Medication Management Policy/Procedure

Transcription

1 Medication Management Policy/Procedure TITLE: Sponsor: Pyxis Automated Dispensing Systems, Medication Removal Manager of Pharmacy NUMBER: Approved by: Director of Pharmacy Applies To: Programs, Pharmacy POLICY Personnel who use the Pyxis Automated Dispensing Systems will adhere to protocols to provide safe and accurate provision of medication, secure storage, accurate accountability for Narcotic and Controlled substances, and compliance with Provincial and Federal Regulations Pharmacy is responsible for loading, unloading, and refilling all medications within the Pyxis Systems. Pharmacy uses the Outdate Tracking function to manage drug expiration dates for replacement of expired items. PROTOCOL Inpatient Care Areas: Medications not available in the MedStation will be supplied as patient specific medications from pharmacy. On a patient s profile the medication will be displayed but will be a light gray in colour, indicating that it is not stored in the MedStation. Narcotic and controlled drugs and a specific list of other medications that may be needed urgently will be accessible from the Pyxis Medstation 24 hours/day using the Override feature. Refer to Medication Management Policy As new orders are initiated, pharmacy personnel will verify the needed medication is available in the MedStation that services that patient s location. Once the order is entered into Meditech, the information is sent to the MedStation and the medication is available from the Medstation. If the medication is not loaded in that MedStation, pharmacy will send patient specific medications.

2 Medication Management Policy Removing Items, Pyxis MedStation Page 2 of 6 During the hours that pharmacy is closed the MedStations will be set in Critical Override, allowing all items in the Medstation to be removed without being reviewed by Pharmacy. Refer to Medication Management Policy During regular hours ( h) Pharmacy will load all narcotic/control drugs into Pyxis. Refer to Medication Management Policy Medications required in a given patient care area will be loaded in the Pyxis MedStation as a standard item to prevent this medication from being unloaded from the MedStation, regardless of usage. Changes to this list will require approval from the care area Clinical Leader/Manager and the Pharmacy Manager. Removing medications A. Remove medications for only one patient at a time to minimize line-up at the MedStation and to minimize error potential. For profile stations, take the patient s Medication Administration Record (MAR) to the MedStation to identify items needed for removal. The MAR represents the official document for determining active medication orders not the Pyxis MedStation profile. In the event there are discrepancies between MedStation profile and the MAR, refer to prescriber orders for clarification. B. Accuracy in the removal quantity of medications provides accurate billing and an accurate inventory of drugs so restocking is timely. The system prompts you to remove the quantity appropriate to the order. Orders with range doses (1 to 2 tablets) will not prompt the quantity to remove. Orders for liquid medications that have decimal points (eg. 0.6 ml) will be blank and require the user to enter the volume to be removed. C. Narcotic and controlled substances will prompt the user to count the items before withdrawing any items and to enter the number (blind perpetual count). If the count is inaccurate per the system records, a red Please Recount alert appears. Recount and enter number again. If the inventory count is still incorrect, the MedStation will allow you to proceed so there is no delay in administering the medication to the patient, and will create a discrepancy. Refer to Medication Management Policy D. Pyxis prompts the user to remove the medication from the designated drawer/door and pocket. E. Most vials are removed as a whole vial (or number of vials), and any unused portion is discarded. The majority of vials contained in the MedStation are single use. There are only a couple of multi-dose vials in the MedStation. If the system prompts

3 Medication Management Policy Removing Items, Pyxis MedStation Page 3 of 6 the user to remove a whole vial, then pharmacy has determined that the multidose vial is cheaper than unit dose vial. Discard the unused portion. F. Multi-dose vials that prompt for removal by ml or units, such as insulin, require the user to draw up the dose needed in a syringe and place the vial back in the pocket/bin prior to closing the drawer/door. Do not leave bottles or vials on the counter. Medications that are left on the counter bypass the features intended to provide safer medication administration to patients. G. For multi-dose products (examples ointments, creams, eye drops) intended for extended use, affix patient label (minimum patient name and unit number) to item to ensure proper identification. H. Pharmacy routinely checks for outdated medications. If expired medications are present in the pocket, an Outdate Med icon will appear on the screen to alert the user. Carefully check removed items for expiration dates as all items may not be outdated. I. If the drawer/door opens and no medications are available in the pocket for removal, double check that you are accessing the correct pocket number as displayed on the screen. Items may have been removed incorrectly if the drawer is empty. For example someone entered to remove 1 vial, but changed their mind and took 2 vials. Pyxis thinks there is a vial in the machine so it doesn t send a refill notice to pharmacy. If the medication is stored in multiple pockets, than try to remove the medication several times until the next pocket opens. If there is not another pocket containing the same medication then notify pharmacy during regular hours. Obtain the medication from another care area. J. Never remove items from Pyxis MedStation to dispense to patients as discharge medications. All discharge medications require a prescription and must be filled by pharmacy or a community pharmacy to meet standards for outpatient labeling. K. For profile stations only: 1. Discontinued medications or those with stop times can be removed up to two hours after the time identified in the pharmacy system if needed to complete therapy. 2. Orders scheduled to start at a later time can be accessed from the Pyxis MedStation up to six hours before the start time scheduled in the pharmacy system if needed. 3. Medications removed within 1 hour of removal of the same medication for the same patient will prompt a too close warning. A too close warning never stops you from removing the medication. If you remove the medication too close, you see the last remove time and the name of the staff who removed it. If you touch Accept for a too close warning, an Override Reason screen appears, providing you with a list of reasons that justify why the medication is

