Pyxis and Profiling

Pyxis is an ADS -- Automated Dispensing System. This is a storage device that allows nurses in hospitals quick, electronic activated and tracked access to common medications. Some hospitals are "cartless" and rely on ADS to dispense all meds that a patient could need. Our hospital uses Pyxis for PRN and emergent meds. Currently only Colace is the only scheduled med in Pyxis and that is because it move there meant saved space and time in the robot (Swisslog -- he is our cartfill beast that lives in the brightest room in the basement).

At first Pyxis was non-profiled. I actually worked side by side with Judy, one of our very experienced informatics pharmacists and pushed up several of the top floor machines. Non-profiled meant that a RN could retrieve any med for any patient as long as the med was stocked in the machine. In essence, it was a fancy, well-lit (and expensive) med cart.

But it can me so much more!!! Pyxis can work with allergy and ADR alerts. It can also be profiled, which we are now, which allows us to restrict access of meds to those that are on a patient's medication list or those that are emergently needed (override activity for meds like lorazepam IV or morphine).

Additionally, going to profile worked well for our ED who adopted Epic in Nov 2009. ASAP (Epic's ED application). ASAP is a CPOE system. As MDs enter a med and sign the order, meds are either autoverified or sent to the pharmacist's verification queue for review/editting.

Autoverified??? How did we decide this and how is this possible?
Excellent question reader! Meds that are autoverified are those that are available as floorstock and readily administered with minimal manipulation. Those that are not autoverified and populate the pharmacists' queues are those that require the IV room to process the order or those that were deemed necessary. Autoverify works because Pyxis profiling and the use of remote stock lists.

Meds on remote stock lists are in Pyxis as inventory but not really.....this will allow the electronic order to cross over and create a transaction on the patient's eMAR. Profiling the machines were necessary so that overrides would populate the correct patient's eMAR (inpatient areas) when the order had not been entered for the patient. In the ED, profiling is not necessary as this is a CPOE system -- so if it is ordered by the MD, overrides are not needed...it's already on the MAR. Because of this, profiling has not been initiated in the ED as the time this blog was blogged. However, remote stock list provided us the flexibility to add medications to floorstock quickly without asking for a medication list addition in Epic. Because Epic and Pyxis 'talk', when something is added to Pyxis' formulary and made available as a station's inventory, Epic sees this and will allow this as a dispense location.

Profiling of the Pyxis was actually implemented on 9/14/09, a solid 2 months before eMAR with RNs was implemented. This kind of strategy was annoying at first -- slowly pulling off a bandaid is not as nice as just ripping it off. However, the baby steps for RNs was likely helpful in their overall transistion.

This is the general, short and sweet story of Pyxis at CSMC as of 12/25/09.