Pyxis Machines...Burning Question!!!

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Shrav

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Hey All,

I am currently a pre pharm student and hoping to get into pharmacy school next year. Right now I am shadowing a hospital pharmacy in a small town and just getting the hang of things (pyxis...IV's etc.) its pretty fun and really interesting stuff. While learning about the Pyxis...I did ask what is done if a patient is in ER and the nurse needs medications out of the pyxis? Since the patient has just rolled into ER...I don't think he has his file/record on the pyxis or even on the hospital mainframe.....so how would you go in and take meds out of the machine without a name....to this i was told that the nurses can go ahead and just put a fictitious name out there temporarily to get stuff out and then its their responsibility to update the file and charge the patient.

I can understand this happening for a smaller hospital where the isn't a huge rush of patients in ER all the time....but what about bigger hospitals? Is there a special pyxis machine for ER that can deal with these problems? Just was curious.

Thanks in advance
Cheers

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Hey All,

I am currently a pre pharm student and hoping to get into pharmacy school next year. Right now I am shadowing a hospital pharmacy in a small town and just getting the hang of things (pyxis...IV's etc.) its pretty fun and really interesting stuff. While learning about the Pyxis...I did ask what is done if a patient is in ER and the nurse needs medications out of the pyxis? Since the patient has just rolled into ER...I don't think he has his file/record on the pyxis or even on the hospital mainframe.....so how would you go in and take meds out of the machine without a name....to this i was told that the nurses can go ahead and just put a fictitious name out there temporarily to get stuff out and then its their responsibility to update the file and charge the patient.

I can understand this happening for a smaller hospital where the isn't a huge rush of patients in ER all the time....but what about bigger hospitals? Is there a special pyxis machine for ER that can deal with these problems? Just was curious.

Thanks in advance
Cheers

This is a huge agenda on the Joint Commission's Medication Management section 4, pharmacy oversight of medication delivery in the ER.

This mandate states every medication dispensed must have a prospective review by a pharmacist unless the prescriber is present when the medication is administered or under emergency situation.

The situation you described where the nurse puts in a fictitious name is called "override" which is frowned upon by the CMS and the JC. Now, a simle retrospective review by pharmacy of the override list isn't good enough. Hospitals are having to employe ER pharmacist who checks the order before a medication is adminsitered. Not everyone is doing it yet. But the JC is certainly pushing for it.

May I suggest you ask your preceptor/pharmacist what does the Joint Commission think about nurses just taking the medications out of Pyxis?
 
Sure thing...I was beginning to point out issues that can could be addressed...but did not know how it was done in bigger hospitals..thanks for the reply...will ask the pharmacist post it on here...I did have another question...is the Pyxis machine used by every hospital in the United States??..I did see that it is really popular amongst hospital pharmacies but some places still do without the Pyxis...i cannot imagine how that would be done....😕...and also does every single med from the pharmacy go into the Pyxis....right now where I am...its just the ones that are not used regularly that go on the Pyxis...the regular meds go into the drug cart on each floor of the hospital....
 
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I work for a hospital that uses pyxis, but are responding to the Joint Comission in a different way. Instead of putting a pharmacist in the ER at this time, they are just making less drugs available on the "override" function. However, this causes problems, when our order entry system in the hospital quits communicating with pyxis (which with our new system, this is a frequent occurance). However, we do not have the pharmacists to place one in the ER. I am actually interested in ER pharmacy, and hope that once I get done with school and a residency that I will be able to go into the hospital and be a leader in getting a pharmacist in the ER!

Some hospitals do not use pyxis, there is a hospital that I know that just got their first pyxis machine.
 
and also does every single med from the pharmacy go into the Pyxis....right now where I am...its just the ones that are not used regularly that go on the Pyxis...the regular meds go into the drug cart on each floor of the hospital....

I know where I am at know we only put controlled substances and floor stock in the pyxis. Regular meds that come from pharmacy for indivdual patients get put in the drop off bin for the nurse to put in the patient's med drawer.
 
Sure thing...I was beginning to point out issues that can could be addressed...but did not know how it was done in bigger hospitals..thanks for the reply...will ask the pharmacist post it on here...I did have another question...is the Pyxis machine used by every hospital in the United States??..I did see that it is really popular amongst hospital pharmacies but some places still do without the Pyxis...i cannot imagine how that would be done....😕...and also does every single med from the pharmacy go into the Pyxis....right now where I am...its just the ones that are not used regularly that go on the Pyxis...the regular meds go into the drug cart on each floor of the hospital....

