Pyxis in ER, Pharmacy Oversight, Joint Commission Requirement.

nuangel1, BSN, RN · Oct 23, 2007

there is a er forum its listed under speciaty forums.we have accudose in our ed when pt comes in if we need a med immediately we put in pts name room etc as we know it and take meds out .then wehen pharmacy comes down later they make sure all the pts info is correct comparing it to the pts registration info.we don't have a pharmacist on night shift .we have to get any md orders faxed to pharmcy by 10 pm if we want them delivered to ed -we get a pt bin with the meds in it .

FireStarterRN, BSN, RN · Oct 23, 2007

there is a er forum its listed under speciaty forums.we have accudose in our ed when pt comes in if we need a med immediately we put in pts name room etc as we know it and take meds out .then wehen pharmacy comes down later they make sure all the pts info is correct comparing it to the pts registration info.we don't have a pharmacist on night shift .we have to get any md orders faxed to pharmcy by 10 pm if we want them delivered to ed -we get a pt bin with the meds in it .

How do you deal with stat meds? Obviously in an ER you need to sometimes give meds immediately, without Pharmacy oversight. In my unit we have stat meds available in the Omnicell.

TazziRN, RN · Oct 23, 2007

The poster above just told you. You can enter the info by hand.

With a Pyxis, we would enter 911 and pull stat meds. When I did that I would enter 911 Chest Pain bed 4, or something like that, so if I didn't have a chance to correct the charge until the end of the shift I would know which pt it was. Especially if I had several 911 pulls that shift.

time4meRN · Oct 23, 2007

I understand what they are trying to do, but my gosh, RN's know our med's ( or at least we should), if we have a question about a med there are numerous books avalable and the pixis has a med info section on it. Health care is already so expensive,over regulated and nurses jobs seem to be slowly taken over by so many entities. Phamacy overseeing meds that we have done for years, ma's doing things in dr's officices that the RN does and has a license to do. I'm so sick of big brother. I want pt's to be protected but it seem regulatory agencies have a way of making everything so complicated. Wouldn't it be easier to make sure through hospital continuing ed that the nurses know their med.

MAISY, RN-ER, BSN, RN · Oct 23, 2007

All patients coming through front door are quick registered (previous patients) and immediately name is linked in computers to charting, pyxis and main data base. In the event, a patient comes by ambulance, we are able to enter name in pyxis without MR # to retrieve meds. Any true emergencies where code cart is used-all meds usually needed are in locked in pre-stocked cart. If sedation meds are required for intubation, they are taken from pyxis and later charted.

Medications ordered by ER docs are in computer and are received and available in pharmacy. Any admit orders on hold patients are scanned to pharmacy and cross checked and their own meds are taken out or changed to our formulary stock. Allergies and weight must be included on our physician orders sheets for daily med administration or meds will not be sent.

We do not keep typical daily meds in stock, however, we keep many iv premixed and vials that need to be reconstitued. During this past year we have had a daytime ER pharmacist and she has been wonderful! One problem we do have is that narcotic medications are not always given in the dose released from the pyxis-and we require another nurse to waste medications with us. This is a problem in an emergency-if you forget to have someone come back and waste with you-it appears as someone has taken medicine because amounts will not match between what was taken and what was given.

As another poster mentioned, we are nurses and ultimately responsible for med administration. If not comfortable with amounts, or circumstances we always have the right to question or withhold a medication. In the event of an emergency-we might not know about a person's allergy, however, if a person is being coded a "side effect or reaction" is the least of their problems. I always have my nursing med book, will call the pharmacy or if during regular hours make use of our pharmacist. In many cases, she will join us in an emergency and be the "runner" for meds.

Either way, it is not prudent or realistic to have every med order overseen. Physicians are supposed to know their meds and nurses need to check prior to administering to make sure they are doing the right thing.

Maisy;)

elizabells, BSN, RN · Oct 23, 2007

One problem we do have is that narcotic medications are not always given in the dose released from the pyxis-and we require another nurse to waste medications with us. This is a problem in an emergency-if you forget to have someone come back and waste with you-it appears as someone has taken medicine because amounts will not match between what was taken and what was given.

This is such a key point. I'm in the NICU, not the ER, but if your Pyxis works anything like ours, and you pull narcs for a pt who dies before you give them, go back to the Pyxis and waste them IMMEDIATELY. Once that pt is out of the computer system, you cannot waste their meds. I just finished a huge drama wherein it appeared (from computer logs only) that I had done something fishy with two full vials of Versed. If another nurse hadn't physically witnessed me wasting them and signed a statement to that effect, I'd have been in deep trouble.

Our current Pyxis override disagreement is that we've been told Vecuronium cannot be overriden because it's not given in emergencies and we should be able to wait the 10-40 mins it usually takes pharmacy to put the order in the Pyxis. Um, what? :trout:

Indy, LPN, LVN · Oct 23, 2007

Ha. That's a riot. If the pharmacy wants to work overnight they are more than welcome to do so, but they will be VERY busy and they will have to answer the phone when I call them 14 times a shift.

Also, they will have to realize that some of the meds in the code cart are used to AVOID a code, and in ICU we should be able to get atropine out via override for gosh sakes. It's more labor-intensive for pharmacy if I have to break open the code cart and get my meds out that way; I don't give a flying squat if they have to do more work or not- I'm going to give ordered meds when the patient needs them, regardless of who's politics get in my way.

Besides which, pharmacy frequently can't read a d/c med order, or decides the doc didn't really want a med when it's in plain english so that even I can read it, etc. Like I said, if they want more oversight then they need to work. Nursing is a 24 hour job; last time I checked medicine was too, pharmacists get to set their own hours so they need to not make the job harder on the rest of us while they are at home asleep.

FireStarterRN, BSN, RN · Oct 24, 2007

Ha. That's a riot. If the pharmacy wants to work overnight they are more than welcome to do so, but they will be VERY busy and they will have to answer the phone when I call them 14 times a shift.
Also, they will have to realize that some of the meds in the code cart are used to AVOID a code, and in ICU we should be able to get atropine out via override for gosh sakes. It's more labor-intensive for pharmacy if I have to break open the code cart and get my meds out that way; I don't give a flying squat if they have to do more work or not- I'm going to give ordered meds when the patient needs them, regardless of who's politics get in my way.
Besides which, pharmacy frequently can't read a d/c med order, or decides the doc didn't really want a med when it's in plain english so that even I can read it, etc. Like I said, if they want more oversight then they need to work. Nursing is a 24 hour job; last time I checked medicine was too, pharmacists get to set their own hours so they need to not make the job harder on the rest of us while they are at home asleep.

In our unit we keep epi, atropine, and lidocaine in each room.

elizabells, BSN, RN · Oct 24, 2007

In our unit we keep epi, atropine, and lidocaine in each room.

In my NICU we have emergency med boxes in each pod with epi, atropine, bicarb, and Ca Gluc. Forgot about those.