Prehospital Care Department UPDATES December November October September 2012

Transcription

1 Prehospital Care Department UPDATES December /6/12 EMS Pyxis update: Pharmacy has recently done some updates/changes to the EMS Pyxis. Unfortunately with that project it has caused some providers access to be disabled. We are unable to verify who this has affected. If you find that your access is not working you can either notify Dave or I or see Matt or Renita in pharmacy. Matt or Renita are the only two that can recreate your access. Sorry for the inconvenience. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator. November /10/12 Last 2012 VVMC Run Review: The last VVMC Run Review for 2012 will be on November 20, 2012 at 1900 in conference room B & C. It will be on Pediatric Patients presented by Jim Boise. October /12/12 Wizard Education Courses: Wizard is doing a Paramedic Course starting December 17 to October 22, The Cottonwood Fire ALS Refresher Courses are February 25, 2013 for 6 days and June 24, 2013 for six days. See for more details. Thanks, Tish. September /4/2012 BioHazard Waste: I apologize for sending this out AGAIN as I know this has been addressed several times. I am asking that you ensure all your providers are made aware of what is to go into the red Bio bags. Housekeeping has provided me again with red Bio bags from the EMS area that have dirty sheets with small amounts of blood, patients clothes that have been cut off with blood or urine on them and several bags with trash from IV start kits. All of these items should either be placed in linen cart or trash. Linen is sterilized by outside provider so no linen with blood or body products should go in the biohazard bag. VVMC pays a lot of money per bag/pound to dispose of this through an incinerator. I have been told multiple times that the disposal service will be taken away for EMS if this is not corrected and each agency will have to dispose of their own biohazard. Please make sure all providers understand this. Thank you, Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center,

2 August /22/12 Burn Patient Updates: Please ensure all providers are aware of recent changes to protocol. Please note! Changes are highlighted. Lactated Ringers are placed back in protocol for fluid resuscitation in regards to burn patients with extensive 2 nd and 3 rd degree burns. In addition, ABLS guidelines (Advanced Burn Life Support) recommend reducing the initial fluid amounts from 4 ml LR X patients body weight in KG X percent TBSA to 2ml. (Peds is different!!!!) Also, this will require agencies to ensure they place LR back on any apparatus they previously removed it from. Dr. Robinson would like to follow the recommendation of ABLS, therefore the changes in protocol reflect this. Thanks, David Guth Pre hospital coordinator assistant, Verde Valley Medical Center, Ph ext Find Burn Protocols at 8/2/12 August Run Review: The August 21 st, 0830 a.m. Run Review will be presented by the Maricopa Medical Center on Burns at the Cottonwood Public Safety Building at 191 S. 6 th Street. 8/2/12 July Prehospital Care Committee Minutes: Prehospital Care Agenda, July 17, 2012 Old Business QI process with Image Trend: The QI process with Image Trend is generally going well. One concern is that not all providers are checking their inbox to verify if they have had a chart review returned to them with comments. Dave Guth will begin placing the providers name and call information so a screen shot can be sent to those responsible for peer review. New medic review process forms: Can be found on verdevalleyems.org website under forms Should be processed on all new medics monthly for first 3 months King Vision Airway Sedona Fire District to trial this month New Business Monthly QI report: Will send out the spreadsheet monthly to provide feedback regularly. Run Review for future 2013: There was considerable debate for future run review options. For the remainder of this year providers will be allowed to continue to get 2 of the required run reviews at FMC. This option may go away for Some concerns were brought up about some of the run review topics presented are beyond the scope of Pre

