U.S. patent application number 12/639485 was filed with the patent office on 2010-05-27 for medication managment system.
This patent application is currently assigned to HOSPIRA, INC.. Invention is credited to Imtiyaz Haque, Geoffrey N. Holland, John W. Huang, Patrick B. Keely, Martin A. McNeela, Charles P. Moran, Jeff Pelletier, Bernardino Rubalcaba, Jr., Raymond P. Silkaitis.
Application Number | 20100130933 12/639485 |
Document ID | / |
Family ID | 46302716 |
Filed Date | 2010-05-27 |
United States Patent
Application |
20100130933 |
Kind Code |
A1 |
Holland; Geoffrey N. ; et
al. |
May 27, 2010 |
MEDICATION MANAGMENT SYSTEM
Abstract
A medication management system (MMS) includes a medication
management unit (MMU) associated with a medical device. The MMU
downloads medication delivery code based on a medication delivery
order to the medical device only if information from a first input
matches information from a second input. The medical device
receives delivery information electronically only from the MMU. The
medication order is performed only after delivery data validation.
The MMU also determines drug-drug incompatibility. The MMU can
modulate (start, stop, sequence and dynamically adjust) medication
order performance.
Inventors: |
Holland; Geoffrey N.;
(Wadsworth, IL) ; Keely; Patrick B.; (Grayslake,
IL) ; Pelletier; Jeff; (Fox River Grove, IL) ;
Moran; Charles P.; (Colleyville, TX) ; Silkaitis;
Raymond P.; (Lake Forest, IL) ; Huang; John W.;
(Hillsborough, CA) ; Rubalcaba, Jr.; Bernardino;
(Escondido, CA) ; McNeela; Martin A.; (Encinitas,
CA) ; Haque; Imtiyaz; (Cupertino, CA) |
Correspondence
Address: |
BRIAN R. WOODWORTH
275 N. FIELD DRIVE, DEPT. NLEG BLDG H-1
LAKE FOREST
IL
60045-2579
US
|
Assignee: |
HOSPIRA, INC.
Lake Forest
IL
|
Family ID: |
46302716 |
Appl. No.: |
12/639485 |
Filed: |
December 16, 2009 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10930358 |
Aug 31, 2004 |
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12639485 |
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|
10783641 |
Feb 20, 2004 |
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10930358 |
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60509404 |
Oct 7, 2003 |
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60527583 |
Dec 5, 2003 |
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Current U.S.
Class: |
604/151 |
Current CPC
Class: |
G16H 20/17 20180101;
G16H 40/67 20180101; G16H 70/40 20180101 |
Class at
Publication: |
604/151 |
International
Class: |
A61M 5/142 20060101
A61M005/142 |
Claims
1. A medication administration system comprising: a medication
administration pump having a user interface and a CPU, said user
interface configured to facilitate programming of said medication
administration device, said CPU configured to operate as a web
server, said user interface further configured to enable a user to
access web-based information.
2. A medication administration system in accordance with claim 1,
wherein said user interface comprises a screen display, said screen
display configured to display both a pump monitor screen portion
and a web browser screen portion.
3. A medication administration system in accordance with claim 2,
wherein said screen display is configured to display both said pump
monitor screen portion and said web browser screen portion
simultaneously.
4. A medication administration system in accordance with claim 2,
wherein said screen display is configured to display said pump
monitor screen portion separately from said web browser screen
portion.
5. A medication administration system in accordance with claim 1,
said system further comprising a housing containing said medication
administration pump, said CPU disposed within an interior of said
housing, said user interface disposed on an exterior of said
housing.
6. A medication administration system in accordance with claim 1,
wherein said CPU is configured to control operation of said
medication administration pump, and wherein said user interface and
said CPU are operatively connected such that user operating
instructions can be programmed into said CPU through said user
interface.
7. A medication administration system in accordance with claim 1,
wherein said user interface and said CPU are operatively connected
such that user web requests can be entered into said CPU through
said user interface.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. Ser. No.
10/930,358 filed on Aug. 31, 2004, which is a continuation-in-part
of U.S. Ser. No. 10/783,641 filed Feb. 20, 2004, which claims
priority based upon U.S. Provisional Application Ser. No.
60/509,404 filed Oct. 7, 2003 and U.S. Provisional Application Ser.
No. 60/527,583 filed Dec. 5, 2003, all of which are expressly
incorporated herein by reference in their entirety.
BACKGROUND OF THE INVENTION
[0002] The present invention relates to the field of delivering
medication to patients, more particularly to an integrated system
for maximizing patient safety and caregiver productivity for
medication delivery.
[0003] Modern medical care often involves the use of medical pump
devices to deliver fluids and/or fluid medicine to patients.
Medical pumps permit the controlled delivery of fluids to a
patient, and such pumps have largely replaced gravity flow systems,
primarily due to the pump's much greater accuracy in delivery rates
and dosages, and due to the possibility for flexible yet controlled
delivery schedules. However, modern medical devices, including
medical pumps, can be complicated and time-consuming for caregivers
to program. Medical facilities struggle to provide appropriate
caregiver staffing levels and training while holding down the cost
of medical care. Human errors in pump programming and other
medication errors can have adverse or even deadly consequences for
the patient.
[0004] Therefore, a principal object of this invention is to
provide an integrated medication management system that reduces the
risks of medication error and improves patient safety.
[0005] A further object of the invention is to provide a medication
management system that improves caregiver productivity.
[0006] Another object of the invention is to provide a medication
management system that improves the accuracy of the medication
delivery process by eliminating labor-intensive tasks that can lead
to human errors.
[0007] A still further object of the invention is to provide a
medication management system that relies on an
electronically-transmitted medication order and machine readable
indicia on the drug container, patient, and medication delivery
device to insure the "five rights" of medication management, i.e.,
that the right medication is delivered to the right patient through
the right route in the right dosage at the right time.
[0008] Another object of the invention is to provide the caregiver
with a pass code or machine-readable indicia to insure that only an
authorized individual caregiver can initiate a medication order and
that an authorized caregiver must confirm the medication order
prior to its administration to the patient.
[0009] A still further object of the invention is to provide a
medication management system wherein the medical device receives
delivery information electronically only through a medication
management unit.
[0010] Another object of the invention is to provide medication
management system wherein the medical device is preprogrammed and
executes the medication order only after a user has validated
delivery data.
[0011] A still further object of the invention is to provide a
medication management system wherein the physical location of a
medical device can be determined and pinpointed based on the last
access node used by the medical device.
[0012] Another object of the invention is to provide a medication
management system for adjusting a patient-specific rule set based
on new patient conditions and/or recent lab results.
[0013] A still further object of the invention is to provide a
medication management system for determining drug-drug
incompatibility between two medication orders for concurrent
delivery (to the same patient at the same time) and/or in an
unacceptably close time sequence.
[0014] Another object of the invention is to provide a medication
management system for remotely sending an order or information to
the medical device to modulate a planned or ongoing medication
order and delivery thereof to the patient.
[0015] A still further object of the invention is to provide a
medication management system for automatically associating a
medical device with a patient based on wireless transmission of a
patient ID to the medical device, thereby establishing a patient
area network.
[0016] Another object of the invention is to provide a medication
management system for caching an updated drug library at the
medical device to replace an existing drug library, during
execution of a medication order.
[0017] A still further object of the invention is to provide a
medication management system for displaying a picture of the
patient on a device within the system, such as at the medical
device, for a caregiver to perform a visual validation of the right
patient.
[0018] Another object of the invention is to provide a medication
management system for evaluating the performance of multiple
medical devices based on information from the multiple medical
devices.
[0019] A still further object of the invention is to provide a
medication management system for evaluating the performance of one
or more caregivers based on information from multiple medical
devices.
[0020] Another object of the invention is to provide a medication
management system for adjusting medical device output conveyed to a
caregiver based on multiple factors.
[0021] These and other objects will be apparent to those skilled in
the art.
SUMMARY OF THE INVENTION
[0022] A medication management system includes a medication
management unit (MMU) associated with a medical device for
performing a prescribed medication order. The MMU compares
medication order information from a first input means to machine
readable delivery information from a second input means and
downloads a medication order to the medical device only if the
information from the first input means matches the information from
the second input means. The medical device receives medication
order information electronically only through the medication
management unit (i.e., does not receive delivery information
directly from the second input means). The MMU permits the medical
device to perform the order only after a user has validated
delivery data at the medical device.
[0023] The MMU determines the general physical location of a
medical device based on the last access node used by the wireless
connectivity capability in the medical device and an audible alarm
can be activated to allow a user to pinpoint the physical location
of the medical device more precisely.
[0024] Using expert clinical support decision rules, the MMU also
determines drug-drug incompatibility between two medication orders
for concurrent delivery (to the same patient at the same time)
and/or in an unacceptably close time sequence through the same
output IV line. Further, the MMU also adjusts patient-specific rule
sets based on newly measured or observed patient conditions and/or
recent lab results. Advantageously, warnings, alarms or alerts
based on violations of these rules are provided as close as
possible to the actual delivery time so that they are more
meaningful, ripe for corrective action, and less likely to be
ignored due to incomplete information.
