OR/PAR PYXIS AT PRH

1. OR/PAR PYXIS AT PRH Presented by Brent Atkinson Professional Practice Leader PRH Pharmacy, IH

2. 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. 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. 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. 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. Lessons Learned: • Involve as many staff early on in process • Pick your battles: • Identify what can be changed and what can’t • 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. 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. OR Pyxis Implementation Challenges Sue Barss

9. Initial Resistance • Old system – burden on the RN • Head of Anesthesiology unsupportive • Resistance to everything! • Culture of many “OR concerns & challenges”

10. 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. 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. 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. Solutions • Daily activity reports to monitor usage and discrepancies • Midazolam Log • Agreement on wastage recording – proposal for change

14. 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!