Pyxis Responsibility and Acknowledgement Form - 2023
Name: 


  1. STATEMENT OF RESPONSIBILITY & ACKNOWLEDGEMENT I acknowledge that my job role requires access to the Pyxis System at Northwest Community Hospital in order to function as part of the clinical care team. I understand, that upon completion and acknowledgement of this statement, I will be provided with the appropriate access to the requested Pyxis machines. I understand that the default access utilized by Pyxis users is my biometric scan and that this will act as my electronic signature for all of my transactions in the Pyxis system for documentation of all medications found in Pyxis including both controlled substances and other patient-specific medications. I understand that utilization of password access must be approved by the Pharmacy Leadership Team and will only be utilized in extenuating circumstances when biometric scanning is not feasible. I understand that if a password is utilized, it must remain confidential and is not to be shared with any other employee or person for any reason. I understand that if a password is utilized, it is my responsibility to protect the integrity of that password at all times and promptly report any purposeful attempt to breach this password to my supervisor. I understand that unauthorized access, release, or dissemination of this information will subject me to disciplinary action. I understand that controlled substance records will be maintained and archived, as per policies of NCH, and will be available for inspection at the request of regulatory bodies, or as deemed necessary. I understand that all Pyxis transactions can be monitored and audited at any time by the leadership team at Northwest Community Hospital and agree to cooperate and comply with any investigations. I understand that any action on my behalf to knowingly divert controlled substances or other medications for inappropriate or illegal purposes will make me liable for criminal prosecution and punishment to the fullest extent of the law. By checking this box, I am electronically signing this acknowledgement and accept the responsibilities associated with access to the Pyxis System at Northwest Community Healthcare.
    Yes, I acknowledge and accept responsibilities associated with the access to the Pyxis System at NCH.
    No