my pyxis nightmare..

[annreese]

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?

[TomCCRN1991]

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

[annreese]

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]

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]

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.

[Spatialized]

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.

Tom

[ZooMommyRN, ADN, RN]

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]

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

[Mommy_of_3_in_AL..RN]

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???

[annreese]

We don't have med rooms here.. what do you use them for?

[leosasha]

How ridiculous. Are there bags on NS available. Draw your own up. We ran out of flushes a couple weeks ago on a weekend. The house supervisor just shook her shoulders ( Oh Well ) when I informed her.:barf02:I grabbed a liter of NS (No 250's available) and went on. As far as pixis goes, I am currently working with an Omnicel. It went bizzerk and would'nt close the other night. All kinds of lights were flashing. I've never seen a pixis act that wacky.

[uscstu4lfe]

everything except saline flushes are kept in the pyxis machine (including IV fluids). This is a total pain in the butt. Do you know how bothersome it is when you have to call and wait for a bag of normal saline when there isn't any left? Or even more bothersome is when you look inside the machine, you can SEE the normal saline bag sitting right there, but the machine tells you that it doesn't have anymore. Ugh! Another problem I have with it is that if you need to pull out two pills, but accidently just pull out one, you can't "go back" in the system to fix your error. Pain in the b-u-t-t. Personally, I think the pyxis system slows down nurses (especially at routinely scheduled med times, when everyone is waiting in line).

Thank goodness we still have saline flushes at our disposal! BUT we are not able to carry them around in our pockets anymore. we have to take one as needed and then dispose of it or put it back if we don't use it right away. Our managers actually walk around and give warnings to nurses for carrying flushes. Bummer!

[tnrose]

amen to that