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Pharmacy Manual
Policy Number: Effective Date: 26/11/2010
Last reviewed:
Pyxis Anesthesia System
Surgery Centres of Australia
Policies & Procedures
For
Inpatient Drug Administration Using Pyxis MedStations
TABLE OF CONTENTS
INTRODUCTION .............................................................................................................................. 2
1. System Details ........................................................................................................................... 3
2. Medication & Ward Inventory Details ................................................................................... 5
3. Maintenance of Ward Inventory ............................................................................................ 8
4. Patient Details ......................................................................................................................... 10
5. Medication Access from MedStations .................................................................................. 11
6. Access and Security ................................................................................................................ 14
7. Identification/Password/BioID .............................................................................................. 16
8. Discrepancy Reports .............................................................................................................. 18
INTRODUCTION
Pyxis is an advanced system that automates the distribution, management and control of
medications via a series of MedStations linked to a central Pyxis console. Management of the
Pyxis system is the responsibility of the Pharmacy department, and there is a dedicated Pyxis
Systems Manager.
MedStations are secure storage units located in the clinical rooms of some wards. Each
MedStation is controlled by its own microprocessor, and communicates on a regular basis
(once every 10 seconds) with the central console in the Pharmacy Stores. The console linked
via the hospitals‟ communication network to GE Healthcare, the hospitals‟
Admission/Discharge/Transfer (ADT) system. The console manages and distributes
information between GE Healthcare the MedStations. It will eventually link to the pharmacy
stock control system.
The inventory of the MedStation is the responsibility of the Pharmacy department. The Ward
Pharmacist or Clinical Pharmacist governs the inventory for each ward based on its particular
specialty. A Pharmacy Technician is allocated to each ward, and is responsible for refilling
the MedStation on a regular basis.
Authorised users obtain medications from the MedStation by entering an identification
number, then either scanning their fingerprint or entering a password at the MedStation, and
following the simple self-help menus. At the time of access, all transaction information
(including patient name, description and quantity of medications, time of removal) is
automatically recorded for refilling and accounting purposes. Medications are charged
automatically via a link between Pyxis and GE Healthcare based on the patients‟ MRN
number and the 6-digit medication code.
These policies provide the recommended framework and approach to the use of the Pyxis
Medstations in the Surgery Centres of Australia.
The following procedures should be used in conjunction with Pyxis Medstation
RxSystem 4000 Station Quick Reference Guide located on the top of all MedStations.
This guide provides the step by step process for completing many of the required actions, and
will be referred to throughout these policies.
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1. System Details
1.1 Pyxis console
The Pyxis console is located in pharmacy stores. It manages the pharmacy side of
Pyxis by storing system-wide information such as the formulary, ward inventory lists,
and a complete list of users. It also acts as the central link between all the
MedStations, and filters Admission/Discharge/Transfer (ADT) messages from GE
Healthcare to and from the appropriate MedStation.
The Pyxis System Manager (PSM) is responsible for managing and maintaining the
console.
1.2 MedStations
MedStations are secure storage units located on the wards containing the stock
inventory. MedStations manage the nursing side of Pyxis by allowing authorised users
to access the ward stock medications using a secure ID and fingerprint or password.
MedStations are connected to the emergency power supply, and are supported by an
internal battery that will allow for a 2-3 minute delay in changing from normal to
emergency power supply.
The Pharmacy department is responsible for the ward inventory, and a Pharmacy
Technician allocated to the ward is responsible for restocking the MedStation. Nurses
are responsible for maintaining the MedStation in a clean and tidy condition.
1.3 Communication
Between Console & MedStations:
The console communications with each MedStation every 10 seconds via the Surgery
Centres of Australia network. This allows information to be communicated between
the wards (MedStations) and pharmacy (console) in a timely manner. For example,
stock outs are communicated to pharmacy almost immediately.
Active communication can be monitored by checking the last link time using the „P‟
icon (refer to ‘Troubleshooting’ section XXX) Between Pyxis & GE Healthcare:
Communication between Pyxis and GE Healthcare is via the Surgery Centres of
Australia network using the CH_Scheduler server. Admission/Discharge/Transfer
(ADT) messages are communicated on a one-way basis from GE Healthcare to Pyxis,
and transaction information is communicated on a one-way basis from Pyxis to GE
Healthcare. The console acts as an intermediary between GE Healthcare and the
MedStations, and directs necessary information to the appropriate MedStation. There
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is a small lag time between the 2 systems, as messages are sent at 4-5 minute
intervals.