[0025] Based on laboratory data or other newly received patient
information, the MMU can modulate the medication order planned or
currently being delivered. The MMU sends an order from the MMU to
the medical device to modulate performance of the medication order.
The patient and the medical device automatically associate with
each other to form a patient area network based on wireless
transmission of ID information. During execution of a medication
order, the medical device caches an updated drug library in a cache
memory and, upon occurrence of a triggering event, replaces an
existing drug library in the primary memory of the device with the
updated library. A picture of the patient is displayed at a device
within the system, such as the medical device, for a caregiver to
perform a visual validation of the right patient. The MMU evaluates
the performance of multiple medical devices and one or more
caregivers based on information communicated from the medical
devices. The MMU adjusts medical device output conveyed to a
caregiver based on multiple factors.
[0026] In other embodiments of the medication management system of
this invention, the MMU receives validated, matched or verified
correct medication order and delivery information from an
information system directly through an electronic network or
indirectly through a wireless handheld point-of-care input
(scanning) device, such as a personal digital assistant (PDA). The
PDA transmits the delivery information and the medication order in
the form of an infusion rate to the MMU.
[0027] The MMU translates the simple infusion rate of the delivery
order into delivery programming code or information suitable for
automatically programming the designated pump and further checks
the delivery order and delivery programming code against a variety
of drug library parameters (including but not limited to hard
and/or soft limits for drug delivery rates), patient-specific
safety factors, and clinical decision support rules including
drug-drug interactions. The MMU can be configured by the user at
the MMU console to monitor the status of the pump and the infusion
(including alarms, event logs, and pump user interface inputs),
generate reports, and control the distribution of drug library and
operating code updates to one or more pumps. A drug library editor
deployed as a part of the MMU, its console, or on a separate
computer, enables the user to import, export and edit whole drug
libraries and individual drug library values to control and
customize a drug library according to hospital preferences.
[0028] The MMU saves the caregiver time by automatically populating
or programming data entry fields in the pump that previously had to
be entered manually. The medication management system of this
invention enhances patient safety by minimizing manual entries. The
system also enhances patient safety by screening drug delivery
orders for conformance with established hospital practices, expert
or clinical decision support rules and recommendations before (more
preferably immediately before) the pump begins to execute the
order. The caregiver is provided with a least one and preferably
several opportunities to catch a medication error before it
happens. The caregiver can confirm the order at the point-of-care
device and/or before pressing the start button on the pump. The
system is flexible enough to permit human interventions and
overrides, but tracks such events for documentation and
trouble-shooting purposes.
DESCRIPTION OF THE DRAWINGS
[0029] FIG. 1 is a schematic diagram of the medication management
system including a medication management unit and a medical device,
integrated with an information system, according to the present
invention.
[0030] FIG. 1A is an alternative schematic diagram of the
medication management system including a medication management unit
and a medical device, integrated with an information system,
according to the present invention.
[0031] FIG. 2 is a schematic diagram of the medication management
unit according to the invention.
[0032] FIG. 3 is a schematic diagram illustrating some of the major
functions performed by the medication management unit according to
the invention.
[0033] FIG. 4 is a pictorial schematic diagram of the medication
management system and its interaction with medical devices and an
information system in a hospital environment.
[0034] FIG. 4A is a schematic diagram of the medical device
according to the invention.
[0035] FIG. 5 is a partial flow chart of the medication management
system processing a drug order through the medication management
unit and medical device, and integrated with an information system
according to the invention.
[0036] FIG. 5A is a continuation of the flow chart of FIG. 5.
[0037] FIG. 6, is an alternative flow chart of the medication
management system processing a drug order through the medication
management unit and medical device, and integrated with an
information system according to the invention.
[0038] FIG. 6A is a continuation of the flow chart of FIG. 6.
[0039] FIG. 7 is a screen shot of a delivery information input
device for entry of a caregiver specific pass code.
[0040] FIG. 8 is a screen shot of a delivery information input
device for pulling up a scan patient option.
[0041] FIG. 9 is a screen shot of a delivery information input
device for entry of patient-specific information.
[0042] FIG. 10 is a screen shot of a delivery information input
device displaying a task list.
[0043] FIG. 11 is a screen shot of a delivery information input
device displaying a medication order prescribed for a patient.
[0044] FIG. 12 is a front view of a medical device displaying a
start up screen.
[0045] FIG. 13 is a front view of a medical device with a display
and user interface means for selecting a clinical care area of a
medical facility.
[0046] FIG. 14 is a front view of a medical device with a display
and user interface means for selecting a desired input channel of
the medical device.
[0047] FIG. 15 is a front view of a medical device with a display
and user interface means for confirming correct delivery
programming code data at the medical device.
[0048] FIG. 16 is a screen shot of a delivery information input
device for confirming correct delivery programming code data.
[0049] FIG. 17 is a schematic diagram of the medication management
system including a medication management unit and one or more
medical devices, showing how the medication management unit
communicates with a medical device to locate the device.
[0050] FIG. 18 is a flow chart of the medication management system
locating a medical device.
[0051] FIG. 19 is a flow chart of the medical device
retrieving/receiving an updated drug library from the medication
management unit.
[0052] FIG. 20 is a flow chart of the medication management system
updating a delivery program code executed on the medical device
based on new information from a lab system, HIS and/or monitoring
device.
[0053] FIG. 21 is an alternative pictorial schematic diagram of the
medication management system and its interaction with medical
devices and the information system.
[0054] FIG. 22 is a flow chart of the medication management system
generating an operation evaluation report of a caregiver or medical
device.
[0055] FIG. 23 is similar to FIG. 1, but shows an alternative
schematic diagram of the medication management system including a
medication management unit and a medical device, integrated with an
information system without using a patient link, according to the
present invention.
[0056] FIG. 24 is a schematic diagram that provides further detail
on the architecture and workflow related to the medication
management system depicted in FIG. 23.
[0057] FIG. 25 is a schematic diagram that depicts the flow of data
with respect to the medication management system of FIG. 23.
[0058] FIG. 26 is a flow chart showing the actions and interactions
for automatically programming a medical device such as an infuser
and monitoring status of the task programmed using the medication
management system of FIG. 23.
[0059] FIG. 27 is a flow chart showing the actions and interactions
for downloading a drug library or other information to a medical
device such as an infuser using the medication management system of
FIG. 23.
[0060] FIG. 28 is a flow chart showing the actions and interactions
for uploading and monitoring infusion status in the medication
management system of FIG. 23.
[0061] FIG. 29 is a flow chart showing the actions and interactions
for uploading and maintaining event logs in the medication
management system of FIG. 23.
[0062] FIG. 30 is a schematic diagram showing the medication
management unit server and the drug library editor deployed on
separate computing machines according to one embodiment of the
present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0063] With reference to FIGS. 1 and 1A, the medication management
system (MMS) 10 of the present invention includes a medication
management unit (MMU) 12 and a medical device 14, typically
operating in conjunction with one or more information systems or
components of a hospital environment 16. The term hospital
environment should be construed broadly herein to mean any medical
care facility, including but not limited to a hospital, treatment
center, clinic, doctor's office, day surgery center, hospice,
nursing home, and any of the above associated with a home care
environment. As discussed below, there can be a variety of
information systems in a hospital environment. As shown in FIG. 1,
the MMU 12 communicates to a hospital information system (HIS) 18
via a caching mechanism 20 that is part of the hospital environment
16.
[0064] It will be understood by those of skill in art that the
caching mechanism 20 is primarily a pass through device for
facilitating communication with the HIS 18 and its functions can be
eliminated or incorporated into the MMU 12 (FIG. 1A) and/or the
medical device 14 and/or the HIS 18 and/or other information
systems or components within the hospital environment 16. The
Caching Mechanism 20 provides temporary storage of hospital
information data separate from the HIS 18, the medication
administration record system (MAR) 22, pharmacy information system
(PhIS) 24, physician order entry (POE) 26, and/or Lab System 28.
The Caching Mechanism 20 provides information storage accessible to
the Medication Management System 10 to support scenarios where
direct access to data within the hospital environment 16 is not
available or not desired. For example, the caching mechanism 20
provides continued flow of information in and out of the MMU 12 in
instances where the HIS 18 down or the connectivity between the MMU
12 and the electronic network (not shown) is down. The caching
mechanism 20 also provides improved response time to queries from
the MMU 12 to the HIS 18, as direct queries to the HIS 18 are not
consistently processed at the same speed and often require a longer
period of time for the HIS 18 to process.
[0065] The HIS 18 communicates with a medication administration
record system (MAR) 22 for maintaining medication records and a
pharmacy information system (PhIS) 24 for delivering drug orders to
the HIS. A physician/provider order entry (POE) device 26 permits a
healthcare provider to deliver a medication order prescribed for a
patient to the hospital information system directly or indirectly
via the PhIS 24. One skilled in the art will also appreciate that a
medication order can be sent to the MMU 12 directly from the PhIS
24 or POE device 26. As used herein the term medication order is
defined as an order to administer something that has a
physiological impact on a person or animal, including but not
limited to liquid or gaseous fluids, drugs or medicines, liquid
nutritional products and combinations thereof.
