Pyxis for the uninitiated

LobotRN, BSN, RN · Apr 17, 2012

Aside from all that....the first time you use one and you have the model where a drawer slides out and then it has further compartmentalization.....well, its kind of like "the price is right" crossed with "whack-a-mole."

Lets see what the firrrrrrrrst med is today behind door number 27! Yessssssireeee, you get metoprolol 50 mg. Now, whack that door shut and see what pops up next....oh yess, omeprazole 20 mg behind door number 13! Yippeeee......The game show pressure comes from the other contestants (errrr nurses) waiting for their chance to try their luck!

And when you have a lovely little lady with 18 am meds, well sometimes it feels like getting the meds and doing the checks will be just as long as her need to take them one pill at a time with a whole bunch of water (wait for it!) and then need the bathroom.

Seriously, I actually do like the system and the ability to override a telephone order med at 0300 after calling the hospitalist, and it is pretty fast considering all the meds are in single dispense blister packs (as opposed to opening containers).

Still, that "plink" of each drawer opening and the "thunk" of shutting it for each med has always made it feel like whack-a-mole. Our system has three full cabinets with about 25 drawers apiece and at least 5 meds per drawer, plus a narc dispenser, so sometimes just figuring out which one will pop open next is half the fun!

CompleteUnknown · Apr 17, 2012

Lol Lobot, and sometimes does it go on the blink and say 'plink.... thunk.... plink... thunk... plink.. thunk.. plink plink plink PLINK!' and all 25 drawers open and everyone in the immediate vicinity is showered with pills? Sort of like winning the jackpot at the casino.

eatmysoxRN, ASN, RN · Apr 17, 2012

The only thing I hate about the Pyxis machine is when you are trying to grab a lot of meds and accidentally grab 1 tab instead of 2...

I see way to many nurses that are too comfortable with it and they don't always double check everything when they grab it and it ends up being the wrong med or dose in the cubie :banghead:

LobotRN, BSN, RN · Apr 17, 2012

@ Complete....that's funny. I live in Nevada. Seriously! The problem is that the "plink-plink-plinkplinkplinkplink" jackpot would be from the non narcotic drawers. NOW...if the "zing-zing-zingzingzingzing" was activated and the norco/perco/roxy showered out....well what a wonderful world it would be on the ortho knee/hip floor. Pain meds for everyone, and I mean EVERYONE , happy hour! (free drinks for those who play the slots....)

Creamsoda, ASN, RN · Apr 17, 2012

https://www.umcsn.com/News-and-Media/Stock-Photos.aspx?intMenuID=149&intPageID=734

A big PITA and waste of much of my time. Im from Canada so theres no such thing as billing each patient for each IV catheter ect. In the US, theyre lucky if each alcohol swab is not billed to them. But thats all it looks like, lol. the lastet software update they put in is everytime I open a door, it says "did you remember to press the button", ugh so annoying

MattNurse, MSN, RN · Apr 17, 2012

hello all!
I've been reading these threads for years, and for the most part have managed to translate your american qualifications, medications and abbreviations into australianisms well enough to understand what it is that you're saying.
However, it had just occurred to me that there is one thing that you all talk about that is beyond me..
The pyxis machine.
but it's ok, in my head i've worked out what it looks like and how it works:
it looks like the lovechild of a dalek and C3PO, with lots of shiny chrome and blue lights and has a little drawer that pops out with whatever medication you may require at the touch of a button.
am i close?

What kind of system do you use in Australia?

Esnooopy, BSN, MSN, DNP, RN, NP · Apr 17, 2012

where i work, we only have controlled substances in the pyxis. most of the patient's meds come in a drawer specifically for them (not in the pyxis), but when we need percocet, ativan, etc, we have to get it from the pyxis and each time you access a med you have to confirm the count of how many are in there and how many you're taking. this way there's no long "narcotics count" at the change of shift, unless there are a few odd meds here or there double locked in the cabinet.

i briefly worked at another hospital where all meds were in the pyxis. this struck me as very very strange. luckily i worked in OB, so it was no big deal as i only needed to get a few things. but the pt population i work with in medicine has tons and tons of meds, i can't even imagine the disaster it would be to have to get each of their pills out of there!

CompleteUnknown · Apr 18, 2012

Where I work, we still get by with old fashioned cupboards and trolleys, and a safe bolted to the wall for the controlled drugs. Lol.

DoGoodThenGo · Apr 19, 2012

The only thing I hate about the Pyxis machine is when you are trying to grab a lot of meds and accidentally grab 1 tab instead of 2...
I see way to many nurses that are too comfortable with it and they don't always double check everything when they grab it and it ends up being the wrong med or dose in the cubie

Happened and or happens more than many think, and has lead to many adverse reactions including patient deaths.

Just a few years ago it seemed every other month there was another report of peds/newborns given incorrect dosage of Heparin. Most always it was because the Pyxis drawer was stocked with adult strength dosage and the nurses in question didn't bother to check what they were drawing up. In a few cases it did turn out that the pharmacy (usually an error by a tech) mislabeled the meds, or was blamed for putting the wrong dosage in the drawers to begin with, but that is neither here nor there.

Just because something is *supposed* to be in drawere "X", does not give any nurse the right to assume anything she or he grabs out of that drawer is what it is supposed to be. Pyxis systems to not replace the Five Rights.

No matter how deep the queue is for the Pyxis and how loudly the other nurses are grumbling for you to "hurry up", it is no excuse for sloppy pulling of meds from the system. Even if one does speed through that bit by slowing down and taking a moment to look at what is in one's hands can save grief and maybe a life.

K+MgSO4, BSN · Apr 19, 2012

Where I work, we still get by with old fashioned cupboards and trolleys, and a safe bolted to the wall for the controlled drugs. Lol.

Same. Our ED and APU has pyxis but nowhere else has an appropriately sized or shaped drug room. We usually put all the non narcotic meds into the pts bedside drawer that we lock. Stocks of all our meds on the drug room and all injectable's stored there as well as 2 nurses required to check. But hten again we don't charge pt for their inpt meds. medicare in this country is slightly different!

wanderlust99 · Apr 19, 2012

I like the pyxis. My first job as a nurse we soley used the pyxis for meds. The top draw of the machine was just tabs of specific patient room numbers with special meds that weren't stocked. So it was easy getting everything out. Right next to it was a large glass machine containing IVF and anything IV. I always selected remove by time, so I'd click 0900 and all of my AM meds from 8-10 would show up that I needed to select.

Now it seems a lot of places have carts with draws for each patient and then some things are found in the pyxis. And some things in the fridge. And some things in another spot. That is frustrating and time consuming...going to 5 different places just to find your meds.

My current hospital (I'm a travel nurse) only stocks certain meds in the pyxis, things like pain meds are still in a locked narcotic drawer which is insane to me that it's not kept in the pyxis. Sigh.

Also a smaller hospital I worked at, the nurse was required to do a weekly inventory of the pyxis. Just another task that is delegated to the nurse when it should be done by the pharmacist.

RainMom · Apr 20, 2012

where i work, we only have controlled substances in the pyxis. most of the patient's meds come in a drawer specifically for them (not in the pyxis), but when we need percocet, ativan, etc, we have to get it from the pyxis and each time you access a med you have to confirm the count of how many are in there and how many you're taking.

This is how my floor is. Routine scheduled meds are in med carts with a drawer assigned to each pt. Narcotics, benzos, prns are in the pyxis. The pyxis also gives access to the fluids in large cabinets sitting next to it. We also have access to a pyxis at night which is in a med room on a different floor if we need something after pharmacy is closed, usually an IV abx that we will prepare ourselves for new admissions.