Most hospitals in the US have some sort of automation.

Pyxis by Cardinal. Acudose by McKesson, MedSelect by Amerisource/Bergen..then there is Omnicell.

Those are the 4 major AMDs.
 
I work for a hospital that uses pyxis, but are responding to the Joint Comission in a different way. Instead of putting a pharmacist in the ER at this time, they are just making less drugs available on the "override" function. However, this causes problems, when our order entry system in the hospital quits communicating with pyxis (which with our new system, this is a frequent occurance). However, we do not have the pharmacists to place one in the ER. I am actually interested in ER pharmacy, and hope that once I get done with school and a residency that I will be able to go into the hospital and be a leader in getting a pharmacist in the ER!

Some hospitals do not use pyxis, there is a hospital that I know that just got their first pyxis machine.


True...I know of one hospital here that plans to get it in the start of the new year...ER pharmacy does sound pretty fun...but also wouldn't it be the same as the regular pharmacist duty just for longer hours and a shift system (as there as to be a pharmacist present every time)...how would it be any different from a regular hospital pharmacy?
 
I work for a hospital that uses pyxis, but are responding to the Joint Comission in a different way. Instead of putting a pharmacist in the ER at this time, they are just making less drugs available on the "override" function. However, this causes problems, when our order entry system in the hospital quits communicating with pyxis (which with our new system, this is a frequent occurance). However, we do not have the pharmacists to place one in the ER. I am actually interested in ER pharmacy, and hope that once I get done with school and a residency that I will be able to go into the hospital and be a leader in getting a pharmacist in the ER!

Some hospitals do not use pyxis, there is a hospital that I know that just got their first pyxis machine.

Less medications on the override list in ER Pyxis is one solution. Then, every ER order must be processed by the Pharmacy. Still not a bad idea. Just a lot more work for the pharmacy...and I can see the ER getting agitated waiting for that emergency docusate 100mg.
 
I know where I am at know we only put controlled substances and floor stock in the pyxis. Regular meds that come from pharmacy for indivdual patients get put in the drop off bin for the nurse to put in the patient's med drawer.

Yep thats kind of what is happening here too...but only some controlled meds tend to get in the Pyxis. I am still trying to figure out the pattern of what to put in the Pyxis and what not to....it seems to me that there is no clear boundary that this HAS to be in the Pyxis and this can be out on the med drawer as well....but of course I could be mistaken...
 
True...I know of one hospital here that plans to get it in the start of the new year...ER pharmacy does sound pretty fun...but also wouldn't it be the same as the regular pharmacist duty just for longer hours and a shift system (as there as to be a pharmacist present every time)...how would it be any different from a regular hospital pharmacy?

There is nothing different about the ER pharmacist. The way I had it at my last hospital, I had a pharmacist on every floor processing orders. To have an ER pharmacist means....you place a pharmacist in ER to process orders right there. But think about it. 24/7 coverage of pharmacist in ER means 4.25 pharmacists. At $140,000 per pharmacist (with benefits)... we're looking at $600,000 per year.

Can your hospital afford it? Or Can your hospital afford not to do it... those are the questions your administrators must ask and answer.
 
There is nothing different about the ER pharmacist. The way I had it at my last hospital, I had a pharmacist on every floor processing orders. To have an ER pharmacist means....you place a pharmacist in ER to process orders right there. But think about it. 24/7 coverage of pharmacist in ER means 4.25 pharmacists. At $140,000 per pharmacist (with benefits)... we're looking at $600,000 per year.

Can your hospital afford it? Or Can your hospital afford not to do it... those are the questions your administrators must ask and answer.


True..... very true...I can imagine that only the bigger hospitals (say one per main city) would be able to afford that cost...but the other alternatives as mentioned was just more work for the pharmacy and also the frustration factor for ER waiting on their meds....that would just mean that there is no long term solution for the problem..as hiring an ER pharmacist is feasible for only a select few hospitals....and directly taking meds from the pharmacy is a painstaking process....so what way is there around this? I presume that even bigger hospitals as yet do not have ER pharmacists that work 24/7 (keeping in mind that the concept is just catching up)....
 