3 hospital providers. Unfortunately when we utilize outreach education we don t always get an accurate description of the material being presented. Often times this information is proprietary and comes to us last minute. Pre hospital will continue to work to try and keep education within the provider s scope and pertinent to local protocols. There was some discussion at considering utilizing different technologies for run reviews including Skype or other electronic means. It was suggested that if this were an option then it should only be considered for outlying stations only and start out small. Dr. Robinson is currently not in favor of utilizing any alternative run review options as he would prefer to have the opportunity to interact with the providers. Agency based run reviews with Dr Robinson: We need to have each agency send out new dates for the agency based run review. Dr. Robinson would like to continue this practice as he feels that it is of great benefit. This will likely mean we will have to double up some months to get this accomplished. A concern was brought forward regarding sending test rosettas. The concern is that it seemed that some of the nursing staff were uneducated on the process of sending 12 leads through the rosetta. Tish explained that all nurses get general training to familiarize them with the process and how to operate the patch line. With the recent large turnover there has been some difficulty in keeping up with some of this training. It will be an ongoing process. Rehabilitation with Medical Monitoring Firefighter Bill Boler to discuss: Chief Boler has rebuilt rehabilitation guidelines. Need to approve the medical monitoring guidelines with Dr. Robinsons approval. Rehab with medical monitoring is separate from patient care. If individual requires medical treatment then they will be treated under our treatment protocols. Protocol Revisions for 2012 signature pages outstanding Trauma Triage decision making: Discussion on trauma triage decision making. It is important that medics in the field utilize the trauma triage guidelines to determine the best appropriate facility for critical and not critical trauma. Charge nurses do not have the ability to always know exactly what your location is and distance from trauma facilities. Those decisions are best derived in the field. If you are dealing with a MCI, you can have Alarm find out what each hospitals census is and their individual ability to accept x number of patients, however, your determination as to what level those patients are will likely dictate where you want to send them. Run Review tonight over Tachycardia presented by Dr. Peek Next meeting is September 18 th at 0930 at Cottonwood Fire Dept. July /18/12 Blitz Pack Drugs: Previously during our Pre Hospital Care Committee we discussed a standard for Blitz packs. It was determined that none of the agencies wanted to incur an additional cost for a drug box. This is the standard list approved by medical direction that is expected on all

4 hike outs. Which pack/box each agency utilizes and how or where it is secured is determined by the department. Reminder that on ambulances this must be secured according to DHS regulations. 1. Vial of Epi 1:1,000, 30 mg. Allergic reaction, anaphylaxis, bradycardia, hypotension, cardiac arrest, etc. 2. Versed 5:1 for seizures/ agitated patients X Two vials 3. Morphine 10 mg X Two vials 20 mg total. 4. Albuterol x2 5. Oral glucose 6. Glucagon x1 7. Narcan X 2 vials 8. Zofran x1 9. ASA x I bottle of NTG 11. Benadryl x1 12. Valium 5 mg Iv x 1 for large muscle spasms. This is not only indicated once the Morphine dosing has been exhausted. This may be necessary for Femur fractures, pelvic fractures, and burns. Please let me know if you have any questions on this. Tish Arwine, RN, BSN, Prehospital/Trauma Coordinator, Verde Valley Medical Center, 269 S Candy Lane, Cottonwood, AZ 86326, /12/12 Versed Update: Below is some information related to the Versed drug shortage. The only concentration available is the 5mg/1ml. This concentration is not recommended to be given direct IV push without being diluted. If using this medication IV route it should be diluted down in a 5cc syringe with NS to give a 1mg per ml concentration. The pyxis will only carry the 5mg/1ml concentration. If 5mg/5ml was used on a patient it will not be a problem to restock the 5mg/1ml from the pyxis. You will not need to follow the below process for restocking only on the outdated medications. Let me know if you have any questions, Tish Arwine, RN Due to the Midazolam shortage Pharmacy will not be able to supply paramedics with the Midazolam 5mg/5ml. The substitute product the we can buy is only good for three months and the historical usage does not support purchasing this product. The process for pharmacy and paramedics is as follows: 1. The paramedic will bring the outdated product to the Pharmacy. 2. A pharmacy tech will return the expired product to the Cll safe. 3. The Pharmacy tech will fill out the triplicate form with the paramedics: company name, date, The following statement is to be written: Pharmacy not able to replace this drug due due to shortage, medication name and quantity, 4. The pharmacy tech and the paramedic will sign at the bottom of the form

