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12/17/2015 Additional information you should know about Pyxis ES. User Access Linked with the Aurora Network. Access can only be obtained by managers submitting an SMS request to have caregiver added to Pyxis ES. If you lock yourself out of the Aurora network (caregiver connect, email, computer, Epic Remote access) you lock yourself out of pyxis and vice versa. All caregivers will be assigned to locations which managers have deemed appropriate for everyday access. If floating to an area outside of your normal assignment, you will need to have Department managers or house supervisor grant you temporary access to the station. Local inpatient pharmacy can no longer add or reset access. This will require a help desk ticket. Patients Scheduled admissions (pre-admits) will display on Pyxis 24hrs in advance of their scheduled admission date and time. Pre-admit patients will fall off of Pyxis after 30hrs of no activity. This should improve the accuracy of the patient list on each pyxis station. Discharge delay will be 2hrs for inpatient area’s and 8hrs for outpatient/procedural areas. Admissions with no pyxis activity will fall off the stations after 5 days in outpatient/procedural areas and 15 days for inpatient areas. If floorstock patients are used, there will not be a default floorstock patient available. A patient will need to be manually added as needed. Pharmacy will be reviewing all manually added patient activity for appropriateness. Dispensing New ES workflow is Patient (select patient), Action (Remove, Return, Waste), Medication (PAM) LORazepam injection will no longer automatically dispense the key for the lock box in the fridge when dispensing from the patient profile. The key must be overridden prior to starting the dispensing sequence. If you forget to do this, attempt to count the medication remembering that the boxes are clear. Once you enter the count then cancel dispense and try again. All Morphine, Ketorolac, and Meperidine orders will cross to pyxis ES as a “range order”. This means if the order is for one standard dose i.e Ketorolac 30mg, the dose will display in pyxis as 30mg-30mg. When the order is selected, the user will still need to enter the dose they want to give the patient. The user cannot request more or less then the order is entered for. Anytime you dispense a medication from Pyxis without an order, Pyxis will always ask you for the amount you plan on giving your patient. Medication orders that have a dose based on mg/kg will not have a predetermined dispense amount on the patient profile. When the order is selected, pyxis will prompt you fill how much of the medication you would like to dispense (1 syringe, 2 tablets etc.) Recover Failed Storage Space- This is something we couldn’t train, but if any of your medications are identified as being in a failed storage space, use the following steps to fix the failed pocket or drawer. This will allow you to remove your medications. 1. From Home screen select Recover a failed storage space. 2. Select failed pocket or drawer on the screen starting at the bottom of the list if there is more than 1 option. 3. Following the on-screen prompts 4. Tap smart CUBIE pocket lid or re-try Discrepancy Management All discrepancies should be cleared within 24hrs. If after 3 business days the discrepancy is still open, the person found at fault will have their privileges revoked. The user will not get their privileges back until the discrepancy is resolved. Resolution reasons should be factual. o The following are examples of inappropriate resolution reasons “There were two in the pocket” We know there were two in the pocket. We want to know why there where 2 in the pocket. “I don’t know” Even if the reason can’t be determine more detail should be given as to the investigation. For example “ all documentation checks out unable to determine cause” When resolving a discrepancy, you can see the previous 5 transaction and up to 5 transactions after the discrepancy was created Activity reports at the station can now be run up to 3day into the past if more information is needed. Visual Indicators Symbol Meaning Buttons and Icons Symbol Critical Override – indicator appears when the device has not been communicating with the server for a determined period of time or if the current time is within the device’s critical override period. Home – returns the user to the Main Menu screen. QUICK REFERENCE Expand – expands a listed entry. Device Disconnected – indicator appears when the device is not communicating with the server. Remove – removes a selected entry from a list. Discrepancy – indicator appears when one or more unresolved discrepancies are displayed on a device. Duplicate last name – indicates the same last name for more than one patient. Medication due – indicates a medication that is due. Failed Drawer (Hardware) – indicator appears when there are one or more failed drawers or pockets in the device. Past due removable medication – indicates a medication that is removable but not due at the current time. Interface Delay – indicator appears on a device in profile mode when the system detects that the facility has a problem with the orders interface. Past due medication – indicates there are past due medications. Interface Down – indicator appears on a device in profile mode when the system detects that the facility has a problem with the orders interface. Selection – indicates that you selected an item. Medication Not Actionable – indicates that a medication cannot be removed, refilled, or loaded. Select the symbol to see more information. Unavailable meds on profile (Greyed out meds) Touching a Grey med on profile if failed storage space is the reason, navigate to the Main Menu and select Recover Storage Space to attempt drawer/pocket recovery. Meaning Pyxis MedStation® ES system Witness required – indicates that a transaction