[MT-L] Meditech 6.0 and Pyxis ES
Zammett, Lorna
Hello List
I’m wondering if anyone is up on the Pyxis Medstation ES Platform? We are currently on Pyxis 4000 and planning an upgrade to ES by the end of 2016.
This changes some of the pharmacy workflows as well as the nursing workflows.
Hoping to find out about lessons learned, time frame for implementation, etc.
Input appreciated.
Lorna
Lorna O. Zammett, RPh, BS, PharmD
Clinical Informatics Specialist
Bristol Hospital
Bristol, CT 06010
Meditech 6.07 PP6, HIMSS Stage 7
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Nuvallie, Patricia
We would also be love to hear from anyone who has upgraded to ES? J
Thank you, Trish
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Patricia Nuvallie |
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Arthur, Jerri
PER OUR PHA DIRECTOR
Please pass on to them that we were the alpha site for Pyxis medstation ES and have been live for several years now. Be glad to answer questions or find answers if I can’t on my own.
Bill
barri...@stillwater-medical.org
From: Arthur, Jerri
Sent: Monday, May 02, 2016 11:19 AM
To: Arrington, Bill
Subject: FW: Meditech 6.0 and Pyxis ES
From: Meditech-l [mailto:meditech-...@mtusers.com]
On Behalf Of Nuvallie, Patricia
Sent: Monday, May 02, 2016 9:24 AM
To: 'Zammett, Lorna'; medit...@mtusers.com
Subject: Re: [MT-L] Meditech 6.0 and Pyxis ES
We would also be love to hear from anyone who has upgraded to ES? J
Thank you, Trish
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Zammett, Lorna
Thanks Bill. I appreciate the offer.
I did look through the archives and found the following topics that I’ll be sure to review:
“Now” Doses
Split Meds
Premixes
SIGs – do you really have to maintain something on an “external order frequency codes”?
Wasting meds
Narcotics and keys (wants you to take out med before you take out the key to get it)
Passing barcodes
PRN Reason
Anyone care to comment/explain this warning in the Pyxis interface documentation? Maybe an example would help? It is imperative that the strength amount equal the total amount if no
concentration volume is provided. The strength amount must be the concentration strength only if a concentration volume is provided.
Tim McCombs
I will answer to what I know or remember. It has been a year and a half now:
“Now” Doses – Can be incorporated with the help of the Pyxis integration engineer
Split Meds – all multicomponent items seem to work fine for us
Premixes – testing the new Premix best practice with 6.15 now, and seems to be ok
SIGs – do you really have to maintain something on an “external order frequency codes”? YES!! If you want to be able to remove anything by time and I hate it. This includes all Meditech system sigs like, Q4H, Q3D, Q5M, MOWEFR, MOWEFR@..., and the entry of military times. Meditech and Pyxis get a complete “F” on this topic. Maybe someone has a newer version of ES that addresses this?
Wasting meds – any med button is gone, which forced us to go back to paper waste for items that don’t list. Does anyone have a better solution I missed?
Narcotics and keys (wants you to take out med before you take out the key to get it) - ??
Passing barcodes – ??
PRN Reason - ??
Zammett, Lorna
Thanks for the input. Very appreciative of the assistance.
On the ones you answered with a ? Tim, I’m in the same place – I just pulled what I could see from the archives.
On the PRN, I believe the issue was that the PRN message (eg Take for Pain Score 1-5) from the order was not flowing. Expect it was just a mapping issue that has since been figured out.
On the BARCODES, we do use the barcode option for refilling the Pyxis, so I believe it was a question related to that, but it wasn’t clear.
One more question on the topic: Do you have the FORMULARY interface from Meditech to Pyxis ES? Lessons learned?
My understanding is that as the IT Analyst I would do my usual build of drugs in the MT drug dictionary, but now this can flow to Pyxis so the Pharmacy staff doesn’t have to do a manual duplicate build of the drug on the Pyxis console.
I expect that at the Pyxis level they’d still have review it and possibly add things? Alternatively, maybe all of this is now accessible via the Pyxis Enterprise Server (THANKS SO MUCH FOR THE PICTURE OF THAT) and either IT or PHA could be making assorted changes to the “Pyxis Console”.
From Bill’s reply on the PRN topic, we also have the Pyxis machines built to require the RN to answer some questions like you do for Epi, for Vitamin K, etc.
Thanks Again
Lorna
From: Arrington, Bill [mailto:BArri...@Stillwater-Medical.org]
Sent: Tuesday, May 03, 2016 12:17 PM
To: Arthur, Jerri; Zammett, Lorna
Subject: RE: [MT-L] Meditech 6.0 and Pyxis ES
Lorna, see my replies in bold following Tims answers. I’ve included a screen shot to help explain my answer about maintaining sigs.