Any problems regarding communication must be logged in the Pyxis Call log, and
addressed to either the IT department or Unitech.
(refer to ‘Logging a Call’ section XXX)
1.4 Archiving
Records of all transactions occurring at MedStations are visible at the MedStation for
72 hours. They are stored at the console for 30 days. After this time, all data is
archived automatically by the archive manager installed by Pyxis.
Retrieving archived data – check with Cathy
1.5 Pyxis Printer
The Pyxis printer is located in Pharmacy Stores. It is linked to the Pyxis console via a
dedicated cable ie. it does not use the hospital network. The Unitech Field Service
Technician should be consulted before this printer is moved.
New cartridges and paper should be ordered from the Purchasing department as for
other printers.
1.6 Attention Notices Bulletin
This is a window that opens immediately on the console screen when an attention
notice is received from a MedStation. It shows details of stock outs, drawer failures,
and communication failures. A printout of the attention notice will automatically print
on the Pyxis printer.
Any person who sees an attention notice must notify the relevant Pharmacy
Technician or Ward Pharmacist immediately, so that the problem can be resolved.
The PSM must ensure that the attention notice window remains open at the console at
all times.
1.7 Reports
Batch reports are set up to print automatically at regular intervals. These include
Refill Pick & Delivery lists for every MedStation, and a report of Undocumented
Discrepancies.
Other reports can be added to the batch reports as required.
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2. Medication & Ward Inventory Details
2.1 Pyxis Formulary
The formulary is the complete list of pharmacy medications available for ward stock
inventory. The formulary is created and managed by the PSM, and is stored at the
console.
When adding an item to the formulary, all fields coloured yellow must be filled in.
These include generic and brand name, strength, dose unit.
check The PSM should be informed of all product updates regarding changes to pack sizes
or dose units, so that the Pyxis formulary can be updated.
Note:
In some cases, it may not be appropriate to use the generic name if only the brand
name is familiar to nurses. For example, Corsodyl mouthwash is loaded with the
generic name „Corsodyl‟ rather than „Chlorhexidine‟, since nurses were unable to
find it using the name chlorhexidine.
However, these incidences should be rare, and must always be approved by the
Clinical Pharmacist.
2.2 6-Digit GE Healthcare Codes in the Pyxis Formulary
Every medication in the Pyxis formulary requires a 6-digit identification code, which
must be the same as the GE Healthcare code for that drug. The PSM must obtain the
GE Healthcare code prior to adding the drug to the Pyxis formulary.
All medication codes must begin with the numbers „51‟, which specifies that it is a
pharmacy item. This code is used by both Pyxis and GE Healthcare to identify
medications for accounting purposes, therefore it imperative that the accurate code is
loaded onto the formulary.
2.3 Count Options
Applying a count option allows pharmacy to control the level of security for each
medication in the Pyxis formulary. Count controls apply per medication, so that they
apply to that medication at all MedStations. It is not possible to have different count
options at different locations.
A blind count requires users to enter the quantity of stock that they see. No suggested
stock level will appear on the screen. This is for Schedule 1-4 medications.
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A confirmation count shows a suggested stock level, according to Pyxis system
records, and asks the user to verify the stock level is correct by answering „YES‟ or
„NO‟ to the question „Is this correct?‟
No count means that the user does not have to enter a stock quantity at all.
Counts of inventory at the MedStation are required at the following times:
Nursing
Blind count on Schedule 1-4 medications when removing;
Confirmation count on all non-Controlled drugs when below minimum level;
All Controlled drugs once per week.
Pharmacy
Blind count on Controlled drugs/Scheduled drugs when refilling
Blind count/confirmation of count on all stock lines when refilling;
Full manual stock take once every 4 weeks.
Each time a blind count or confirmation count is wrong, a prompt requires the user to
re-enter the stock level. This gives the user a „second chance‟ to count the stock
correctly, and verify their count. If the stock level is still different to the record at the
MedStation, a discrepancy is created. The PSM and Team Leaders monitor
discrepancies as part of continuous quality management.
