Pyxis report question...being falsely accused!

LakeEmerald · Feb 20, 2014

Where I work, usually the wasting nurse sets up the waste by getting into the pyxis first, then the witness signs in and witnesses. It's been done the other way occasionally, but typically not. The way you stated seems backwards.

Sorry you are going through this. Hope it gets sorted out soon!

imintrouble, BSN, RN · Feb 20, 2014

I don't understand what you describe. Could you be more clear?

Where I work this is how it works.

I have an order for 1 mg Ativan and the cartridge is for 2mg

I remove the med.

Second nurse watches me draw up and waste.

Then the second nurse initials the waste in the the pyxis.

The nurse who removes and dispenses the med is NOT the one who wastes.

What exactly did you do?

Jasper676 · Feb 20, 2014

Thanks for the info. That seems to be the general way to do things but apparently, we have been doing it backwards.

Jasper676 · Feb 20, 2014

Sorry if this seemed confusing. We withdraw out our meds such as ativan, morphine etc. The only available amounts are always more that we will use. The pyxis asks if we will use all the med and we alway say yes and go on our way. Later, after the patient is medicated and/or no more is needed, we then go back to the pyxis at a a later time to "waste" the unused medication portion. The witnessing RN signs in first and the "wasting" nurse completes the wasted medication transaction in the pyxis. From what I have been reading, the way we have been doing this is not correct :/

Sun0408, ASN, RN · Feb 20, 2014

Sorry this has happened to you OP. We only say "yes" if we are in fact giving all of it or its an emergency ie someone is actively having seizures and no one is right there to waste. Other than that, we pull/waste/witness all right there; the extra medication is squirted in the sink.

SouthernPoint · Feb 21, 2014

Somethings sounds off here. If you are using the pyxis this is how the company explained it to us.

Order = 0.5mg (controlled substance).

Pyxis = 1mg (controlled substance).

Difference of 0.5mg (which is your waste).

I (the giving nurse) sign into pyxis. I locate my patient and then I locate my controlled substance I am going to be giving. When I click on the medication it is going to ask if I will be giving the whole 1mg. My answer will be no, then I type in 0.5mg. Now I will get a waste/witness screen. This is were another nurse will need to type in their information. Once that is done, the medication draw will pop and I will take the medication, pull what I need and discard the left over per P&P.

You should NEVER take and wait to deal with a waste after the fact. Unless it is a true emergency.

Sorry you are goong through this, maybe this is a great time for some pyxis education on your unit. Sounds like everyone could benefit from it.

Jasper676 · Feb 21, 2014

Wow, thanks SouthernPoint for the information. I was working in a pre surgical area and ALL of the nurses pull the whole amount, give 1/4 or 1/2 of the med, label it, and pocket it for future use. If the pt doesn't require anymore and/or leaves for the OR, THEN the left over medication is wasted. An RN is asked to sign in, then the "wasting" RN chooses the pt names and completes the waste. The way we have been doing this, the RN originally pulling the med isn't getting credit for "wasting" the unused portion. They are actually witnessing it, not wasting it after the fact. Sounds like much education is needed there.

annie.rn · Apr 3, 2014

Our process is a bit messed up too. Here's an example: 0.4mg Dilaudid IV is ordered for the pt. The nurse administering the medication pulls a vial of 2mg/ml Dilaudid and takes the whole vial into the pt's room where it is scanned into the EMAR, the necessary dose is drawn up and administered. Later in the shift, the administering nurse finds a witness and wastes the remaining 1.6 mg of the vile in the Pyxis room. I personally won't use the same vial more than once even for the same pt. It gets too confusing.

Ideally we should be pulling up the entire contents of the vial in the med room and wasting what we are not going to give into the sink or sharps container with a witness there observing it all. The administering nurse then keeps the empty vial in his/her pocket for scanning into the EMAR once he/she enters the pt.'s room. When the med has been given, the empty syringe and vial are then thrown away in the room's sharps container.

I feel much better doing it the second way. Maybe it's done the (in my opinion) sloppy way b/c there is rarely someone around to witness a waste vwhen you need them. Our unit is crazy busy.

BrandonLPN, LPN · Apr 4, 2014

OK, stupid question from someone who never worked with IV push medications: Why can't IVP dilaudid come in pre-dosed syringes? Like a 0.4mg syringe, a 0.5mg one, etc? Why does it always have to be in vials and part drawn up and part wasted?

LadyFree28, BSN, LPN, RN · Apr 4, 2014

OK, stupid question from someone who never worked with IV push medications: Why can't IVP dilaudid come in pre-dosed syringes? Like a 0.4mg syringe, a 0.5mg one, etc? Why does it always have to be in vials and part drawn up and part wasted?

Sounds like a pretty good idea, would it REALLY be Dilaudid??? How would you know w/o the packaging, that sort of thing would come into play, unfortunately...

Loo17 · Apr 4, 2014

OK stupid question from someone who never worked with IV push medications: Why can't IVP dilaudid come in pre-dosed syringes? Like a 0.4mg syringe, a 0.5mg one, etc? Why does it always have to be in vials and part drawn up and part wasted?[/quote']
It does come in pre-pilled single use syringes in the most common doses. A pyxis can only hold a specific number of controlled substances. The one where I work has 1mg and 2mg because those are the most common doses.
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