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02/26/19 AA -- Pyxis Interface: Verification and Rescheduling

From: Aaron Atkins
Sent: Tuesday, February 26, 2019 10:09:43 AM
Subject: RE: Pyxis Interface: Verification and Rescheduling

**NEW** Critical Pyxis Issue:

If MODIFYING a medication to change the PRODUCT or MED TYPE (Med/Intermittent/Continuous)—for example changing something from PO to IV: For now, please discontinue or void the previous order and enter a new order for the product.  This is similar to our processes with iCare. 

Related to the original issue below, if the order is modified from a Pyxis item to a Non-Pyxis item, Pyxis does not receive the modification since we block Not in Pyxis items from being sent to the interface.  Therefore, Pyxis could still display the previous tablet order when the new order should be for an IV product prepared by PSP.

We are actively working on a solution, but wanted to make sure all staff is aware for now and the best process for handling this in the interim.  Thank you.

Aaron B. Atkins, Pharm.D., BCPS
Clinical Pharmacist, Informatics Lead

From: Aaron Atkins

Sent: Monday, February 25, 2019 7:01:57 PM

Subject: Pyxis Interface: Verification and Rescheduling

To All Pharmacists:

There was an interface update implemented this evening to correct some issues we have been having with rescheduling doses in Cerner and it properly reflecting these changes in Pyxis for removal to match with MAR tasks in 1Chart. As a consequence, there are some important notes regarding verification of orders and timing/tasking outlined below that are important to be aware of. With this interface change in place, we are now ready to remove Pyxis from CRITICAL OVERRIDE status tomorrow (Tuesday, Feb. 26) at 7AM. ED Pyxis devices which have been converted to Profile will remain in Override Status for a couple more weeks. An exception to this is PODG (Observation Unit) which will be placed off Critical Override with the rest of the floor machines.

A few important quick notes regarding orders in 1Chart and their interactions with Pyxis interface:

-If you are verifying a scheduled order BEFORE the start date/time, the start date/time within Pyxis will be the same as the start date/time in 1Chart.

-If you are verifying a scheduled order AFTER the start date time, but WITHIN 2 hours after the start date time, the start date/time within Pyxis will the same as the start date/time in 1Chart.

-If you are verifying a scheduled order AFTER the start date time, but AFTER 2 hours of the start date/time, the start date/time within Pyxis will be the NEXT dose time and will NOT match the 1Chart start/date time. In this situation, a dose/task will be due at the start date/time in 1Chart, but will NOT be removable from Pyxis until the NEXT dose date/time.

Given the above behavior: If you are verifying a scheduled order >= 2 hours AFTER the start date/time of the order, it is best to VOID the order and re-enter to update the dosing schedule so that it appears correctly in Pyxis. This will then match tasks in 1Chart appropriately. Otherwise, Pyxis will default for removal based on the NEXT dose date/time.

Additionally, when RESCHEDULING a dose, please realize that any PAST doses will still remain on the 1Chart MAR for charting purposes. However, Pyxis will be updated to show NEXT DOSE date/time following the reschedule (previous doses in Pyxis will not be retrievable).

Finally: There is ONE outstanding interface issue being worked on with IT: There are SOME instances of PSP-prepared/delivered products (ex. ertapenem ___ mg IVPB) crossing to Pyxis when they should not. We are actively working on a solution, but wanted to give everyone a heads up in case you see this reported from Nursing.

Thank you!

Aaron B. Atkins, Pharm.D., BCPS