PYXIS ProfileRaising the PROFILE of

Medication Safety

November 2009

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Profile is a:Safety Enhancement Feature on the Pyxis MedStation

Goal of ProfileTo provide pharmacy verified, patient-specific medication lists that offer qualified staff* the greatest level of confidence in the accuracy, appropriateness and safety of their patients’ medications before administration. All staff will continue to use their clinical judgment prior to administering medications to their patients!

* “Qualified Staff are members of Capital Health and Caritas Staff who are permitted by legislation to dispense or administer medications within their defined scopes of practice.”

What is Profile ?

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Which areas are profiled?

33 inpatient care unitsICU’s, OR, PARR, ER, EIP, 4E3 and 5F3 units are NOT Profiled Areas.

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How does Profile work?Medications will appear on the patient’s Profile, after Pharmacy has completed order processing and verification. A pharmacist reviews each new medication order for:

Drug-drug interactionDrug dosageDuplication in drug therapyDrug allergiesAdverse drug-reactionsDrug-disease contraindications

When is Profile in Effect?Profile is live on the PYXIS MedStation 24 hours a day, 7 days a week. The patient’s profile is updated to include new medication orders, after verification by PharmacyOrders written between 2230 and 0700 will not display on the patient’s profile until they have been processed by pharmacy the following morning.

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How do I use Profile?Log on to the Pyxis MedStationTouch <Remove>Select the patientA patient-specific profile with all pharmacy processed and verified medications will displayTouch the medications you want to remove and touch <Remove Selections>

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What will it look like on the Medstation?

………………

Dose, route, frequency, and

last dose removed time now displayed

Profile Medication Removal DisplayAccuracy is key.

Always verify or enter the correct amount to be removed!

For non-fractional doses (ex. 2 tabs), the "amount to be given" will display the required amount to be removed.Fractional doses (ex. 1.5 tabs), the "amount to be given" will display blank. The staff must enter the amount to be removed.

EXCEPTION - For non-narcotic tablets, where a portion of a tablet is required, the system will display the number of whole tablets to be removed. Staff will then discard the unused portion.

Self Meds and Pass meds – adjust remove screen to reflect exactly how many meds are being removed.

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Profile Medication Removal Display"Each items" like small multi-dose bottles, tubes, vials, or inhalers will display "1" to be removed.

Range dosing will display amount to be removed as blank. Staff must enter the required amount to be removed.

Example: 325-650mg Tylenol po prn

Medication doses that change daily will show up as “Variable Dose” (Check Chart). Staff are required to enter the amount to be removed as the display will show zero.

Example: Decadron, Prednisone, Insulin, Warfarin

Variable Dose

Variable Dose

Combo Dose

Combo Dose

Combo Dose

Combo Dose

Greyed Out Medication Access Pathway

Other Display Notes

NC stands for non-catalogued. This indicates the medication may be non-formulary, compounded by pharmacy, or a patient’s own medication. The medication will show up in alphabetical order by name on the MAR, with NC indicated underneath, but on the profiled MedStation it will show up in alphabetical order under, for example- NC intermittent IV. The name of the medication is not on the MedStation. It is the NC’s on the MAR and the Profile that need to be matched.

zz – multiple item orders. To reduce confusion diluents are entered with “zz” in front of the name so these entries show up at the end of the Profile list.

What if the medicationis not on profile?

Override FunctionThe OVERRIDE function allows you to bypass the

profile to access a pre-determined list of medications from the cabinet. There are two types of Override.

Limited OverrideEffective during the hours of 0800-1600 Mon-Fri and allows access to a limited list of medications. It is meant to be used for an urgent or emergent clinical condition ONLY.Whenever selecting a medication from this urgent or emergent clinical condition list, you will be required to enter a reason for the override. See next slide.

