Published Feb 17, 2002
Our facililty is going Live with Pyxis within the next two months and I am Nursing System manager. Our system will only be used for medications at this point. Although I have worked with Pyxis in the past, many of our nurses have not used this system. I want to be prepared for possible problems, concerns or complaints and would like to know what issues, if any, other nurses have with Pyxis. Any insight is greatly appreciated!!
Make sure that if you do narcotic counts on yours, that the nurses do not get lazy and not count the drawer themselves when removing a narcotic.
Also, try and make all of your PRN meds overidable, and you will cut down on thefts of drugs from the pixys. OUr nurses, myself included have a hard time remembering to charge out those items we borrowed, because we know where it is in pyxis and just get it through creative means. Like say you are going fo acetomenophine and instead, take a propofol from the pocket next to it while the drawer is open.
Telling yourself you will come back and charge it out later. It never hapens that you go banck and actually charge, and your budget goes over, because pharmacy is not going to eat that cost.
If you have specific questions, PM or post here, I will try and come back.
What do you guys keep in your pyxis? I'm just wondering because at the hospital that I volunteer at, all meds stocked on the floor or the unit *except emergency meds, are kept in the pyxis. everything is in the pyxis, they even keep bottles of NS in the pyxis. Does your hospital do this? J\W
The pyxis I am familiar with using are the ones that only give you access to one "pie wedge" at a time that holds the drug you specifically want. It does not allow a nurse access to any other drug than the one she/he enters into the pyxis system. The reason for having these expensive machines is to: cut down on theft of drugs, to do away with narcotic counts each change of shift, and to keep a more accurate record of what drugs are removed from it. What kind of pyxis allows nurses to grab different drugs at the same time she/he accesses the system for one specific drug at a time?
NurseDennie, BSN, RN
In the Pyxis machines I've used, the pie-wedges are only used for the narcs. The other drawers open up as drawers, and you dip your little hand into the correctly-numbered bin to withdraw the med you need. The cool thing is that you count as you go - so problems don't get a chance to multiply.
I liked it very much when it first came on our floor (we were the test floor, of course) and there were only PRN drugs in there. I didn't like it so much when the pharmacy stopped delivering the scheduled drugs and we had to stand in line to get the meds.
We adjusted for that by having the shift going off pull the 0800 and the 2000 meds for the next shift. So they could get report, hit the floor and the meds were in the nurse-server, ready to go. The only thing we didn't pull for the first pass for the next shift were the ones that you have to answer "do you really intend to administer this med?" e.g., narcs. THEN the powers that be didn't like that, so we had to stop pulling anything ahead of time. We weren't even allowed to pull out the 1000 meds when we pulled the 0800 meds.
The powers that be "fixed" that problem by changing the 0800 meds to 1000 meds. Yeah, right. K don't know how that worked out - I left!
I like the Pyxis, once I got used to it. Three of the hospitals I have worked at have used it. We still kept Pitocin, Methergine, and narcan at the bedside (L&D) for the emergency when you REALLY don't have time to run to the machine. Then, we have to remember to charge it to the patients when we restock the room. I found you really do have time to get it out of the machine, it only takes 30 seconds.
P_RN, ADN, RN
We did the med pulls as Dennie described. And here I thought that was an original idea!
We had the pie wedges for only the controlled drugs. The rest were in a slave unit and were in cubby holes.
I liked it better for only the prns but we did finally use it for all meds. When we just did the prns we had extra spaces for thngs like fleets enemas and baby powder.
Later after I left they went to the entire system with ALL supplies in the glassed in cabinets in the supply room. My biggest peeve was the times chosen by the pharmacy to restock. It was usually at our busiest times.
Be careful and emphasize that NO ONE is to leave the Pyxis if a discrepancy appears in the number of meds there.
Oh we also kept one narcotic drawer for the odd stuff like epidural narcotic bags. The keys for that drawer were also in the Pyxis under the word......KEYS. Made it easy to see who had been into that drawer too.
I disagree on the all prn over ride. The major ones OK. But the exotics such as anabolic steroids and the heavy duty ones like marinol etc. were only to be accessed per profile.
For the start-up we had a day long skills fair where every nurse got to play with the machine and then got a printout certifying that they were OK on the use.
