Pyxis MedStation 3000Educator ReferenceManualRevised June 23, 2008by: Karen Murphy, RN, BScN, CNE—SurgeryRevised: September 2009by: CIS 2 Pyxis Profile Implementation Team

Table of ContentsOverview of Training Manual . 4Booking the MedStation Training Unit . 4Room OC2.57 Access .4Pyxis MedStation Mode .5Expectations of Users .5Refilling Medications: . 5Environment . 6Registering New Users . 7Activating Users.7Logging On & Off (CNE/Instructors). 8Generic Username .8Generic Password.8MedStation Resources. 9For problems with the Pyxis training machine contact:.9For Pyxis Supplies .9Written Resource Information.9Technical Support.9Pharmacy Pyxis Technician:. 9Training Session . 10Overview of Nursing Unit Medication Area.10Non-Profiled vs Profiled .10Non-profiled MedStations . 10Profiled MedStations . 11Removal of Non-narcotic Medications .12Removal of Multi-dose Medications .13Narcotic Removal.13Narcotic Wastes during the Remove Process.14Narcotic Wastes after Prior Removal .14Medication Discrepancies .15What is a Discrepancy? . 15Resolving a Discrepancy/Narcotic Inventory . 15Documenting Discrepancies . 16Unresolvable Discrepancies . 16Examples: Here are some sample discrepancies you may like to use. 17Returns for ALL Medications .18Return of Non-narcotic Medications. 18Return of Narcotics (excluding PCA and Patches) . 18PCA and Narcotic Patches . 18Adding a Patient.19Steps for adding a patient: .19Troubleshooting . 20Data Problems .20Patient’s Name does not appear on the MedStation list. 20Patient’s Name Listed Twice. 20Profile Problems.20Profile is blank. 20What if a one time order medication needs to be re-removed. 20Profile is missing meds . 20Physical Problems .21Recover a Failed Drawer . 21Recover a Failed Cubie Pocket . 21\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc2

Station Display Screen is Black . 22Keyboard is Unresponsive . 22The Touchscreen is Unresponsive . 23BioID Lens Failure. 23Instructor/Educator Skills Checklist. 24\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc3

Overview of Training ManualThis manual is meant to be a quick resource for Clinical Nurse Educator (CNE)/Instructor usewith the Training MedStation. It is not a comprehensive resource and users are directed to theUAH/Stollery Pyxis User Manual for more in-depth discussion and direction where necessary.CNE’s/Instructors are required to be familiar with both resources.Booking the MedStation Training UnitPrior to being able to book into the MedStation Training Unit calendar, you will need to begranted access; to do this, contact the Learning Centre.1. Go to Microsoft Outlook2. In Calendar, click File menu, Open command, select Other User's Folder.3. In the window that appears, select the calendar from the address book by clicking Name(to see the Global Address List) and type edm.meeting room4. Scroll to find EDM.Meeting Room WMC 0C2.57, click to highlight, then click the OK.5. Under Other Calendars in your Calendar window, you will now see an entry for thetraining room. When it is checked, you will see and be able to enter training times.ALWAYS enter your name, program and phone number for the slot you are booking.6. Under Pyxis Training, enter your name and contact number.Room OC2.57 AccessThis room is kept locked at all times. It requires opening by security. There is telephone accessin the alcove outside of OC2.57. Please dial Security at 7.8347 and ask for a room unlock forOC2.57. Hospital identification must be shown to security personnel. Staff should allow at least15 minutes for arrival of security, and realize they should be present at time of security’s arrival.Security will not wait and another phone call will be necessitated.\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc4