(Refer to Section XXX – Discrepancies)
2.4 Ward Inventory
The Ward pharmacist/Clinical Pharmacist is responsible for the stock kept in the
ward‟s MedStation. The Pharmacy Technician allocated to the ward is responsible for
refilling the MedStation on a regular basis.
MedStations do NOT contain:
Refrigerated stock items
Items manufactured in pharmacy for specific individuals (eg Total Parenteral
Nutrition solutions)
On most wards, MedStations do NOT contain „Treatment room‟ items (eg. Some
IV fluids and irrigation solutions, antiseptics, blood glucose testing strips, urinalysis
strips, amps of water and saline etc.)
The relevant Pharmacy Technician restocks these items on a weekly basis, as per the
previous restocking procedure.
NOTE: The procedure for Cardiac Arrest remains unchanged –
drugs required are not stored in MedStation.
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2.5 Maximum & Minimum Stock Levels
Each item on the ward inventory is designated a maximum and minimum stock level
when it is loaded into the MedStation. These levels are determined by the drug issue
history for that ward, based on a thrice-weekly refill schedule.
The minimum is the amount to which the stock level must fall at the MedStation in
order to generate a refill message.
The maximum is the highest stock level that can be loaded into the MedStation, and
determines the suggested refill quantity ie. the refill quantity suggested will ensure
stock is refilled to the maximum level.
Maximum and minimum stock levels can be changed according to the current needs
of the ward. For example; to cover a high dose during the weekend, the maximum
level may be increased so that more stock can be loaded into the MedStation. The
PSM or Pharmacy Technician should make any changes at the console.
2.6 Changes to Ward Inventory
The Ward Pharmacist must approve requests for changes to the ward Pyxis inventory.
If changes are appropriate, the relevant Pharmacy Technician is responsible for
loading or unloading medications at the MedStation.
The PSM should update the ward stock lists on the pharmacy stock-control system.
Changes to ward inventory must be immediately recorded in the Pyxis files in the
Inpatient and Outpatient pharmacies.
Once a month, a new „Hospital Wide Med Summary‟ report must be printed and
given it to the Chief Technician for filing in the pharmacy Pyxis files.
Refer to section 6.3 ‘Loading/Unloading Inventory’
2.7 Controlled Drugs in Pyxis
Controlled drugs (CD‟s) are loaded into MedStations on some wards as stock items.
They are stored in a carousel drawer for security purposes (check cubies) and
require a witness to log in before the drawer will open.
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A blind count must be entered before removal or refill. An error in the count will raise
a discrepancy, which must be resolved by the nurse in charge prior to the end of the
shift. These will be monitored by the PSM, as discussed in section XXX. Nurses must request CD‟s using their CD order book, and refills must be done by a
Pharmacist or a Pharmacy Technician, with a nurse as a witness.
Items that are not usually part of the ward inventory but have been requested by the
ward must be loaded into the MedStation by the Pharmacist or Pharmacy Technician.
They may be later unloaded if no longer required.
Refer to section XXX – Removing CD’s & Section XXX Refilling
Controlled Drugs
2.9 Individually Dispensed Medications (‘Patient’s Own Meds in Pyxis’)
Where possible, medications dispensed for individual patients (ie. Items that are NOT
stock in the MedStation) will be stored in the MedStation under the name „Patient‟s
Own Meds in Pyxis‟. The drawer pockets are numbered according to the rooms on the
ward, and medications should be stored in the appropriate pocket for the patient‟s
room number.
The medication entry „Patient‟s Own Meds in Pyxis‟ is fictional, and is set up so that
it has a stock count of around 5000 units. Users should take care to maintain this high
stock level, so that it never appears as a stock out, therefore becoming unavailable for
removal by the nurses.
These medications can be accessed by all nurses using the „Remove‟ function, and by
pharmacy staff using the „Inventory‟ function.
Refer to section XXX
2.10 Medications Brought to the Surgery Centres of Australia by Patients
If a patient brings their own medications into the hospital, the nurse must act in
accordance with the Surgery Centres of Australia policies for Patient‟s Own
Medication and Patient Self-medication.
These medications are not to be treated as a stock supply, and should NOT be stored
in the Pyxis MedStation until the ward pharmacist has confirmed that they are
appropriate for use.
3. Maintenance of Ward Inventory
The Pharmacy department is responsible for maintaining the inventory for each ward.
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Refilling the MedStation – Non-Controlled Medications
The Pharmacy Technician designated for the ward will refill the MedStation on a
regular basis.
