I guess I'll jump into the fray. What we do is keep the entire container in our narcotic vault and dispense on a unit dose basis (24 hours supply), unless prn, in which case we would supply a 48 hour supply. This we only do for non-formulary narcotics. In each Pyxis machine, we have a pocket called "Miscelaneous Narcotics" where we can load non-formulary narcotics. We keep the count high enough that they can make actual removals. For narcotics that are on the formulary, the patient has to use our narcotics. They can either send their's home or we can keep it in our narcotic vault (and we do keep an inventory log). We just had a patient come in with a bottle of over 500 morphine tablets this past weekend. Someone found this on top of a medication cart and told the nurse that this was a no-no, so we counted how many were there and stored it in our narcotic vault since the patient had no one to take it back to their home. Charlie
Charles Downs Pharm.D. Washington County Hospital Inpatient Pharmacy 251 E. Antietam Street Hagerstown, MD, 21740 301-790-8904 ----- Original Message ----- From: [EMAIL PROTECTED] To: Alan Miller Cc: Davis Daniel - Southern Hills ; [email protected] ; [EMAIL PROTECTED] ; [EMAIL PROTECTED] Sent: Wednesday, January 03, 2007 3:36 PM Subject: RE: [MEDITECH-L] Pyxis/BMV/Patient Own Med Controls The original post used the term "vial", and the replies added the term "multidose", but I'm thinking that the original question was about a prescription vial (bottle) with a bunch of tablets/capsules, and not about a multidose vial of some injectable narcotic. This situation almost never comes up, but we've had it, too, for example, when a patient is on an amphetamine (which we don't stock), and they have to bring their own bottle of meds (in the original Rx container) from home. We also attach an Rx barcode to the bottle. Instead of going through the motions of an aborted "Remove", the nurse can use the "Inventory" feature to get the bottle back into Pyxis, which will also serve as an added control. Of course, your nurses have to have Inventory privileges for that to work. Our staff nurses do physical inventories on controlled substances at the Pyxis stations, so they do have those Inventory privileges. Steven Dailey, RPh Pharmacist/Information Services Union Hospital Elkton, MD 21921 Note: This message and any attachments are intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender. "Alan Miller" <[EMAIL PROTECTED]> Sent by: [email protected] 12/28/2006 08:02 AM To "Davis Daniel - Southern Hills" <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>, "Ed T Lanoue" <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]> cc Subject RE: [MEDITECH-L] Pyxis/BMV/Patient Own Med Controls Using controlled substance multi-dose vials brought in by the patient? That raises so many red flags I'd think I was in Moscow! Just say Nyet! Alan Miller, RPh >>> "Davis Daniel - Southern Hills" <[EMAIL PROTECTED]> 12/27/2006 10:55 >>> With out engineering contrived barcodes created simply for the sake of hitting 100%, I doubt a facility can ever hit a 100% scan rate. However, many staff can hit 100% if they don't have a patient with some of those outlier situations. However, bringing in controlled meds puts this discussion in a whole other realm. We have always taken additional precautions with controlled meds. I would assume that most facilities have moved away from multidose vials for controlled meds already, and probably for most other meds for a myriad of reasons. You would want to look at the practice of allow the patient to bring controlled meds in multidose vials and the impact it can have on things at your facility. If you determine that it is the safest, best practice to continue doing that, then I would guess that you would have to determine whether you want to skip the BMV so that your users don't have to "replace" the vial, or if you design a way around the return issue so that you can have the additional safety of scanning a controlled medication at the bedside. Best of luck to you, Daniel Davis, RN ________________________________ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Tuesday, December 26, 2006 10:49 PM To: 'Lanoue, Ed T'; [EMAIL PROTECTED] Subject: RE: [MEDITECH-L] Pyxis/BMV/Patient Own Med Controls Hey Ed- Is BMV supposed to hit 100% scanned meds? Most likely this is a fantastic example of one that actually shouldn't be scanned for the reasons you described. From a "patient safety" view, a solid implemented point of care medication administration/documentation program should be the goal - but let's make them realistic and obtainable. Another reference on this would be the folks at www.PointofCareForum.com - Kevin. Kevin McConnell, PharmD. Clinical Consultant (713)480-6810 [EMAIL PROTECTED] www.RPhInformatics.com ________________________________ From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf Of Lanoue, Ed T Sent: Tuesday, December 26, 2006 11:41 AM To: [EMAIL PROTECTED] Subject: [MEDITECH-L] Pyxis/BMV/Patient Own Med Controls Hi Everybody, I am trying to find an easier way to track a patient's controlled medications that are stored in Pyxis and coded by RX number and tracked by inventory. The nurse removes the drug from Pyxis like all other medications, but I'm wondering how to get the vial (which has the order specific barcode on it) to the patient bedside and then back into the Pyxis. I suppose we could have nurses attempt to remove it again and hit the Cancel button to "return" it. I hate that idea but that's what I'm coming up with in order to keep the inventory correct. Does anyone have a better solution to this problem? 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