Safe medication practices promoted by national organizations and the JCAHO require pharmacist order review prior to medication administration. At KU Med Center, order reviewed by pharmacists result in 4000 to 6000 documented clinical interventions per month. These interventions include recommendations for alternate drug selection and order clarifications, to assure the correct dose, route, frequency, and rate. Except in emergent situations, it is important that all clarifications take place prior to drug administration. The importance of order review is heightened in the environment of an academic medical center. To ensure proper and reliable availability of medications, KU Med Center utilizes Pyxis® stations in the hospital for the access and distribution of many medications.

This newsletter summarizes the policy for medication order processing and accessing medications from the Pyxis® system. The policy was developed to maximize medication access while optimizing patient safety. According to policy, all orders are faxed to the pharmacy and a pharmacist reviews the order before it appears on the patient’s Pyxis® profile. Nurses are able to access medications listed on the patient’s Pyxis® profile. In cases of emergency, nurses may access a select group of medications via the override function.

The Medication Distribution Process

Once new medication orders are faxed to the pharmacy, they are available from Pyxis® as soon as the order is entered into the pharmacy computer system and verified by pharmacists. Orders are triaged immediately upon receipt to the following categories of medication availability:

• "STAT" denotes the need for an emergent response in order processing and availability of a medication on the unit. The medication is available as soon as processing time permits.
• "NOW" denotes the need for an urgent response and are processed after any pending STAT. The ordered medication should be available in the Pyxis® unit within 30 minutes of receiving the faxed order in the pharmacy.
• All other orders, including ASAP orders are scheduled according to the KU Med Center Standard Medication Administration Times. All orders are prioritized according to the indication (i.e. IV antibiotics prior to oral maintenance medications) so that critical medications are available first and all medications are available as soon as possible. The ordered medication should be available in the Pyxis® unit within 30 minutes of receiving the faxed order in the pharmacy

Status of Medications on the Pyxis® Patient Profile

The Pyxis® patient profile is like a "mini" real-time medication administration record (MAR). All of the medications that are active in the pharmacy computer system for a patient are on the Pyxis® profile. However, some of these medications may be "grayed-out". There are three reasons for a "gray-out" medication.

1. An ordered medication is out of stock. The count is zero, the medication needs to be refilled in Pyxis® and a stock-out report has already printed in pharmacy. The medication will be loaded into the Pyxis® station later the same day for future dose availability.
2. The order is currently on hold. The medication has been placed on hold in the pharmacy computer system. Possible causes include: a transfer between ICU and a floor, surgery, or a specific order to hold by the physician.
3. An ordered medication is not loaded in this station. The medication has not been loaded in the Pyxis® unit. The first dose of the medication will be sent up to the nursing unit in deliveries from pharmacy. The medication will then be loaded into the Pyxis® station later the same day for future dose availability.

The Pyxis® Override Policy

The Pyxis® Override Policy allows access to a limited number of medications through the Pyxis® override function when clinical need for quick administration outweighs the safety and benefit of having a clinical pharmacist review the order. What medications are on the override list are not as important as the reasons that the medications are being accessed without going through the normal system that allows for review of orders. The surveyors reviewing JCAHO standard (TX 3.5.2) will most likely not be interested in seeing the list of medications, but instead may ask to see what has been overridden and ask for documentation of the situation that resulted in a need for the medication to be overridden.

The override list includes medications such as immediate release pain medications, anxiolytics, ACLS medications, neuromuscular blocking agents, intravenous steroids, and insulin.

Prepared by Antonia Zapantis, Pharm.D., Pharmacy Practice Management

12/18/01