requires a witness. Access Issues Call IT Helpdesk at 1-800-889-9677. Locked accounts or password reset Call Manger or House Supervisor: If you can log in but have no access to patient. You will need to be activated at the station. Call Central Pharmacy: Supervisor/Manager can’t grant access. User will need to be assigned to facility. LOG IN TO THE STATION Your Pyxis Username and Password are now the same as your domain credentials (i.e., email login). Successful Pyxis BioID Tips: • Avoid the use of lotion, oil, or any other substance prior to placing finger on the Pyxis BioID scanner. • Select a finger and place it on the scanner. Avoid rolling your finger. • Use the screen prompts to guide correct finger placement. • If your scan continues to fail, try using a finger on your non-dominant hand, especially if you have had trouble with Pyxis BioID in the past. BASIC WORKFLOW: “NON-PROFILE” STATION 1.) Select a patient using All Available Patients option (suggested). 2.) Select the function. RETURN TO MAIN MENU Select “Home” icon to return to Main Menu. SEARCH PATIENTS Search by last name. ADD TEMPORARY PATIENT 3.) Type in first three letters of medication (brand or generic name) in the search field. To add temp patient, go to All Available Patients menu and select Add Temporary Patient. 4.) Select medication(s). 5.) Follow the prompts (e.g., CDC, count, witness, etc.). 6.) Remove medication(s), close drawer. 7.) Continue to next patient or sign out. NOTE: List of medications will not display until the first three letters of the med is entered into the search field. Search can be performed using brand or generic name. WASTE AND RETURN When performing a waste or return function, ensure the waste or return corresponds with the correct remove transaction. WASTE WORKFLOW Medications that require a witness and are removed in excess of the required amount must be wasted. You can waste the medication during the removal process by selecting “Waste Now”. You can also waste it at a later time by selecting the “Waste Later” option or simply by closing the pocket/drawer. If you choose to Waste Later, the amount not wasted is flagged as undocumented waste. If you have undocumented waste that has not been resolved, an undocumented waste indicator appears at the bottom of the main menu. DISCREPANCY RESOLUTION *NEW* Discrepancy Workflow Includes ability to add notes, perform count, and print detail around time of discrepancy to assist in resolution. BASIC WORKFLOW: “PROFILE” STATION 1.) Select patient from list using either patient list option. 2.) Select the function. 3.) Select medication(s). 4.) Follow the prompts (e.g., CDC, count, witness, etc.). 5.) Remove medication(s), close drawer. 6.) Continue to next patient or sign out. ORDER PROFILE: “SORTED” WORKFLOW When selecting the Remove button from a patient view, the Med Profile removal screen on the Due Now tab for the selected patient appears. If there are no orders/tasks to display on the Due Now tab, the All Orders screen appears. You can toggle between the Due Now, PRN, and All Orders screens at any time to locate and select the desired medication for removal. MEDICATION OVERRIDE Override is now available as its own action item. That can be select without being in the patient profile. Use the search box in the upper right corner to find meds PATIENT SUMMARY When My Patients list is utilized at profile stations, the Patient Summary offers quick access to medication orders on a patient profile. Troubleshoot Finding Meds Patient Information Not Displayed GLOBAL MEDICATION FIND WASTE/RETURN WORKFLOW: SEARCH ALL MEDS Global Medication Find is permission-based. Regardless of a user's permission (Global Find or Extended Global Find), Global Find results include only facility devices of the same device type as the currently accessed device. For example, results of a Global Find search launched from a Pyxis® Anesthesia ES device include only Pyxis® Anesthesia ES devices. For the user with Global Find permissions, Global Find is displayed as a home screen menu option. The Search All Meds feature is used for medications that do not have an associated prior remove transaction. Users can search and select from a list of active formulary items that they have security group permission to remove. Search All Meds is used for the following reasons: Within each Area grouping, Global Find displays devices in alphabetical order by device name. Users need to waste/return a medication that was not initially removed from the device. A transition to a new ADT and/or Pharmacy Information System (also known as Host Conversion) inactivates an old transaction against which a user needs to reconcile waste. The item is not stored in the device. If a new admission does not display as expected at a device, check to verify patient is admitted in Epic. If patient is displaying as admitted, then notify Central Pharmacy at ext. 3100. This indicates an interface problem. Access Issues Call IT Helpdesk at 1-800-889-9677. Locked accounts or password reset Call Manger or House Supervisor: If you can log in but have no access to patient. You will need to be activated at the station. Call Central Pharmacy: Supervisor/Manager can’t grant access. User will need to be assigned to facility. Station isn’t functioning If the user selects Global Find from a medication availability tooltip, it searches devices in which the item is available. Screen is frozen or Black. Reboot the station using the power button in upper right corner of the back of the main station. If station still doesn’t work call Carefusion Help Desk. Drawer doesn’t register as being closed. Carefusion help desk. Carefusion Help Desk 800-727-6102 Devices in which the item has been blocked from being loaded (for example, using Block Load) and devices that are Out of Service do not appear. You will need the Site ID. It Should be labeled below the monitor of the station.