The reason our thefts occur, is a doctor writes an order, for say propofol for a burn debreedment. Well unfortunately we have the worlds laziest pharmacist on nights. He will take up to two hours to put an order in Pyxis. So without him putting in the order you can't get a drug without using creative means. It took me 5 months of pititioning to get haldol to be an overidable drug. Before that I had to steal it. Se what I mean? Ours also only uses the wedges for Narcotics, and narcotic box keys.
Another thing to watch out for, is if your system is tied in with admitting, make sure you get the person admitted to pyxis before the arrive on the floor. It will save you headaches in the long run. Otherwise you have to manually enter them and then there are two entries for that person that need to be merged.
All of our supplies are in the pyxis also. but the funny thing is they do not directly bill the patient if an item costs less than 20 dollars. Thus we are always over budjet, because of meds, and mutiple 200$ burn dressing changes where every item costs less than twenty dollars. It bogles the mind.
In the hospital where I used the Pyxis, "other" stuff wasn't in the Pyxis. Like the NS bags weren't in the Pyxis but if there was K in the bag, then it was in the Pyxis. They stopped having us mix the K bags a year or more before I even left - that was a big relief.
The thing that got me was WHO decided what would be on over-ride, and what wouldn't? We had most pain meds on over-ride, but not the most common muscle relaxer. And we couldn't get the most common post-op abx on over-ride. That's an issue, too! We'd get these lumbar laminectomies and they're ordered abx Q4 x 3 and we could have had them 100% up to date on their meds EXCEPT that we couldn't get the abx on time! So I'd report off to the night nurse "we got him back about 1400 and you'll note that he hasn't had any abx." Duhhhhhhhh It was a shame, too, because they sent those folks home the next day, and if I'd been able to get the first 2 abx doses in, then the night nurse could have D/C'd the IV if it seemed appropriate. People sleep better without an IV and you need all the help you can get when you're in hospital - even for such a short time (maybe moreso then!) Lum-Lams used to stay in bed for over a week and we'd logroll them - I don't even remember how long.
Not a big abuse potential for those antibiotics - so what's the thinking?!?!?
all narcotics, tylenol, solumedrol, nitro, narcan,
lasix, other non narcotics, the keys to the med drawers, the paper for the pyxis (dont ask me why)
keys for the pca pumps.
i like the pyxis for a couple of reasons. for one thing it does away with the hand narcotics counts.
it keeps track of who took out what and when so there is no question. and it helps me keep track of when i give narcotics. you get a reciept when you take out a drug. it has the time on it. i save those and when im charting i make sure i put them all in. it helps me cos sometimes i dont chart till later and cant remember the time.
Sounds like everyone needs the BCMA, Bar Code Medication Administration instead. Cuts down on medication errors
Laptop on the medcarts, a scanner, a drawer for each pt with his/her name on it. Each med in it's own little packet w/ a barcode on it that's scanned. The pt's wrist band is scanned first, then all his meds are displayed (for that med pass only) on the screen. Each pill, tablet whatever is scanned to be given. The right pt, the right med, the right dose for the right time which you give the right route. The system only has medication. No IV's or anything like that. No standing in line. You have your own cart with your own computer on top. The narcotics are still kept in the med room in the locked box. I think the new version will have the narcs locked in the drawers in the carts. At the end of the med pass, you print out a sheet of any missed meds. (there shouldn't be any) If so, then you have to go back and check it to see if you missed it, or maybe it didn't show up to give it and correct the problem. The sheet is put in a three ring binder and twice a month it is audited. If your missed med doesn't have a correction next to it with your initials, it's considered a med error and an incident report is made out and is placed into your file. oh, and the tx's also show up on the display screen, but you can do them anytime during the shift.
I am currently working at a facility that still manually counts narcs
every shift. It wouldn't be so bad but we have some Nurses both
L's and R's that don't know how to sign stuff out before they give it then "ooops" who gave the ms 2 or whatever. A royal pain.
I can't believe they are so archaic. Then on top of that the nurses
(mainly older ones, no offense) are initimidated by possibly having to use a pyxis. I think they're great, I have used them both
for just narcs and scheduled meds, prn's and narcs. Ain't technology great!
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