4 Medication Management Policy Removing Items, Pyxis MedStation Page 4 of 6 being removed despite the warning. Select the appropriate reason or select Other and type your own reason. 4. If ordered medications do not appear on the patient s profile: a. Switch from generic to brand name display and try to locate the medication again. b. Check the order start time, if it is more than six hours in the future, the order will not display. (Contact pharmacy to adjust the time, if standard times cannot be followed). c. Check the physician s order and verify that the order was scanned to pharmacy. d. If the orders were previously scanned, call pharmacy. 5. If an ordered medication appears on the profile but is in gray, select the item and a screen displays indicating the reason in yellow. Common reasons include: a. The start time has not been reached. b. The order is on hold. c. The order is expired or past the stop time. d. The order has been discontinued. e. The order is a one time medication and has been removed. f. The medication is out of stock. g. The medications are not loaded at the Station. Pharmacy will send patient specific supply. Check the patient s unit dose bin, pharmacy beige bin, paper bags or pneumatic tube system for items. h. The ordered medications are in a failed drawer. Refer to Medication Management Policy Multi-dose vials or liquids will not prompt for a removal amount. Enter the volume to withdraw. 6. Calculate to determine the quantity/volume required for the patient s dose. Choose "Verify Calc" button to check calculations. Non-Inpatient Care Areas (Non-profile): A. All of the medications stored in non-profile MedStations are available for removal without review of orders by pharmacy. Orders for Medications not stored in the MedStations will be scanned to pharmacy and will be prepared as patient specific medications. B. The system requires you to designate a removal quantity. The number of doses taken from the Pyxis must be entered accurately into the system. Accuracy in the removal

5 Medication Management Policy Removing Items, Pyxis MedStation Page 5 of 6 quantity of medications provides accurate billing and an accurate inventory of drugs so restocking is timely. C. Most vials are removed as a whole vial (or number of vials), and any unused portion is discarded. The majority of vials contained in the MedStation are single use. There are only a couple of multi-dose vials in the MedStation. If the system prompts the user to remove a whole vial, then pharmacy has determined that the multidose vial is cheaper than unit dose vial. Discard the unused portion. D. Multi-dose vials that prompt for removal by ml or units, such as insulin, require the user to draw up the dose needed in a syringe and place the vial back in the pocket/bin prior to closing the drawer/door. Do not leave bottles or vials on the counter. Medications that are left on the counter bypass the features intended to provide safer medication administration to patients. E. Narcotic and controlled substances that are stored in Cubie or Carousel Pockets will prompt the user to count the items before withdrawing any items and to enter the number (blind perpetual count). If the count is inaccurate per the system records, a red Please Recount alert appears. Recount and enter number again. If the inventory count is still incorrect, the MedStation will allow you to proceed so there is no delay in administering the medication to the patient, and will create a discrepancy. Refer to Medication Management Policy F. Medications removed within 1 hour of removal of the same medication for the same patient will prompt a too close warning. A too close warning never stops you from removing the medication. If you remove the medication too close, you see the last remove time and the name of the staff who removed it. If you touch Accept for a too close warning, an Override Reason screen appears, providing you with a list of reasons that justify why the medication is being removed despite the warning. Select the appropriate reason or select Other and type your own reason. G. Pharmacy routinely checks for outdated medications. If expired medications are present in the pocket, an Outdate Med icon will appear on the screen to alert the user. Carefully check removed items for expiration dates as all items may not be outdated. H. If the drawer/door opens and no medications are available in the pocket for removal, double check that you are accessing the correct pocket number as displayed on the screen. Items may have been removed incorrectly if the drawer is empty. For example someone entered to remove 1 vial, but changed their mind and took 2 vials. Pyxis thinks there is a vial in the machine so it doesn t send a refill notice to pharmacy. If the medication is stored in multiple pockets, than try to remove the medication several times until the next pocket opens. If there is not another pocket containing the same medication then notify pharmacy during regular hours. Obtain the medication from another care area.

6 Medication Management Policy Removing Items, Pyxis MedStation Page 6 of 6 Definitions APPENDIX A Pyxis MedStations and Pyxis Anesthesia System are medication inventory management systems. They are not used to document medications administered to patients. Records of removals from Pyxis will be reflected in Meditech, however the Patient s Medication Administration Records and/or Anesthesia Records are the documents that indicate whether the medication(s) were actually administered to a patient. Pyxis Anesthesia System Pyxis Anesthesia System is an electronic medication cart used in the Operating Rooms to capture information about medication removal, wastage and charges. Profile and Non-profile Pyxis MedStations There are two types of Pyxis MedStations: profiled and non-profiled. Profiled MedStations are located in inpatient care areas. Profile MedStations operate on an interface to the Meditech system to display the list of ordered medications for each patient that have been reviewed and entered into the system by pharmacy. Non-profile MedStations are limited to Emergency Department, Hematology/Oncology Clinic, Birth Unit, Birth Unit Recovery Room, Same Day Surgery and Pediatric Recovery Room, Pediatric OR, Adult Recovery Room. Patients in these areas do not have medication profiles in Meditech. All of the medications stored in these MedStations are available for removal without review of orders by pharmacy. Orders for Medications not stored in the MedStations will be scanned to pharmacy and will be prepared as patient specific medications. *** IWK Policies Being Replaced Version History Major Revisions (e.g. Standard 4 year review) Minor Revisions (e.g. spelling correction, wording changes, etc.)