Refills must be done on a Monday and Friday, and on at least one other day (at the
discretion of the Technician). The Technician must also manually check the non-
Pyxis stock (i.v. fluids, externals and refrigerated items) at least once a week, using
stock lists generated by the pharmacy stock control system (JAC).
Procedure:
The Pharmacy Technician should view or print the Refill Pick and Delivery list at the
console for their ward. Once the stock has been assembled and booked out using the
pharmacy stock control system, the Technician should use the „Refill‟ function at the
MedStation.
Refer to ‘Refill’ section – Pyxis Quick Reference Guide
The Technician must ensure that stock for refill is in date, and that the batch number
and expiry date is visible on all stock loaded into the MedStation. Therefore only
complete packs, or whole strips of tablets, may be loaded as stock.
3.2 Refilling Controlled Drugs
Controlled Drugs (CD‟s) are loaded into MedStations on some wards as stock. They
are kept in carousel drawers for security and require a witness to log-in for removal or
refill.
Procedure: The ward must still request controlled drugs (CDs) using the ward CD register. CDs
should be dispensed from the Inpatient pharmacy in the usual manner and recorded in
the IP CD register. The drugs must be delivered to the ward by a Pharmacist or
Pharmacy Technician, and the receipt recorded in the ward CD register. The
Pharmacy person must refill the items into the MedStation, and a nurse must log in as
a witness.
If the ward requires CD‟s that are not already stock in their MedStation, they must be
loaded as new stock items by the Pharmacist or Pharmacy Technician. They can be
unloaded at a later date if they are not required as permanent stock.
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3.3 Stock Out Attention Notices
Stock Out attention notices appear on the screen at the console in pharmacy stores at
the time they occur. A notice is also printed on the Pyxis printer.
Whoever sees the attention notice must notify the relevant pharmacy technician as
soon as possible. The technician will then refill the stock item at the earliest
opportunity.
A report detailing the attention notices will be reviewed regularly by the PSM.
Maximum and minimum stock levels should be altered when items are regularly out
of stock.
3.4 Load/Unload medications
Adding or removing stock from the Pyxis machine will be the responsibility of the
Pharmacy department.
The ward Pharmacist or Clinical Pharmacist must approve requests for items to be
added or removed from the ward inventory. The Pharmacy Technician is responsible
for adding new items into the MedStation, using the „Assign & Load‟ function, and
for removing stock items, using the „Unload‟ function.
Refer to ‘Load’ & ‘Unload’ sections - Pyxis Quick Reference Guide
When loading new items, the Technician must ensure that they are loaded correctly.
For example, a number must be stuck onto the pocket or bin that it is loaded into, and
a bin must always be used in a tower.
When stock is loaded or unloaded at the MedStation, the ward inventory list is
immediately updated at the console. After any change to the ward inventory, the PSM
must update the pharmacy stock control system, and a new copy of the ward inventory
must be printed by for the IP pharmacy reference folder (using the report „Hospital
Wide Med Summary‟ for the relevant ward).
4. Patient Details
4.1 Standard Patient Details
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GE Healthcare communicates the standard patient details to Pyxis via an interface on
a one-way basis.
Once a patient has been admitted onto GE Healthcare, the details are sent to the
MedStation on the relevant ward. Therefore, until the patient has been formally
admitted by the ward clerk/nurse, their details will not appear on the Pyxis
MedStation patient list.
4.2 Patients not available on Pyxis through routine ADT interface
If the patient details do not appear on the MedStation patient list, the user has the
option to add a ‘temporary patient’ through the „Add Patient‟ feature. The MRN
must be entered for temporary patients, as Pyxis and GE Healthcare share information
based on the MRN.
The details for a temporary patient will remain at the MedStation for 14 hours. Nurses
should ensure that the patient is admitted onto GE Healthcare as soon as possible, so
that the permanent record can be communicated to Pyxis.
If the permanent record appears while the temporary details are still present, users
should take care to use the permanent record rather than the temporary one.
Refer to ‘Remove Meds; section 2 - add patient’ - Pyxis Quick Reference
Guide.
4.3 Discharge/Transfer of Patients
Patients discharged or transferred from a Pyxis ward via GE Healthcare will remain
on the Medstation screen for 2 hours post discharge/transfers. This enables interim
doses to be given as well as unused stock to be returned under the specific patient.
