1. Insulin Multi-Dose Vial (MDV) for Multi-Patient Use
Wisconsin Nursing Workflow
Description
Technical Contact
This course {Describe outcome here.} It will take approximately 15 minutes to complete it.
Contact the Service Desk at in Milwaukee or
Instructions
Content Contact
This course is tested and guaranteed to function on an Advocate Aurora network PC
How to navigate this course
This course does not have sound
Chad Smith PharmD MBA BCPS
Vice President, Pharmacy Operations
Julie Mackenzie BSN RN
Nurse Clinician, SLMC Education
Created: August 2019
Reviewed:
Updated:

2. Learning Objectives
The audience for this course includes RNs at Wisconsin sites who administer insulin to adult patients.
After completing this course, you will be able to:
Apply the change in practice from single dose insulin to community dose insulin.

3. Insulin MDV for Multi-patient use
Currently Wisconsin dispenses regular insulin and insulin lispro patient specific where each patient gets their own vial
Future state is to have all sites to dispense regular insulin and insulin lispro from Pyxis MedStations as community vials.
Exception to this is for pediatric education and for patients that come in with insulin pumps where a bulk product will be used

4. Insulin Dispensing Practice Overview
Nurse to confirm insulin dose on MAR prior to opening Pyxis.
Nurse will remove ordered dose from a MDV stored in Pyxis. Leave Pyxis pocket open
The nurse will draw up the desired dose in the med room according to policy.
Bulk vials must remain in the unit med room/pyxis storage area. Bulk vials are not to be brought into patient care areas.
The nurse will attach a barcode label (provided in medication pocket of Pyxis by Pharmacy) to the drawn up syringe.
Prior to closing the Pyxis drawer, the nurse will return the insulin vial back to its pocket.
When working in an area that does not have short acting insulin stocked in a Pyxis device, and your patient has an order for sliding you will need to request your dose from the Pharmacy.

5. End User Dispensing Workflow
Pyxis ES Sites
Select your patient and select the insulin order from the patient’s profile. The order will move to the right.
Select Remove Med.
Pyxis 4000 Sites
Select your patient and select the insulin product from profile.
Select Remove Now.

6. Pyxis ES and Pyxis 4000 Pyxis ES Pyxis 4000
For sliding scale orders you will be asked for # of UNITS
Pyxis 4000
For sliding scale orders you will be asked for # of INJ. Enter UNITS

7. Pyxis ES and Pyxis 4000
Pyxis ES The display will show the amount in mL’s, as well as the dose in units. For sliding scale this will be what you just entered. For scheduled doses this will be ordered dose
Pyxis 4000
End user will be required to enter the dose in units
For sliding scale enter the insulin dose in units
For scheduled doses this will be ordered dose

8. Adhere Flag Label
Draw up your dose and adhere a flag label (generated by Pharmacy) to your insulin syringe. You should find this label in the Pyxis medication cubie.

9. Return Vial Remember: Return the Vial Before Closing Pyxis
A message will appear at the bottom of the screen to remind you to
“Put back any remaining amount before closing drawer”
If you forget to put the vial back do the following:
1. Process another removal
2. Place the vial back into the Pyxis device
3. Cancel the removal.
It is very important to cancel the removal when using this work around. Failure to do so will charge the patient for a dose he/she has not received. Nursing cannot process a “return” to put the vial back.

10. Workflow Review
Print/View the Wisconsin Community Insulin Vial Dispensing Practice Workflow Checklist. It will also be be available for your reference on the nursing unit. *
Examples of what the barcode flag label may look like (not all sites have same barcode labeling systems):
**It is very important to cancel the removal when using this work around. Failure to do so will charge the patient for a dose he/she has not received. Nursing cannot process a ‘return’ to put the vial back.
Please note: For patients in a location not serviced by a Pyxis device and who have an order for sliding scale dosed insulin, the nurse will need to send a medication message to pharmacy indicating the desired dose of insulin to be sent.