Pyxis in Never wrong?

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:o So, at the hospital I work at they have pyxis for all meds. They do not do a narcotic count every day. To make a long story short there was a discrepensie.There are 2 missing pills and it is pointing back to me. I told pyxis man that when I got them out, the the 2nd drawer opened. He said that the front drawer should have opened cause there were suppose to be 2 pills in there,that it should have only opened the one in front. I told him that there were no pills in the front drawer only the back. I explained it to my supervisor and she understood. I told her that I had tried to administer 2 pills to 2 different people and they did not want them, so I returned them. Those pills were found in the return bin by the pyxis man. I also told her that I had administered 1 pill to one person and is documented on the mar. Pyxis man was standing right there when I was explaining this. Then he said in th 14 yrs that he has been using pyxis that it has Never been wrong. ---I am soo worried, what if they don't find the mistake? This Sucks! I am ready to tell them to take my blood and test it!!! Or whatever sample they want!!
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Specializes in Med-Surg.

Most of the time these things can be traced to a human error. Hopefully you'll be cleared of any wrong doing. They're just doing their job, so don't take it personally. If they really suspect you or can't resolve it they might ask for a urine sample, which isn't unheard of.

Best wishes.

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Specializes in ob/gyn med /surg.

yes pixus can be wrong .. it is filled by humans and of course it can be wrong.. we've had techs fill the pixus and not add to the totals what they've added.. don't worry about it..

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The Pyxis man can be so wrong. Try to remain calm, this will work out. I do suggest you write down exactly what happened and how you rectified the event. Be sure to include the fact the pills were in the return drawer. Good luck and I am sure it will be fine.Oh, make sure you keep this note for yourself and give a copy to the HN if needed.

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Specializes in NICU, PACU, Pediatrics.

yes it can be wrong...If the person who filled it made a mistake it can definitely be off count. At the hospital where I was manager we only counted once a week and we often found mistakes that we traced back to the pharmacy

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Specializes in ER, Clinical Informatics.

I was a Pyxis Coordinator for the longest time. At my last facility, a handful of individuals and myself were responsible for implementing roughly around 40 pyxis stations and getting them all up and running for the facility. I will say this, even though it is a great system for inventory control, it too has it's short comings.

What I would recommend is contacting the pharmacy and having an activity report ran from the last verified inventory/refill from pharmacy and then comparing the activity per user and meds to see if they coincide. Sometimes another RN will pull the medication and be interrupted in the middle of the transaction. This would appear as a canceled transaction. The pyxis will believe that the medication was NOT pulled from the inventory and hence you'll have a discrepancy. This would cover BOTH error by pharmacy refilling AND Nursing transactions.

I hope your able to be cleared of this since I know that it is pretty nerve wreaking. Let me know if you have any questions.

Mig

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Specializes in NICU, PACU, Pediatrics.

that's a good idea cause I know that in ours that if the drawer failed it cancelled the transaction and if the nurse took it out already it would create a discrepancy

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Specializes in ER, Clinical Informatics.

I used to have to track down all sorts of Discrepancies when I worked in pharmacy. That was a good portion of problems with pyxis. I've found that you can track down most things with this type of report.

I know how hairy it can get during AM and PM med passes. Trust me that I have seen some pretty interesting discrepancies that have baffled me and have had no other idea on how to solve. Just take your time when doing the med pull and don't get rushed. Even if there is a "C" word and you need meds STAT, thats what the crash cart is for.

I hope this helps all and like i said before, if anyone has any pyxis questions, feel free to ask.

Mig

ps- I guess you can call me a double agent now!! LOL Go figure, 12 years in pharmacy and then deciding to go into Nursing!

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In my experience, the counts in the pixis is wrong a lot, not just with narcs, but all meds, and especially with the confusion of things such as: taking out one when you meant to take two, then trying to go back and get the second one without charging the pt. And, returning meds not wanted by the pt. There are so many reasons for counts to be off that can usually always be traced back to human error somewhere down the line. So, no worrys.. They should be able to figure it out eventually. Good luck! :specs:

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Specializes in Peds; Peds Oncology.

The Pyxis is filled by humans.

Last week the pharmacy person (I don't know who) filled the injectable Toradol pocket with PO Toradol.

Try not to worry too much about it.

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Absolutely Pyxis can be wrong!

Pharmacy staff filled our prefilled saline flushes with prefilled hep flushes!!

Also, there have been times when the pharmacy-filled pill packet is missing a narc or a benzo pill because the machine glitched.

There are many reasons for Pyxis errors, do your best to keep calm and document the situation for yourself while it's still fresh in your mind. Good luck!

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Specializes in LTAC.

Sounds like Mr. Pyxis Man was just trying to freak you out. The silly thing is a computer, and computers mess up all the time. Plus, they're stocked and programmed by humans....and well, nobody's perfect. No worries.

~T:Crash:

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