Less medications on the override list in ER Pyxis is one solution. Then, every ER order must be processed by the Pharmacy. Still not a bad idea. Just a lot more work for the pharmacy...and I can see the ER getting agitated waiting for that emergency docusate 100mg.

At first the system had a lot of kinks in it, which was mainly due to the fact that the ER was faxing orders to the pharmacy instead of scanning them like the rest of the hospital does. They know have it set up for scanning, and the system is running smoothly. The nurse can usually get a med out of the pyxis for a patient w/in 5-10 minutes depending on the workload in the pharmacy.
 
True..... very true...I can imagine that only the bigger hospitals (say one per main city) would be able to afford that cost...but the other alternatives as mentioned was just more work for the pharmacy and also the frustration factor for ER waiting on their meds....that would just mean that there is no long term solution for the problem..as hiring an ER pharmacist is feasible for only a select few hospitals....and directly taking meds from the pharmacy is a painstaking process....so what way is there around this? I presume that even bigger hospitals as yet do not have ER pharmacists that work 24/7 (keeping in mind that the concept is just catching up)....

You're getting a first hand experience on the Joint Commission's ruthless mandate without the consideration of difficulty of implementation. And it's our job to scratch our heads..and come up with something that will work.

That's why hosital pharmacy is intriguing, exciting, and the sky is the limit, if you want it to be.
 
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At first the system had a lot of kinks in it, which was mainly due to the fact that the ER was faxing orders to the pharmacy instead of scanning them like the rest of the hospital does. They know have it set up for scanning, and the system is running smoothly. The nurse can usually get a med out of the pyxis for a patient w/in 5-10 minutes depending on the workload in the pharmacy.

How about during the graveyard shift?
 
Yep thats kind of what is happening here too...but only some controlled meds tend to get in the Pyxis. I am still trying to figure out the pattern of what to put in the Pyxis and what not to....it seems to me that there is no clear boundary that this HAS to be in the Pyxis and this can be out on the med drawer as well....but of course I could be mistaken...

I know what you are saying. I think it probably varies from hospital to hospital and even floor to floor. I know as a general rule at the hospital I work at, most prn meds are placed in the pyxis while those meds that are on a schedule are placed in the patients med. drawer. There is exceptions to this rule, and a lot of times the lines get really fuzzy. You just have to get use to how your insitution does it.
 
How about during the graveyard shift?

about the only time during the graveyard shift that it gets gammed up, is when there is a code in the hospital,and that is just because there is only one pharmacist. As long as no code is happening, then the pharmacist on graveyard can usually handle the workload just as quick as they do in the daytime.
 
I know what you are saying. I think it probably varies from hospital to hospital and even floor to floor. I know as a general rule at the hospital I work at, most prn meds are placed in the pyxis while those meds that are on a schedule are placed in the patients med. drawer. There is exceptions to this rule, and a lot of times the lines get really fuzzy. You just have to get use to how your insitution does it.

The pharmacy and therapeutics commettee should dictate what goes into which cabinet... which means the pharmacy and each unit should corroborate and define what should be on the list.
 
In the hospital I work at, we are actually expanding the use of our Pyxis machines to include more towers and drawers. The goal is to have everything in the pyxis by end of the year. Of course, we can't possibly load every drug in the formulary on every unit. Basically, we starting with loading the machines with the most commonly used drugs for the floor not just the prn and controlled stuff. The techs have the "load" and "unload" functions in their pyxis profiles. When the nurses scan orders for meds that are not loaded in the pyxis the techs go out and load those meds (of course, the pharmacists check them first). If the machines are full, we first run a report to see which meds are not being used by the nurses. We, then, unload those meds and load the new ones in. Its a lot of work but it has dramatically cut down on the need for cart fills and exchanges. It has also cut back the meds that goes back to pharmacy for credits. We have pyxis in the ER too. But I have not yet seen a problem with nurses accessing meds for patients. If they don't have it in their pyxis we just tube it to them (as long as its not a controlled med or an expensive med, in which cases they come and pick it up), after they send us the order. They do have override functions for some of the meds that are in the pyxis. However, overrides are highly discouraged as much as possible.
 
I work in an 800 bed hospital, almost every floor is what we call SureMed always, which means no patient drawers, everything that floor needs is in the machine.