Pyxis MedStation Mode – Profile or Non-ProfileContact a Pyxis Superuser to ensure the Pyxis is in the mode (profile/non-profile) thatyou require. Call close to your booked time in case another user required a differentmode for the time slot immediately prior to you. Pager: 445 – 5915Expectations of UsersRefilling Medications: It is the expectation of all educators/instructors that product will be re-stocked & alldiscrepancies removed at the end of every training session. (To prevent any ‘surprises’during’ training, it is suggested users do an Inventory of the product they’ll be usingprior to the training session). To refill medications, you must go in under the PHARM username. The RN usernamewill not give you access to the Refill button.o Username – enter PHARMo Two passwords are available. The passwords are alternated every 3 months. 654321 123456 Codeine 30mg/Acetaminophen 325mg (Tylenol #3) and Morphine 10 mg/ml should havea maximum quantity of 12. There is no limit to the maximum for non – narcotics.To Refill a Non-narcotic Medication:1. From the Main Menu, touch Refill2. The Refill – Select by Med screen appears3. To refill specific medications, select All Medications4. Type in medication name5. Select Refill Selections6. Beginning Count screen appears for non narcotics7. You will be asked “Is This Correct?”8. Select Yes9. Enter number to refill10. Touch AcceptTo Re-fill a Narcotic Medication:1. The Verify Medication count screen appears2. Enter beginning count, touch Accept3. Refill the medication and enter the number added4. Touch Accept\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc5

Environment Paper should be loaded in the training machine Room is tidy upon exiting Mechanical defects such as jammed drawers etc. should be reported immediately toPharmacy (see contact in Resources section of this manual).\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc6

Registering New Users The instructor/educator must complete a Pyxis New User form requesting to be addedto the training machine, form is faxed to Pharmacy where a Pyxis superuser enters theinformation. Pyxis New User Forms can be found on the Intranets’ Virtual Learning Center Educator Resource tab scroll down to Pyxis MedStation. CNE’s and unit managerswill often house hard copies of the form. All new employees/students must have completed a Pyxis New User form to gainentrance to the system. (Best to do this at least 2 days prior to teaching session, toenable staff to register their log on during the training session). The Pyxis New User form must be signed by a CNE, PCM (Patient Care Manager orUM (unit manager). * Nursing programs please take note and, when possible, havetraining done prior to student’s arrival on the unit. New staff/students should enter their first initial and last name as their username on thePyxis New User form. If staff/student has no middle initial, please cite this on the form Please use 123456 as the password for everybody. This number is temporary until theyenter their own; this prevents staff from forgetting their password when training occurs.Activating Users Educator/instructor Activates the new employee(s). This is done by touching UserMenu Activate User Select user’s last name touch Activate. Have the newly activated employee log on with their personal username and assignedpassword. Pyxis will prompt them to change their password by citing Your BioID is noton record. Do you want to register? Touch Yes BioID screen appears touchScan scan one finger 4 times confirmation screen appears touch OK. Once on the unit, only permanent staff of the site (CNE, Manager or RN) may Activatenew employees for use on Pyxis, and only if they themselves have been added to thatparticular MedStation (training or ward station). This is done by touching User Menu Activate User Select user’s last name touch Activate. After first time log in procedure completed, new employee can use his/her Usernameand BioID on any of the unit’s MedStation’s to which they’ve been added, eithertemporarily or permanently. Only staff with the following designations, RN, PCM, UM, CNE, can add a TemporaryUser to the MedStation i.e. staff forget their password or haven’t completed the PyxisNew User form. They are activated for exactly 14 hours duration. Temporary users are activated only when:1. They’ve completed a Pyxis New User form, but they have not yet been put into theconsole by pharmacy\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc7

2. They have permanent access to the MedStation but have forgotten their passwordLogging On & Off (CNE/Instructors)Instructors/Educators require both a user name & password to enter the Pyxis systemGeneric UsernameTwo usernames are supplied so the educator/instructor can witness discrepancies, fill wardstock etc.1. Username – enter RN2. Username – enter PHARMGeneric PasswordTwo passwords are available; each one can be used with one or the other username i.e.between the RN and PHARM username. The passwords are alternated every 3 months.1. 6543212. 123456 When prompted by Pyxis to Change Password, always change it to one of the abovecombinations. Usernames and passwords are located on top of the MedStation in plastic sleeve. If you are the one prompted to change the password, communicate the change to allusers by checking off the appropriate box on the piece of paper located in plastic sleeve. Below is an example of the information that is in the plastic sleeve.Generic User ID’sGeneric Password’s RN 654321 PHARM 123456 Place a check mark ; beside the password currently being used.Password requires changing every 3 months. Always change password toone of the above combinations.Remember to log off after transactions completed. System is automatically logged off after 7minutes if the drawer is left open and 3 minutes if the drawer is closed.\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc8