If the record of a discharged patient disappears from the MedStation before the patient
actually leaves the hospital, then the patient must not be added as a temporary patient.
5. Medication Access from MedStations
5.1 Access to Remove Medications
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Authorised user access (ID/BioID/password) and valid patient selection is required to
remove any medications from Pyxis.
Note: The Drug Chart remains the definitive reference point and LEGAL DOCUMENT for
determining active prescriptions and drug administration requirements.
5.2 Medications Visible on MedStation Screen
All medications stocked in the MedStation will appear on the screen in alphabetical order.
Those medications available from the MedStation will be in bold type, while medications that
are currently out of stock will be shaded Grey.
5.3 Removal of Non-Controlled Drugs
Refer to ‘Remove Meds’ section - Pyxis Quick Reference Guide.
5.4 Removal of Controlled Drugs
A valid witness is required for all transactions dealing with Controlled Drugs (CD‟s).
After having defined the quantity of a CD to be removed, a witness will be
required. The witness must log in to the system using a valid ID and BioID.
The subsequent question regarding waste should be answered correctly ie “yes” if
you plan to administer the entire dose or “no” if you plan to waste part of the dose.
If you plan to waste a portion of the dose, the reason for wastage (e.g. priming of
line) can be recorded in the “Waste Reason” field (free text).
A blind count of the stock on hand is required at this stage.
Follow the remainder of the actions through in sequence as required by the
Medstation.
This process records the following details electronically for the completed
transactions:
- MedStation ID;
- Date and time of transaction;
- Patient name and MRN number;
- Drug details;
- Amount given, amount wasted;
- Stock on hand;
- Nurse removing drug (name and ID);
- Witness name and ID.
5.5 Quantities to be taken from Pyxis
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Users should remove only those medications to be administered at that time. Only the
required dose should be removed, according to the minimum dose unit.
The minimum dose unit for injections and orals is one vial/ampoule/tablet, and for
liquids it is either 1ml or 5ml. Users should remove the exact amount, or round up to
the next dose unit if necessary. For example, if only part of a dose is to be given (ie.
half a tablet, 2.5ml of liquid), the user must still remove a whole dose, and waste the
remainder.
Refer to section XXX (waste)
5.6 Accessing Non-Pyxis Medication (Individually Dispensed items)
As detailed above, medications that are not stocked in the MedStation are dispensed
from the Inpatient pharmacy and stored in the MedStation under the name „Patient‟s
Own Meds in Pyxis‟. They are charged for by the pharmacy, and therefore carry no
charge when removed at the MedStation.
These medications can be removed as normal, selecting the medication titled
„Patient‟s own meds in Pyxis‟.
5.7 Medication Returns
Medications that not administered to the patient can be returned to the internal return
bin, which provides secure storage for returned medications. Returns are done on an
individual patient basis, and a credit is issued to the patient‟s account, therefore any
items returned should be re-usable (ie. unopened).
Procedure: Injections: Return unused injections to the Internal Return Bin using the return
facility.
Orals: Generally all partially used oral medications at discharge should be
provided to the pharmacy with the discharge prescription for use in the
dispensing of the TTA medications.
If, at any time, oral medications are identified as being no longer
required, the following procedure should be followed.
If product is unused and remains as originally presented in Pyxis, it
may be returned at the MedStation to the Pyxis return bin, creating a
credit to the patients‟ account.
If product is partially used (eg. Bottle of liquid, half a tablet) do NOT
return via Pyxis, but use existing drug return mechanism to the
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Pharmacy (Place in Green Bag in clinical room). Credit to the patient
will be issued at the discretion of the pharmacy.
I.V. fluids: Return unused bags to pharmacy using existing mechanism.
A printout of the transaction will be issued, and this should be stored in the box
provided, for checking at a later date by the Pharmacy Technician.
If the item for return does not fit into the Internal Returns Bin, the user should use the
existing returns mechanism.
Refer to ‘Return Med’ section - Pyxis Quick Reference Guide
The Internal Returns Bin will be emptied regularly by the relevant Pharmacy
Technician, using the function „Empty Returns Bin‟, located in the „Unload‟ menu.
The bin must by unlocked using the „Electronics Drawer‟ key, which is kept in the
Inpatient pharmacy. The contents of the bin should be checked against a list of returns
that is automatically printed when the bin is emptied, to ensure that all returned items
have been put in the bin.
