pyxis questions

[tussionex]

ok, so i asked over in gasforums for some OR specific input...so i thought i would pop this up on the pharmacy board too.

we are smack in the middle of a pyxis rollout...non profile for now, profile early next year.

what does everyone like/hate....ideas for improvement?


thanks a lot!

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[njac]

umm details?

I haven't dealt with the pyxis med machines... just accudose and omnicell, although we use pyxis connect...

 

[Maestrojo]

oh boy pyxis can be a really good thing or a bad thing. you will go through a series of problems that pop upbut they are easily fixed. here are just a few of them:

1. PO meds like asprin/tylenol/nexium/protonix/levaquin/and sometimes even zyloprim will always come up short. This is because nurses are taking extra for their "personal" use. So, even though they aren't narcotics you should still implement a blind count on those meds.

2. If you have a narcotic drawer that is 2 or more sections deep and there are meds in the back pocket, nurses will sometimes move the narcs to the front of the drawer which creates discrepencies. The Pyxis will think there are meds in the back pocket when there really isn't, because they were moved to a pocket that was supposed to be empty!

3. If you're using the fingerprint pass you will get a ton of complaints about it. After about a month of use they start to go bad so make sure you have extra thumb print boxes on hand just in case one needs to be replaced.

4. NEVER overfill a pocket or carosel drawer. If you have a particular patient using a lot of a specific med, just bring the meds up to be filled in the med cart drawers. IF you overfill there are a couple of things that can go wrong:

4a. Meds can fall inside the pyxis machine which is a real pain becuse drawers that seems perfectly fine will constatnly "mysteriously" jam for no reason.

4b. If you get your meds unit dosed (packs of 10) then always make sure you tear up every pill. If you throw the whole sheet in a pocket you increase the chance of a getting stuck in a drawer plus nurses will sometimes pull out the whole sheet, tear a pill off and drop the sheet into the wrong pocket!

But in the end pyxis won't really make your job easier but it will keep things organized. Once you work out the kinks its a very nice system to use. Our hospital has been using it for about 3 years.

Man, there are so many things I can tell you about pyxis. I can type another post that is this same length, but i've got homework to do.

Let me kow if you have any specific questions.

BTW topic creator, I like your name.

 

[WVUPharm2007]

I swear to god this is true....if all else fails smack the thing. I fixed countless Pyxis machines that way back in the early college technician days.

Also, that autonomous robot is a bad idea. The damn 5 ft. tall thing got lost and wound up in a patient room once....scared the crap out of this elderly patient when it stopped at the foot of his bed and kept repeating "please remove the obstruction" over and over again...at least until someone from the pharmacy came over to retrieve the 800 lbs paperweight. Dude thought he was losing his mind at first.....

 

[pharmboy30]

teach RNs how to recover a drawer so you don't get 43 calls about it - all it really takes is push one button, the drawer should pop out, check the pockets for any jams, etc and close.

drawer won't shut? kick it.

make sure RN's remember their passwords so when the fingerprint fails, you don't have to reset it.

make other RN's witness other RN discrepancies, they shouldn't feel like they need to call pharmacy every time to fix....

 

[Maestrojo]

teach RNs how to recover a drawer so you don't get 43 calls about it - all it really takes is push one button, the drawer should pop out, check the pockets for any jams, etc and close.

Ha,

the nurses in our hospital dom't even bother fixing it. they just leave the door cropped open and travel to another ward to pull meds.

 

[Shrav]

Ha,

the nurses in our hospital dom't even bother fixing it. they just leave the door cropped open and travel to another ward to pull meds.

Wow...thats new news to me....the place where I work is fine..except for surgery and anesthesia always send up a sheet of what they use out of their anesthesia carts (diprivan, lidocane, fentanyl, ultane etc...) and we get an idea what to charge the patient because they go ahead and refill their carts from the pyxis...so we just check the sheet that they mark all the stuff used and compare it to what comes out of the pyxis...it works...but for the odd staff anesthetist who feels that the patient can get free meds and does not enter it on the pyxis...any one else having trouble with that?

 

[humira49]

Wow...thats new news to me....the place where I work is fine..except for surgery and anesthesia always send up a sheet of what they use out of their anesthesia carts (diprivan, lidocane, fentanyl, ultane etc...) and we get an idea what to charge the patient because they go ahead and refill their carts from the pyxis...so we just check the sheet that they mark all the stuff used and compare it to what comes out of the pyxis...it works...but for the odd staff anesthetist who feels that the patient can get free meds and does not enter it on the pyxis...any one else having trouble with that?

nope - nothin's free! We bill off the anesthesia record. That is something most physicians won't mess with. So, we add up the mg/mcg used & bill that. Yes, its tedious!

 

[Shrav]

nope - nothin's free! We bill off the anesthesia record. That is something most physicians won't mess with. So, we add up the mg/mcg used & bill that. Yes, its tedious!

How about refilling the carts then? Does that come straight out of the pharmacy?

 

[humira49]

Tuss,

We've talked before, but with me under a different name. We'll see how long this one lasts before they shut me down.

But, I wanted to know how you're holding up?

This is not an easy transition & you've been doing this, what - a month or so?

What are your big complaints? The time it takes to get meds out? The logjam at 9, 10, 2, 6, etc....?

Do a unit check in Jan or so....you'll find they've "stockpiled" drugs for "emergencies" - you know those "stat" dss orders & pyxis is out....