[0066] Lab system 28 and monitoring device 30 also communicate with
the MMU 12 to deliver updated patient-specific information to the
MMU 12. For example, the lab system 28 sends lab results of blood
work on a specific patient to the MMU 12, while the monitoring
device 30 sends current and/or logged monitoring information such
as heart rate to the MMU 12. As shown, the MMU 12 communicates
directly to the lab system 28 and monitoring device 30. However, it
will be understood to those of skill in art that the MMU 12 can
communicate to the lab system 28 and monitoring device 30
indirectly via the HIS 18, the caching mechanism 20, the medical
device 14 or some other intermediary device or system. This
real-time or near delivery time patient-specific information is
useful in adapting patient therapy because it may not have been
available at the time the medication order was prescribed. As used
herein, the term real-time denotes a response time with a latency
of less than 3 seconds. The real-time digital communications
between the MMU 12 and other interconnected devices and networks
prevents errors in patient care before administration of
medications to the patient, especially in the critical seconds just
prior to the start of medication delivery.
[0067] Delivery information input device 32 also communicates with
the MMU 12 to assist in processing drug orders for delivery through
the MMU 12. The delivery information input device 32 can be any
sort of data input means, including those adapted to read machine
readable indicia such as barcode labels; for example a personal
digital assistant (PDA) with a barcode scanner. Hereinafter the
delivery information input device 32 will be referred to as input
device 32. Alternatively, the machine readable indicia may be in
other known forms, such as radio frequency identification (RFID)
tag, two-dimensional bar code, ID matrix, transmitted radio ID
code, human biometric data such as fingerprints, etc. and the input
device 32 adapted to "read" or recognize such indicia. The input
device 32 is shown as a separate device from the medical device 14;
alternatively, the input device 32 communicates directly with the
medical device 14 or may be integrated wholly or in part with the
medical device.
[0068] With reference to FIG. 2, the medication management unit 12
includes a network interface 34 for connecting the MMU 12 to
multiple components of a hospital environment 16, the medical
device 14, and any other desired device or network. A processing
unit 36 is included in MMU 12 and performs various operations
described in greater detail below. A display/input device 38
communicates with the processing unit 36 and allows the user to
receive output from processing unit 36 and/or input information
into the processing unit 36. Those of ordinary skill in the art
will appreciate that display/input device 38 may be provided as a
separate display device and a separate input device.
[0069] An electronic storage medium 40 communicates with the
processing unit 36 and stores programming code and data necessary
for the processing unit 36 to perform the functions of the MMU 12.
More specifically, the storage medium 40 stores multiple programs
formed in accordance with the present invention for various
functions of the MMU 12 including but not limited to the following
programs: Maintain Drug Library 42; Download Drug Library 44;
Process Drug Order 46; Maintain Expert Clinical Rules 48; Apply
Expert Clinical Rules 50; Monitor Pumps 52; Monitor Lines 54;
Generate Reports 56; View Data 58; Configure the MMS 60; and
Monitor the MMS 62. The Maintain Drug Library 42 program creates,
updates, and deletes drug entries and establishes a current active
drug library. The Download Drug Library 44 program updates medical
devices 14 with the current drug library. The Process Drug Order 46
program processes the medication order for a patient, verifying
that the point-of-care (POC) medication and delivery parameters
match those ordered. The Maintain Expert Clinical Rules 48 program
creates, updates, and deletes the rules that describe the
hospital's therapy and protocol regimens. The Apply Expert Clinical
Rules 50 program performs logic processing to ensure safety and
considers other infusions or medication orders, patient
demographics, and current patient conditions that include blood
chemistry values such as insulin/glucose, monitored data such as
pulse and respiration, and clinician assessments such as pain or
responsiveness. The Monitor Pumps 52 program acquires ongoing
updates of status, events, and alarms transmitted both real-time
and in batch mode, as well as tracking the location, current
assignment, and software versions such as the drug library version
residing on medical device 14. The Monitor Lines 54 program
acquires ongoing updates of status, events and alarms for each
channel or line for a medical device 14 that supports multiple drug
delivery channels or lines. The Generate Reports 56 program
provides a mechanism that allows the user to generate various
reports of the data held in the MMU storage medium 40. The View
Data 58 program provides a mechanism that supports various display
or view capabilities for users of the MMU 12. The Notifications 59
program provides a mechanism for scheduling and delivery of events
to external systems and users. The Configure the MMS 60 program
provides a mechanism for system administrators to install and
configure the MMS 10. The Monitor the MMS 62 program enables
information technology operations staff capabilities to see the
current status of MMS 10 components and processing, and other
aspects of day-to-day operations such as system start up, shut
down, backup and restore.
[0070] With reference to FIG. 3, the various functional programs
42-62 of the MMU 12, each including separate features and rules,
are partitioned (at a higher level than shown in FIG. 2) and
logically organized into interrelated managing units of the MMU 12.
As shown, the MMU 12 includes an asset manager 64, an alarm manager
66, a drug library manager (such as, for example, HOSPIRA
MEDNET.TM.) 68, a caregiver manager 70, a therapy manager 72,
and/or a clinical data manager 73. However, one of ordinary skill
in the art will appreciate that additional or alternative hospital
system managing units can be provided without departing from the
present invention. Additionally, the MMU 12 includes a master
adjudicator 74 between the separate interrelated hospital system
managing units 64-73 of the MMU 12, to regulate the interaction
between the separate management units.
[0071] Further, while the MMU 12 as described herein appears as a
single device, there may be more than one MMU 12 operating
harmoniously and sharing the same database. For example the MMU 12
can consist of a collection of MMU specific applications running on
distinct servers in order to avoid a single point of failure,
address availability requirements, and handle a high volume of
requests. In this example, each individual server portion of the
MMU 12 operates in conjunction with other server portions of the
MMU 12 to redirect service requests to another server portion of
the MMU 12. Additionally, the master adjudicator 74 assigns
redirected service requests to another server portion of the MMU
12, prioritizing each request and also ensuring that each request
is processed.
[0072] With reference to FIGS. 2 and 3, the managing units 64-72
each include separate features and rules to govern their operation.
For example the asset manager 64 governs the execution of the
Monitor Pumps 52 and Monitor Lines 54 programs; the drug library
manager 68 governs the execution of the Drug Library 42 and
Download Drug Library 44 programs; the therapy manager 72 governs
the execution of the Process Drug Order 46, Maintain Expert
Clinical Rules 48, and Apply Expert Clinical Rules 50 programs; and
the clinical data manager 73 governs the execution of the Generate
Reports 56 and View Data 58 programs. Other distribution of the
functional MMU programs 42-62 among the hospital system managing
units 64-73 can be made in accordance with the present
invention.
[0073] With reference to FIG. 4, an electronic network 76 connects
the MMU 12, medical device 14, HIS 18, and input device 32 for
electronic communication. The electronic network 76 can be a
completely wireless network, a completely hard wired network, or
some combination thereof. The medical device 14 and input device 32
are located in a treatment location 77. As shown, the medical
device 14 and input device 32 are equipped with antennas 78 and 80,
respectively. The antennae 78 and 80 provide for wireless
communication to the electronic network 76 via an antenna 82 of
access node 84 connected to the electronic network 76. Further
details on the antenna 78 can be found in commonly assigned
co-pending application entitled SYSTEM FOR MAINTAINING DRUG
INFORMATION AND COMMUNICATING WITH MEDICATION DELIVERY DEVICES
filed on Feb. 20, 2004, which is expressly incorporated herein in
its entirety.
[0074] In the context of the present invention, the term "medical
device" includes without limitation a device that acts upon a
cassette, reservoir, vial, syringe, or tubing to convey medication
or fluid to or from a patient (for example, an enteral pump,
infusion pump, a patient controlled analgesia (PCA) or pain
management medication pump, or a suction pump), a monitor for
monitoring patient vital signs or other parameters, or a diagnostic
device.
[0075] For the purpose of exemplary illustration only, the medical
device 14 of FIG. 4 is disclosed as a cassette type infusion pump.
The pump style medical device 14 includes a user interface means
86, display 88, first channel 90, and first channel machine
readable indicator 92. A first IV line 98 has a conventional
cassette 99A (not shown) that is inserted into the first channel
90, and includes a medication bag 100 with a machine readable
indicator 102. A second IV line 101 is connected to an input port
of the cassette 99A, and includes a medication bag 106 with a
machine readable indicator 108. A single output IV line 98 is
connected to an outlet port of the cassette 99A and connected to a
patient 110 who has a machine readable indicator 112 on a
wristband, ankle band, badge or similar article that includes
patient-specific and or identifying information, including but not
limited to patient ID, and demographics.
[0076] In an alternative embodiment illustrated by dashed lines in
FIG. 4, the medical device 14 is a multi-channel pump having a
first channel 90 with first channel machine readable indicator 92
and at least a second channel 94 with a second channel machine
readable indicator 96. The line 101 from the medication bag 106 is
eliminated and replaced by line 104 with a cassette 99B (not shown)
inserted into the second channel 94 and an output line 104 extends
from the cassette to the patient. The same type of cassette 99 (not
shown) is inserted in the first channel 90. Additional details on
such a multi-channel pump and cassette 99A can be found in commonly
owned U.S. patent application Ser. No. 10/696,830 entitled MEDICAL
DEVICE SYSTEM, which is incorporated by reference herein in its
entirety.
