Surgery Centres of Australia Policies & Procedures For Inpatient …medica.dsgs.com.au/docs/Pyxis/PyxisAnesthesiaSystem-PolicyAnd... · Surgery Centres of Australia Policies & Procedures

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.

Pyxis Anesthesia System December 1, 2010 3

Created by Vicki Oldfield

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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:

Documents

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