Open Forum

Currently we are working on a process to have medication orders placed prior to the MA, ATC, or RN pulling medications from the Pyxis for the providers to give during an in clinic procedure.  We are using Epic Ambulatory for charting and are not allowed to place verbal orders.  The proposed process is to have clinical staff pend the medication orders to the provider once the patient checks in, provider signs, clinical staff retrieves the medications from the Pyxis, prepares it for the procedure, provider administers the medication, and staff then document for another user on the MAR.  Many of these procedures require compounded medications of 2-3 meds per injection and some patients may be getting bilateral injections.  Some of our busy injection clinics are doing 40 procedures per day.  I am wondering how other Joint Commission Regulated Clinics are handling high volume injection clinics within compliance?  Appreciate any and all ideas!  I have listed some of the barriers below.

Barriers

• Inability to sign orders until patient checks in
• Inability to sign/hold orders prior to check in
• Multiple medication orders to place and document on for compounded meds
• Clinic staff is not always in the room when the injection is done so may not be aware of exactly how much was given to document
• Need to document for another user (the provider) on the MAR after medication is given
• Decrease in efficiency for high volume procedure clinics

Thanks for posting this question. We do not have pyxis in our ambulatory space, but I am curious why the providers aren't mixing their own medications since they are injecting and administering?  My gut reaction as an RN would be to have the provider document anything that he/she gives and have the provider witness me mixing the medication or have the provider mix his/her own medication.  The liability of the injection and mixing is on the provider.  I have seen this practice in my systems ambulatory space, minus pyxis.  I encourage MAs and RNs to have witness of components being mixed if asked to mix with specific directions and make sure it is documented.  Has this practice been brought to your legal department's attention for their opinion?  

I would be curious to hear how other systems are handling this issue.  

Currently we are working on a process to have medication orders placed prior to the MA, ATC, or RN pulling medications from the Pyxis for the providers to give during an in clinic procedure.  We are using Epic Ambulatory for charting and are not allowed to place verbal orders.  The proposed process is to have clinical staff pend the medication orders to the provider once the patient checks in, provider signs, clinical staff retrieves the medications from the Pyxis, prepares it for the procedure, provider administers the medication, and staff then document for another user on the MAR.  Many of these procedures require compounded medications of 2-3 meds per injection and some patients may be getting bilateral injections.  Some of our busy injection clinics are doing 40 procedures per day.  I am wondering how other Joint Commission Regulated Clinics are handling high volume injection clinics within compliance?  Appreciate any and all ideas!  I have listed some of the barriers below.

Barriers

• Inability to sign orders until patient checks in
• Inability to sign/hold orders prior to check in
• Multiple medication orders to place and document on for compounded meds
• Clinic staff is not always in the room when the injection is done so may not be aware of exactly how much was given to document
• Need to document for another user (the provider) on the MAR after medication is given
• Decrease in efficiency for high volume procedure clinics

Hi Margaret,

Thanks for responding and for your feedback!  I have discussed these concerns with our regulatory department and it is within scope for an RN or Athletic Trainer to compound medications for providers to give as long as the compounded medication is labeled.  In my mind this is similar to pharmacy mixing medications in the pharmacy and sending to the floor for administration.  In clinics that only contain Medical Assistants, meds are pulled from the Pyxis and given to providers for providers to compound/mix, but we will still be required to document on the MAR.  Our providers are documenting within their procedure note but our regulatory department has decided that all things also need to be documented on the MAR, especially since a provider note is not always signed immediately after the procedure.  

Thanks!

Thanks for posting this question. We do not have pyxis in our ambulatory space, but I am curious why the providers aren't mixing their own medications since they are injecting and administering?  My gut reaction as an RN would be to have the provider document anything that he/she gives and have the provider witness me mixing the medication or have the provider mix his/her own medication.  The liability of the injection and mixing is on the provider.  I have seen this practice in my systems ambulatory space, minus pyxis.  I encourage MAs and RNs to have witness of components being mixed if asked to mix with specific directions and make sure it is documented.  Has this practice been brought to your legal department's attention for their opinion?  

I would be curious to hear how other systems are handling this issue.  

Currently we are working on a process to have medication orders placed prior to the MA, ATC, or RN pulling medications from the Pyxis for the providers to give during an in clinic procedure.  We are using Epic Ambulatory for charting and are not allowed to place verbal orders.  The proposed process is to have clinical staff pend the medication orders to the provider once the patient checks in, provider signs, clinical staff retrieves the medications from the Pyxis, prepares it for the procedure, provider administers the medication, and staff then document for another user on the MAR.  Many of these procedures require compounded medications of 2-3 meds per injection and some patients may be getting bilateral injections.  Some of our busy injection clinics are doing 40 procedures per day.  I am wondering how other Joint Commission Regulated Clinics are handling high volume injection clinics within compliance?  Appreciate any and all ideas!  I have listed some of the barriers below.

Barriers

• Inability to sign orders until patient checks in
• Inability to sign/hold orders prior to check in
• Multiple medication orders to place and document on for compounded meds
• Clinic staff is not always in the room when the injection is done so may not be aware of exactly how much was given to document
• Need to document for another user (the provider) on the MAR after medication is given
• Decrease in efficiency for high volume procedure clinics