MedStation ResourcesFor problems with the Pyxis training machine contact:Carole Dugas (Pyxis Super User)PH: 407 – 2600Pager: 445 – 5915Available: Monday - Friday 0730 – 1530 hoursFor Pyxis SuppliesThe training MedStation supplies will be located in the back of the Matrix drawer. Thesesupplies are the responsibility of the CNE’s; pharmacy is not accountable to this duty.Written Resource InformationA hard copy of the Cardinal Health MedStation 3000 User Guide & a copy of the NursingReference Manual are located on top of the MedStation. Both of these resources are alsolocated on the Medication Management Portal, which can be found by accessing the StartMenu Clinical Applications, and on the intranet’s Virtual Learning Center.Technical SupportPharmacy Pyxis Technician: is available from 0730 – 2230 Monday through Sunday @ pager445-5911 for supplies and mechanical problems staff are unable to trouble shoot.Cardinal Pyxis Technician (Field Services Technician) needs to access the back of theMedStation, will need to call Security to get the keys if Pharmacy is closed. If accessing any ofthe drawers, they will need to have someone stay with the FST. 1-800-727-6102. UAH Customer File #107681.\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc9

Training SessionOverview of Nursing Unit Medication AreaThe medication rooms’ design is replicated on every ward & is equipped with: phone, MainPyxis MedStation, Pyxis Tower, exchange cart containing necessary IV/medication supplies,resource texts, patient specific bins, ward stock bins, fridge & flat screen computer. Reference materials include:1. UAH/Stollery Pyxis Medstation 3000 Training Manual2. Pyxis MedStation 3000 System User Guide3. Cardinal Health P&P Manual4. Cardinal Health icon – Including: Lexicomp Drug Information Database for Nursing,Patient Information Sheets Narcotics & non-narcotics are contained in Pyxis, including 90% of ward stock Patient specific meds will be located in room/bed specific bins, either at roomtemperature or in refrigerator. Non-formulary meds do not display on the Pyxis screen EXCEPTION profiled units willdisplay Non-formulary meds on the profile OR the medication is loaded in Pyxis BioID works via infrared light. Should finger print not be detected, try cleaning the lenswith water and 2X2 gauze; avoid use of products that leave residue i.e. Lint from tissuepaper. Pyxis will give user the option of re-scanning their finger should print not bediscerned within 3 attempts. Screen and keyboard can be cleaned with a slightly damp facecloth Paper does not come on unit exchange carts, requires staff call the Pyxis Technician formore supply Learn to pay close attention to the ENTIRE screen, not just the amount section. Alwaysread the screen prompts that are highlighted in yellow & red, these colors indicatesomething of particular importance.Non-Profiled vs ProfiledThroughout this manual, there are references that are either Profile or Non-Profile specific. Theicon below (pharmacy icon) will be used to identify these points.Non-profiled MedStationsMedStations that are non-profiled offer staff access to all medications located within the cabinetat all times.\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc10

