Pyxis Training MedStation 2000 Rx

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Pyxis TrainingMedStation 2000 Rx

• Vanderbilt University Medical Center

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Overview of Pyxis Training

• In this program, you will be responsible for
  understanding the Pyxis MedStation and related
  medication topics, including the
  following
• How Tos of the Pyxis MedStation
• Controlled Substances Management
• Medication Order Review

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How Tos of the Pyxis MedStation

• Lets begin by reviewing the basics of the Pyxis
  MedStation.
• In this lesson, we will cover
• Logging into the MedStation
• Main Menu removing, returning, and wasting
  medications
• Reports

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Logging In

• Users are given a User ID and a generic password
  prior to the initial login to the MedStation.
• Think of a unique password that is easily
  remembered but difficult for others to find out.
• A password can be 4-7 characters in length.

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You will be prompted to enter your User ID and
Password to access the system.
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• Your password is your electronic signature and
  verifies your identity
• no one should know it but you!
• Never share your password with anyone, regardless
  of the circumstance.
• If you suspect someone may know your password,
  change it immediately!

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• Profile MedStations
• Many Pyxis MedStations are configured with a
  medication profile for each patient. When
  selecting a patient, only active medication
  orders that have been reviewed by the pharmacy
  can be accessed at the MedStation.

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• Non-Profile MedStations
• Certain MedStations do not have patient profiles
  available.
• Medications are removed by selecting the
  necessary medication.
• Non-profile units include the Emergency
  Department, Radiology, and Surgery.

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In the Main Menu, frequently used icons on the
left side of the screen include remove, return,
and waste. Lets review their functions. When
using the Remove icon users will be directed to
remove the desired medication.
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After selecting the patient name and appropriate
medication from the patient profile, the
medication can be removed.
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The MedStation will ask for a quantity of
medication desired and the user will enter the
appropriate value. The drawer will open for
removal of the medication.When removing a
controlled substance, you are prompted to count
the medication prior to removing the medication
from the pocket.If the count is incorrect, the
machine will ask for a recount. If still
incorrect, a discrepancy is created.
(Discrepancies will be reviewed later)
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• A patient account is charged when removing a
  medication
• via patient profile.

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If a medication is discontinued or the dose has
changed the medication may need to be returned.

Lets review returning a medication to Pyxis.The
following screen appears after selecting the
patient and medication
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• The user will enter the quantity to be returned.
  If it is a controlled substance, the user will be
  prompted to enter the beginning count prior to
  returning the medication to the pocket. A witness
  is required for the return of a controlled
  substance.
• The returned medication must be in its original,
  unopened package.
• Returning a medication credits the patient
  account.

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• The Waste function documents controlled substance
  wastage and creates an audit record. Medications
  opened - not in original package - MUST be
  wasted.
• The remaining, unused portion of a controlled
  substance medication dose MUST be wasted - NOT
  saved for subsequent dosing. Ex. if using a
  Morphine 10 mg syringe for a 4 mg dose, the
  remaining 6 mg must be wasted.
• Select Waste from the Main Menu and follow the
  prompts. The process is very similar to returning
  a medication.
• Wasting a controlled substance requires a witness.

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All users may access the Report Menu in the Main
Menu as shown. Perhaps the Activity Report may
be helpful for questions about a removal or a
discrepancy. The activity report will print your
transactions only for the previous 24 hours.
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• - Always log off from the Pyxis MedStation when
  finished. - Never walk away from the machine
  with an active screen. - A diverter could access
  medications under your User ID. - To log off,
  touch the Exit icon in the upper right corner
  of the screen.

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Occasionally, a MedStation drawer will fail. A
Recover Drawer icon will appear on the Main
Menu. Follow the prompts to recover the drawer,
and call the pharmacy for troubleshooting.
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• If a Pyxis MedStation malfunctions, call the
  pharmacy immediately if you are unable to resolve
  the problem.
• Do not unplug or reboot the machine unless you
  are instructed to do so.
• Use another Pyxis MedStation if necessary.

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• Controlled Substances
• Management
• All controlled substances must be accounted for
  at all times.

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• Controlled substances are often stored in cubies
  in Pyxis MedStation. Cubies allow for limited
  access and safe storage of controlled substances.

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• As mentioned earlier, a discrepancy will be
  created if the expected count of a controlled
  medication is different from the actual count.
• A message on the screen will notify users that a
  discrepancy has occurred.

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• First, take care of the patient, then return to
  Pyxis MedStation to resolve the discrepancy.
• A Discrepancy icon will appear in the lower
  left corner of the Main Menu to alert the user of
  a discrepancy. The Document Discrepancy icon
  will appear on the right side of the screen when
  a discrepancy
• needs to be resolved.