[0077] Within a patient area network 113 (hereinafter, PAN 113), a
caregiver 114 (if present) has a machine readable indicator 116 on
a wristband, badge, or similar article and operates the input
device 32. The input device 32 includes an input means 118 for
reading the machine readable indicators 92, 96, 102, 108, 112, and
116. An input/output device 120 is included on the input device 32.
The input/output device 120 allows the user to receive output from
the input device 32 and/or input into the input device 32. Those of
ordinary skill in the art will appreciate that display/input device
120 may be provided as a separate display device and a separate
input device.
[0078] With reference to FIG. 4A, the pump style medical device 14
includes a network interface 122 for connecting the medical device
14 to the electronic network 76. The network interface 122 operates
the antenna 78 for wireless connection to the electronic network
76. A processor 124 is included in the medical device 14 and
performs various operations described in greater detail below. The
input/output device 87 (display 88 and user interface means 86)
allows the user to receive output from the medical device 14 and/or
input information into the medical device 14. Those of ordinary
skill in the art will appreciate that input/output device 87 may be
provided as a separate display device and a separate input device
(as shown in FIG. 4, display 88 and user interface means 86) or
combined into a touch screen for both input and output. A memory
126 communicates with the processor 124 and stores code and data
necessary for the processor 124 to perform the functions of the
medical device 14. More specifically, the memory 126 stores
multiple programs formed in accordance with the present invention
for various functions of the medical device 14 as is relates to the
MMU 12 including the following programs: Process Drug Order 128,
Monitor Pump 130, and Download Drug Library 132.
[0079] With reference to FIGS. 5 and 5A, the functional steps of
the Process Drug Order 46 and Apply Expert Clinical Rules 50
programs of the MMU 12 and the Process Drug Order 128 program of
the medical device 14 are shown in operation with the HIS 18, the
caching mechanism 20 and the input device 32.
[0080] With reference to FIGS. 4, 5 and 7, to begin to process a
drug order, the input device 32 displays a default screen (not
shown) on input/output device 120 which the caregiver uses to
access password screen 133B (FIG. 7). The password screen 133B
prompts the caregiver 114 to enter caregiver specific
identification information (caregiver ID). The caregiver 114 enters
caregiver ID such as a username and/or password or pass code, or
the machine readable indicator 116. The input device 32 enters this
caregiver ID at step 134.
[0081] With reference to FIGS. 4, 5 and 8-9, the input device 32
then displays a scan patient screen 135A (FIG. 8) which prompts the
caregiver 114 to enter patient-specific identification information
(patient ID). The caregiver 114 enters the patient ID such as the
machine readable indicator 112. The input device 32 enters this
patient ID and at step 136, and displays a confirmed scan patient
screen 135B (FIG. 9) indicating that the patient ID was
successfully entered into the input device 32.
[0082] With reference to FIG. 5, the input device 32 then transmits
the patient ID to the caching mechanism 20 at step 138. The caching
mechanism 20 transmits the patient ID to the HIS 18 at step 140.
The HIS 18 retrieves a patient-specific task list and
patient-specific order information based on the patient ID and
transmits both to the caching mechanism 20 at step 142. The order
information includes but is not limited to an order detail for a
medication order, patient demographic information, and other
hospital information systems data such as lab results data. The
caching mechanism 20 transmits the task list to the input device 32
at step 143.
[0083] With reference to FIGS. 4, 5 and 10-11, the input device 32
then displays a task list screen 143A (FIG. 10) which prompts the
caregiver 114 to access the task list on the input device 32. The
input device 32 prompts the caregiver 114 to enter drug specific
identification information or drug ID from the container 100. The
caregiver 114 enters a drug ID such as the drug container specific
machine-readable indicator 102. The input device 32 enters this
drug ID at step 144. The input device 32 processes the drug ID to
select the correct task from the task list, then displays a task
screen 143B (FIG. 11), and transmits a request (dispense ID) based
upon the entered drug ID to the caching mechanism 20 requesting an
order ID at step 146. The caching mechanism 20 transmits a request
(dispense ID) to the HIS 18 requesting an order ID at step 148. The
order ID is simply a unique identifier for the medication order,
lab test, or other task or procedure to be performed. The order ID
can be a number, alphanumeric code, etc. The HIS 18 transmits an
order ID to the caching mechanism 20 at step 150. The caching
mechanism 20 forwards this order ID to the input device 32 at step
152.
[0084] The input device 32 matches the order ID with an item in the
task list to ensure a Five Rights check at step 154. The "Five
Rights" in this section refer to the "Five Rights of Medical
Administration". Alternatively, the Five Rights check is done at
the MMU 12 once the MMU 12 receives the order information as well
as the patient, dispense, and channel IDs. A description of these
"rights" follows. Right patient, is the drug being administered to
the correct patient. Right drug, is the correct drug being
administered to the patient. Right dose, is the correct dosage of
the drug being administered to the patient. Right time, is the drug
being administered to the patient at the correct time. Right route,
is the drug being administered into the patient by the correct
route, in this case intravenously through an IV. Once the order ID
and item in the task list are reconciled, the input device 32 sends
an order confirmed message to the caching mechanism 20 at step 156.
In response, the caching mechanism 20 sends the order detail
(medication order prescribed for a patient) of the order
information to the input device 32 at step 158.
[0085] With reference to FIGS. 4, 5, 11, the input device 32 then
displays a scan device/channel screen 143B (FIG. 11) which prompts
the caregiver 114 to enter channel identification information
(channel ID) regarding which channels of the medical device 14 are
to be used for the delivery. The caregiver 114 enters a channel ID
such as the machine readable indicator 92. The input device 32
enters this channel ID at step 160, and displays a confirmed scan
device screen 159B (FIG. 11B) indicating that the channel ID was
successfully entered into the input device 32. It will be
appreciated that the channel ID indicator 92 can include
information also identifying the medical device 14 (medical device
ID). Alternatively, it is contemplated that an additional machine
readable indicator (not shown) may be provided for the medical
device itself separate from the channel ID machine readable
indicator 92. If the medical device 14 has a single channel, a
single indicator will clearly suffice. If the medical device 14 is
a multi-channel device, the channel indicators can also carry
information that uniquely identifies the device the channel is on.
At any rate, it should be apparent that a second entry of a
combined device/channel ID may be redundant and could be
eliminated. The input device 32 then transmits the delivery
information including caregiver ID, patient ID, medical device ID
and/or channel ID, drug ID, and order ID to the MMU 12 at step
162.
[0086] Alternatively, the three entered IDs (patient ID, drug ID,
and channel ID) are entered in a different specific order or
without regard to order. Where the IDs are entered without regard
to order, the IDs would be maintained within the MMS 10 and/or
caching mechanism 20 as they are entered, so that the IDs can be
recalled when needed to complete the medication delivery
workflow.
[0087] With reference to FIGS. 4, 5 and 12-14, when the medical
device 14 is turned on at step 164 the medical device 14 displays a
start up screen 163A (FIG. 12) on the display 88 of the medical
device 14. The medical device 14 then displays a clinical care area
selection screen 163B (FIG. 13) which prompts the caregiver 114 to
select the clinical care area (CCA) that the medical device 14 is
being assigned to. The caregiver 114 enters or selects the CCA at
step 166 using scroll and select/enter keys on the user interface
means 86. The medical device 14 then displays a channel selection
screen 163C (FIG. 14) that prompts the caregiver 114 to select the
desired channel (90 or 94) or bag source (100 or 106) using soft
keys 163D-G, more particularly 163E, 163F respectively. The medical
device 14 enters this channel ID at step 168. The CCA information
is transmitted to the MMU 12 by the medical device 14 at step 170.
Alternatively, where the CCA is known and available to the HIS 18,
the CCA can be automatically generated for the medical device 14,
and sent from the HIS 18 to the MMU 12
[0088] With reference to FIGS. 2 and 5, the MMU 12 executes the
Process Drug Order 46 program and sends an active order request
based on the delivery information from the input device 32 to the
caching mechanism 20 at step 172. The caching mechanism 20 responds
by sending the corresponding patient-specific order information to
the MMU 12 at step 174. The caching mechanism 20 may send to the
MMU 12 order information regarding all information associated with
the particular patient, including but not limited to order detail
for a medication order, patient demographic information, and other
hospital information systems data such as lab results data or
monitoring data.
[0089] Referring to FIG. 5A, the MMU 12 then executes the Apply
Expert Clinical Rules 50 program to process the CCA information
from the medical device 14 and the delivery information from the
input device 32, at step 178. The Apply Expert Clinical Rules 50
program compares the delivery information with an expert rule set
to determines expert rule set violations based on correlating
treatment based protocols, disease based protocols, drug-drug
incompatibility, patient data (age, height, weight, etc), vital
signs, fluid in/out, blood chemistry, and status assessments (such
as pain and cognition). As used herein, the term drug-drug
incompatibility includes but is not limited to determinations of
drug-drug interactions and/or drug-drug compatibility between two
or more medication orders for concurrent delivery (to the same
patient at the same time) and/or in a time sequence for the same
patient (i.e. through a common output IV line). In cases where the
Apply Expert Clinical Rules 50 program finds an expert rule set
violation (such as a drug-drug incompatibility), the Apply Expert
Clinical Rules 50 program generates an alarm and/or requires a time
delay in execution for one of the two separate delivery information
submissions.
