus narcs) to a locked cabinet in the patient room. Saved so many steps --- and headaches.
PMHNP10
1,041 Posts
My thoughts exactly. Many policies/interventions are not evidence based (although this is changing). Perhaps proper pre-preparation of meds. for multiple patients is safer, more efficient than one at a time; perhaps it is not. There are tons of examples where we've been doing things for years because an authority figure said we should, but research shows the authority was wrong. A prime example that I just learned is CPR. How many years were we required to find the zyphoid process, then 2 finger widths above. As of 2/06, that all changed due to empirical data indicating simply placing middle finger at mid-nipple line is most efficient; and instead of different compression/respirations ratios for infants, children, and adults, it's the same 30:2 for all.