Reconciling Diversion Activity Utilizing Pyxis MedStation

Reconciling Diversion
Activity Utilizing
Pyxis MedStation® system
Dr Carolyn Masengale
DNP MSN RN NEA-BC.
Director Customer Advocacy Quality
June 5, 2014
1
CONFIDENTIAL INFORMATION –
for internal use only
© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Agenda
•  Overview of Pyxis Medstation
•  Pyxis Medstation
®
®
remove, return & waste
•  Discrepancy management
•  User security
•  Reports to monitor diversion
•  How to catch diversion (case studies)
•  Q & A Session
2
CONFIDENTIAL INFORMATION –
for internal use only
© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Objectives
•  After completing this offering the participant will
be able to :
◦  Describe Pyxis MedStation
system features that help
deter controlled substance diversion
◦  Describe user security
◦  Describe reports to monitor/detect diversion
3
®
© 2009-2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
What is a Pyxis Med
station®?
Subtitle (28)
P
yxis (pik’sis)
1. A cylindrical vase
or container with a cover.
Used by ancient Greeks
and Romans to store
medicinal herbs.
© 2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
History of Pyxis®
•  An idea was born in 1987…
–  John McLaughlin, a LA doctor, came up with an idea of an automated
dispensing cabinet that could help reduce health care costs in the hospital
–  Ron Taylor became CEO in August of 1987
•  In 1990, Pyxis launched its Pyxis MedStation
®
system
•  In 1992, Pyxis decided to go public
•  In 1996, Cardinal Health acquired Pyxis® Corporation
•  In 2009, there was a spinoff resulting in CareFusion
Corporation from Cardinal Health
6
© 2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Pyxis® MedStation® system
Barcode scanner -2D
15-inch display
Flat workspace area
for MAR or chart
Enhanced BioID
fingerprint
identification system
Secured drawers for single
medication/single dose
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Pyxis MedStation® system
Drawer Types
Four Drawer Types:
•  Matrix drawers
•  Carousel drawers
•  MiniDrawer secure medication dispensing
pockets
•  CUBIE® drawers
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Matrix Drawer
•  Multiple Drug access
•  For large non
controlled, over the
counter type
medications
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Carousel Drawer
•  Single Drug access
•  Utilized for large
controlled
medications
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
MiniDrawer secure medication
dispensing pockets
•  MiniDrawer secure
medication dispensing
pockets can be
configured at the
console to dispense a
single dose of a
controlled substance
each time the drug is
requested. This
prevents the user from
removing more doses
than requested.
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
CUBIE® drawer
•  Single Drug Access
•  Controlled
medications
•  Non-Controlled
medications with
need for limited
access
•  Three sizes
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Subtitle (28)
Medication
Removal
Return
Waste
Medication Removal
•  Select a medication by touching the medication
on the screen
•  Profile stations will display quantity as ordered
•  Non-profile stations – enter quantity to be
removed
•  Quantity can be adjusted
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Medication Removal:
Override
•  What is override?
•  Ramifications of overriding
•  Establish an override philosophy
‒  Urgent patient conditions
‒  Emergent patient conditions
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Medication Removal
Controlled Substance Management Counting
•  Verify count – nurse verifies
the count on the screen is
correct or corrects count
•  Blind count – nurse is asked
to count and enter the
amount in the pocket
o  Recount prompt if first
recount entered does not
match expected count
•  Expected count different for
entered count then a
discrepancy is created
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Returning a Medication
The Return function is
used to return medications
and credit the patient’s
account:
•  The returned medication
must be in unit dose and
original, unopened package
•  Use of the return bin vs.
return to stock
17
© 2009-2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Return Bin
© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Wasting a Medication
•  Waste function
documents
controlled
substance waste
◦  Creates an audit
◦ 
◦ 
record
Waste all or part of a
removed medication
Requires a witness
•  Waste while
removing
◦  Liquids and
injectables
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Undocumented Waste
Tracks and alerts users to document any transactions
where remove amount exceeds the ordered dose
If undocumented waste is present, the user receives
an alert the next time they log back into the device
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Discrepancy
Management
Subtitle (28)
Discrepancy Management
Discrepancy Icon:
Alerts nursing to a controlled substance variance
•  A discrepancy occurs when the
medication count does NOT
match the count expected by
the system
•  A discrepancy icon appears at
the bottom of the screen to
alert the nurse to a controlled
substances variance has
occurred
•  Icon disappears after the
Discrepancy is resolved
22
© 2009-2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Resolving Discrepancies
•  Nurses have many visual
clues that there is a
discrepancy on the Pyxis
MedStation® system.
