I am looking for opinions on the following situation. Right now an entire hospital is using the Pyxis for the storage of all medications. For example, each unit has one large Pyxis for all meds for all patients. In other words, pharmacy does not come up with bags or drawers for each patient. The nurse must pull all meds from the Pyxis for all of her patients one by one. Respiratory therapists also use the Pyxis as many of the respiratory meds (except for inhalers) are kept in the Pyxis as well. I felt the need to clarify in detail because I have told others this situation and they have been thoroughly confused.
This hospital also is about to go to the electronic medication administration, including the scanning of meds and the patient. The practice of "double checking" all anticoagulants, including Coumadin and any subcutaneous, e.g. Lovenox, is also about to begin.
My question, I guess, is whether or not this system is reasonable, from an outside perspective.
Here's my two cents--In theory the Pyxis system for storage of all meds seems like a good one. MANY meds are kept in the Pyxis and if a patient is put on a new med and it is stocked in the Pyxis, or if you have a new admission, you don't have to wait for the meds to arrive from pharmacy. There are a lot of negative things about the Pyxis system though, IMHO. When the acuity is high, one RN may not have time to stand at the Pyxis for that long fighting with the drawers and waiting for them to open. There is an option to assign yourself patients and remove meds by time, and this does make it somewhat helpful. Also, I should mention that this Pyxis system is rigged with a very large refrigerator-looking section with bins inside. So instead of the medication being spit out or a drawer and compartment opening, sometimes you have to sort through many bins and medications looking for the right one. There is also the inherent problem with the Pyxis--when you are forced to stand in line with the other RNs, RTs, and pharmacy techs if it needs filled, waiting to get out that one pill. Another annoyance about this system is that the Pyxis is monitored by the pharmacy, and there is a minimum bin level where the pharmacy is supposed to come and re-fill. The reality is that this rarely happens and the pharmacy is always getting calls to send more meds. Oh, and the extra narcs? Yeah, they are still kept in the old narc drawer--requiring a daily narc count and taking away any of the aforementioned convenience of said Pyxis system.
Now that each med has been painstakingly removed from the Pyxis, the idea is that each patient will be scanned. Then each med is scanned. Is this redundant? My exact thoughts on this matter are.."Are you serious? One or the other, Pyxis or the barcodes on all these meds! I am already taking one out at a time from the Pyxis!" That being said, back in the day when Pyxis was used for mainly narcs, I could see myself being ok with doing double duty and removing from Pyxis AND scanning..it is only the pain med afterall, that takes considerably less time removing and scanning that one PRN rather than removing and scanning every scheduled med.
THEN Coumadin and lovenox are supposed to be double checked and will require a witnessing RN to swipe her card at the time of administration. I understand the necessity to have IV Heparin and I will accept the fact that insulin needs double checked as well. But Coumadin and lovenox? Is this just to look good for the Joint Commission? Why don't we double check every med while we are at it? Oxycontin can be given with one RN, but Fragmin is suddenly so dangerous that it requires a witness. I understand the need for patient safety, but where is the line drawn? People have died taking aspirin too--will that need a double check? Is an RN no longer competent enough to administer meds? How long before three nurses need to check insulin? Or until 2 RNs must assess together? Sure this is all great in theory, sure it would be great if the doctor and pharmacist could come to the floor and scan their badges too, but there is no time for all of this, ESPECIALLY with the advent of the E-MAR and the documentation of the exact time of administration. There are not enough nurses and there is not enough time in a day for all of these requirements.
So let me take you through the process if your patient is on Lovenox or Coumadin..
Sign onto Pyxis, remove all meds, take meds to patient room, sign onto E-MAR, scan patient nameband, scan all meds, have another RN swipe to witness, and give the meds.
I am all for correct patient identification and I will concede that scanning every med is actually a good (albeit time consuming) thing. I am all about correctly identifying the patient and what meds he/she will be receiving..essentially, patient safety. But removing the meds from the Pyxis (although it was implemented first in this change to the E-MAR) seems like whoever thought of this "ingenious" system has never once administered a medication on the floor, and is inadvertently and unknowingly putting patient care/safety on the backburner. It is taking time and wasting it--and while it is meant to increase patient safety, it actually works against it. The burdens of this Pyxis system outweigh its benefit. What say you?
Specializes in Acute Care Cardiac, Education, Prof Practice.
Thanks guys, I have to admit that I am new at this and I am very randomly pressing a "Thanks" button on some posts, although I am not too sure what it does! I hope it sends all of you some money or something (fat chance!)
Specializes in Psychiatric,QI and Informatics, Ambulato.
I work in an inpatient psych facility that uses an Omnicell system (all meds stored in the Omnicell) plus med computer carts and exactly the process you describe, and it works just fine. Of course, we use a "team nursing" system with one med nurse, so we don't have multiple people trying to pull meds from the machine at the same time. I would encourage you to approach the new system with an open mind and positive attitude, and wait to see how things work out. This is the first time I've worked with a med admin system like this, but I really like it. The best thing about it, I think, is that it makes it almost impossible to make a med error -- you have to really work at it. :)
Elkpark-
This is an old thread, but am hoping you will take a look at this.
Our current hospital med administration is similar to yours. One nurse passing meds to 25-30 mostly unstable, paranoid psyc patients. We are going to EMAR and considering pyxis, omnicell and some other automated dispensing systems. I am having trouble wrapping my head around the new process with these in place.
Does your med nurse belly up to the pyxis/omnicell pull each pts meds individually as they come to the med window then document in EMAR or pull all pts meds at once putting them in another cart (obviously labeled with identifying info)?? Then as patients come up taking meds from this "other" cart checking meds again and documenting given on EMAR.
I hope these questions make sense. Anyone else who has some input let me know. We are rolling out our new EHR this fall and as far as I can tell there is not linkability (is that a word-well it should be) with the EHR and scanning or automated dispensing maching--so looks as though pulling meds and documenting in EMAR will be separate systems-actions.
Specializes in Acute Care Cardiac, Education, Prof Practice.
I didn't look at the date on the thread. As I was reading it I was like "hey that sounds like my place of work!" and then I realized it was my own response.
I would get written up for that. We aren't allowed to pull meds until the time they're due.
This week I saw a nurse put patient labels on a "cheat sheet" that they used to scan instead of the patient ID band. What's the point of having all this new fangled equipment and then bypass the safety features??
Not only that but some Emars are linked with the Pyxis system so they will show that the med has been pulled from Pyxis at "X" time and not given until "Y." (I did clinicals at a hospital like this)
At the hospital I am at now, we have computers in every room and everywhere. Scanners everywhere. Only one Pyxis. There can be bottlenecks at times but it seems to work well. I think if you have enough resources it can be good. But with the hospital I did clinicals at, they only had a limited number of computers on wheels and this made everything super inconvienient.
We've had pyxis's in our hospital for over 10 yrs and have been scanning meds and pt bands for at least 5 yrs. I really couldn't imagine doing it any other way in acute care. I do work per diem in LTC and feel really old school to still pull meds from a bubble pack and med cart.
We've had pyxis's in our hospital for over 10 yrs and have been scanning meds and pt bands for at least 5 yrs. I really couldn't imagine doing it any other way in acute care. I do work per diem in LTC and feel really old school to still pull meds from a bubble pack and med cart.
I cant even imagine trying to give meds to 20/25 patients with 10 to 20 meds apiece using a scanner.....now, if you want to give me a "pez" type dispenser, it might work...lol
Tait, MSN, RN
2,142 Posts
Oddly enough, this can be done!
http://tipjoy.com/
Ok done derailing :)
Tait