reconciling diversion activity utilizing pyxis … · reconciling diversion activity utilizing...

© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.

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Reconciling Diversion Activity Utilizing

Pyxis MedStation® system

Dr Carolyn Masengale DNP MSN RN NEA-BC. Director Customer Advocacy Quality June 5, 2014

CONFIDENTIAL INFORMATION – for internal use only


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Agenda •  Overview of Pyxis Medstation ®

•  Pyxis Medstation ® remove, return & waste •  Discrepancy management •  User security •  Reports to monitor diversion •  How to catch diversion (case studies) •  Q & A Session

CONFIDENTIAL INFORMATION – for internal use only

© 2009-2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.

Objectives

•  After completing this offering the participant will be able to : ◦  Describe Pyxis MedStation ® system features that help

deter controlled substance diversion ◦  Describe user security ◦  Describe reports to monitor/detect diversion

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What is a Pyxis Medstation®? Subtitle (28)


yxis (pik’sis) 1. A cylindrical vase or container with a cover. Used by ancient Greeks and Romans to store medicinal herbs.

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•  An idea was born in 1987… –  John McLaughlin, a LA doctor, came up with an idea of an automated

dispensing cabinet that could help reduce health care costs in the hospital –  Ron Taylor became CEO in August of 1987

•  In 1990, Pyxis launched its Pyxis MedStation ® system

•  In 1992, Pyxis decided to go public

•  In 1996, Cardinal Health acquired Pyxis® Corporation

•  In 2009, there was a spinoff resulting in CareFusion Corporation from Cardinal Health

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History of Pyxis®


Pyxis® MedStation® system

15-inch display Barcode scanner -2D

Secured drawers for single medication/single dose

Flat workspace area for MAR or chart

Enhanced BioID fingerprint identification system


Pyxis MedStation® system Drawer Types Four Drawer Types: •  Matrix drawers

•  Carousel drawers •  MiniDrawer secure medication dispensing

pockets •  CUBIE® drawers


Matrix Drawer

•  Multiple Drug access

•  For large non controlled, over the counter type medications


Carousel Drawer

•  Single Drug access

•  Utilized for large controlled medications


MiniDrawer secure medication dispensing pockets

•  MiniDrawer secure medication dispensing pockets can be configured at the console to dispense a single dose of a controlled substance each time the drug is requested. This prevents the user from removing more doses than requested.


CUBIE® drawer

•  Single Drug Access •  Controlled

medications •  Non-Controlled

medications with need for limited access

•  Three sizes

Medication Removal Return Waste

Subtitle (28)


Medication Removal •  Select a medication by touching the medication

on the screen

•  Profile stations will display quantity as ordered

•  Non-profile stations – enter quantity to be removed

•  Quantity can be adjusted


Medication Removal: Override

•  What is override? •  Ramifications of overriding

•  Establish an override philosophy ‒  Urgent patient conditions

‒  Emergent patient conditions


Medication Removal Controlled Substance Management - Counting •  Verify count – nurse verifies

the count on the screen is correct or corrects count

•  Blind count – nurse is asked to count and enter the amount in the pocket o  Recount prompt if first

recount entered does not match expected count

•  Expected count different for entered count then a discrepancy is created


Returning a Medication

•  The returned medication must be in unit dose and original, unopened package

•  Use of the return bin vs. return to stock

The Return function is used to return medications and credit the patient’s account:

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Return Bin


Wasting a Medication

•  Waste function documents controlled substance waste ◦  Creates an audit

record ◦  Waste all or part of a

removed medication ◦  Requires a witness

•  Waste while removing ◦  Liquids and

injectables


Undocumented Waste

Tracks and alerts users to document any transactions where remove amount exceeds the ordered dose If undocumented waste is present, the user receives an alert the next time they log back into the device

Discrepancy Management Subtitle (28)


Discrepancy Management

•  A discrepancy occurs when the medication count does NOT match the count expected by the system

•  A discrepancy icon appears at the bottom of the screen to alert the nurse to a controlled substances variance has occurred

•  Icon disappears after the Discrepancy is resolved

Discrepancy Icon: Alerts nursing to a controlled substance variance

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Resolving Discrepancies

•  Nurses have many visual clues that there is a discrepancy on the Pyxis MedStation® system.