Returned items should be immediately refilled into the MedStation. If this is not
possible, the items should be taken to the Inpatient pharmacy for return to pharmacy
stock.
5.8 Drug Waste
Drug waste may be recorded at the MedStation either at the time of medication
removal, or later. The waste function must be used for any transactions involving
controlled drugs where only a partial dose is administered.
Importantly, the waste procedure does not issue a credit to the patient‟s account. It is
used for recording purposes only.
Refer to ‘Waste Med’ section - Pyxis Quick Reference Guide
6. Access and Security
6.1 Authorised Access
Nurses:
New access to Pyxis MedStations requires authorisation via the Senior Sister/Pyxis
Team Leader of that ward.
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All permanent nurses must have access to Pyxis, and agency staff may be given either
temporary or permanent access depending on how regularly they work at the Surgery
Centres of Australia. Access privileges will depend on the position held by nurse.
Pharmacy:
All permanent pharmacy staff must have access to Pyxis. Locum staff may be given
access depending on their tenure of employment. Access privileges will also depend
on position held.
Other Users:
Other members of staff at the Surgery Centres of Australia may be given access to
MedStations, for example RMO‟s, IT support staff. Their level of access will be
decided by the PSM on an individual basis.
6.2 Levels of Access and Security
The following grid defines current levels of privileges at the MedStation and console,
and for accessing medications for pharmacy and nursing staff.
User Groups
1 2 3 4 5
MedStation/Console Privileges
station log-in/witness ability X X X X X
station report access X X X X X
admit/edit/discharge patients X X X X
activate/create temporary user X X X X
create permanent users X X
refill stock X
load new stock items X X
system menu (to shut down) X X X
Medication Privileges
non-CD* removal X X
CD* removal X X
non-CD* inventory X X X
CD* inventory X X X X *CD = Controlled Drugs
Groups defined as:
Group 1 Managers, Nursing Administration, and Pyxis Team Leaders
Group 2 Staff Nurses
Group 3 Regular Agency Nurses
Group 4 Enrolled Nurses
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Group 5 Wardsmen
Access to all drugs including Controlled Drugs is restricted to permanently
employed nurses and pharmacy only (Groups 1 & 2).
Other user groups, as mentioned above, may be given access to MedStations, and
will be given access privileges similar to that of Group 3.
6.3 Temporary Users Access
Temporary users can be created on the Pyxis MedStation to meet temporary staffing
needs (i.e. agency nurses). Temporary users can be created by permanent nursing staff
and pharmacy staff – Groups 1,2,4 & 5.
A log-in ID is printed at the MedStation, and the temporary user must log-in, change
their password and register their fingerprint (refer to Section XXX First Time
Log In). Temporary user access is limited to 14 hours duration.
Refer to ‘Create Temporary User’ section -Pyxis Quick Reference
Guide.
Reports generated from the Pharmacy Console will monitor the creation of temporary
users on a daily basis.
7. Identification/Password/BioID
7.1 Identification
The Pyxis Identification (ID) will be the GE Healthcare log-in ID where possible. If
the user does not have a GE Healthcare ID, the Pharmacy System Manager will create
an alternative ID based on the users‟ initials.
7.2 Password
Passwords are user defined and should be maintained in strict confidence as a unique
identifier (electronic signature) for each individual. The Pyxis password is limited to
6 characters. These can be any combination of alpha or numeric characters.
Passwords will only be used to log in at the MedStation if BioID is not available.
7.3 Biometric ID
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The MedStations are set up so that Biometric ID (Bio ID) is used to log in. Users will
enter their ID and scan their fingerprint to gain access to the main menu.
If there are problems using Bio-ID, the PSM can change the access for that individual
so that they log in using a password instead.
7.4 First log-in
When a user signs on to Pyxis for the first time using their valid ID, „123‟ will be the
initial password. A prompt will instruct the user to change the password to one of
their own choosing.
The user will then log in using their ID and new password, and will be prompted to
register their fingerprint scan for Bio ID (a total of 4 fingerprint scans).
Once initial log in is completed, users log in by entering their ID, then scanning their
fingerprint.
7.5 Password Update
Passwords may be changed at the MedStation on an individual basis.
