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Pyxis Usergroup Meeting September 23-25, 2008 OR/PAR PYXIS AT PRH Presented by Brent Atkinson Professional Practice Leader PRH Pharmacy, IH.

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Presentation on theme: "Pyxis Usergroup Meeting September 23-25, 2008 OR/PAR PYXIS AT PRH Presented by Brent Atkinson Professional Practice Leader PRH Pharmacy, IH."— Presentation transcript:

1 Pyxis Usergroup Meeting September 23-25, 2008 OR/PAR PYXIS AT PRH Presented by Brent Atkinson Professional Practice Leader PRH Pharmacy, IH

2 Pyxis Usergroup Meeting September 23-25, 2008 Background: Chief of Anesthesia very supportive Perception of sole-use for anesthetists Orientation sessions poorly attended by Physicians OR manager very proactive for improving Narcotic accountability in OR IH Narcotic Audit revealed OR/PAR at high risk due to lack of compliance with regulations

3 Pyxis Usergroup Meeting September 23-25, 2008 The Resistance Begins! 1 anesthetist resigns on the first go-live day! Many complaints about the access screen (complicated by dual, NSG/MD access) Complaints received re: lack of training and support by Pyxis and pharmacy Refusal to complete pt-specific narcotic sign-off sheets

4 Pyxis Usergroup Meeting September 23-25, 2008 The Dialogue/Conflict Resolution Much venting from anesthetists Meetings with: –Dept Head –Individual physicians –Pyxis/Pharmacy management –OR Manager Modified access screen Provided personalized coaching/instruction

5 Pyxis Usergroup Meeting September 23-25, 2008 Conflict Resolution-continued Attended Dept Anesthesia meeting Reinforced regulatory and IH requirements (utilized the Dept Head and OR manager) Insured that pharmacy staff was present at the OR Pyxis first thing in the morning Gave OR queries high priority for response Followed up with individual practitioners who did not follow policy/procedures

6 Pyxis Usergroup Meeting September 23-25, 2008 Lessons Learned: Involve as many staff early on in process Pick your battles: –Identify what can be changed and what cant –Be as flexible as reason would dictate but be very firm on the non-negotiable part Find out who your key contacts and alliances are and utilize them Invest in plenty of support staff up front in the first days of go-live

7 Pyxis Usergroup Meeting September 23-25, 2008 Present/Future Goals: Real-time follow-up of issues Report generation/follow-up: –OR Narcotic Report –Temporary User Access –Discrepancy follow-up –User access management

8 Pyxis Usergroup Meeting September 23-25, 2008 OR Pyxis Implementation Challenges Sue Barss

9 Pyxis Usergroup Meeting September 23-25, 2008 Initial Resistance Old system – burden on the RN Head of Anesthesiology unsupportive Resistance to everything! Culture of many OR concerns & challenges

10 Pyxis Usergroup Meeting September 23-25, 2008 Concerns Log ins – 3 times for anesthetists to accommodate RN use Returns procedure cumbersome meds must be returned by med and drawer Unclear how this machine could detect diversion Used to having midazolam & ketamine available on OR med trays Refusal to sign waste log ( all information on patients chart)

11 Pyxis Usergroup Meeting September 23-25, 2008 Initial Practice Inadequate training Refusal to fill out waste log – numbers not reliable or useful Several physicians refused to return meds to machine, returned meds to narcotic cupboard Large number of discrepancies – amount returned more/less than stated Request made to have pyxis keys available Minidrawer speed errors, drawers left open, etc. Inadvertent errors having huge impact

12 Pyxis Usergroup Meeting September 23-25, 2008 Solutions Many meetings and discussions Information gathering Many parties involved Change of Head of Anesthesia Recognition of shortfalls and frustrations of OR pyxis machine from Anesthetists perspective Emergency Medication Box available at all times No compromise on Ketamine but Midazolam compromise

13 Pyxis Usergroup Meeting September 23-25, 2008 Solutions Daily activity reports to monitor usage and discrepancies Midazolam Log Agreement on wastage recording – proposal for change

14 Pyxis Usergroup Meeting September 23-25, 2008 If We Had to Do It Over Familiarity with pyxis system and some of the weakness in the system – anticipation of concerns Awareness of OR Culture Workload!


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