5 5. Pharmacy keeps the yellow and pink copies, the paramedic keeps the white copy. Matthew Gilliam, Pharmacy TECH3/PYXIS Tech 07/10/12 Run Review: July Dr. Peak June /27/12 New ADHS, BEMS Inspector: As you may have heard already Kim Briggs with Department of Health Services has resigned her position. She has graduated nursing school and has accepted a new position. Brian Oleary with be taking over her position temporarily until filled. He contact information for any DHS related concerns is Brian.Oleary@azdhs.gov and his phone number is Tish Arwine 6/21/2012 EPIC Traumatic Brain Injury Project: All Some of you may be already be aware AZDHS latest initative to improve prehospital care relates to treatment for Traumatic Brain Injuries. EPIC is a program designed to educate EMS providers/agencies on Brain Injury Guidelines established in I have attached the newsletter and website for you to read more information on the program. On September 18 th we will conducting the Master Trainer Course instead of our Pre Hospital Care Meeting. The Master training course will take up to 3 hours. I need each you to plan on attending this training as your agencies train the trainer. If you would like to have additional people attend to assist with the training of all ALS and BLS providers that is not a problem. More info to follow on exact time and location but plan for around 9:30 to noon. That evening for run review we will also be conducting the provider course. I have opened up the conference rooms to have both rooms. I encourage as may providers as possible to attend (BLS too) to minimize the agency training. I encourage you to learn more at: Thanks, Tish Arwine 6/14/12 EMS Patching regarding Cath Lab: Just a reminder for all agencies. Please pass this information on to providers. When transporting a STEMI patient remember to re patch when you get to Willard to confirm direct admission into the Cath Lab. This second patch enables the ED staff to redirect you to the ED if for some reason the Cath team is not ready. Thanks, David Guth, Pre hospital coordinator assistant, Verde Valley Medical Center, Ph ext May /30/12 Updated VVMC Treatment Guidelines: There have been several minor changes to some of the protocols to improve clarity in viewing and wording. For instance any protocol that allows providers to administer Morphine reflects verbiage changes for initial dosages and subsequent ranges. Certain Footnotes have been re worded, removed, or re inserted in other locations. There have also been changes in dosing for Versed during the use of CPAP, and the IEMT guidelines had Valium added for patients that require pacing. Although these changes are minor in nature they have occurred throughout the entire document, therefore

6 making it prudent that all providers review the entire document to re familiarize themselves with the protocols and associated changes. Please forward these out to all the providers. They will also be posted on the website: I will need each ALS provider to review the Guidelines and the Orientation Manual. Sign the annual review signature page in the Orientation Manual (page 11) to indicate you have read both documents. Each agency representative will need to ensure 100 percent review and signature and then return to Pre Hospital Care Dept. As many of you are aware Dr Robinson will be assuming his role as EMS Medical Director on June 1, He has been making his way to many of the stations meeting the crews. Dr Robinson is very excited to come on board in his new role. There has been many concerns brought forward regarding changes to Guidelines and scope of Practice. Dr. Robinson has no intentions of making any changes at this time. He feels that the EMS system is running great right now and wants to take some time to review and learn more about the Verde Valley EMS system. Thanks, Tish Arwine 5/4/2012 Cath Lab Activation: Per Tish Arwine: In continued efforts to expedite STEMI patients requiring cardiac catheterization the Cardiologists, Emergency Physicians, and the EMS Medical Director have decided and agreed to activate the cath lab for STEMI patients based on the pre hospital patch and MI presentation. In order for this to occur EMS providers must clearly present their findings over the patch line to include patient description, 12 lead findings including location of elevation and degree of elevation. Patch must also include the patients name and DOB and clearly request the activation of the cath lab. For Example: I have a 70 year old male with chief complaint of sub sternal chest pain that radiates down both arms. Pain is rated at a 7 on 10 and began approximately 20 min ago. 12 lead shows 2 mm ST elevation in leads V2, and V3. Patient is diaphoretic and has mild shortness of breath. Patients name is John Doe; DOB, 12,12,1942. Request Cath lab activation. Medics are expected to patch early to provide pertinent patient information (as suggested above). This is a pre patch to get the cath lab process started. A re patch should be made prior to arrival to verify if patient care will be a direct to cath transfer. Every attempt should be made to still send a 12 lead EKG through Rosetta to provide additional information to the ED physician and cardiologist. In addition this provides an opportunity to compare old EKG Strips to new. Thank you. David Guth, Pre hospital Coordinator Assistant April /3/12 April VVMC Run Review: Dr. Biglari (Banner Samaritan) will continue his lecture on reading 12 Lead EKG s. April 17, 2012 at 0830 in VVMC Conference Room B & C. CHANGED DO TO CANCELATION. March 2012