Refer to ‘Change Password’ section - Pyxis Reference Guide
7.6 Forgotten Password
When a password is forgotten, it should be reported to the Pharmacy Systems
Manager.
A temporary password will be created to enable an initial log in to the system, at
which point the user will follow the procedure as for a first-time log in.
7.7 User List Changes
The Team Leader on the ward should notify the Pharmacy Systems Manager
regarding:
Staff to be added to Pyxis as permanent users;
Staff to be removed from Pyxis (ie. staff who have left the hospital);
Any changes to the user ID;
Notification should be via e-mail, or on the form provided (for wards that do not have
access to e-mail).
Training will be organised for new users prior to their start date (Refer to Section
XXX Training).
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8. Discrepancy Reports
Discrepancies occur only on medications set to require counting or confirmation of
count prior to removal or return (i.e. Scheduled and Controlled Drugs routinely, and
non-Controlled Drugs when below minimum level) refer to Section XXX Count
Options. A discrepancy occurs when the quantity of medications in the pocket being
accessed does not match the quantity expected by the system.
Open discrepancies refer to those that remain unresolved or undocumented.
Documented discrepancies have documented at the MedStation.
8.1 Discrepancy Responsibility
The Team Leader, or nurse in charge for the shift, is accountable for all aspects of
discrepancy resolution. This means resolving every discrepancy before the end of the
shift. This is important as eventually discrepancy resolution will replace the end of
shift count for CD‟s.
The PSM will check the discrepancy resolution printouts at the MedStations on a
regular basis, and will also check a report of unresolved discrepancies at the console.
Frequently occurring problems will be brought to the attention of the Team Leader
and Ward Pharmacist, for further action to be taken.
The Team Leader and Ward Pharmacist are responsible for continuous quality
monitoring, including viewing the discrepancy report at the MedStation, and
counseling of personnel frequently involved with discrepancies.
8.2 Resolving Discrepancies at the MedStation
Procedure 1. The open discrepancy should be brought to the attention of the Team Leader or
nurse in charge of the shift, who should try to clarify and resolve discrepancies at
this time with relevant staff.
2. The Sister should resolve the discrepancy using the „Document Discrepancy‟
function, and type an explanation for why it happened.
3. If the discrepancy appears to be unresolvable, the Ward Pharmacist must be
notified at the earliest opportunity. The pharmacist will then take appropriate
action to resolve the problem.
Refer to ‘Document Discrepancy’ section - Pyxis Quick Reference Guide
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IMPORTANT
All discrepancies must be documented before the end of the shift.
If the discrepancy is left undocumented, the nurse in charge of that shift
will be responsible for the stock count error.
8.3 Discrepancy Report at the MedStation
The Team Leader and Ward Pharmacist can view or print a report at the MedStation
as part of monitoring discrepancies. There are 3 types of reports available:
All Discrepancies
Undocumented Discrepancies
Documented Discrepancies
Refer to ‘Reports: Discrepancy’ section - Pyxis Quick Reference Guide
The Team Leader should check the undocumented discrepancies report to monitor
which nurses are not resolving discrepancies before their shift ends.
The Ward Pharmacist can check the documented discrepancies report to ensure
explanations are valid.
8.4 Discrepancy Report at the Console
The PSM will print a report of undocumented discrepancies on a weekly basis, and
inform the Senior Sister or Team Leader so that the relevant staff can be counseled.
This report will serve as a useful quality check on compliance with procedures and
appropriateness of drug selection as well as provide a measurement of shrinkage.
9. Training
9.1 Training Responsibility
Training of new Pyxis users is provided by the PSM at the request of the Team Leader
or Chief Pharmacist. It is the responsibility of the Team Leader or Chief Pharmacist to
inform the PSM of training requirements for new users so that training can occur as
part of their induction.
9.2 Training Guidelines
Training for new users should encompass the following points:
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Nurses
Logging In & Out of the MedStation
Setting User Preferences
Removing Medications
Non-Pyxis Medications („Patients Own Meds in Pyxis‟)
Returning Medications
Wasting Medications
Inventory of Medications
Discrepancy procedure
Creating a Temporary User
Reports
Drawer Failure procedure
Changing Paper Rolls
Downtime Procedures
Pharmacy
Logging In & Out of the MedStation
Refilling the MedStation
Inventory of Medications
Non-Pyxis Medications („Patients Own Meds in Pyxis‟)
Emptying the Returns Bin
Creating a Temporary User
Discrepancy Procedure
Stock Out Procedure
Reports
Change Paper Roll
Troubleshooting Resolution & Procedure
Downtime Procedure
Using the „P‟ icon
Quick Reference Guide
Setting User Preference
Refer to Nurse Training Guidelines & Pharmacy Training Guidelines for a more
detailed description of these procedures and training requirements.
