Each person creates their individualized kits based on personal preference, then gives them a unique name in the pyxis kit software. For instance, anyone at my hospital with anesthesia access can log-on, press the master kit icon, and will given the choice to create their own kit, or withdraw meds for their patient using my kits:
Trin big geta = 5 mg midaz, 10 mg morphine, 500 mic fent
Trin little geta = 2 mg midaz, 250 mic fent
Trin carcinoid = 5 mg midaz, sandostatin, albumin, 1 mg fent, etc.
Same idea for CABG, little MAC, big MAC, etc. Much easier than requesting the meds one by one, especially when you're getting meds for a big case.
This is pretty much what we have for all our "regular" anesthesiologists.
We have a few locums who come in so we have general kits as well - c/s, appy, etc.
We have about 5 Pyxis throughout the OR & each anesthesiologist has their own carts uniquely set up the way they want. Each cart has dantrolene & a small intralipid, also one of each in pyxis. Dantrolene gets tossed more than it gets used & its expensive, but ...... the cost of doing business.
Additionally, there is some of each drug, which is contained in each kit, in pyxis as individual drugs so they can be accessed alone - in case something gets dropped, extra is needed, etc. All drugs are listed by their generic name, which is a problem for nurses at times. We try to keep a list of the newer brand names & how they're listed in Pyxis right on the top of the machine so they're not looking. During the weekdays, if extra of anything is needed, the circulator calls the pharmacy & we bring it from the OR pharmacy stock - the circulator never leaves the room for drugs while we are there. Its just easier & faster for us and them.
All our "licensed" personnel have logins, fingerprints & passwords. They can use either fingerprint or password - their choice. So, all nurses - RN, LVN, techs, perfusionists, physicians, etc can all get in. Likewise, our locums physicians or relief nurses are given a rotating login/password for that day - no fingerprints. For physicians, if they have access level to the OR, they have access level to PACU, ICU, L&D, ED & the step down unit. So far, that has covered their needs, but can be changed by any pharmacist at any time just by changing the programming - it takes minutes & doesn't require any administrative "mess". There is a pharmacist 24/7 who can make these changes, so far we haven't heard complaints if there are any.
In the beginning, it was a steep learning curve. The biggest problems were what you noted - the jam at 0545, the fine tuning of the kits, running out of drug during long cases, getting the transition set up for anesthesia to get the post-op drugs running in ICU, etc...
But, patience & many meetings & feedback helped. Also, the pharmacy can go a long way in presenting the whole system as a way to facilitate better drug usage rather than capturing charges or following diversion, which it does well. The primary purpose for all of us is the patient, so the system should not prevent good patient care by being a burden. Yeah, the bean counters like it, but we found by removing some of the really needed items - dantrolene, lipids, etc...and keeping those readily accessible was far more important than the charges.
But, we've got good communication with OR & pharmacy so that goes a long way. A few years back, administration tried to cut staff & one place they looked at was the OR pharmacists since we had put in Pyxis. The OR director absoutely said no. Don't know what kind of power he has, but we're still there and have added more pyxis units.
