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Using Clinical Data Categories with the Pyxis MedStation™ system

Using Clinical Data Categories

Clinical Data Categories (CDCs) are a Pyxis MedStation system software tool that will allow facilities the opportunity to

customize data collection or provide information to the end user. This information can be collected from and provided

to end users when medications are removed from, returned to, or wasted at the Pyxis MedStation system. CDCs can be

limited to removal of medications during the override function. Used appropriately and judiciously, CDCs can help reduce

the possibility of medication errors.

CDCs can be used in various ways to enhance clinical care and process monitoring:

• Prompt Nursing staff to enter information for data collection on quality review activities, drug use evaluation,

or research studies

• Communicate important instructional or educational information

• Pass clinical information to an electronic charting system

Objectives

This guide covers the following topics:

• Pyxis MedStation system version specifications

• Examples of how CDCs can be used

• Charting implications

• Reporting

• General considerations in using CDCs

• CDC setup

Specifications

The following table details Pyxis MedStation system specifications:

Pyxis MedStation system version

Types of CDCs Number of CDCsNumber of characters

2000 4.1Remove Return Waste

15 30

2000 4.2, 3000, and later versions

Remove Return Waste

200 60

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CDC List name Sample responses Examples of use

Heparin Has patient received Lovenox today?

If no, ADMINISTER If yes, CANCEL & CALL PHARMACY

Heparin to avoid excessive anticoagulation

Reason for use Reason for use For pain For temperature

Tylenol

Pain scale Pain scale 1 2 3 4 5 You may want to consider type in for this option as 10 displays before 2 Or, remember to chart pain scale on MAR

Morphine; may be used on removal or on administration if electronic charting interface is utilized

Route of admin Route of admin IV IM

If electronic charting interface is utilized

Only IM Only IM (OKAY) I will give IM Penicillin G Procaine Penicillin G Benzathine

Must dilute in 10 mL normal saline

Must be diluted before use

(OKAY) I will dilute in 10 mL normal saline

Allergies Check allergies (CALL RPh) possible allergy (DO NOT GIVE) has allergy (OKAY) not allergic

All antibiotics at nonprofile stations and override at profile stations

PCN allergy Do not give if Penicillin allergic

(CALL RPh) possible allergy (DO NOT GIVE) has allergy (OKAY) not allergic

Unasyn Zosyn

INR What is current INR? (Type in response) Warfarin Best to use with charting interface; warn Nursing that they will need this info before removing

INR INR <1.5 give dose and call MD 1.5-2.0 (OKAY TO GIVE) >2.0 hold dose and call MD

Warfarin

Do not crush Do not crush (CALL RPh) pt has feeding tube (OKAY) patient can swallow

Sustained release tablets

Vancomycin DUE

Reason for vancomycin order

MRSA Penicillin allergic

Return Reason for return Patient off floor Patient asleep Patient nauseated Patient refused Titrated dose

IV push rate Give IV push over XX minutes

IV Pepcid

IV infusion rate Is vanco for IV infusion? Yes, infuse over 90 minutes No, used for irrigation

IV vancomycin

Examples of how CDCs can be used

The following chart contains examples of ways CDCs might be used:

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Override reason (problem assessment period)

Reason for override New admission and Pharmacy closed Patient emergency MD verbal order and MD at bedside

To assess Nurse’s perspective of why they need to override; to be used only for a short period to identify problems then move to CDC below

Override reason Reason for override Not an emergency, will wait Code 90 Acute pain HR/BP outside limits Nauseated Allergic reaction Antidote/reversal agent

To meet Joint Commission standards for override documentation

Magnesium alertFor Eclamptic seizure tx only

(DO NOT GIVE) cancel remove (OKAY) usual dose = 4 grams

Lidocaine PF Is it preservative free?(CALL PHARMACY) mis-filled med (OKAY TO GIVE) no preservative

Paralytics Is patient on ventilator? (CANCEL REMOVE) not on ventilator (OKAY TO GIVE) patient on ventilator

Vecuronium

Heparin flush Use NS for routine line flush

(OKAY) heparin is indicated not NS Heparin flush on override or nonprofile Pyxis MedStation system

Anesthesia kit Do not return kit here Return to USED KIT pocket Returning anesthesia kits

Used anesthesia kit Is anesthesia record included?

YES anesthesia record inside Returning anesthesia kits

Hypaque allergy Allergic to iodine/contrast?

