Pneumatic Tube System

[28657]

What meds are "banned" from being tubed at your institution?

For one facility where I work, we can't tube Epogen, at another we can't tube Albumin (but I can tube Albumin at the first facility, and Epogen at the 2nd).

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[tussionex]

no controls, no patient's own medications, no verbal order forms.
we don't stock albumin...blood bank.

we're waffling on epo/insulin.

anything in glass gets wrapped in plastic bag...or face the wrath of the guy who fixes the tube!

 

[njac]

Nothing in glass (other than small vials, I would say >100mL doesn't.)

No protein products - no epogen, no albumin, no insulin, no vaccines, no G-CSF

nothing expensive - daptomycin, tigecycline

no chemo

nothing >1L - we used to tube 2 1L bags at a time but they were getting stuck a lot...

no stuff that gets too foamy - ie: Amiodarone foams up like a mofo, and if it's stat...

Ampho B is on the list but I'm not sure why... the vials say to shake vigorously.

And Bicarb bags to our MICU. It's in the new hospital, almost 1/2 mile away on foot (not sure how far in the tubes) but bicarb bags always seem to explode going there.

no narcotics, no patient own meds...

really, I swear we do get to tube most things!

 

[tussionex]

yeah, i wouldn't tube any of the things that are mentioned above, either.
expensive and exploding is bad!

 

[Epic]

Take this one step further.

The medication security mandate of the Joint Commission requires only licensed staff who handle medications have access to the tube system to receive medications.

I have known surveyors who times the medication delivery system along with observing who has access to the tube system.

Prevent RFIs. Make sure the tube system is secure.

 

[off2skl]

We could send narcs and patient meds, but we had to use the secure tube feature. Basically calling the unit and speaking with the nurse and giving them a code to access the tube. Then there was a way of programming it in on our end. Their tube would beep and not let anything else through until the code was entered. Other than that, the hospital I worked at was pretty similar...no epo, chemo, expensive meds, meds requiring refrigeration (otherwise they sit and end up being wasted), mag citrate....

BTW, Amanda long time no see. You're now working 2 jobs????

 

[tussionex]

Take this one step further.

The medication security mandate of the Joint Commission requires only licensed staff who handle medications have access to the tube system to receive medications.

I have known surveyors who times the medication delivery system along with observing who has access to the tube system.

Prevent RFIs. Make sure the tube system is secure.

our tube system also encompasses the lab and the blood bank. how does JCAHO handle that?

 

[Epic]

our tube system also encompasses the lab and the blood bank. how does JCAHO handle that?

User passcode to open at the receiving end of the tube system takes care of the security mandate. Compliance, of course, is a whole another issue.

ADM (pyxis etc) requires user signon and passcode so why shouldn't the tube system when medications are involved?

 

[WVUPharm2007]

Anything that is a protein....more or less. It can be denatured, thus destroying its tertiary composition...or whatever....

 

[pion]

Speaking from retail - we have a ghetto metal box that travels out to the second lane of drive-thru. I once sent out a pint of roxicet and someone failed to screw the lid on completely. The patient sent it back without saying anything to us, so much to our surprise the box descends from the ceiling with what appears to be bright red blood gushing out of it. It was like a scene from the Shining (and quite a mess).

We no longer send liquids out that way 🙂

 

[bananaface]

I bet you had people outside licking the pickup station.

 

[DrugDealer]

I bet you had people outside licking the pickup station.

mmm...sparkly clean!

 

[RoyalBean]

The tube system is by far the most amazing feature of a hospital pharmacy, it amazes me every day.

We are not supposed to tube Chemo IVs, TPNs, Narcotics, and basically anything without a patient label on it. Oh, and no food.

No one seems to follow the rules, especially in the afternoon or nights. We tube random things to ORs all the time, even without paitent labels, that way you don't have to put on scrubs. Narcotics and food both get tubed a lot, but if you take something out of the vault, and tube it to where it needs to go, its under your name, and your screwed if it doesn't get there. I've never done it myself, but people who have worked there a while, including the pharmacists do it. Usually they call the station as the send it and keep them on the phone till they recieve it so that way it is more "secure". Also, don't let the supervisor see you do it.

I don't know why food shows up once and a while. There is no easy way to tell where things come from, so its just like a bonus i guess.

We tube 1 liter bags all the time, and I am amazed at the sucking power, i've never seen our system clog up once.

Also, maybe I am missing something basic, but why do some places not allow the tubing of patients own meds?