Thanks
Bill Arrington
Stillwater Medical Center
From: Arthur, Jerri
Sent: Monday, May 02, 2016 3:10 PM
To: Arrington, Bill
Subject: FW: [MT-L] Meditech 6.0 and Pyxis ES
FYI
From: Meditech-l [mailto:meditech-...@mtusers.com]
On Behalf Of Tim McCombs
Sent: Monday, May 02, 2016 2:20 PM
To: 'Zammett, Lorna'; medit...@mtusers.com
Subject: Re: [MT-L] Meditech 6.0 and Pyxis ES
I will answer to what I know or remember. It has been a year and a half now:
“Now” Doses – Can be incorporated with the help of the Pyxis integration engineer – same here at Stillwater
Split Meds – all multicomponent items seem to work fine for us- -same here at Stillwater
Premixes – testing the new Premix best practice with 6.15 now, and seems to be ok –same here at Stillwater
SIGs – do you really have to maintain something on an “external order frequency codes”? YES!! If you want to be able to remove anything by time and I hate it. This includes all Meditech system sigs like, Q4H, Q3D, Q5M, MOWEFR, MOWEFR@..., and the entry of military times. Meditech and Pyxis get a complete “F” on this topic. Maybe someone has a newer version of ES that addresses this?-we don’t have to regularly maintain sigs in the “external order frequency codes” Lorna. We need to only when a new sig is added to Meditech, and that’s rare. Of course we built a lot of sigs originally to match Meditech directions. That said there are a number of “free form” frequencies doctors will come up with for some reason that show up in pyxis, which we don’t try to define. For instance we have a TIDCC frequency, but if a doctor enters a .TIDCC (leading period), Meditech accepts that. But pharmacy changes it to TIDCC as part of our order verification process. See the attached screen shot file. And we are running V 1.3.4 for the ES system and V 4.4.1.7 for the servers if that matters.
Wasting meds – any med button is gone, which forced us to go back to paper waste for items that don’t list. Does anyone have a better solution I missed? – nurses here are able to either waste on removal or go back and waste partial or full doses after the removal process.
Narcotics and keys (wants you to take out med before you take out the key to get it) - ??- with narcotic cabinet keys the nurse first acts like they are doing a count of that item and removes the key. They then would return the key using that same process. BUT, we keep all narcotics in the pyxis. The only ones locked in a cabinet requiring keys (double locked here) are the rare use of a patients own controlled drug. If you need a key first each time your nurses may need to “count” the key, remove the narc, then “count” the key again to return the key.
Passing barcodes – ??-We don’t use the bar code system to restock pyxis here but in testing that function with Pyxis it worked well. Is that the function you wondered about?
PRN Reason - ??- We have several reasons added to certain drugs. We want to gather data for use of Epi for instance so ask the nurse something like “is this being used for an allergic reaction- y/n”. Those responses can be reported out.
Arrington, Bill
Lorna
Regarding PRN orders, at the medstation, when the nurse pulls up the patients profile, the nurse sees a line called “medication administration”, as part of the drugs profile, with whatever has been typed in the specific order for each drug. That information comes from the “label comments” section of the meditech drug order. So that can be a pain score or whatever else you have in that field since it’s a free form field.
We don’t use barcodes for refills either but I’ve seen a demo and it’s actually a pretty quick process.
Regarding the formulary, you no longer will be doing manual builds in Pyxis. When a drug is added to Meditech formulary, the information is sent via interface to Pyxis automatically. You then go into the Pyxis approval queue and click the approve button for that drug. Once its in the approved formulary, if you need to further tweak the drugs information, you can do that in the facility formulary using the edit function. We find that we usually don’t have to tweak one very often.
One thing I forgot to add- We went from Pyxis 3000 to ES. I don’t know about 4000, but with E.S. you can access the pyxis server from anywhere you need it. Here in pharmacy all our computers have access to the server files and reports. Nurses can also do a lot of their pyxis work away from the medstation also. That is a great timesaver for us.
Happy Thursday
Bill
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Tim McCombs
Hi Lorna,
Just to clarify some of my replies.
We have PRN reasons display in Pyxis. They are part of the comments and seem to work fine. I wasn’t sure if you were looking for more.
Sigs – the nightmare for us is really the military times. We have some old school pharmacists that insist to keep using pure military times in the sigs. It is impossible for me to make every combination of these into Pyxis. We currently are around 1200 sigs in Pyxis and still growing. Do you still enter times as sigs? Has everyone else scrapped that practice?
Barcodes – we use Parx, so yes we use the wholesale barcode for refilling. We did not try NDCs yet.
We do see new formulary adds in Meditech go over to the Pyxis approval queue. The approval queue is new and holds these entries until you address them. You need to approve, then add your settings (security group, etc) before they are active. This was much to my surprise as we did not see it in testing, then discovered after go live. It is actually quite nice and has caused us no problems.
A pain point for us is reports. We want to schedule reports to download to files, but users don’t have control of this. You have to enter a request to set up each one. Modifying reports for paper is sometimes a challenge. We are looking for greater customization and output control.
Also to note, we have virtualized all of the consoles, servers, etc, which is very nice. You can pull up the console from anywhere, with multiple users logged in. Also, love the unlimited areas, override groups, etc. that have been added. More work for you, but better control.