The Emergency room thing is scary, everything is on override. I did an impromptu survey of users removing C-II meds from the ER OmniCells, and found a nurse taking out 6 times the amount of hydromorphone 2mg syringes than any other nurse per month. I approached the nurse manager, he said she was a "float nurse" and this was normal, as she is the one who runs to get all of the meds while other nurses stabilize patients. Sounded like a convenient position to hold to me. I told him to make sure she was documenting all of the narcotics she was pulling out. He said he trusted her, but would look into it. One week later, he emailed my boss requesting that this nurse's access to the OmniCells be revoked.

On a brighter note for Epic, in our 800 bed hospital, only one active carbapenem order total for the last week. So much for the empiric use the "guidelines" recommend. Three piperacillin/tazobactam orders active in the last seven days......
 
At the old hospital I used to work at, they did an annual audit of the machines and they found that over 500 unit doses of Zithromax had "disappeared" that year. It was before it went generic.....it cracked me up at the time. They actually made it a perpetual inventory drug from that point on...haha...
 
On a brighter note for Epic, in our 800 bed hospital, only one active carbapenem order total for the last week. So much for the empiric use the "guidelines" recommend. Three piperacillin/tazobactam orders active in the last seven days......

How many active Echinocandin, Linezolid, Dapto, and Tygacil?
 
At the old hospital I used to work at, they did an annual audit of the machines and they found that over 500 unit doses of Zithromax had "disappeared" that year. It was before it went generic.....it cracked me up at the time. They actually made it a perpetual inventory drug from that point on...haha...

ZPak...most stolen med by pharmacists...I've been told.
 
At the old hospital I used to work at, they did an annual audit of the machines and they found that over 500 unit doses of Zithromax had "disappeared" that year. It was before it went generic.....it cracked me up at the time. They actually made it a perpetual inventory drug from that point on...haha...

Antibiotics mysteriously disappear from Pyxis during the cold season.. I wonder why...

That's why I treat ABX like a controlled substance with blind count system..where nurses can't cheat..
 
We don't have a 24hr pharmacist - its just not cost effective.

IMO, I'd disagree with Epic - there is not a huge problem with JC when you have consistent drug protocols with predefined order sets.

We use this both in the ER & ICU. Our "demographic" interface falls behind the actual patient time-wise...so, even if we have an order right in front of us - the computer interface is lagging.

So - we have order sets - STEMI, stroke in progress, traumatic pain, etc...

For ICU, we have standard post-op, CABG, trauma surgery, valve replacements, etc...

This gives basic & primarily needed medications for resucitation & pain relief, even if we have a John or Jane Doe. The name & medical record number is entered later when it is acquired. It also gives some basic antibiotic choices - some situations will require by JC an antibiotic given within a certain number of hours of the labwork being drawn & the OR cut time or other intervention.

This gives nursing/medicine choices to make the first acquisitions out of pyxis without interferring with JC requirements or medical necessity.

For actual code situations, you bypass pyxis entirely & use the code cart. No passwords or computer entry is needed.

The important thing you always need to remember - we are responsible for not just getting the right drug to the right patient - but ALSO at the right time! If we let machines get in the way of the right time - the other issues get forgotten.

All our medications are in pyxis. We no longer have drug carts. Most everything that might be required is available in one pyxis or another throughout the hospital. Since each pyxis is updated daily with new medications, one of the resposibilities of the outgoing pharmacist is to give the latest list of medication possibilities to the nursing supervisor. He/she can always access something at night & most often, there is another choice. There is rarely a reason for a pharmacist to return to work at night - once or twice a year perhaps.

Our pyxis lists do not go thru P&T. We meet with the nurse managers on whatever service the pyxis is located on, get input from the physicians on that medical service, then adjust pyxis accordingly. We evaluate it monthly based on usage & delete those items which don't have significant turnover.
 
At the old hospital I used to work at, they did an annual audit of the machines and they found that over 500 unit doses of Zithromax had "disappeared" that year. It was before it went generic.....it cracked me up at the time. They actually made it a perpetual inventory drug from that point on...haha...

Are you serious??? How can that have been cost effective?
 
How many active Echinocandin, Linezolid, Dapto, and Tygacil?

Zero tigecycline (probably no use in a month), one daptomycin, hold for the others. Linezolid and caspo will be a bit higher, always under 10 active orders though. Can't remember precisely the number when I grabbed the report this morning.
 
We don't have a 24hr pharmacist - its just not cost effective.