Profiled MedStationsProfile is a safety enhancement feature that provides pharmacy verified, patient-specificmedication lists. This feature offers qualified staff the greatest level of confidence in theaccuracy, appropriateness and safety of their patients’ medications prior to administration.Profile is active on Pyxis 24 hours a day, 365 days a year. All inpatient units are profiled withthe exception of ICU’s, OR, PARR, ER, EIP, 5F3 and 4E3.Staff is always expected to work off the patient’s profile in Pyxis to obtain medications. If amedication does not appear on the profile that has been ordered, staff is expected to wait onehour from the scan time for pharmacy to process and put on profile. After that hour is up, ifthe medication is still not on Profile, staff is expected to contact pharmacy to inquire about thestatus of the order. Staff must have the scan time available when making this call to assistpharmacy in location of their order.At times it will not be possible to wait one hour to access the medication on Profile. In thesecases, the override feature may be accessed. The OVERRIDE function allows you to bypassthe profile to access medications in the MedStation. When accessing a medication on override,staff is required to ensure dose, route, and frequency are appropriate for the patient. TheCaution Sheet must also be reviewed to ensure there are no reported allergies or adversereactions to the medication.Limited Override Effective during the hours of 0800-1600 Mon-Fri and allows access to a limited list ofmedications. It is meant to be used for an urgent or emergent clinical condition ONLY.o A list of the medications available during this time can be found on the VirtualLearning Center at XXXX Whenever selecting a medication from this urgent or emergent clinical condition list,you will be required to enter a reason for the override. Medications required STAT that are not on this list, must have the orders sent STATto pharmacy and will be processed in priority order.Complete Override In effect during the hours of 1600-0800 on weekdays as well as weekends, and Statholidays. Provides access to the complete list of medications in the MedStation. Is meant to be used:o in emergent/urgent clinical conditions,o if it has taken greater than one hour for pharmacy to profile themedication, oro if the order was written when pharmacy was closed. You will always be required to enter an override reason for the medications on theurgent/emergent list onlyPlease refer to the UAH/Stollery Pyxis User Manual for more details on Profile differences.\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc11

Removing MedicationsMedication Removal Tips It is possible to remove one medication or several at a time. Read the screen prompts (information is highlighted in yellow) when completingMedStation activities. This helps to prevent errors and reduces time at theMedStation. Check pocket for correct medication before removing. This prevents errors as meds canmove around due to the high quantity stored with in the MedStation so always doublecheck. Exit MedStation after removing medications. Check (against MAR and/or chart)and prepare your medications away from the MedStation. This reduces theamount of time at the MedStation. NON-PROFILE - Patient specific medications do not appear on the medication list as theMedStation only displays the medications that are part of the MedStation inventoryRemoval of Non-narcotic Medications1. Touch Remove and the Patient List screen appears2. Select a patient by touching the screen, or type the beginning letters of the patient’s lastname to search the patient name and then select3. Select the meds to remove.4. Type the beginning letters of the medication to search. You can select Generic or Brandname to change the display5. Verify/Enter the quantity required. If entering the quantity:a. Type the quantity that you are actually removingi. This prevents stock outs by ensuring that pharmacy is always aware of when thepocket needs refilling.IMPORTANT: Always check the unit of removal when accessingmedications. Ex. tabs, mls, bottles, tubes, etc.6. To remove single medication, touch Remove Now.7. To remove multiple medications:On profiled units you will highlight all required meds on the list and you mustverify/enter quantity required. Non-profiled units must touch Select next Medand repeat steps 3, 4 and 5.a. The medication(s) you have selected will be highlighted in blue across the screen. Youcan deselect the medication by touching that particular medication selection.b. To view a list of the medications that you have selected, touch the List Selections buttonlocated on the bottom right hand side of the MedStation screenc. Touch Remove Selections8. To cancel the removal of a medication at any time, touch the Cancel Med button or Skipthis Med prior to closing cubie or drawer.\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc12

