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my pyxis nightmare..

Specializes in ICU/ER/CCU.

Okay so my hospital has been migrating towards taking medications out of the pyxis units more and more for about a year. It started off they took out the controlled drugs, than the expensive one,s then some other ones. It has come to the point where there are no more drugs kept in our pyxis, we order then from the pharmacy and they come up through the tube thingy. It's pretty fast, almost instantaneous, I am not sure how it works. I think the only drugs we keep on the floor are in the crash cart. So this morning I go to pyxis to grab a saline flush.....no saline flush.... I run over to the other pyxis down the hall....no saline flush. I ask a colleague of mine and apparently saline flushes are also considered a legend med now and thus will not be kept on the floor any longer. I was LIVID, you mean I have to ORDER a saline flush? Are you kidding me? That is absolutely ridiculous. I just DO NOT understand the rationale behind this. Apparently they still have them on the floor in ER, but not in the CCU? I under stand not keeping narcotics, even other drugs, but when they start taking my saline I will not sit and be quiet. What do you keep in your pyxis? Am I just crazy for thinking this is a bad idea?

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

Wow, that's very strange. At work, they've actually been working to increase the drugs stored in the Pyxis. Besides narcs, and common pyxis drugs like Tylenol and Zofran, we now have Insulin. We also have IV fluids, saline and heparin flushes, and flavoring for meds. If they took the flushes away, I would also be upset.

nurse grace RN, BSN

Specializes in med/surg, TELE,CM, clinica[ documentation.

Our pyxis is pretty much stocked with everything needed on a med/surg floor: narcotics, cardiac meds (plavix,bp meds, coumadin etc.) gi stuff(nexium,prevacid, mmalox, etc. We have bins of 2cc and 10 cc saline flushes. Individual patient drawers have the daily stock of meds. We do get rounds where pharmacy techs bring up the newly ordered meds through out the day. I would go crazy if I had to go to the tube system for every med ordered for my patients.:bowingpur


Specializes in ICU/ER/CCU.

I actually somewhat understand the underlying logic. They are trying to integrate the pharmD into the whole process, we input the orders into the computer, they go down to pharmacy, pharmacy overlooks the order, sometimes theyll call us up if theres a problem and they send up the order, occasionally already drawn up and everything, its actually kind of nifty, however I think theyve taken it a bit too far, they took our IV bags and that was enough of an annoyance, but now this is just ridiculous. And to boot the other nurses didn't see a problem with it! other nurse: "well how often do you need to flush" me:"uh I don't know, quite often" other nurse:"and its so urgent you can't 30 seconds for it...?"...well ok maybe not but thats not the point, why should I have to wait? No one has given me a good answer to that question. I think I'll go up to nurse management tomorrow and figure out what the deal is.

Reno1978, BSN, RN

Specializes in SRNA.

Working in a critical care area, I think my head would explode if I couldn't find saline flushes...

"Oh, the patient is coding?...can someone order some saline flushes from pharmacy, please?"


Specializes in critical care, PACU.

thats so wierd. so no vials, no syringes--you cant draw up your own yourself. wth?! soooo wierd. I guess it doesnt come up too often because every patient seems to be on some fluids or another so we always just flush with the bag we have...but Im just a student.

madwife2002, BSN, RN

Specializes in RN, BSN, CHDN.

No meds on the floor can I ask what the rationale is behind this?

blondy2061h, MSN, RN

Specializes in Oncology.

We not only keep saline flushes on the floor, but in the patients' rooms. They DO say "RX Only" though, thus making them a legend drug. Technically. Pretty lame. We all rinse our contacts with them around hour 10 or so ;)

Wow that is different. We keep everything in ours except the pre-filled saline and heparin flushes.

So whats next the patient can call down and ask for their medication?

I have seen saline flushes kept outside the pyxis, but heparin flushes within the machine, seems like a time killer.


Specializes in Pediatric Heme/Onc/BMT.

