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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.