Do residents at your program have access to pyxis/supplies?

[MacGyver]

Sound off here. I think all residents should be given pyxis access. Its ridiculous that you should have to wait for the unit clerk to page the nurse who is off in some other room that takes 15 mins to come back to the unit desk who then has to walk you into the pyxis to log in and get supplies.

They dont have to give residents access to everything, but the commonly used stuff like central line kits, ABG kits, dressings/bandages, syringes, vacutainers, IV kits, etc should be open for resident use without having to go thru a 3rd party.

This is such a time waster that I'm seriously considering giving weight to pyxis access in my rank order list for programs.

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[Blade28]

Yes, but only because I've asked nurses to give me codes for each floor...and I keep them in a text file on my Treo.

 

[doctawife]

Our residents have the same access that I (an attending) have to supplies. In the EC, we have fairly open access. Common stuff - suture kits, ET tubes, scalpel's, I&D kits, saline wash - is all out in the open in the core. Even some not-so-common stuff for pediatrics is available (chest tubes come to mind.)

On the floor, even in the observation unit (technically still in the EC), most everything is locked in the Pyxis. And no one can get in there except nursing. Period. There is no stealing codes, no secret stashes.

I think it's a good balance. We have ready access in the busiest area, and getting nurses to get us into the Pyxis is really not that big a deal on the floor. I've never waited 15 minutes... at least not 15 unproductive minutes. Sure, I've scribbled in the chart for a while, waiting for my nurse to bring me the packing I need. But I needed to write in the chart anyway, so... not a problem.

 

[GoodMonkey]

i can get everything i need in terms of supplies. @ my hospital, the only thing kept in pyxis = meds. 👍

 

[Winged Scapula]

Floors> yes

ICU/Trauma Bay > no.

All supplies, even the toothpaste is now kept in Pyxis. No more free tubes of Crest anymore!🙁

Speaking of central line kits, it was one of the reasons they went to Pyxis. It would take so long to get them up from central that we would go to the units or trauma bay to "steal" them and departments would complain about being charged for things that went to other services.

So, obviously the solution was to lock the supplies up rather than try and figure out why we felt we needed to "steal" them. 🙄 Its an exceedingly good idea to have the places where you need them the fastest to have the most difficult access. At least in the ICU the nurses are more helpful than in the Trauma Bay.

 

[docB]

Giving residents and even attendings Pyxis codes is not a good idea. Watch what happens some resident trys to give 125 mg of dig Iv and that will be that. As for me I don't want to be delivering meds. I don't know how to mix up a drip or how slow you have to push Rocephin IV.

 

[Bitsy3221]

We have free-reign access to all supplies everywhere in the hospital (supplies are kept in shelves in rooms, not even a Pyxis), but all meds are locked away with only nursing having (wanting,needing) access.

 

[Winged Scapula]

Giving residents and even attendings Pyxis codes is not a good idea. Watch what happens some resident trys to give 125 mg of dig Iv and that will be that. As for me I don't want to be delivering meds. I don't know how to mix up a drip or how slow you have to push Rocephin IV.

We had separate Pyxis (Pyxii?) for meds which physicians did not have access to. I agree...I don't want it, don't know how to mix things up or how to administer them, nor do I want to learn how.

 

[docB]

We had separate Pyxis (Pyxii?) for meds which physicians did not have access to. I agree...I don't want it, don't know how to mix things up or how to administer them, nor do I want to learn how.

I should have pointed out that I'm used to the Pyxis holding drugs. I don't think that docs should be unable to get supplies. That just slows everything down.

 

[Winged Scapula]

I should have pointed out that I'm used to the Pyxis holding drugs. I don't think that docs should be unable to get supplies. That just slows everything down.

Its probably different in the ED than on the floors or ICU. Our meds were stocked separate from the basic supplies...agreed, would have gone crazy if I couldn't have gotten basic med-surg supplies without getting a nurse to help me.

 

[telenurse]

The system at my hospital is somewhat doc friendly...
The supplies aren't in the pyxis...they are in the supply rooms
Each floor of the new hospital has a treatment room stocked specifically to that floors specialty with O2, suction, heart monitors. (my floor has pars for 2 c-line kits,1-2 thoractomy trays, the extra portable pacer {for the pt's with pacer wires}, suture kits, I&D kits etc.)
The rapid response nurse carries a "toolbox" with emergency meds so we don't always have to break open the crash cart. The ICU has a pharmacist 24 hours a day, who has a rapid sequence intubation med box that we can call for for a pt in respiratory distress that isn't coding yet, but may need intubated.