[0090] The Apply Expert Clinical Rules 50 program also establishes
a patient-specific rule algorithm. The patient-specific rule
algorithm is primarily based on the expert rule set described above
applied to a specific order detail. The patient-specific rule
algorithm generates a patient-specific rule set (discussed in
greater detail below, at the description of FIG. 20) according to
patient-specific order information including but not limited to
patient demographic information, and other hospital information
systems data such as lab results data or monitoring data. The
patient-specific rule set includes hard and soft dosage limits for
each drug being administered. The patient-specific rule set is
included in the delivery programming code sent to the medical
device 14 at step 182.
[0091] Any alarms generated by the Process Drug Order 46 or Apply
Expert Clinical Rules 50 programs are delivered to the medical
device 14, HIS 18, and/or input device 32, computer 254 (FIG. 17),
at step 180. Computer 254 can be located in a remote nurse station
or a biomedical technician area. If no alarms are generated, the
MMU 12 transmits a delivery program code to the medical device 14,
at step 182. The delivery program code sent from MMU 12 to the
medical device 14 includes a patient-specific rule set generated
from any rule based adjudication at the MMU 12, including hard and
soft dosage limits for each drug being administered. The medical
device 14 caches the patient-specific rule set contained in the
delivery program code. Alternatively, the MMU 12 can generate an
alarm at the medical device 14 or another location and not download
the delivery program code.
[0092] With reference to FIGS. 5, 5A and 15, the medical device 14
displays an order dose confirmation screen 187A (FIG. 15) which
prompts the caregiver 114 to confirm the delivery data. As shown,
the caregiver 114 selects the "yes" soft key 187B on the medical
device 14 to confirm the delivery data and the no soft key 187C to
cancel the delivery. The caregiver 114 confirms the delivery data
at the medical device 14 at step 188. Once the caregiver 114
confirms the delivery data at the medical device 14, the medical
device 14 then executes the delivery program code and begins
infusion at step 198. As part of the program code, the infusion may
be delayed for a predetermined period of time.
[0093] Alternatively, confirmation from the caregiver can be made
at the input device 32 or required from both the input device 32
and medical device 14. As shown, a redundant additional
confirmation performed by the caregiver 114 at the input device 32
after the medical device has received the delivery program code.
Specifically, the medical device 14 transmits a canonical
representation of the delivery programming code data (delivery
data) to the MMU 12 detailing the infusion to be performed by the
medical device 14, at step 184. The MMU 12 then transmits the same
delivery data that was originally transmitted to the medical device
14 to the input device 32 at step 186. Alternatively, the delivery
data can be passed to another remote computer (254 in FIG. 17),
including but not limited to a computer at a nurse station, for
confirmation.
[0094] With reference to FIGS. 5A and 16, the input device 32
displays an order dose confirmation screen 191A (FIG. 16) that
prompts the caregiver 114 to confirm the delivery data. As shown,
the caregiver 114 selects the complete button 191B on the input
device 32 to confirm the delivery data and the cancel button 191C
to cancel the delivery. The caregiver 114 confirms the delivery
data at the input device 32 at step 192, and the confirmation is
used for documentation by the HIS 18, or other systems within the
hospital environment 16.
[0095] With reference to FIGS. 4A and 5A, during infusion, the
medical device 14 executes its Process Drug Order 128 program. The
Process Drug Order 128 program sends infusion change events and
infusion time events in a delivery event log message 200 to the MMU
12. The MMU 12 forwards these delivery event log messages to the
input device 32 or other system within the hospital environment 16
at step 202. The caregiver 114 acknowledges these delivery event
log messages on the input device 32, at step 204. The input device
32 then sends an acknowledged delivery event log message 206 to the
caching mechanism 20, detailing the delivery event, the caregiver
ID, and the caregiver acknowledgment. The caching mechanism passes
the delivery event message to the HIS 18 at step 208.
[0096] Once infusion has ended at step 210, the medical device 14
sends an infusion ended message 212 to the MMU 12. The MMU 12 then
aggregates all the delivery event messages 200 sent during the
infusion at step 214. The MMU 12 sends the aggregated delivery
events 216 to the input device 32. The caregiver 114 enters a
completed task 218 on the input device 32, and sends the aggregated
delivery events to the caching mechanism at step 220, which in turn
passes the delivery event log messages to the HIS 18 at step
222.
[0097] With reference to FIGS. 6 and 6A, an alternative flow chart
of the MMS 10 processing a drug order through the MMU 12 and
medical device 14 is shown. With reference to FIGS. 4, 6 and 6A,
the caregiver 114 enters the patient ID, which then is stored in
the caching mechanism 20. The caching mechanism 20 transmits the
patient ID to the HIS 18 and retrieves a patient-specific task list
for that patient ID. The caregiver 114 then enters the drug ID from
the indicator 102 of the container 100 that may be translated into
a dispense ID, which subsequently is stored in the caching
mechanism 20. The caching mechanism 20 transmits the drug ID or
dispense ID to the HIS 18, and retrieves a patient-specific order
information, including but not limited to an order detail, patient
demographic information, and other hospital information systems
data such as lab results data. The caregiver 114 then enters the
channel ID, which is stored in the MMU 12.
[0098] Alternatively, the three entered IDs (patient ID, drug ID,
and channel ID) are entered in a different specific order or
without regard to order. Where the IDs are entered without regard
to order, the IDs would be maintained within the MMS 10 and or
caching mechanism 20 as they are entered, so that the IDs can be
recalled when needed to complete the medication delivery
workflow.
[0099] Upon receipt of the channel ID, the MMU 12 requests the
order information (order detail, patient demographic information,
and other hospital information systems data) and retrieves it from
the caching mechanism 20. This order information is stored within
the MMU 12 and utilized for subsequent rule processing such as
"Five Rights" checking and other rule set algorithms. The Process
Drug Order 46 program processes the delivery information from the
input device 32 (including caregiver ID, patient ID, medical
device/channel ID, and drug ID or dispense ID) and compares this
delivery information with the corresponding order detail portion of
the order information from the caching mechanism 20, at step 176.
Where the order information and delivery information do not match,
the device program code downloaded to the medical device 14 at step
182 includes an alarm message indicating that the five rights check
was not met. Additionally, the alarm message can include a
description of which particular right(s) did not match.
Alternatively, the NMU 12 can generate an alarm at the medical
device 14 or another location and not download the program code for
delivery of the medication order.
[0100] Alternatively, the MMU 12 can accept a Five Rights check
from another device, such as a HIS 18 or an input device 32. This
check can be accepted either by a direct data element being sent to
the MMU 12 indicating a Five Rights check, or implied through the
workflow provided by the HIS 18 or input device 32.
[0101] The other steps shown in FIGS. 6 and 6A are similar to
corresponding steps in FIGS. 5 and 5A. Accordingly, these steps
will not be described with any further detail here. One skilled in
the art will appreciate that the vertical lines in FIGS. 5, 5A, 6,
6A do not necessarily represent a firm time sequence. Some steps
may be done sooner than shown (for example, turning on the medical
device) or later than shown (for example, aggregate delivery
events).
[0102] With reference to FIGS. 2, 4A, 5, 5A and 20, in one
embodiment, the Process Drug Order 46 program of the MMU 12 and the
corresponding Process Drug Order 128 program of the medical device
14 permit the MMU 12 to remotely control the medical device 14 to
modulate performance of a medication order. For example, the MMU 12
can remotely start and/or stop the medical device 14. Once the
delivery program code is received by the medical device 14 at step
184, the Process Drug Order 46 of MMU 12 remotely starts execution
of the infusion by sending a start order 224, which triggers the
medical device to begin infusion at step 225. Likewise, when the
infusion is to end at step 228, the Process Drug Order 46 program
can remotely stop the infusion by sending a stop order 226 to the
medical device 14, which triggers the medical device to end
infusion at step 228. Inmost cases, the MMU 12 requires the
caregiver to confirm the start or stop of execution. This
confirmation by the caregiver may take place at the input device 32
or the medical device 14. However, one skilled in the art will
appreciate that there may be emergency situations where an order
could and should be stopped without human confirmation.
[0103] With reference to FIGS. 2, 5, 5A and 20, in one embodiment,
the Apply Expert Clinical Rules 50 program of the MMU 12 permits
the MMU 12 to adjust a previously fixed patient-specific rule set
based on new patient conditions and/or recent lab results, and
notify the caregiver that adjustment is recommended by the MMU 12.
As discussed above in regard to FIGS. 5 and 5A, the Apply Expert
Clinical Rules 50 program establishes a patient-specific rule
algorithm. The patient-specific rule algorithm is primarily based
on the expert rule set described above applied to a specific order
detail. The patient-specific rule algorithm generates a
patient-specific rule set according to patient-specific order
information including but not limited to patient demographic
information, and other hospital information systems data such as
lab results data or monitoring data. The patient-specific rule set
includes hard and soft dosage limits for each drug being
administered, and these hard and soft dosage limits likewise are
adjusted when the patient-specific rule set is adjusted.