7 3/7/12 Odansetron Tablets: To all, Ondansetron injectable has continued to come up as one of the medications on the drug shortage lists. Currently we do still have a minimal supply of injectable Ondansetron at VVMC. Dr. Burns has authorized the use of Oral Disintegrating Tablets (ODT) in place of injectable. The ODT s are 4 mg each. I have attached the AZDHS drug profile for Ondansetron. Particular attention should be paid to the Special Notes section of the profile on use of the ODT. The minimum age for the administration of the ODT is 4 years old. The pharmacy is recommending using the same amount as we are currently using for IV dosing. As in the IV administration for adult begin with 4 mg and may repeat in 10 minutes. Be aware that onset of action will be longer with the ODT version. All pediatric patients between 4 and 14 years old will receive a single 4 mg dose. All providers must review the profile before use of the ODT. Please keep on record a sign in sheet for each ALS provider to sign after review of the profile and forward to me in Pre Hospital Care office. The ODT Ondansetron has already been placed in the Verde pyxis and will be the SEC pyxis shortly. If you have any questions concerning this matter please do not hesitate to contact me. 3/5/2012 Base Station Run Review: Run Review, March 20, 2012, 1900, VVMC Conference Room B, Easy IO Access, Specifically humeral access, Presented by Isabelle Deslauriers, CEP, Vidacare February /16/2012 February 21 Run Review: EMS Run Review, February 21, 2012, 0830 am, VVMC Conference Room C, 12 Lead EKG Review, Presented by Banner Good Sam, Dr. Biglari 02/15/12 Annual Updates CANCELLED: In reviewing possible changes to the Pre hospital Care Guidelines there are no significant changes, additional drugs or equipment being added. Therefore for 2012 there will not be annual update run reviews. Initially the plan was to refresh on some of the equipment that has been in use recently ie CPAP, Easy IO, PICC line access and a few others. It was decided that it would serve better to have each agency establish their own review process for providers. More information to follow regarding this. Previously I sent out the dates for updates. Please make sure all providers know that we have cancelled the updates. We will still have a general run review topic on April 17 th at Thanks, Tish 02/15/12 New Airway & RSI Form: The new Airway and RSI Form have been added to under Forms. 02/09/12 Documentation of Death: In documenting on patients that have deceased Dr. Burns is requesting crews to avoid using terms "pronounced dead" or writing "time of death." Instead document in the chart resuscitation was terminated at time or resuscitation withheld by physician order at time. There are evolving problems with the coroner (Medical Examiner) about EMS declaring a time of death. More of this will be discussed at updates. 02/07/12 VVMC Annual Updates: The VVMC Base Station Annual Updates required for all IEMT s and CEP s are: April 10 th at 0830 at Cottonwood Public Safety Building April 16 th at 1900 at VVMC Conference Room B April 17 th at 0830 at VVMC Conference Room B

8 April 25 th at 0830 at Cottonwood Public Safety Building 02/02/12 Prehospital Care Meeting: Prehospital Care Meeting January 17th, 2012 Old Business The question was asked whether agencies can utilize a different bougieac device. Dr. Burns felt there shouldn t be an issue. When disposable CPAP devices initially came out there was only one vendor or device available. Bring documentation or the device for Dr Burns to review to the Prehospital Care office to be evaluated. No other Old business discussed New Business: QI Process with Image Trend. Reviewing calls have to go through Image Trend to review. Dave is getting additional information and expanding the QI process through Image Trend. Please provide feedback on all calls initially as to how the QI process if evolving. All future QI feedback will be coming through Image trend for agencies utilizing this system. notification goes through Image trend to the provider. Signing into image trend will be necessary to review the feedback. Other agencies using different charting programs will continue to receive QI feedback through previous methods. EMSCOM Radios reprogram. State is doing away with Phoenix emscom and a request was previously been made to go to free standing repeaters. Channel 11 is a free standing repeater on Mingus that has been designated by DPS for our use. Agencies need to reprogram all emscom radios by next Tuesday, 1/24/2012 to hit the freestanding repeater and not PHX EMSOCM. Receive and transmit frequencies must be changed. As of next Tuesday Med 1 and Med 5 will no longer be programmed on the VVMC patch phonetherefore EMS agencies or Phoenix EMSOM will not be able to reach us on those channels. Receive TX PL Airway Form Changes. Changes have been made to the airway form for better data collection. More information is being targeted to help identify reasons for difficult airways and the reasons why less invasive airways occurred. Better data collection can result in improved skill sets, possible grant opportunities etc. Prehospital will send out form to agencies in a PDF format. Dave will discuss Jeff Boyd or Brian Espiau to see if they are able to convert to a usable PDF File initially. Additional discussion on forms and requirements for airway calls, flights and codes. Each agency needs to still provide a method of informing pre hospital of all Flights, Codes and Airways done in the field within 24 hours. Airways now include all airway measures including BLS. (NPA, OPA, BVM) King Vision. King Vision Airway: Presentation of the device and literature was distributed to the committee. All agencies present expressed an interest in a demo and felt that it could be a valuable tool to enhance first intubation attempt success. The first agency to demo the unit will be VVAC. Pre hospital will contact the representative for the device and see if we can get a second demo unit. If an additional unit if obtained it will go to MRFD as their budgeting process for operations must be completed by mid February. Drug box Blitz packs. Dr burns is requesting a required standardization for what medications are carried in during hike outs and remote locations. An example of packs and contents was distributed for blitz packs utilized by