 

[psychoandy]

We "can't" tube the following...
-chemo obviously...and ganciclovir
-tpns...well tpns are too big...even the d10 mixes we walk up
-anything over 1 liter. but i've definitely broken this rule like a bicarb bag + some minibags. once we tubed 2 stat liter bags of pressors in 1 tube and we didn't get any complaints. i think the trick is getting a good tube, i.e. a new one where the bristle ring things aren't worn to hell.
-protein things like xigris, ATG, digibind, etc...we don't do albumin thankfully
-any controls...although rn's have offered to tube me things. i don't know how ANYONE would even consider doing that. we have like 70 tube stations and with my luck, i know my controls would be in the tube that goes to the wrong area. that and controls are always stocked in the med room or omnicell. way too much paperwork to even risk that.
-pt own meds aren't really tubed at my hospital
-golytelys and anything huge for that matter...as much as we'd like to

Glass things we DO tube...even the huge 500mL peripheral amios...just gotta double cushion, although i do worry that whoever opens it won't pay attention and will break it. I've NEVER heard of anyone breaking them. You'd be surprised how far high you can drop a d50/bicarb amp without it breaking...they bounce. We also tube plenty of expensive things like ampho b, dapto, and all the fancy gorillacillins. All of the weird blood things like epo we tube (i don't think there's that much room to slosh around, and the force of a tube hitting the station is about the same to me as dropping a vial on the ground), as well as most refrigerated things, since our rns are pretty good about throwing things in the fridge.

As far as JCAHO don't get me started...we don't have nearly enough staff to bring up everything or to even have techs/interns covering several floors...unless you consider 1 tech for 10 units a good ratio with minimal staffing in central/satellites. If it were up to me, I'd either make unit secretaries/personnel get licensed in something, or just have the RNs draw straws each day and 1 RN (or just the charge RN or something) deals with all tubes qshift. If you think about it the RN idea would make sense since you don't have 5 RNs opening up 5 tubes and putting meds or whatever in 5 different places...

With the secure tube system thing, I didn't even know a user passcode/id/whatever was even feasible. It would definitely be nice to have that kind of accountability for JCAHO, as well as potentially reducing missing med claims since they would have to log on to recieve a tube.

Now my question is...what's the weirdest item you've ever gotten in the tubes, other than 500ml bags of blood or urine specimens? I've never gotten food, but I have gotten a pair of glasses, pants, a cheap necklace, a love letter...why anyone would use tubes to send anything remotely important (like a pair of eyeglasses) is beyond me.

 

[tussionex]

last night one of the nurses tubed down a birthday card and dinner money for one of my techs. they're friends and she was too busy with her patients to come down the the pharmacy. sometimes she tubes us candy, too !

 

[pharmtard]

We were asked not to tube the 1L bags at a hospital I worked at because the initial suction power meant you had to "help" the tube get started.

One day one of my coworkers went up to the ER because pneumatic tube systems and fingers don't mix. Amazingly she was the only one it happened to, and we all pushed the bags up all the time.

Other than that the usual expensive/fragile/etc.

 

[njac]

I've had a satellite pharmacist tube me a book... a friend is a RN on a unit far, far away and we send each other notes (because we're dorks) all the time.


to be facetious when the crotchety night pharmacist is working she sends him love notes.

 

[lord999]

There's a pharmacist letter list somewhere out there about that issue:

My facility:

Prohibited:
Under 1 L
EPO/Darbo/biologicals
Electrical equipment (someone sent a PCA pump once that shattered)
Inhalers
Insulin (all types)
Emulsions (all types)
Xigris (It's $15K a treatment day here)
Biohazard materials (chemo, body fluids, radio)
Vaccines
Glass
340B orders
Live animals (Have no clue what triggered that one)

Things we can tube:
Narcs (because there is a secure function)
TPNs
Inpatient orders

 

[sdn1977]

Years & years ago....there used to be this really handsome hospital engineer who would have to be called when the tube system when down.

There was another pharmacist who was brand new - from the Univ. of Mich I think. She & I would "break" that darn system 2 or 3 times a night. This engineer would have to come down ot "fix"it - (the controls were in the pharmacy)....so we spent lots & lots of time with Mr.Handsome....

Now - there is the true story of the nurse who rode the dumbwaiter down to the pharmacy after we had closed. She tried to get access to the pharmacy for "nefariious" reasons (it was locked on our side). This poor woman spent hours riding the dumbwaiterr until she could get off - then she was hauled off for rehabilitation. Don't know whaat every became of her..

 

[Epic]

Years & years ago....there used to be this really handsome hospital engineer who would have to be called when the tube system when down.

There was another pharmacist who was brand new - from the Univ. of Mich I think. She & I would "break" that darn system 2 or 3 times a night. This engineer would have to come down ot "fix"it - (the controls were in the pharmacy)....so we spent lots & lots of time with Mr.Handsome....

Now - there is the true story of the nurse who rode the dumbwaiter down to the pharmacy after we had closed. She tried to get access to the pharmacy for "nefariious" reasons (it was locked on our side). This poor woman spent hours riding the dumbwaiterr until she could get off - then she was hauled off for rehabilitation. Don't know whaat every became of her..

You know, I was a tube/dumbwaiter engineer before I started pharmacy school. And some nights, pharmacy will always screw up the tube system and I would get paged to go fix it. And there were these 2 hot female pharmacists giggling in the corner as I worked while purposely showing off my butt crack....

 

[Epic]

But all I want to say right now is San Jose airport sux....😡

And I hold you responsible SDN1977...

 

[bananaface]

There's a pharmacist letter list somewhere out there about that issue:

My facility:

Prohibited:
Under 1 L

Under? 😕

Y'all got some big tubes.

 

[eman77]

If you remove the air from an amiodarone bag, will it still foam in the tube system? Just a thought I had.