•  A “Document Discrepancy”
button will appear on the
main menu screen
•  Discrepancies can then be
researched
◦  using the information on the
screen
◦  interviewing the prior user
and/or reviewing the chart
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Resolving Discrepancies
•  Pre-defined reasons or customized reasons
•  If none of the reasons fits, choose “Other”
and type in the reason
•  The reason must explain why the discrepancy
occurred
•  All discrepancies should be resolved by the
end of each shift
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
User Security
Subtitle (28)
User Security
Pyxis MedStation®
◦  System ID / Password / BioID
◦  Require picture ID for password
reset
26
© 2009-2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Biometric Identification
• 
Enhances user security
• 
Minimizes potential for
diversion
• 
Improved surface and
imaging with 2D spectral
Biometric enhanced
imaging technology
• 
Register the same finger
three times initially
• 
Use the same finger when
accessing the machine
• 
Supports regulatory
compliance
Pyxis MedStation®
System Management
Reports
Subtitle (28)
Discrepancy Reports
•  ALL discrepancies should be resolved by the end
of the shift
‒  To document that there are no unresolved discrepancies,
the charge nurse can run an Open Discrepancy Report
at the end of the shift, review and sign the report and
leave it for the nurse manager to review.
•  Nurse managers review the All Discrepancies
Report daily to provide a “closed loop” system
‒  Do the reasons for resolved discrepancies make sense?
‒  Are the same users consistently creating discrepancies?
‒  Is there an educational or lack of compliance issue?
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Activities Report Controlled Substance Monitoring
•  Weekly, the nurse manager chooses a controlled
substance to study
•  Run an Activities Report for the medication to be studied
•  Compare the medications vended versus medications
charted
‒  Was waste appropriately documented?
‒  Was there an order for the medication?
‒  How often is the nurse removing the medication for a
particular patient?
‒  Are there vends of more than two each of a single line item
at a time? If so, why?
‒  Is effectiveness of medication documented?
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Return/Waste Reports
Return/Waste report by user:
perform random audits of nurses for accurate
documentation of controlled substances removed
from and wasted at the Pyxis MedStation®
system.
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Return/Waste Reports
Return/Waste report by user:
perform random audits of nurses for accurate
documentation of controlled substances removed
from and wasted at the Pyxis MedStation®
system.
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Suggested Monitoring
•  End Users
‒  Activity report by user, medication or patient
•  Charge Nurse and Nurse Manager
‒  Open Discrepancy Report
‒  Activity report/override activity at end of shift for unusual
activity
‒  Undocumented Waste
•  Nurse Manager
‒  Activity reports by patient or user to check charting
accuracy
‒  Random activity reports by user to check for
appropriateness
‒  Periodic review of user list
‒  Discrepancy reports from pharmacy
33
© 2009-2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
How users try to beat the system…
•  Inventory
•  Cancel transaction
•  Change quantity
•  Use someone else’s
–  User ID
–  Password
Positive identification
option/BioID
34
© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Case Study
Subtitle (28)
How to catch diversion…
Case Study #1:
A nurse is stealing medications upon removal from
the Pyxis MedStation® What reports can be run?
–  Discrepancy Report – will display date, time, user,
medication, pocket, and incorrect count
Service Messages – will identify the transactions
that were started at the Pyxis MedStation® but
subsequently cancelled
All Station Events Report – will give a complete
detailed listing of all activity performed at the Pyxis
MedStation®
36
© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.
How to catch diversion…
Case Study #2:
A nurse uses the override capability at the Pyxis
MedStation® in order to divert medications without
causing discrepancies or cancelled transactions.
What reports can be run?
–  Profile Override Report – can be run to find out what
medications a nurse has overridden for any patient. An
order must exist for that medication for that patient.
37
© 2009 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Objectives
After completing this offering the participant will
be able to :
Describe Pyxis MedStation® system features that
help deter controlled substance diversion
•  CUBIE® pockets, MiniDrawer secure medication dispensing
pockets and Carousel drawers provide secured pockets that
give the user access only to the medication requested. This
prevents the user from removing a medication in an adjacent
pocket when the drawer is opened.
•  Blind Count.
◦  Describe user security
Pyxis MedStation® system ID / Password / BioID
◦  Describe reports to monitor/detect diversion
•  Discrepancy, return, waste, activity
38
© 2009-2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Additional Resources
•  The Insider, quarterly customer newsletter
http://www.carefusion.com/insider
•  Customer Connection
‒  Product information
‒  Best Practices Information
http://www.pyxis.com/CustomerConnection.aspx
•  Center for Safety and Clinical Excellence
‒  Provides free educational web casts
•  ISMP resource site
http://clinicalismpresource.carefusion.com
© 2009-2012 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Questions
The CareFusion logo, Pyxis, CIISafe, CUBIE, Pyxis MedStation and PARX are trademarks or registered trademarks of CareFusion
Corporation or one of its subsidiaries. All other trademarks are the property of their respective owners.
Thank you