•  A “Document Discrepancy” button will appear on the main menu screen

•  Discrepancies can then be researched ◦  using the information on the

screen ◦  interviewing the prior user

and/or reviewing the chart


Resolving Discrepancies

•  Pre-defined reasons or customized reasons •  If none of the reasons fits, choose “Other”

and type in the reason •  The reason must explain why the discrepancy

occurred •  All discrepancies should be resolved by the

end of each shift

User Security Subtitle (28)


User Security

Pyxis MedStation® ◦  System ID / Password / BioID ◦  Require picture ID for password

reset

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Biometric Identification

•  Enhances user security •  Minimizes potential for

diversion

•  Improved surface and imaging with 2D spectral Biometric enhanced imaging technology

•  Register the same finger three times initially

•  Use the same finger when accessing the machine

•  Supports regulatory compliance

Pyxis MedStation® System Management Reports Subtitle (28)


Discrepancy Reports

•  ALL discrepancies should be resolved by the end of the shift ‒  To document that there are no unresolved discrepancies,

the charge nurse can run an Open Discrepancy Report at the end of the shift, review and sign the report and leave it for the nurse manager to review.

•  Nurse managers review the All Discrepancies Report daily to provide a “closed loop” system ‒  Do the reasons for resolved discrepancies make sense? ‒  Are the same users consistently creating discrepancies?

‒  Is there an educational or lack of compliance issue?


Activities Report - Controlled Substance Monitoring •  Weekly, the nurse manager chooses a controlled

substance to study •  Run an Activities Report for the medication to be studied •  Compare the medications vended versus medications

charted ‒  Was waste appropriately documented? ‒  Was there an order for the medication? ‒  How often is the nurse removing the medication for a

particular patient?

‒  Are there vends of more than two each of a single line item at a time? If so, why?

‒  Is effectiveness of medication documented?


Return/Waste Reports

Return/Waste report by user: perform random audits of nurses for accurate documentation of controlled substances removed from and wasted at the Pyxis MedStation®

system.


Return/Waste Reports

Return/Waste report by user: perform random audits of nurses for accurate documentation of controlled substances removed from and wasted at the Pyxis MedStation® system.


Suggested Monitoring •  End Users ‒  Activity report by user, medication or patient

•  Charge Nurse and Nurse Manager ‒  Open Discrepancy Report ‒  Activity report/override activity at end of shift for unusual

activity ‒  Undocumented Waste

•  Nurse Manager ‒  Activity reports by patient or user to check charting

accuracy ‒  Random activity reports by user to check for

appropriateness ‒  Periodic review of user list ‒  Discrepancy reports from pharmacy

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How users try to beat the system…

•  Inventory •  Cancel transaction •  Change quantity •  Use someone else’s

–  User ID –  Password

Positive identification option/BioID

Case Study

Subtitle (28)


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How to catch diversion…

Case Study #1: A nurse is stealing medications upon removal from the Pyxis MedStation® What reports can be run?

–  Discrepancy Report – will display date, time, user, medication, pocket, and incorrect count

Service Messages – will identify the transactions that were started at the Pyxis MedStation® but subsequently cancelled All Station Events Report – will give a complete detailed listing of all activity performed at the Pyxis MedStation®


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How to catch diversion…

Case Study #2: A nurse uses the override capability at the Pyxis MedStation® in order to divert medications without causing discrepancies or cancelled transactions. What reports can be run?

–  Profile Override Report – can be run to find out what medications a nurse has overridden for any patient. An order must exist for that medication for that patient.


Objectives

After completing this offering the participant will be able to : Describe Pyxis MedStation® system features that help deter controlled substance diversion

•  CUBIE® pockets, MiniDrawer secure medication dispensing pockets and Carousel drawers provide secured pockets that give the user access only to the medication requested. This prevents the user from removing a medication in an adjacent pocket when the drawer is opened.

•  Blind Count. ◦  Describe user security

Pyxis MedStation® system ID / Password / BioID ◦  Describe reports to monitor/detect diversion •  Discrepancy, return, waste, activity

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Additional Resources •  The Insider, quarterly customer newsletter

http://www.carefusion.com/insider •  Customer Connection ‒  Product information

‒  Best Practices Information http://www.pyxis.com/CustomerConnection.aspx

•  Center for Safety and Clinical Excellence ‒  Provides free educational web casts

•  ISMP resource site http://clinicalismpresource.carefusion.com

Questions

Thank you

The CareFusion logo, Pyxis, CIISafe, CUBIE, Pyxis MedStation and PARX are trademarks or registered trademarks of CareFusion Corporation or one of its subsidiaries. All other trademarks are the property of their respective owners.

reconciling diversion activity utilizing pyxis … · reconciling diversion activity utilizing...

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