10. Troubleshooting
10.1 Troubleshooting Responsibility
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All Pyxis users bear a measure of responsibility for maintaining the system.
Nurses
Nurses must be able to recover a failed drawer. Calls to Pharmacy should not be made
regarding a drawer failure until the nurses have tried to resolve the problem
themselves.
Pharmacy
All Pharmacy staff must be competent in basic troubleshooting procedures at the
MedStation. These include:
Recovering a failed drawer
Checking communication is occurring between the MedStation and the console.
Shutting down the MedStation
Opening the MedStation manually and popping the drawers.
Recovering a frozen screen.
Downtime procedures.
A Troubleshooting Guide is available as a reference, and is stored in each of the
pharmacy locations, and given to the on-call pharmacist (see below).
10.2Troubleshooting Procedure – MedStations
Problems with the MedStations should be reported immediately to the pharmacy via
phone or e-mail, as detailed on information sheets posted by the MedStations on the
ward.
Procedure:
1. Call/e-mail received by pharmacy from nurse.
2. Pharmacy person receiving the call should inform the Pharmacy Technician
who is responsible for managing that ward, or the PSM.
3. The Pharmacy Technician or PSM should contact the ward and check whether
the nurses have attempted to resolve the problem using their troubleshooting
skills.
4. If the problem cannot be resolved by the nurse via phone, the call must be
logged in the „Troubleshooting Call Log‟ in the Inpatient Pharmacy. The
Pharmacy Technician or PSM must assign a call number based on the initials
PH, the date and number of the call, and record all other pertinent information
such as a detailed description of the problem. They should then go to the ward
and try to resolve the problem themselves, using the Troubleshooting Guide
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(refer to Section XXX Troubleshooting Guide).
5. If the problem cannot be resolved by the Pharmacy Technician or PSM, they
should contact either the IT department, or the Unitech Field Service
Technician (depending on the nature of the problem). This should be recorded
in the Call Log.
6. Once the problem has been fully resolved, it must be logged out of the Call
Log, and signed.
10.3 Troubleshooting Procedure - Console
Problems with the console should be referred to the PSM. If necessary, the PSM
should log the call as per the above procedure, and contact either the IT department or
the Unitech Field Service Technician for support.
10.4 Troubleshooting Out of Pharmacy Hours
Out of normal Pharmacy working hours, Pyxis problems should be referred to the on-
call pharmacist via switchboard. The pharmacist should attempt to resolve the
problem via phone using the Troubleshooting Guide provided (see below). If the
problem cannot be resolved, the pharmacist should contact either the IT department or
the Unitech Field Service Technician for further support.
The on-call pharmacist should attempt to log the problem in the Call Log as soon as
possible.
10.5Troubleshooting Guide
Troubleshooting Guides are provided for all pharmacy locations, and for the on-call
pharmacist file.
These must be available to all Pharmacy staff at all times as a reference tool when
attempting to resolve a problem.
10.6 Security Keys
Security keys for access to medstations will be located in the key box in the Inpatient
Pharmacy. The keys are labelled „Back left‟, „Back right‟ and „Electronics drawer‟.
There is one set for each MedStation, although all keys are interchangeable and may
be used at any MedStation.
The security keys should be accessed by Pharmacy staff only.
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APPROVALS
Name/Signature of Individual, Committee Chair, or Signing
Authority
Date
Authored/Developed/
Revised by
Mark Young Supply Manager / Pyxis Administrator 30/11/2010
Department Dir/Mgr
Matthew Mackay Director of Clinical Services
TO BE COMPLETED UPON REVISION / DELETION / REVIEW OF POLICY / PROCEDURE
Title of policy: Pyxis Anaesthesia System Date Policy
Became Effective: 30/11/2010
Date Policy
Was Reviewed:
Was Revised:
Was Deleted:
Supersedes:
If this Policy was replaced by another policy, name of replacement policy:
Date Replacement Policy became
Effective:
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