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Drop Down of clinical conditions

List you will see:CodeAgitation/AggressionAllergy/AnaphylaxisAnticoagulationAnxiety/SedationBleedingBlood PressureCardiac Rhythm DisturbanceCerebral EdemaElectrolyte/Glucose DisturbanceFeverImmunosuppressionInfectionNauseaOverdosePainPreoperative/Pre-ProcedureRenal Failure/EdemaRespiratory DistressSeizuresStrokeBedside ProceduresWait for medication > 1hourOrder written between 2230-0700

Override FunctionComplete Override

Currently in effect during the hours of 1600-0800 on weekdays as well as weekends, and Stat holidays.Provides access to the complete list of drugs in the MedStation. Is meant to be used:

in emergent/urgent clinical conditions, if it has taken greater than one hour for pharmacy to profile the medication, or if the order was written when pharmacy was closed.

You will be required to enter an override reason for the medications on the urgent/emergent list only.

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What will it look like on the Medstation?

Override Button

Additions to Override Medication List

Requests for additions to the Override Medication List can only be made by a manager or physician

All requests must be communicated to the pharmacy manager.

Tips for Processing OrdersAll medications need a doctor’s order scanned to pharmacy to show up on Profile and MAR

EXCEPTION – Dextrose tabs administered as per PCM 2.1.1POP MUST be entered or pharmacy is UNABLE to process.If there is a new order to be started immediately, ensure to mark STAT.

Ex. Adjustment to Metformin dose immediately prior to lunchtime dose – send stat so is available right away.

If a regular dose increase is ordered and is expected to be started immediately, this must be stated in order and scanned stat.Ensure the formulation is patient appropriate prior to scanning i.e. PO – tablet or liquid and strengthEnsure consults are co-signed.Patients transferred from a different level of care i.e. ICU/Emerg will need orders scanned by the receiving unit.

Tips for ScanningOrders should be scanned to Pharmacy ASAP, to ensure prompt entry on the Profile.

Be sure to document the Scanned date, time and initial of scanner on the order once it has been scanned.

Ensure orders are facing the right direction on the Pyxis Connect Scanner – if scanned upside down, Pharmacy receives a blank page.Ensure if there are several pages, to scan one at a time to ensure the scanner does not pull more than one at a time causing pharmacy to not receive pages.Ensure to document scan time on the order AFTER scanningScan orders when received on nights, will get processed faster in am.NEVER re-scan postoperative orders unless verified with pharmacy that they were not received.

SCAN ProcessSCAN Process

FF--Flag all medication ordersFlag all medication orders

AA--Assess order for Dr signatureAssess order for Dr signature

SS--Scan order to pharmacy within Scan order to pharmacy within

one hourone hour

TT--Time, date stamp order as Time, date stamp order as

scanned and initial scanned and initial 0800 13Jan2009 CH RN

TroubleshootingIf profile is blank:

Check to see if patient was accidently discharged from the unit in TandemCheck Patient list to see if patient double entered. If so, the manual entry will NOT display the profile.Ensure Post op orders were not rescannedEnsure POP is completeIf patient was on the unit for greateer than one year, ensure to notify pharmacy to reload profile.

What if a one time order medication needs to be re-removed (ex. Was dropped or spilled)

Call pharmacy to reload the order thus allowing the medication to be removed again.

TroubleshootingIf profile is missing meds:

Is the medication only given on certain days? If so, will not see on Profile for days it is not due.Check the chart to ensure order scannedIf there is still a concern, phone pharmacy refill line; tell them specifically what you are missing and where it is missing.

You must provide the patient name, UAH MRN, and Scan Time.If not STAT order, wait one hour from time of scan to phone pharmacy.

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Downtime ProcedureIf the pharmacy is unable to maintain the patient’s profile in a timely manner due to software/equipment failure or backlog of orders, they will put Pyxis on Complete Override for this time period. What this means:

The icon to the right will appear on the main Pyxis screen which indicates the machine is in Complete Override.Continue to work from Profile.Use the flowchart process for when medications do not appear on profile.

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References

Profile Policy (in development)

Pyxis User Manual

Virtual Learning Centre

CNE