(Call RPh) possible allergy (DO NOT GIVE) has allergy (OKAY TO GIVE) no allergy

Central line Infuse through central line only

(CANCEL REMOVE) no central line (OKAY) patient has central line

Return bin Don’t return to bin OKAY I need to waste Carpujects

Hx seizures/ renal failure

Hx seizures/renal failure (CANCEL Page RPh) seizure/renal (OKAY TO GIVE) no history

Drug protocol Please refer to protocol ###

Maximum use per day

Maximum is 4g/day (CANCEL) total >4g in 24 hours (OKAY) total <4g in 24 hours

Acetaminophen

Drug interaction Drug interaction Do not administer drug A if patient receiving drug B

Any 2 drugs on the override list that may interact

Drug name alert HydrALAzine is used for blood pressure

OK, ordered for blood pressure (CANCEL) need HydrOXYzine for itching

Hydralazine on override or nonprofile Pyxis MedStation system

High alert medication

High alert med Double check dose/math before administration

Insulin

Drug/procedure interaction

Drug/radiology procedure interaction

D/C metformin 48h before procedure Resume 48 hours post procedure OK, no procedure scheduled

Metformin

Feeding tube warning

D/C feeding 1 hour before and for 2 hours after administration via NGT

(CANCEL) need to wait (OKAY) patient does not have NGT (OKAY) tube feeding d/c > 1 hour

Phenytoin

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New drug education Angiomaxtest 6/1-6/8 Indicated for PTCA May be used with Aspirin Rec. dose 1 mg/kg IV bolus followed by 4 hr infusion at 2.5 mg/kg/hr

Angiomax: Give the information for 2 weeks

ADE Is this to treat an ADE? Yes No

Dextrose 50% Diphenhydramine Epinephrine Hydroxyzine Methylprednisolone Naloxone Flumazenil Vitamin K Protamine: Black box warning—pregnancy—do not handle medication if pregnant or planning to become pregnant

Waste old patch Fentanyl Waste old patch: Cut into 4 pieces and put in sharps container

OK I will waste N/A 1st patch

Return to Pharmacy Controlled meds in unit dose cups

Return to Pharmacy: Too big for return bin

Waste CDC

Waste location Waste location Sink sharps container States that require waste location to be documented

Number of days used

Number of days used 1 2 3

Fentanyl patch

Pyxis MedStation system showing a Nurse removing Benadryl

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Charting

If the hospital has an electronic charting system and

charting interface with the Pyxis MedStation system,

CDCs can be used to pass charting messages, such as site

of injection, pain rating, apical pulse, blood glucose, blood

pressure or other pertinent clinical patient observations,

back to the electronic chart. Careful testing should be

completed if electronic data is expected to transfer to a

third-party vendor for charting. Without a charting interface,

Nurses may be required to document this information on a

manual medical record. Therefore, careful discussion

should be given to the necessity of requiring this

information at the point of removal.

Reporting on CDC information

The following section describes information on CDC

reports available on Pyxis MedStation systems:

• For Pyxis MedStation system 4.1 and earlier, the only

CDC report available at the console is the All Station

Events report. This report contains all of the medication

activity data, including CDC information, and may be

very detailed. This report can be limited by selecting

only the medications that have a CDC attached to them

at the formulary level.

• For Pyxis MedStation system 4.2 and later, a specific

CDC report is available. This report allows the user to

select criteria such as CDC type (remove, return, waste),

CDC, medication, medication class and unit. Currently,

the report cannot be limited by CDC response.

• The Pyxis MedStation system archive data stores the

CDC responses in the file*.cdc. This data may be used

to retrieve all responses users enter for analysis using

a product such as Pyxis® Consultant version 1.80 or

later, or a third-party data mining tool.

• CDC data is not supported by Pyxis Reporter software.

Regulatory concerns

In some states, Pharmacy boards require that Nurses

record the name of the ordering Physician for controlled

substances. A CDC can be set up to list prescribing

Physicians. The CDC is then attached to all controlled

medications. Other states require the waste location

to be documented.

General considerations for using CDCs

CDCs provide a “speed bump” to remind users about

important information to consider when removing

medications, and prior to administering them. If used

selectively, CDCs are an important tool that might

prevent medication errors. However, if CDCs are used

too frequently, users may see them as nuisance notices

and not fully read or comprehend the warnings, thus

compromising the effectiveness of the information.

CDCs can be configured by device and medication and can

also be configured for a mandatory or optional response.

This flexibility allows the message to be displayed on

select devices or all devices. CDCs may be used at Pyxis

MedStation systems in both profile and non-profile mode.

Guidelines for using CDCs

Consider the following issues when deciding how and when

to use CDCs:

• CDCs add process steps to removing, returning or

wasting medications

• CDCs should be used carefully, with the end users’ time

in mind

• Directives and responses should be as brief as possible

• Lists should be short to minimize the need to scroll

• Nurses should be educated before CDCs are activated

• Before implementing a new or upgraded system, it is

best practice to create several CDCs so users can be

educated on CDCs along with any other new features

• The most commonly used reason should not be placed

at the top of the list to encourage end users to read all

responses before making a selection

• Nursing and Pharmacy should work together to

determine which CDCs would be most beneficial to

implement at their facility

Setting up CDCs

For CDCs to work, they must be created, assigned to

formulary items and then turned on at the device level. The

device toggle allows for greater flexibility in using the CDCs.

For example, if CDCs are used to track ADEs, you may elect

not to capture Flumazenil use in the recovery room. When

a CDC is attached to a formulary item, it will prompt the

user for a response each time the item is removed, returned

or overridden, depending on how the CDC is created. It

cannot be limited to the first time that the item is removed,

returned or overridden.