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• Follow these steps to resolve a discrepancy
• 1) Research the reason for the discrepancy by
  selecting the Document Discrepancy icon or by
  reviewing the Pyxis printout. Find the prior
  user if necessary.

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• Steps to resolve a discrepancy
• 2) When the reason is identified, go to the
  Document Discrepancy icon.
• 3) Select a pre-configured reason or press
  Other to enter a brief description (witness is
  required).
• 4) Discrepancies must be resolved by the end of
  the shift.

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• More steps to resolve a discrepancy
• 5) If a discrepancy is unable to be resolved,
  notify the nurse manager.
• 6) After investigation, if the reason for a
  discrepancy cannot be determined, the nurse
  manager will file an occurrence/ incident report.
  
• 7) Call the pharmacy if you need assistance with
  a discrepancy.

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• Detailed documentation is required for all
  controlled substances.
• Ask yourself the following questions
• Is there an active order for this medication?
• Has each dose been documented on the MAR?
• Have all discrepancies been resolved?
• Remember - a witness is required for the wastage
  or return of controlled substances.

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• Certain patient-specific controlled drug
  preparations not routinely stocked in the Pyxis
  MedStation will be sent to the floor with a
  Controlled Drug Record
  (CDR).
• Detailed documentation of administration,
  wastage, and appropriate witnesses is required.
• These items should be stored in the Pyxis
  miscellaneous narcotic drawer or the infusion
  lock box.
• These items should never be left unattended!

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• Medication Order Review
• All medications administered to a patient require
  a documented physician order.

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• Most medication orders are entered by
• the physician into WizOrder
  (Computerized Patient Order Entry System).
• WizOrder interfaces with the pharmacy computer
  system, where pharmacists review the order for
  the appropriate dosing, frequency, and duration.
• Pharmacists also review the order for potential
  allergies, drug interactions, and therapeutic
  duplications.

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• Studies have shown these types of important
  patient safety checks reduce the potential for
  medication errors.

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• VUMCs Automated Dispensing System--Pyxis Policy
  (CL 30-06.19) states that, with few exceptions,
  all medication orders must be reviewed by a
  pharmacist prior to administration of a
  medication to a patient.
• What are the exceptions?

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• The Joint Commission on Accreditation of
  Healthcare Organizations (JCAHO) envisions only
  two situations in which the hospital pharmacy is
  not required to review a medication order before
  the medication is administered to the patient.

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• One exception is
• STAT or emergency situations
• The way we define that is - clinical harm would
  have to come to the patient if there were a delay
  in the medication administration caused by review
  of the medication order by the pharmacy.
• Darryl S. Rich, Director of Surveyor Development
  and Management for JCAHO

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• The second exception
• The pharmacist does not need to review the
  orders prior to administration when a Physician
  is directly involved in the supervision of the
  care.
• Kenneth G. Hermann, a hospital consultant for
• Joint Commission Resources, Inc., a JCAHO
  subsidiary
• This may be applicable in the
• Emergency Department or Surgery.

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• How long does it take VUMCs pharmacists to
  review a medication order?
• On average, approximately 75 of orders are
  reviewed within ten minutes.
• Occasionally, ten minutes will not be quick
  enough. What should you do?

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• In certain patient-specific situations, it may
  be necessary to use the override
  function in the Pyxis MedStation.
• In most cases, medications obtained via override
  have not been reviewed for important patient
  safety checks.
• Ask yourself if the benefits of bypassing patient
  safety checks outweigh the risks to the patient?
  

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• For the safety of our patients,
• do not create an override
• out of convenience
• for the patients first dose
• because you know the medication is available via
  the override function
• Call the pharmacy if you would like a particular
  order reviewed urgently to avoid an override!

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• Remember, an override should only be considered
  if the clinical situation of the patient suggests
  that you do not have enough time to wait for
  pharmacy to review the medication orderor if
  the physician is directly involved in the
  supervision of the patients care.

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• If an override is necessary
• Ask another nurse or physician to verify the
  medication prior to administration to the
  patient.
• Follow up to confirm that an order has been
  documented in WizOrder.

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Always Remember

• Safeguard your password.
• Read screens carefully.
• A patient account is charged when
  removing a medication via patient
  profile.
• Log off when finished.

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Always Remember

• Documentation of controlled substances is
  critical.
• Resolve discrepancies by the end of the shift.
• Medication overrides are situational
• Think patient safety!
• Call the pharmacy for questions or
  troubleshooting.

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This is the end of the presentation.

• You must now take the competency test.
• First, close this window by clicking the in
  the top right corner of the window.
• On the Webinservice Learning home page, find the
  link for Test - click the link.
• Read the instructions for the test, then click
  the icon in the upper right
  portion of the screen to start the test.

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