Just be sure to pull out all the drawers in the old med room, open all the cabinets, etc.....Cath lab, ED & L&D are particular areas that like to do this (oh....along with the OR). But, take it away slowly - just the expired stuff.

You know - go along to get along.....for awhile.

Good luck & happy holiday!

 

[humira49]

How about refilling the carts then? Does that come straight out of the pharmacy?

We no longer have med carts. Everything is out of Pyxis.

Ooops - were you talking anesthesia carts? Yes, anesthesia carts are filled directly from the OR pharmacy.

 

[tussionex]

Tuss,

We've talked before, but with me under a different name. We'll see how long this one lasts before they shut me down.

But, I wanted to know how you're holding up?

This is not an easy transition & you've been doing this, what - a month or so?

What are your big complaints? The time it takes to get meds out? The logjam at 9, 10, 2, 6, etc....?

Do a unit check in Jan or so....you'll find they've "stockpiled" drugs for "emergencies" - you know those "stat" dss orders & pyxis is out....

Just be sure to pull out all the drawers in the old med room, open all the cabinets, etc.....Cath lab, ED & L&D are particular areas that like to do this (oh....along with the OR). But, take it away slowly - just the expired stuff.

You know - go along to get along.....for awhile.

Good luck & happy holiday!

our biggest complaints come at 7 and 7 shift change narcotic counts....they somehow have lost the ability to count! i should bring in my elementary school teacher mom to give them a refresher course. then, while not counting correctly, they invariably jam/break/cause sparks to shoot out of the drawers and upstairs we go!

also a big problem is user training on off shifts and getting users who didnt fill out login paperwork set up to login during second and third shift. i dont mind getting them activated, but the floors have had this paperwork since august!


they also have little to no understanding on how to remove a key to open the fridge [no remote managers yet]

any ideas?

we took away lots of their stockpiles...but let them have some stuff kicking around just so they feel more secure.

it will be a bigger battle when we roll out profile!

thanks for the good wishes and happy holidays to you too!

 

[Shrav]

We no longer have med carts. Everything is out of Pyxis.

Ooops - were you talking anesthesia carts? Yes, anesthesia carts are filled directly from the OR pharmacy.

Yes I actually was on anesthesia carts, I guess it really differs on preference...but the pharmacy filling up the carts themselves I guess would give more control and a better way to see what exactly is being used. The problem might come in when you have to ID each drug and match it to the patient used on (just a guess)....and then charge it correctly..also the returns..and wastes are to be credited back to the patient and that might pose to be a problem later on...

 

[Maestrojo]

We no longer have med carts. Everything is out of Pyxis.

wow i'm impressed How did you manage that? Your pyxis must be huge.

How do you find room for all of the oddballs like creams and ointments?

and what about the oddball narcotics? You know, the ones that are only used once or twice a year? for example, Tussionex, which is only availiable in the large bottle.

and what about Lortab elixir? Sure you could probably fit it into the carosal drawers, but they take up so much space.

 

[njac]

sadly we still have cart fill, we've significantly reduced it by putting lots of common meds in the Accudose like Nexium and certain Levothyroxine strengths, certainly the usual APAP/IBU/ASA, some BP meds

I'm told it's easier to tailor the machine with an OmniCell or Pyxis vs the Accudose, because there's no way we have room for everything in there, the cells are too big, we'd need an entire room of Accudose.

 

[tussionex]

wow i'm impressed How did you manage that? Your pyxis must be huge.

check out the cardinal web site. there is literally a pyxis for everything! in all shapes and sizes. boy, am i glad we dont have the scrub station. all i have to do to get scrubs is listen to the linens lady say "no, you dont LOOK like a small!"

 

[Shrav]

wow i'm impressed How did you manage that? Your pyxis must be huge.

How do you find room for all of the oddballs like creams and ointments?

and what about the oddball narcotics? You know, the ones that are only used once or twice a year? for example, Tussionex, which is only availiable in the large bottle.

The pyxis can be quite huge as we keep 'adding drawers' to it. I had a couple of pyxis reps come in the other day to renew our contract and they said that its not really physically making the pyxis bigger/taller...its just creating more drawers in the bottom one by partitioning off more sections so now the same drawer can hold more meds....

As for the oddball antibiotics..any other med that is not floor stock (tylenol type meds) and is not in the pyxis is basically one that differs from patient to patient. So the moment we get a patient in ...the pharmacy sends one ointment/nasal spray (or any other thing that is not common) and puts it into the med drawer at once so they have that stock. A lot of the ointments and sprays etc can be PRN too so it is taken up relatively quickly.

 

[psychoandy]

This thread is good...I had this whole impression that pyxis was so much better and awesome and now I know they're all the same and crappy and everyone resorts to kicking the drawers!

BTW, while I'm sure there's plenty of diversion with APAP and other incredibly stupid things, at my hospital messed up counts are almost always due to the following: one nurse will take out meds for their pt, and then whatever nurses around take some out as well without logging it, since the drawer is already open. Not only do the 3 other pts not get charged but the inventory gets messed up! And then they whine about how they're missing all these things they're supposed to stock...Don't even get me started on insulin, bulk items like APAP liquid for pedi floors, or narcotic discrepancies...

Also, I would rather fish a 10 pack of unit dosed oxycodone out of the back of a machine than rip them into individual tabs...not only would it be a PITA for us, nursing would eat you alive if they had to keep counting crap like that.