[0104] For example, during or even before an infusion, the MMU 12
may receive updated patient information that can impact an ongoing
or impending infusion. As shown in FIG. 20, the lab 28 sends
updated patient-specific lab results to the MMU 12 at step 230.
Likewise, the monitoring device 30 sends updated patient-specific
monitoring information to the MMU 12 at step 232. Additionally the
MMU 12 queries the HIS 18 for patient information including:
Patient Allergies, Patient Diet, and Current Patient Medical
Orders. Patient Allergies are used to check for drug-allergy
interactions, at step 231. Patient Diet information is used to
check for drug-food interactions. Current Patient Medical Orders
are used to check for drug-drug incompatibility. Like the patient
information gathered from the Lab 28 and the monitoring device 30,
the patient information from HIS 18 is also used by the MMU 12 to
update the delivery program order.
[0105] As shown in FIGS. 5 and 5A, in cases where the MMU 12 is
processing a drug order for the medical device 14, the MMU 12
executes the Apply Expert Clinical Rules 50 program at step 178 to
establish a patient-specific rule set based on updated patient
information received or retrieved from the lab 28, the monitoring
device 30, and or the HIS 18 (FIG. 20). This real-time or near
delivery time updated patient-specific information is useful in
adapting patient therapy because it may not have been available at
the time the medication order was prescribed.
[0106] As shown in FIG. 20, The MMU 12 also modifies the existing
patient-specific rule set in the existing delivery program code at
step 234 based on updated patient information received or retrieved
from the lab 28, the monitoring device 30, and or the HIS 18. The
MMU 12 optionally alerts the input device 32 and/or the medical
device 14 of changes to the patient-specific rule set. MMU 12 also
optionally generates an alert message if the delivery programming
code violates any parameter of the adjusted hard and soft dosage
limits. Additionally, the MMU 12 optionally requests confirmation
by the caregiver prior to instituting the new patient-specific rule
set. The MMU 12 then delivers an updated delivery program code to
the medical device 14 for execution at step 236. The medical device
14 then executes this updated delivery program code as step 238.
The updated delivery program code sent from MMU 12 to the medical
device 14 includes an updated patient-specific rule set generated
from any rule based adjudication at the MMU 12, including hard and
soft dosage limits for each drug being administered. The medical
device 14 caches the updated patient-specific rule set contained in
the delivery program code. Additionally, the MMU 12 collects,
stores, and reports the changes to the patient-specific rule set,
changes to the hard and soft limits, as well as the history of each
medication order.
[0107] An example of how the MMU 12 updates the patient-specific
rule set based on lab results or monitored patient conditions is
provided below with respect to the drug Heparin, which is a blood
thinner. The medication order entered by the physician might be:
[0108] Give heparin 1000 units/hour. If the activated partial
thromboplastin time (APTT) >75 seconds then decrease heparin to
800 units/hour. If the medical device 14 has started the infusion
at 1000 units/hour and the MMU 12 subsequently receives an updated
APTT value of 100 seconds from the lab 28 on the patient, the MMU
automatically commands the medical device 14 to decrease the
infusion rate to 800 units/hour. Alternatively, when the MMU is
notified by lab 28, an alarm will be generated to the PDA 32 and/or
the medical device 14 to notify the caregiver of the need to change
the infusion rate. The MMU can preprogram the pump for the
caregiver to confirm the recommended change.
[0109] In further embodiment or method, the hospital may establish
expert rules or clinical decision support rules in the MMU 12 that
will be applied automatically to incoming prescribed orders, such
that the physician may simply write an order for 1000 or 1200
units/hour. The hospital best practices formulated by the
appropriate medical personnel are established in the MMU 12 and can
dictate that all heparin orders are to be conditioned on the APTT
lab result and such an expert rule or clinical decision support
rule will be used by the MMU 12 to govern the operation of the
medical device 14. The MMU 12 also can check the most recent
patient data and provide an alarm and/or temporarily modify the
delivery order prior to the start of the infusion if the prescribed
order is no longer appropriate given the expert rules or clinical
decision support rules and the latest lab results or monitored
patient conditions. It should be apparent that this kind of
intervention by the MMU 12 during or immediately prior to an
infusion is particularly useful in preventing adverse consequences
for the patient and the hospital.
[0110] Where the MMU 12 adjusts a previously fixed patient-specific
rule set based on new patient conditions and/or recent lab results,
as described above, the MMU 12 provides dynamic advanced reports of
real-time rule set changes in relation to changes in the condition
of the patient (an "information cascade"). These advanced reports
detail the history of both hard and soft upper and lower limits, as
well as the activation of overrides and confirmations based on
these limits for each medical device 14 managed by the MMU 12.
Further details on this feature can be found in commonly owned
co-pending application entitled SYSTEM FOR MAINTAINING DRUG
INFORMATION AND COMMUNICATING WITH MEDICATION DELIVERY DEVICES
filed on Feb. 20, 2004, which is expressly incorporated herein in
its entirety.
[0111] With reference to FIGS. 2, 4A and 19, the Download Drug
Library 44 program in the MMU 12 and the corresponding Download
Drug Library 132 program in the medical device 14 operate to send a
drug library to the medical device 14 from the MMU 12. The drug
library includes drug and device related information, which may
include but is not limited to drug name, drug class, drug
concentration, drug amount, drug units, diluent amount, diluent
units, dosing units, delivery dose or rate, medication parameters
or limits, device/infuser settings and/or modes, CCA designations
and constraints, and library version. The Download Drug Library 132
program is designed to cache in a cache memory 126A a new database
or drug library at medical device 14 while maintaining an existing
older version database or drug library in its primary memory 126.
This allows the medical device to operate or deliver an infusion
based on the older version of the drug library without disruption
until a trigger event occurs, at which time the new drug library
replaces the older version in the primary memory 126. It is
contemplated that the medical device 14 can be equipped with an
initial drug library at the factory.
[0112] The Download Drug Library 132 program in the medical device
14 begins at a block 240 and at block 242 a determination is made
that a drug library update needed event has occurred. For instance
the drug library update needed event could be a completed infusion,
a stopped infusion, elapsed time, a specific date and time,
creation of the new drug library, the medical device 14 being or
entering into a particular configurable mode such as stop, "sleep"
or "wakeup", connection of the medical device 14 to an access node
84 in a new CCA, a download of a new or modified drug library to
the medication management unit, or a determination that the
existing drug library at the medical device needs updating. The
configurable mode could be any number of device modes including a
power-on sleeping mode and a power-off mode. The determination that
a drug library update needed event has occurred can be made by (at)
the MMU 12, the medical device 14 or by a combination of the
two.
[0113] Based on the specific drug library update needed event, the
Download Drug Library 132 proceeds to block 244 where it retrieves
or receives a new drug library. Once retrieved or received, the
Download Drug Library 132 proceeds to block 246 where it stores the
new drug library in the cache memory 126A of the medical device 14.
While a medical device 14 is operating on a patient or in an
otherwise nonconfigurable mode, information such as a new drug
library or database is stored in a cache memory 126A of the medical
device 14 as the information is received from a wired or wireless
link through the network interface 122. The Download Drug Library
132 proceeds to block 248 where it determines if a specific trigger
event has occurred. For instance, the trigger event could be a
completed infusion, a stopped infusion, a determination that the
device is in a configurable mode, elapsed time, a specific date and
time, creation of the new drug library, a download of a new or
modified drug library to the medication management unit, and a
determination that the existing drug library at the medical device
needs updating. The configurable mode could be any number of device
modes including a power-on sleeping mode and a power-off mode. The
determination that a trigger event has occurred can be made by (at)
the MMU 12, the medical device 14 or by a combination of the
two.
[0114] The Download Drug Library 132 then proceeds to block 250
where it deletes the existing drug library in primary memory 126
and installs the new drug library, and the new drug library from
cache memory 126A will replace the older information in the memory
126 of the medical device 14. The Download Drug Library 132 process
is then complete and ends in block 252.
[0115] Additional related features of the Download Drug Library 44
program in the MMU 12 and the corresponding Download Drug Library
132 program include recording the history of the download, verify
the correct download, notification to the caregiver of a change of
library, and a preliminary note on the medical device 14 display
stating that the drug library will be changed after any current
infusion (i.e., before the next infusion).
[0116] Additionally, partial updates of the drug database within
the medical device 14 are also made possible by the present
invention. The MMU 12 is supplied with a drug database that allows
a user to update a single data item (row, column, or cell) in the
database without re-writing the entire database. This provides
faster processing and downloading times when modifying the drug
database.
[0117] Further, the Download Drug Library 44 program in the MMU 12
is designed to modify a medication library from the HIS 18 in such
a way that only a single configuration of a single drug library is
necessary to provide download information to multiple separate and
different medical devices 14 where each device has unique
parameters (different models, processors, computer architecture,
software, binary format, or manufacturers, for example). In this
embodiment, the configured drug library is designed so that only a
subset of the configured drug library is specific for each unique
type of medical device 14, and only the specific information is
selected for transfer to each medical device 14. Additionally,
pre-validation of the configured drug library is done through use
of a rule set editor prior to sending from the MMU 12 to the
medical device 14, and post-validation occurs where the medical
device 14 confirms receipt of an acceptable drug library back to
the MMU 12.