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CDCs at the console

The following illustration shows CDC setup at the console:

• Name: Define the CDC for the console. Select a name

that describes the purpose of the CDC.

• Type-in only: Select this option if you do not plan to give

the end user a selection list and require a typed response.

For example: Pulse rate.

• Single: Select this option if only one response is allowed.

For example: ADE response.

• Multiple: Select this option if users can select up to three

responses from a single CDC. For example: With charting

feature, multiple observations.

• Required: Select this option if you want to force the end

user to respond before removing the medication.

For example: INR.

NOTE: Clearing the Required check box allows the user to bypass entering clinical data.

• Once: Select this option if you want to allow users

to respond to the same CDC for multiple medication

removals with the same CDC response. For example:

To document the ordering Physician for multiple

medications for the same patient.

• Override only: Select this option if you want the CDC to

display only when the medication is removed using the

Override feature. For example: Allergies.

• Type-in allowed: Select this option if you want to give

the user the choice of typing in or selecting an answer

from a list. For example: Reason for override.

• One list: Select this option if you want to set up

one selection list for the user (used in most CDCs).

• Several: Select this option if you want to set up several

lists for the user.

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CDCs by device

The following illustration shows CDC setup for an individual Pyxis MedStation system:

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Creating a CDC for tracking adverse drug events

Use the following guidelines to set up a CDC for tracking adverse drug events:

1. From the Pyxis MedStation console’s main menu, select System Setup > Clinical Data

The following screen appears:

2. Select any category that has not been defined and click Edit

The Clinical Data Edit screen appears:

3. In the Name field, enter ADE

4. In the left box below the Name field, click Single to allow users to enter only one response to the ADE question

5. In the right box below the Name field, click Required to force users to select a response before proceeding

6. In the Clinical Data Lists area, click One List

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7. Click Add

The Add List Name and Responses screen appears:

8. In the Name field, enter Is this being used to treat an ADE?

9. Click Save: The Add button is activated

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10. Click Add

The Add List Name and Responses screen appears:

11. In the Response field, enter the response you want to appear on the Pyxis MedStation system screen

(for example, YES Adverse Reaction) and click Save

12. To add more responses, repeat steps 10 and 11 until all desired responses have been entered

13. When you are finished adding responses, click Save and then click Close

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Setting up the formulary

Once a CDC is created, it must be assigned to the appropriate formulary items. If a medication is assigned to several CDCs,

the order in which the CDCs are assigned determines the order in which the system displays the CDCs. For example, if a

user first assigns an ADE CDC to Benadryl and then assigns an Override Reason CDC to Benadryl, the ADE CDC will appear

first on the screen when the user accesses Benadryl. Up to four CDCs can be assigned to a medication for a Remove,

Waste and Return transaction.

Follow the guidelines in this section to assign a CDC to formulary items.

1. From the Pyxis MedStation console main menu select System Setup > Formulary Management > Formulary

2. Select the formulary item to assign to the CDC

For an ADE CDC, formulary items might include the medications listed in the article published in the journal Formulary

or those you have targeted to monitor at your facility.

3. Click the Formulary Categories tab

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4. From the Remove Clinical Data drop-down list, select ADE

The Save button is activated:

5. Click Save

6. To assign additional medications, repeat steps 2 through 5 for each medication

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Setting up a CDC for a unit

For the CDC to appear on the Pyxis MedStation system’s display screen, it must be activated at the unit.

Follow the guidelines in this section to activate a CDC at a unit.

1. From the Pyxis MedStation system console main menu select System Setup > Devices

2. From the list of devices, select the Pyxis MedStation system where the CDC should be available

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3. Click Edit and then click the Clinical Data tab

4. From the CDC list, select the desired CDC (in this case ADE)

5. Click Activate/Deactivate Clinical Data

6. Click Save, and then click Close

7. Log off the console

NOTE:

If a medication is used throughout the facility, but an ADE CDC only needs to be displayed in select care areas,

a separate ADE CDC will need to be created for the medication, and then assigned to the desired areas. For example,

an article published in the journal Formulary mentioned that a facility planned to stop tracking Romazicon® in the

recovery room. To facilitate this, an ADE CDC was assigned to all medications except romazicon using the process

described above. Another separate ADE CDC that has similar wording was created for Romazicon and activated at

all Pyxis MedStation systems except those in the recovery room.

CareFusion San Diego, CA

carefusion.com

© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved. MedStation and Pyxis are trademarks or registered trademarks of CareFusion Corporation or one of its subsidiaries. DI2078 (1010/PDF)

References:

1. Published articles: http:// www.formularyjournal.com, March 2002. Adding query screen to

Pyxis machines: Simple strategy drastically improves ADE capture rate.

CareFusion provides this document for use as a general resource only. Anyoneusing this document should determine whether it is compatible with applicable state laws, regulations, professional practice guidelines and accreditation standards. Use of this document should be at all times governed by professional judgment of the user.