IMO, I'd disagree with Epic - there is not a huge problem with JC when you have consistent drug protocols with predefined order sets.

You disagree with me because we're not talking about the same thing. Order sets and protocols have nothing to do with the JC MM 4.1 which requires pharmacist oversight on ever drug dispensed in the hospital. The big issues of the late has been the ER and Radiology. Maybe you haven't been involved with it. There are many medications dispensed from ER without pharmacist prospective check...like tylenol and docusate...unless pharmacy dispenses those in your hospital which I doubt. Yes, the JC wants pharmacist to check everything before it's administered to patients unless Prescriber dispenses and administers or in full supervision of administration and/or in emergency situation. So the protocol you have in place which dictates what drugs are used for different disease state doesn't help here unless those drugs are checked by a pharmacist before it's dispensed. This is a huge problem and an issue...just like the Medication Reconciliation which the JC made us do..which many hospitals failed miserably.

Now, in your non 24/7 hospital, how will you handle prospective chcke of medication that is dispensed in the ER? You can't..... guess what, the JC doesn't care you're not 24/7...they may just as well issue an RFI on it.. See, another example of irresponsible mandate.

Our pyxis lists do not go thru P&T. We meet with the nurse managers on whatever service the pyxis is located on, get input from the physicians on that medical service, then adjust pyxis accordingly. We evaluate it monthly based on usage & delete those items which don't have significant turnover.


Check your policy and procedures. On most P&P I have used requires an annual approval of fthe list of floor stock medications which is also the JC mandate...along the line of having the formulary and emergency med list approved annually. The drugs in Pyxis are considered "floor stock med."

Of course you work out the details of what goes in the cabinet with nursing...but you still have to get the list approved prospectively or retrospectively through P&T.

Though I work primarily with clinical stuff now... I'm still plagued by rugulatory and operational issues of pharmacy.
 
Zero tigecycline (probably no use in a month), one daptomycin, hold for the others. Linezolid and caspo will be a bit higher, always under 10 active orders though. Can't remember precisely the number when I grabbed the report this morning.

How would you like to ID a candida in 2.5 hours? I have a meeting next week to learn about this....could be worth millions in savings in Echinocandin use..
 
No - I am talking about MM 4.1. There are 2 exceptions - when the LIP is either administering or present during the administration of the medication. That pretty much covers all our standard post-op & ER standard orders. These don't include acetaminophen, unless temperature reducation is imperative (urgent) - then, the LIP is "present". So far, no one actually has tried to observe our LIP at the bedside, altho Darryl Rich woud have you believe that actually happens. "Bedside" has many connotations & often does within a community hospital. JC inspectors live in different reality. The standard orders which are used for a John or Jane Doe are truly considered emergent/urgent. So far, we don't have to actually have video documentation the physician stood writing notes while the nurse pushed the 4mg MS....🙄

There is NO urgent or emergent situation for docusate - contrary to what any nurse might say.

Since we rarely have pts "boarded" in the ER, there is often not much need for prospective review - just retrospective. However, if a prosepctive review is needed, the order gets "bumped" to the ICU pharmacist. Silly actually - like I'm going to argue with a physician about adding Levophed....no so much in an emergent situation. Just get the d*mn Levophed (which is why so often they bypass pyxis & get into the crash cart:meanie:).

As for our p&p - we have an annual review of all pyxis changes. But, that doesn't mean the contents don't change monthly, if not daily! What is in pyxis reflects the pts on the floor at the time. For those items that are kept routinely, yes....they get "blessed" more often than annually - usually quarterly.

Again - making the rules fit the scenarios. So far, no dings.

The only real issue for us is radiology or cath lab. The techs give the dye, but now we make sure the chart shows an LIP present - it can be anesthesia, cardiology or radiology - whichever is appropriate. The times must just "jive". So - they don't take it out of pyxis until the LIP gets there. Again - no need for prospective review by pharmacist. For L&D, its really silly.....prospective review means all pts will get their oxytocin approved. Again - who are we to argue with an OB who says the pt needs oxytocin?

For those orders that only require retrospective review - booooorrrrring!

An overwhelming reason to think twice about being a hospital pharmacist without experience!
 