9. The final screen in the Remove process displays the name of the patient, the specifiedremove quantity, the medication name, the drawer and pocket, and the date and time lastremoved.10. The required medication pocket(s)/drawer(s) will open.11. When the drawers open, they do not open in the order that you entered the medications, butin the drawer order.12. If several medications are being removed from the same cubie drawer, after you remove thefirst medication and close the lid, the next medication will appear on the screen and the nextcubie pocket will open.13. Remove the medication from the pocket checking against the MedStation screen that youhave removed the correct quantity and the correct medication.14. Close the drawerRemoval of Multi-dose Medications Some examples include: Tylenol elixir, potassium suspension, Heparin & insulin A screen prompt on the MedStation will ask you to check the patient specific bin prior toremoval The quantity may be edited as long as the drawer is open. ENSURE to enter theappropriate value based on the units provided, ex. Bottle, mLs. Place patient identification label on multi-dose container ensuring drug name,concentration & expiry date are visible. Placing the label on as a ‘flag’ works best. Placemed in patient specific bin after initial dose is given. Only when another bottle of medication is given will staff require visiting the MedStationagain. Any unused medication is discarded in the garbage. Do not return to pharmacy or usefor another patient as it’s not in keeping with infection control practice.Narcotic Removal1. Select medication to remove2. Enter or verify quantity to remove3. Select physician from list (This is only done on NON-PROFILED units)a. Touch Accept Responseb. If physician not on list, touch Other Response and type in admitting physicianc. Touch Accept Text4. Verify Medication Count screen displays5. Enter the number of medications in the pocket prior to removal6. Touch Accept7. When the count and the meds in the pocket do not match, a discrepancy icon appears and aprint out of the discrepancy occurs. (Keep this paper until the discrepancy is resolved. SeeDiscrepancy Resolution)\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc13

Narcotic Wastes during the Remove Process1. An on – screen message asks whether you are administering a full dose:a. Touch Yes if administering a full doseb. Touch no if not administering a full dose2. Medication to be witnessed displays3. Touch Accept4. Witness enters Id and presses Enter5. Witness enters Password/BioID and presses Enter6. Enter amount to administer and touch Accept7. Amount to waste is calculated for youThe witness is required by law to stay and observe the actual wastage.Narcotic Wastes after Prior Removal1. On the Main Menu, touch Waste2. Select the patient and a list of previously removed medications appears3. Select the med to waste; ensuring it is the correct medication, time and person removingthe medication4.5.6.7.Touch Waste Selections and the medication to be wasted is listed for verificationTouch AcceptWitness enters ID and presses EnterWitness enters password/BioID and presses Enter8. Enter the amount given, the amount wasted is displayed9. Touch Accept\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Material\Final Education documents sent toDawn Saik\Sep09 Pyxis MedStation Reference Manual for Nurse Educators.doc14

Medication DiscrepanciesWhat is a Discrepancy?During the removal process for narcotics and controlled drugs or during inventory of these samemedications, all users are prompted to do a BEGINNING COUNT. A discrepancy occurswhenever the beginning count is different than the count the MedStation expects to be found inthat pocket or drawer.Discrepancy CreationThe user is given two attempts to enter the correct beginning count. If an incorrect quantity isentered on the first try, a message to Please Recount will be shown and recount themedications and enter the value.If, on the second attempt you enter a value discrepant to what Pyxis understands as the correctcount, then a Discrepancy will be created.When this happens: DISCREPANCY CREATED displays on the screen (See previous page)A DISCREPANCY ICON appears on the bottom right hand side of the MedStationscreenA print out of the discrepancy occursDocument Discrepancy button appears on the Main MenuResolving a Discrepancy/Narcotic InventoryThe charge nurse is responsible to ensure all narcotic discrepancies are resolved as percorporate policy (CAD 2.3.11). Discrepancy Resolution is a Health Canada requirement andcompliance is monitored by Health Canada auditors.When the discrepancy occurs:When a discrepancy occurs, continue to remove the medication you are accessing andadminister as required. Ensure to keep the print out of the discrepancy with you. This print out identifies thedrawer and pocket number, along with the user and prior access information to assistyou in resolution of the discrepancy.Complete a Controlled Medication InventoryDoing an inventory is key in resolving discrepancies. It confirms the current count in the pocket.You will need a witness to complete this process.1. Go to the Main Menu, touch Inventory2. Select By Med3. Select medication to inventorya. Medication may be in more than one drawerb. Refer to discrepancy transaction slip for drawer/pocket number4. Select Inventory Selections\\racfdm02\PROJECTS\Clinical IS MM Phase II\Teams\06 Profile\06 Training Mate

located on the Medication Management Portal, which can be found by accessing the Start Menu Clinical Applications, and on the intranet’s Virtual Learning Center. Technical Support Pharmacy Pyxis Technician: is available from 0730 – 2230 Monday through Sunday @ pager 445-5911 for