It's just waiting for things like hespan and drips that the pharmacy needs to mix thats a pain in the @ss.

 

[Hernandez]

the things which my hospital locks up which annoy me. all white script pads, Pink controlled substance scripts, 30 mL bottles of saline. other than that, things are locked in the supply closet which is easy to get into.

 

[drfunktacular]

Does anyone else have to deal with OmniCells? At my school even the 4x4's and tape for dressing changes are locked up, and even residents have to ask nurses for a box of gauze.

 

[Blade28]

Access to meds, no.

Access to everything else, yes, if you're creative.

Otherwise if you had to ask every time you changed a dressing...argh!

 

[Samoa]

We have access to supplies, but the majority of meds are kept in the Pyxis. I don't want access to the Pyxis - you actually have to verify the counts any time you take something out, and I don't want to deal with any discrepancies that may arise, particularly w.r.t. narcotics. Not to mention that if you take out a controlled substance, you have to find somebody to verify your count.

A shared resident access code is a decent idea, but I don't think JCAHO would go for that if they knew, and also it has accountability pitfalls of its own.

I'm happy to let the nurses deal with the Pyxis.

 

[Winged Scapula]

Does anyone else have to deal with OmniCells? At my school even the 4x4's and tape for dressing changes are locked up, and even residents have to ask nurses for a box of gauze.

Yep, that is what we had, but we (the residents) had our own codes, so we could get access to the supplies, but it was a lot faster when they were just out on open shelves.

I understand the need to lock up some supplies, but gauze and tape?😡

 

[Blade28]

I understand the need to lock up some supplies, but gauze and tape?😡

I always wondered about locking up supplies...it's not like we'd be stealing central line kits, chest tube kits, etc. for home use? 😕

But then a charge nurse once told me people would steal supplies from one hospital and bring them to another (presumably because the latter was in short supply). I know of some residents who bring their own supplies from home when taking home call to get in-and-out of the hospital more quickly (e.g. I&D supplies).

 

[drfunktacular]

I always wondered about locking up supplies...it's not like we'd be stealing central line kits, chest tube kits, etc. for home use? 😕

But then a charge nurse once told me people would steal supplies from one hospital and bring them to another (presumably because the latter was in short supply). I know of some residents who bring their own supplies from home when taking home call to get in-and-out of the hospital more quickly (e.g. I&D supplies).

One resident I worked with carried a big duffel bag with all of the rounds-supplies he had managed to steal. It did make things run much more smoothly.

 

[Blade28]

We'll carry around a big box full of supplies (usually the med students help stock it) when going around from room to room changing dressings.

 

[Tired]

But then a charge nurse once told me people would steal supplies from one hospital and bring them to another (presumably because the latter was in short supply). I know of some residents who bring their own supplies from home when taking home call to get in-and-out of the hospital more quickly (e.g. I&D supplies).

In my hospital, different floors have their own budgets. Obviously if I'm going to a Medicine floor to do something, I head up to the surgical ward first to steal what I need, because (1) I know they'll actually have what I want, and (2) I know where to find it. Try telling a Heme/Onc nurse you need some Adaptic, a wound vac kit, and medipore tape; you get nothing but a blank stare.

This works for me, but totally screws the surgical ward, because I'm taking money from their budget for a patient on a different floor.

That's why we periodically discuss locking things up.

 

[Winged Scapula]

In my hospital, different floors have their own budgets. Obviously if I'm going to a Medicine floor to do something, I head up to the surgical ward first to steal what I need, because (1) I know they'll actually have what I want, and (2) I know where to find it. Try telling a Heme/Onc nurse you need some Adaptic, a wound vac kit, and medipore tape; you get nothing but a blank stare.

This works for me, but totally screws the surgical ward, because I'm taking money from their budget for a patient on a different floor.

That's why we periodically discuss locking things up.

That was the reason my residency hospital gave for getting the Pyxis. It was much quicker and easier to "steal" central line kits, vac dressing kits, etc. from the surgical floors and units than try and get it from central and risk the wrong thing being sent up.