No - I am talking about MM 4.1. There are 2 exceptions - when the LIP is either administering or present during the administration of the medication. That pretty much covers all our standard post-op & ER standard orders. These don't include acetaminophen, unless temperature reducation is imperative (urgent) - then, the LIP is "present". So far, no one actually has tried to observe our LIP at the bedside, altho Darryl Rich woud have you believe that actually happens. "Bedside" has many connotations & often does within a community hospital. JC inspectors live in different reality. The standard orders which are used for a John or Jane Doe are truly considered emergent/urgent. So far, we don't have to actually have video documentation the physician stood writing notes while the nurse pushed the 4mg MS....🙄

Darryl Rich is an SC grad...tho we tore him a nice one 2 years ago.. 60 DOPs ganged up on him.....poor guy.

JC surveyors have been easy on ER ....but the last PPR, we got an RFI on ED... with 200 visits per day, there is no way the LIP is "present" on all meds dispensed. Again, it's an unreasonable mandate...especially when the hospital pharmacy isn't 24/7. It's also very difficult for larger hospitals with 300 visits to the ER per day...
 
our pyxises's stock is floor stock and narcotics only. we dont have the $$ or the pharmacy resources to support a full-on, everything in pyxis approach just yet. i honestly dont know how we are addressing the JC mandate about pharmacists' review of ER orders; that's for my dop to worry about...i just have to make the machines work.
to answer the OP from a pharmacy/IT combination perspective...our interface from hospital ADT is fast, really fast...when the A01 [admit] message is sent from the hospital ADT system, it reaches the pyxis workstation 30 seconds to 1 minute later. our ER patients are registered at the bedside, which can cause problems if the nurses want to give meds before the registration staff has gotten to that bed...in those cases, the nurses have the option to manually enter the patient onto the pyxis census...but the mobile registration folks are usually pretty quick to get to the patient and this is becoming less of an issue.
our ER machines are "non-profile"...meaning they dont display the patient profile, just a list of meds from which the nurse can pick according to an order. this is acceptable for floor stock meds. on our floors, however, we will be using "profile" mode, where the patient profile from the pharmacy computer system will be displayed as a pyxis profile on the workstation.
 
Darryl Rich is an SC grad...tho we tore him a nice one 2 years ago.. 60 DOPs ganged up on him.....poor guy.

JC surveyors have been easy on ER ....but the last PPR, we got an RFI on ED... with 200 visits per day, there is no way the LIP is "present" on all meds dispensed. Again, it's an unreasonable mandate...especially when the hospital pharmacy isn't 24/7. It's also very difficult for larger hospitals with 300 visits to the ER per day...

Newer EDs are being designed in "pods" in large hospitals so the LIP is really "present" for each patient. Poor Darryl - he did not define "presence" - like in touching the sheets.

Now - the bedside might be 20 feet away - but not "outside" the room as in the old fashioned EDs...

Interesting way to get around the issue - particularly when CA hospitals have to be remodeled by 2013 (it used to be 2008, but was extended I think) to get around the earthquake safety standards.

Ultimately cheaper - to spend the $$ on capital improvements to keep the LIP nearby rather than commit to an often unnecessary labor committment.

As a pharmacist, this along with med rec is one of the more ridiculous & embarrassing pharmacist instigated rules JC has made!

I'm fully in favor of pharmacists being an integral person in the hospital, but really, I don't need to prospectively give the OK for the 86 yo F with a broken hip to get her 4mg MS prior to transport to the floor.
 
.

As a pharmacist, this along with med rec is one of the more ridiculous & embarrassing pharmacist instigated rules JC has made!

I'm fully in favor of pharmacists being an integral person in the hospital, but really, I don't need to prospectively give the OK for the 86 yo F with a broken hip to get her 4mg MS prior to transport to the floor.


i second that, sdn....and if we have to prospectively ok the 4mg of MS [unacceptable abbreviation😉], how come we don't have to prospectively ok it at the pre-hospital level? or, are we going to have to ride with the paramedics next? the JC needs to get a little bit of a clue.
 
i second that, sdn....and if we have to prospectively ok the 4mg of MS [unacceptable abbreviation😉], how come we don't have to prospectively ok it at the pre-hospital level? or, are we going to have to ride with the paramedics next? the JC needs to get a little bit of a clue.

👍
 
How would you like to ID a candida in 2.5 hours? I have a meeting next week to learn about this....could be worth millions in savings in Echinocandin use..

Please let me know how this meeting goes and your thoughts on the product offered....either on here or PM.
 
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