Further details on these additional related features can be found
in commonly owned co-pending application entitled SYSTEM FOR
MAINTAINING DRUG INFORMATION AND COMMUNICATING WITH MEDICATION
DELIVERY DEVICES filed on Feb. 20, 2004, which is expressly
incorporated herein in its entirety.
[0118] With reference to FIGS. 2, 3, and 4A, the Monitor Pump 44
program in the MMU 12 and the corresponding Monitor Pump 130
program in the medical device 14 operate to map the approximate or
general physical location of each medical device 14 within the
hospital environment and to enable a user to trigger a locator
alarm to locate a particular medical device 14. Additionally, the
programming enabling the medical device locator would be located in
an asset manager 64 portion of the MMU 12.
[0119] With reference to FIG. 17, the MMU 12 communicates with one
or more (more preferably a plurality of) medical devices 14A, 14B,
and 14C through the electronic network 76. The medical device or
devices 14A, 14B, and 14C connect to the electronic network 76
through one or more (more preferably a plurality of) access nodes
84A, 84B, and 84C distributed in one or more (more preferably a
plurality of) CCAs 253A and 253B. More than one medical device 14
can operate from an individual access node 84 and be associated
with a particular patient. Typically, there is one access node per
room (101, 103, and 301), but it also is possible to have more than
one access node per room and more than one room or CCA per access
node. Additionally, as discussed above with regard to FIG. 4, the
connection between the medical devices 14A, 14B, and 14C and the
access nodes 84A, 84B, and 84C can be wireless. A user access
device such as a computer system 254 is remotely located from the
MMU 12 and the medical device 14 and communicates with the MMU 12
to permit a user 256 to activate the Monitor Pump 44 program in the
MMU 12 and remotely activate the corresponding Monitor Pump 130
program in the medical device 14. The computer 254 can be located
in a variety of locations, including but not limited to a nurse
station or a biomedical technician area.
[0120] With reference to FIG. 18, the functional steps of the
Monitor Pump 52 program in the MMU 12 and the corresponding Monitor
Pump 130 program in the medical device 14A are shown in operation
with the computer 254. To begin to request a physical location for
a medical device 14, the user 256 (not shown) enters a query for
the location of a medical device 14A. The computer 254 sends a
request device location 258 message to the MMU 12. The MMU 12 in
turn sends a request last used access node 260 message to the
medical device 14A. It is also contemplated that the Monitor Pump
Program 130 can be operated with the input device 32.
[0121] The medical device 14A determines the last access node
84A-84C used to connect with the electronic network 76 at step 262.
A report of the last used access node 264 is sent from the medical
device 14 to the MMU 12. The MMU 12 processes the report of the
last used access node 264 to determine the general physical
location of the device at step 266. Once the physical location of
the medical device 14A is determined by the MMU 12, a report
physical location 268 message is sent from the MMU 12 to the
computer 254. Additionally, the MMU 12 tracks "change of infuser
access node" events, when a medical device 14 begins to communicate
through a different network access node 84. The MMU 12 communicates
the physical locations of medical devices 14 to the HIS 18.
[0122] If the user 256 requires additional assistance in locating
the particular medical device 14A, the user 256 can instruct the
computer 254 to send a request audio location alarm 270 message to
the MMU 12. The MMU 12 in turn sends an order audio locator alarm
272 message to the medical device 14A. The medical device 14A then
activates an audio alarm at step 274 to assist the user 256 in
locating the medical device 14A. The audio alarm activation can be
delayed by a predetermined time to allow the user time to travel to
the area of the last used access node. The audio alarm feature is
useful in allowing the user to more precisely pinpoint the location
of the medical device 14. The audio alarm feature is particularly
useful if the medical device 14 is very close to other medical
devices or has been moved to a storage closet or other location
where it is not readily apparent visually.
[0123] Alternatively, the functional steps of the Monitor Pump 44
program in the MMU 12 and the corresponding the Monitor Pump 130
program shown in FIG. 18 can be performed as a series of "push"
steps instead of a series of "pull" steps (as shown in FIG. 18). In
a "push" embodiment the medical device 14A periodically determines
the last used access node and periodically reports the last used
access node to the MMU 12 as a "here I am" signal. Likewise, the
MMU 12 periodically determines the physical location of the medical
device 14A based on the last access node 84A used by the medical
device 14, and periodically reports the physical location of the
medical device 14A to the user access device 254. Alternatively,
the MMU 12 programming allows it to determine which of access nodes
84 was the last access node used by the device 14 (step 259
indicated by a dashed line) and the MMU can report the general
physical location of the medical device 14 to the computer 254
without requesting a report from the medical device 14.
[0124] In one embodiment described above, the association between
medical devices 14, patient 110, drug 100, and caregiver 114 (if
present), is accomplished by swiping machine readable indicators on
each of these elements of the PAN 113 (See FIG. 4). This
association is made in software residing the MMU 12. Alternatively,
the association is made in software residing in the medical device
14. With reference to FIG. 21, in another embodiment, the
association between medical devices 14A, patient 110, drug 100, and
caregiver 114, is accomplished by "auto-association".
Auto-association is desirable in situations where the patient's
wrist is not readily accessible (e.g. during surgery, or a neonate
in an incubator).
[0125] In the auto-association embodiment, the MMU 12 and medical
device 14A are designed to establish the patient as the focus of
the MMS 10. In this embodiment, the patient 110 is equipped with a
machine readable indicator 112A on a wristband, toe tag, badge or
similar article. The machine readable indicator 112A contains
transmitter/receiver chip 278, capable of short-range transmission.
The transmitter/receiver chip 278 is a low power RF Bluetooth.TM.,
a dedicated RF transmitter working with a PIC processor, or any
other suitable transmitter/receiver. The patient 110 is fitted with
the machine readable indicator 112A at the time of admission. The
unique ID number of the particular machine readable indicator 112A
is stored with an electronic patient record at the HIS 18 and hence
MMU 12. The MMU 12 is thereby notified of the particular machine
readable indicator 112A associated with the particular patient 110.
Additionally, it is contemplated, that any other machine readable
indicator used with the present invention, may also contains
transmitter/receiver chip capable of short-range transmission. For
instance, the caregiver machine readable indicator 116 and
medication machine readable indicator 102 may also be equipped with
a transmitter/receiver chip.
[0126] Each medical device 14A is also equipped with a
transmitter/receiver chip 280A. Upon placing a medical device 14 at
the patient 110 bedside, within the PAN 113, the
transmitter/receiver chip 280A of the medical device 14A "pings" by
sending out a "request for patient" command to any
transmitter/receiver chip 278 that is in the area. Each
transmitter/receiver chip 278, which is in the area (usually about
0-10 meters, more preferably about 0-3 meters), replies to the ping
by sending the transmitter/receiver chip 280 of the medical device
14A the unique ID number of the particular machine readable
indicator 112A. Upon receipt of a signal from the machine readable
indicator 112A, the medical device 14A places the ID number of the
machine readable indicator 112A in memory 126 (See FIG. 4A) and
also transmits the same to the MMU 12. Alternatively, the unique ID
of the indicator 112A can be transmitted directly to an MMU 12
located in the area or indirectly through another route, including
but not limited to the medical device 14. With reference to FIGS.
5, 5A, 6 and 6A, the MMU 12 Process Drug Order 46 program then
checks the patient ID entered at step 162 and the device/channel ID
entered at step 160 to ensure the correct match. The MMU 12
associates the medical device 14A only to the identified patient
based on the patient ID number sent to the MMU 12. Dissociating the
medical device 14A from the patient is done based on a command from
a user, or other method.
[0127] It should be noted, that the machine readable indicator 112A
(as well as the machine readable indicator 112), can include
equipment for monitoring the wearer, and transmitting this
monitored information to the medical device 14 and/or the MMU
12.
[0128] With reference back to FIG. 21, placing a second medical
device 14B within the PAN 113 leads to a repeat of the same
process. In this case the first medical device 14A "pings" any
transmitter/receiver chip that is in the area. The
transmitter/receiver chip 280B of the second medical device 14B
replies to the ping by sending the transmitter/receiver chip 280A
of the first medical device 14A the unique ID number of the
particular machine readable indicator 92B. Upon receipt of a signal
from the machine readable indicator 92B, the first medical device
14A places the ID number of the machine readable indicator 92B in
memory 126 (See FIG. 4A) and also transmits the same to the MMU 12.
The patient ID number is then sent from the first medical device
14A to the second medical device 14B.
[0129] An additional or alternative validation of the "right
patient" can be accomplished by caregiver visual confirmation of
the patient following the auto-association procedure described
above in relation to FIG. 21, and is also applicable to the
five-rights procedures described above with respect to FIGS. 5, 5A,
6 and 6A. In this process, the patient 110 is photographed with a
digital camera (not shown) at the time of admission and the digital
photo is stored with the electronic patient record at the HIS 18.
When a medication order is requested for a specific patient, the
digital photo is sent to the MMU 12 and upon completion of the
association process, the digital photo is transmitted from MMU 12
to the medical device 14 at the patient 110 bedside. The image of
the patient 110 is sent to the display 88 of the medical device 14,
which is preferably a high resolution touch screen at least
approximately 12 cm by 12 cm. The image of the patient 110 is then
placed on the display 88 and the caregiver 114 is prompted by the
display 88 to "Confirm Patient". The caregiver 114 confirms a
patient match upon visual comparison of the patient 110 with the
image on the display 88.