We have heparin in the Omnicell, but saline flushes are locked in a cabinet outside the patient's room with the rest of their scheduled meds.

I generally stash several in my pocket at the start of a shift (for initial assessments) ... does the pharmacy have a rush at shift change of nurses just wanting flushes?

What do they think is going to happen if a patient gets a hold of a flush?

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I imagine it has something to do with money and micromanaging charges.


Specializes in Critical Care.

Apparently, JCAHO has WAY too much time on their hands, to worry about us hurting patients with saline flushes!! This is too much.:banghead:


Specializes in ICU/ER/CCU.

definitely a time killer. We can draw up our own from the patients IV bag if they have one, we do still have syringes. But why should I have to, I really don't understand the logic, I understood when the took the narcotics off the floor, to prevent diversion and such we had some incidences a while back. And they explained when they took off the other meds. But saline? Oh give me a break.....No one is going to steal saline....and its pretty hard if you ask me to overdose a patient on saline with a 10ml syringe so the pharmacist really doesnt need to overlook the order. argh I don't know. maybe I'll have one the doctors write an order for 1000ml of saline in 10ml syringes every morning, thatll drive the pharmacy crazy. "wait who gets billed for it?" "uh the cranky one on the end?, yea him he called me a candy striper" actually i dont think we bill for saline flushes but thats beyond the point

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice.

We keep our saline flushes in the PIXIS as well, however I know we have issues with them for monetary reasons. We are supposed to chart them when we use them, but of course when you have a patient getting dilaudid Q2 and are using a bazillion flushes, some get missed.

However I know our hospital apparently lost like $500,000 dollars in flushes alone last year.

Reno1978, BSN, RN

Specializes in SRNA.

This just sounds so bizarre to me. Where I work each patient has a cart outside their room that is stocked with around 50 flushes each...there's really no accounting for them.


Specializes in Cardiac Telemetry/PCU, SNF.

NS flushes are in the med room where we can grab them by the handful if needed. We keep heparin flushes in the Pyxis however so we can charge for them and control access to them.

We keep almost all the normal meds inPyxis anyways. Only odd meds that the patients are on, like Sildenafil for the pulmonary HTN patients come up from pharmacy and are put in the lock boxes outside the patients' rooms. For us getting meds from pharmacy can be a nightmare at times, others it's OK.


ZooMommyRN, ADN, RN

Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.

I'd go nutts! Our NS flushes aren't even kept in pyxis, we have 3cc & 10cc in buckets in the med room, we have almost everything known to man in ours, once a blue moon I'll have to run down to ICU and pull something, and once in a while ICU has to come to ours. The only thing that irritates me is that recently they changed the set up, a new med can not be pulled more than 1hr in advance 1st pass, really a pain when you want to get all your 6&7's pulled and ready at 4am so everyone isn't at the pyxis at the same time, altho with a NM that likes you it's not too bad, they can over ride it to save you time later

blondy2061h, MSN, RN

Specializes in Oncology.

We don't use heparin flushes, except for through a mediport right before the patient is discharged. Do other people use them regularly?


Specializes in MICU, SICU, CRRT,.

I dont agree with this policy at all. The only thing not kept in our pyxis is refrigerated meds (antibiotics mainly). They are in the med room in the medication refrigerator. I believe that all meds should be stocked in easy access to the nurse. Pyxis or whatever. In SICU, there always isnt time to call down for the med, then have someone man the tube to wait on it. What if there is a patient on a PRN ativan or something, for anxiety, seizure, etc, and needs it ASAP. That should be technically at the nurses discretion, especially if it is within the time limit and ordered by the physician. Sometimes meds are needed in an emergency, although it isnt a code, meaning there is no reason to turn to the code cart. And flushes!!! I absolutely cannot stand having to get those out of the pyxis. It is a saline flush for Christ sake. They are much more beneficial and easier to access if they are in the patient room. I understand cost containment and all, so i am not saying to keep a hundred of them at the bedside, but 5-10 stocked in the room should be fine. So, we are risking lives to save a dollar???

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