Pyxis Machines

[Requiem]

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Step up to the large vending machine with bright colors and familiar logos. Scan the delectable treats. Put in $1.50. Hit C5. Out comes your Reese Peanut Butter Cups.

Step up to the large, dull grey machine. Scan your thumb. Push "G", find "ganciclovir", out comes your vial. Give it to your patient overnight, and again as pharmacy still haven't entered that order!

Time for patient's third dose. Still not there. What is wrong with pharmacy?! Phone them, where is my patient's dose? This was ordered last night!

I take this phone call. Oh, yes ma'am I've found the script. We've been trying to contact the resident as... *interrupted*

But I've been giving this to him all night! What is wrong with it!


... as the patient is in renal impairment and this dose will cause accumulation and subsequent toxicity.

Oh.

Well at least he didn't get his 1000 dose! Haha!



This not so fictitious depiction of some of the problems with pyxis is something that I have concerns about. I agree people need meds overnight when pharmacists aren't around, but this isn't the best option. I think we need an overnight pharmacist... I can't see another way around it. Otherwise we have nurses who are in effect acting as pharmacists when they choose to order up and dispense their med and it is without a proper check. What are your sites doing? How do you feel about this?

 

[spacecowgirl]

We have 24 hour verification. When we're not there, we have off-site verification by another facility in our organization. We have a list of meds that are on critical override that can only be taken out by the charge nurse (except in ER and OR). We monitor override activity and do our best to make sure that overrides are used sparingly. You need better Pyxis management.

 

[All4MyDaughter]

We have 24 hour verification. When we're not there, we have off-site verification by another facility in our organization. We have a list of meds that are on critical override that can only be taken out by the charge nurse (except in ER and OR). We monitor override activity and do our best to make sure that overrides are used sparingly. You need better Pyxis management.

I didn't know nurses could just get stuff out of Pyxis without a valid order. But I work in a hospital with 24 hour coverage.

 

[spacecowgirl]

I didn't know nurses could just get stuff out of Pyxis without a valid order. But I work in a hospital with 24 hour coverage.

They probably do at your facility too, you just don't know about it Do you run override reports? Do they have the inventory function capability? Anything in a matrix drawer can be fair game as well. If you are getting calls for restocks that don't match your pick lists, you know that they are getting stuff out that is not being accounted for.

But not having on-site coverage 24/7 is why we allow overrides. Not sure what other places do.

 

[owlegrad]

I didn't know nurses could just get stuff out of Pyxis without a valid order. But I work in a hospital with 24 hour coverage.

Here it takes one nurse and the charge nurse to perform an override, which is only allowed after hours. And they frequently make mistakes about what they were supposed to pull. We check the override report and compare it to the overnight orders to make sure everything is correct. It usually is, but not always.

 

[confettiflyer]

You need better Pyxis management.

QFT.

Critical override should not be SOP.

 

[All4MyDaughter]

They probably do at your facility too, you just don't know about it Do you run override reports? Do they have the inventory function capability? Anything in a matrix drawer can be fair game as well. If you are getting calls for restocks that don't match your pick lists, you know that they are getting stuff out that is not being accounted for.

But not having on-site coverage 24/7 is why we allow overrides. Not sure what other places do.

Yes, we do run override reports. So I do suppose it can happen. There would be an override of the BCMA system too. And it wouldn't show on the MAR as administered either. Circumventing all that technology sounds dangerous. I guess I am just not that familiar with what happens overnight.

 

[fungikid]

QFT.

Critical override should not be SOP.

It is at the hospital I worked at. Come 9pm and Critical Override is on until next morning at 8am.

 

[ethyl]

For our Pyxis, overrides are very discouraged and most nurses are afraid to do it because most of them have been burned. We have an electronic MAR and a 24 hour pharmacy, so usually we get the orders entered timely... but a Pyxis problem still lurks around when nurses pull and administer meds for drugs that may be suspended. Our Pyxis doesn't restrict a suspended order and dispenses it with no problem.

 

[confettiflyer]

It is at the hospital I worked at. Come 9pm and Critical Override is on until next morning at 8am.

my keyword is "should." I know the reality is pharmacy coverage isn't available 24/7 at some institutions, hopefully that'll change as a glut of pharm graduates and lower wages could make it more cost effective to have some review overnight.