9 Guardian ground. Having a standard drug component with all medications is important to avoid situations when the anticipated patient may not present as expected and appropriate medications are not available. Discussion construed as to how the agencies can create blitz packs with minimuim medications without having to accrue additional costs. DHS has minimum requirements for what is in each ambulance but does not regulate what is on other apparatus. Engines, can utilize the current drug boxes that exist and just make up the compliment in a smaller case that can be kept and secured on each first out engine. If agencies are looking at doing this in addition to the established amounts, then something will need to be worked out with Pharmacy. If agencies wish to just utilize the current compliment from engine drug boxes then the current list is what will be the expectation for standardization of drugs utilized for hike outs. The pack name that is utilized by Gaurdian is called a Stat pack. Each agency will need to inform Pre hospital Care Department by the end of January as to how they wish to meet the required medications. If an additional box is put into place the charge will be adjusted on the following year billing (June 2012). New Medic Review Process. Concern is that we are not getting necessary feedback on new medics from their mentor or even if a mentor has been assigned. Per policy each new medic should have a medic assigned to them and a monthly report provided to pre hospital as to how the new provider is doing? Pre hospital will send out a form to give some general guidelines for agencies to provide feedback to pre hospital. This process was created to assist the new medics and guiding them in their patient care. It also addresses patient care concerns early on so a trend does not develop. As new Paramedics are hired or advanced from BLS to ALS within your agency information regarding mentorship needs to be provided to PHC prior to their orientation. Transport Requirements. Agencies are required to patch on all inter facility transport as outlined in policy. Certain cases will require physician consult. This applies to all ALS inter facility transports whether they are going from SEC to VVMC, Phoenix Children s, Good Sam ect; or whether they are going from an inpatient unit at VVMC to another facility. This patch will enable medical input for patients and hopefully alleviate potential problems of crews taking critical patients on transports before adequate stabilization is made by the physician. In addition, it will help ensure medics are not transporting medication drips that are outside their scope of practice. BLS inter facilities do not require a patch to VVMC however, FMC does request a courtesy notification on all patients. Physicians will be provided a letter this week notifying them of the responsibility to be available to the patch phone on critical patients that are being transported from one facility to the next. Protocol Revisions for 2012 schedule for roll outs April. Pre hospital will a list out once the availability of the conference rooms are determined. There will be four dates scheduled over a period of 3 weeks and all shifts. As a reminder; 100 percent attendance is required for the roll outs/updates. Attendance while on duty will not count if crew has to leave for a call. Review of training of PICC lines, Vents, CCR and possibly others. Have providers send requests for changes they want to see or review of current Protocols. Agency Based dates for Please provide the agency based run review dates to PHC by the end of January. VVFD 1st requested the first week of November. Run review tonight will be on Tachycardic rhythms. The focus on future run reviews will be on 12 lead interpretation and cardiac calls. Ventilator meeting will follow PHC Committee meeting. Meeting adjourned

10 Peer Review Committee: Peer Review Minutes, January 17, 2012, Meeting was opened up to discuss the validity of the process and direction the group intends to go. The original intent was to give the agencies additional input from medical direction on calls that each agency ran on that may have special circumstances requiring further review and decision making from medical control. In addition it provided those individuals charged with doing peer review on reports an avenue for additional medical control input. There was a brief discussion considering changing the number of times the group meets as it sometimes seems difficult to find calls to review and bring to the process every other month. It was agreed that the process is still valid and should continue every other month. Participants should strive to bring a couple of calls for review each time as that is the primary reason for this committee forming. In addition, Pre hospital relies on the agencies to bring the calls as each agency is in a better position to trend problems or issues that may arise specific to their agency. Meeting then became a round table session with discussion on a variety of topics as followed: An issue was brought up regarding a concern that every patient should receive a blood sugar. Possible causes include a check box the patch nurse is trying to fill out or it has occurred often enough that it causes providers to think every patient needs to have one completed. In the end it was reinterated by Dr. Burns that blood sugar is not required on every patient, but if the paramedic providing patient care was concerned that blood sugar may be a issue due to other patient complaints, presentation or history then there should be no concerns. If there are specific cases that need to be brought to review then those should be brought to Prehospital care department. Dr. Burns would like to discuss Narcan due to some issues of narcan being utilized on Codes secondary to documentation of such. In some charts it appears Narcan is being given right in the middle of CCR. CCR guideline only indicates for Epinephrine to be administered during the first 8 minutes of a code. In addition when a patient is coded, the respiratory component is being handled with O2 deliver and definitive airway control. If there are other factors that mitigate the use of other medications or treatments documentation needs to reflect any deviation from standard algorhythm. Stemi calls require a 12 lead to activate the cath lab. There was a meeting with ED Physicians to evaluate the changes in technology that reduce the effectiveness of our ability to transmit these 12 leads. There have been no definitive answers regarding either spending the money to fix the technological issues or spend more time training ED Staff and prehospital. Training would include a focus on reading and presenting 12 lead information more effectively. In addition training to the ED staff would include acceptance of the medics 12 lead interpretation. Call Review to share with providers: 19 Y/O Male CC of Chest Pain with secondary complaint of Hypothermia. Documentation of determining whether or not chest pain is cardiac related or is it not cardiac related. Does the documentation include what is the suspected reason for the chest pain is?

11 Medic chose to treat using the cardiac algorhythm (asa given) but did not obtain a 12 lead ECG. No documentation of support for using this protocol. Also no temp on a hypothermic patient. Setting your documentation up in the beginning with a good initial impression of what your patient presents as. This can help identify why you would either go down a cardiac treatment route or non cardiac treatment route. Patch with base hospital did not relate enough information to indicate whether or not the patient was suspected to have cardiac involvement. In addition, if a provider is decides to go down a cardiac treatment modality then a 12 lead should be completed. January /24/12 EMSCOM RADIO: The Carepoint Radio at Verde Valley Medical Center has now been reprogrammed to utilize the freestanding repeater MED channel 11. Hopefully all agencies have reprogrammed their radios. As a free standing repeater you will not go through Phoenix EMSCOM but will directly trigger tones for VVMC using MED Channel 11. The following represents the procedure to patch using MED channel 11: Ensure your radio is set to Channel 11. To contact VVMC key the mic. for 3 to 5 seconds, then release. (this will trigger the tones at VVMC) An incoming call alarm will sound at the Nurses station. While the incoming call alarm is sounding we will not be able to hear you nor will you hear us. When the ED staff nurse picks up the patch phone he or she will identify VVMC s EMSCOM identifier (Y1100) RN name (ex. Tish) and what MD is on go ahead You will then proceed with your patch as normal. For example: This is Y1131.(add ambulance id and agency as well; ex. A531 with Sedona Fire District). with a courtesy notification (or patch)..i have a. This was tested today from the parking lot at VVMC and worked successfully. A 12 Lead was also transmitted through EMSCOM clearly. To transmit the 12 lead you must keep the mike keyed while transmitting from the Rosetta. There is a cable available from General Devices that plugs from the Rosetta to the EMSCOM radio. This would eliminate the need to keep the mike keyed. Some of the agencies may have already purchased this cable. Flagstaff Medical Center primarily uses MED channel 3 for their free standing repeater. The Rx is and the TX is The pl is the same This information may want to also be programmed into the radios for transports to FMC. Please let me know if you have any questions for this. I encourage some refresher training on this process with all crew members. Thanks, Tish

12 01/04/12 New Pharmacy Pyxis Reminder: Pharmacy has placed an additional check on removing controlled substances from the Pyxis. The message will notify you that you must remove controlled substances under a patients name. All you need to do is touch the message on the screen and click accept. It will then open the drawer to allow you to remove the medication. Again this is only a reminder to limit all the previous removal of controlled substances under outdates, restock Please let me know if you have questions. Tish 01/01/12 VVMC Base Station Run Reviews: January 17 th 1900, February 21 st 0830, March 20 th 1900, April 17 th 0830, May 15 th 1900, June 19 th 0830, July 17 th 1900, August 21 st 0830, September 18 th 1900, October 16 th 0830 and November 20 th 1900.