[0130] Alternatively, the digital photo information alternatively
can be stored on the indicator 112 or 112A and transmitted by the
transmitter/receiver 178 thereof. The digital photo is transmitted
to the medical device 14 when the medical device 14 has been
associated with the patient 110.
[0131] With reference to FIG. 22, another portion of the functional
steps of the Monitor Pump 52 program in the MMU 12 and the
corresponding Monitor Pump 130 program in the medical device 14 are
shown in operation with the computer 254. To begin to request a
specific evaluation for the operation of a specific medical device
14, or group of medical devices 14, the user 256 (not shown) enters
a query for the operation evaluation of a medical device 14. The
computer 254 sends an operation evaluation request 282 message to
the MMU 12. The MMU 12 in turn sends a request operation data 284
message to the medical device 14. The medical device 14 sends a
report operation data 286 message (including but not limited to
event logs, settings, CCA and utilization information) back to the
MMU 12 at step 286. The MMU 12 processes the report operation data
286 to generate an operational evaluation at step 288. Once the
operational evaluation of the medical device 14 is determined by
the MMU 12, a report operational evaluation 290 message is sent
from the MMU 12 to the computer 254.
[0132] Alternatively, the functional steps of the Monitor Pump 44
program in the MMU 12 and the corresponding the Monitor Pump 130
program shown in FIG. 22 can be performed as a series of "push"
steps instead of a series of "pull" steps (as shown in FIG. 22). In
a "push" embodiment the medical device 14 periodically reports the
operation data to the MMU 12. Likewise, the MMU 12 periodically
processes the report operation data 286 to generate an operational
evaluation at step 288, and periodically reports the operational
evaluation of the medical device 14 to the user access device 254
at step 290.
[0133] The automated operational evaluation described above,
provides a method of evaluating medical device 14 while in
operation; thus eliminating the need to postpone evaluation until
the medical device 14 is taken out of use. The real-time data
collection capabilities of the MMU 12 and Monitor Pump 52 program
allow the MMU 12 to determine medical device 14 performance
including advanced statistical operations in order to provide
quality control data sorting algorithms and aggregation of data and
control for a PAN 113 (not shown). For example, consider a MMS 10
where multiple discreet single or multiple channel medical devices
14 (or channels) are connected to a single patient 110 (not shown).
The Monitor Pump 52 program collects all medical device 14
information in real-time and then compares medical device 14
statistics to one another. Likewise, infuser channels can be
compared to other infuser channels within the same multiple channel
medical device or in other devices. Monitor Pump 52 program
therefore can detect a "bad actor" if any one of the medical
devices 14 or channels is operating at a level statistically lower
or higher than the other medical devices 14 or channels. This
statistical determination can be made by collecting and comparing
the mean and standard deviation of appropriate data elements. This
statistical determination can be performed selectably on any of the
data that is routinely collected by the medical device 14 event log
and any that may be acquired from the instrumentation of the
medical device 14. For example, statistical determinations could be
performed based on air alarm events, occlusion alarm events,
battery usage data, screen response time, etc. MMU 12 then sends
the operational evaluation message (including any relevant quality
control alert) to an appropriate area (including but not limited to
the computer 254) in a form that is appropriate for the particular
alert (usually including but not limited to graphically or
audibly). Additionally, operational evaluation message (including
any relevant quality control alert) can be sent to any number of
individuals including but not limited to the caregiver, a
biomedical engineer, caregiver supervisor, and a doctor.
[0134] With reference to FIG. 17, the medical device 14 is designed
as a multi-processor, where many features are not hardwired, but
instead can be uniquely configured based on rules, the location of
the medical device 14, etc. For example, the medical device 14 is
designed to allow a customized display based on the Clinical Care
Area (CCA) 253A or 253B the medical device 14 is located in and/or
assigned too. An example of this would be the MMU 12 instructing
the medical device 14 to have a display of a particular color or
warning tones/volumes based on the location of the medical device
14 in the hospital, time of day, caregiver information, patient
information, or the type of medication being supplied. For example,
the patient information could include a patient diagnosis and/or a
disease state. For example, alarm volumes and display brightness
can be set lower in the pediatric clinical care area or at night
than in the emergency room clinical care area or during the
daytime.
[0135] With reference to FIG. 4, similarly, the medical device 14
is designed to allow a customized display based on user information
supplied to the medical device 14 (from the MMU 12 for example).
Such user based customized display could include changes in
language preference, limited access depending on the security level
of the caregiver 114, customizing the displayed information based
on the training level of the individual or recent interactions
therewith, and/or customizing an automated help function based on
training level of the user or recent interactions therewith. The
MMU 12 presents a user with a default view based on the user's
role. The MMU 12 permits a default view for each role to be
configurable in terms of the data detail presented. The MMU 12
allows a user with the appropriate privilege to set a particular
presented view as the preferred or default starting view for that
user following login. The MMU 12 allows a user to access databases
and details based on role and privilege. The MMU 12 allows a user
to access other views based on role and privilege. Each presented
view includes: a common means of navigating among views, both
summary and detail, access to privacy, security, and other policy
statements, access to online help, and a logoff capability.
Additionally, an emergency bypass (such as a pass-code) would be
provided to bypass security restrictions in case of an
emergency.
[0136] With reference to FIG. 22, another portion of the functional
steps of the Monitor Pump 52 program in the MMU 12 and the
corresponding Monitor Pump 130 program in the medical device 14 are
shown in operation with the computer 254. The MMU 12 tracks and
records actions taken by the caregiver 114 based on operational
data reported from one or more medical devices 14. Just as the MMU
12 is capable of generating an operational evaluation of each
medical device 14, the MMU 12 can likewise generating an
operational evaluation of each caregiver 114 (not shown) at step
288. This operational evaluation of each caregiver 114 includes
records of each caregiver's 114 actions (or, in some cases,
inactions), sorting of these actions based on given criteria, and
tracking of any trends in these actions. In general, these records
of actions include any task lists, medication administration
records, treatments, and other actions associated with the
caregiver's 114 responsibilities. Such records of actions may
combine medications administered, treatments, and other actions for
multiple patients under the care of an individual caregiver. MMU 12
then sends the operational evaluation message (including any
relevant quality control alert) to an appropriate area (e.g. to the
computer 254 or caregiver supervisor's computer (not shown)) in a
form that is appropriate for the particular alert (usually
including but not limited to graphically or audibly). Additionally,
operational evaluation message (including any relevant quality
control alert) can be sent to any number of individuals including
but not limited to the caregiver, a biomedical engineer, caregiver
supervisor, and a doctor.
[0137] Additionally, the MMU 12 can instruct the medical device 14
to customized display 88 based on the operational evaluation
message. Thus, the display 88 is adjusted by the MMU 12 based a
determination that the caregiver 114 requires additional or
different information displayed to improve caregiver 114
interaction with the medical device 14. For example, detailed step
by step instructions can be placed on display 88, where the MMU 12
recognizes a caregiver 114 who is not familiar with a particular
therapy, using the display 88 as the instruction means. Likewise,
where the MMU 12 recognizes that a caregiver 114 has limited
experience programming the medical device 14 (caregiver experience)
or in previous interactions had made errors programming a
particular function (caregiver error rate) or was a statistically
longer than the norm at programming a particular function
(caregiver response time), the MMU 12 instructs the medical device
14 to display pertinent training information.
[0138] In another embodiment best understood with reference to FIG.
4A, the medical device 14 is designed to act as a web server for
the input device 32 or other similar devices within proximity to
the medical device 14. In this embodiment, medical device 14 is
equipped to supply the input device 32 web browser (client) with
medical device related information as well as non-medical device
related information such as task lists, etc. Additionally, the
medical device 14 displays a dual function screen having both a
pump monitor screen portion and a web browser screen portion.
Further, supplying the medical device 14 as a web server permits a
remote web browser to associate with the medical device 14 to
configure the medical device 14 or run diagnostics on the medical
device 14.
[0139] With reference to FIGS. 2 and 4A, another portion of the
Monitor Pump 52 program in the MMU 12 and the corresponding Monitor
Pump 130 program in the medical device 14 is directed to cloning
between medical devices 14. The medical devices 14 are designed to
have wireless data sharing between each medical device 14
sufficient to permit cloning of all patient information between
each medical device 14, and/or the multi-sequencing of a set of
medical devices 14 without a hardwired connection. The MMU 12
adjudicates this cloning and/or multi-sequencing.
[0140] FIGS. 23-30 assist in illustrating another set of
embodiments of the invention. As best understood in view of FIGS. 1
and 23, the patient link 20 is eliminated from the system in this
set of embodiments and an input device 32, including but not
limited to a point-of-care (POC) device such as a personal digital
assistant (PDA) equipped with a scanner or machine label reader,
connects or communicates with the HIS 18 and the MMU 12 of the MMS
10. With reference to FIGS. 23-24, another input means 26 or device
such as a POE (physician order entry) computer connects and
communicates with the HIS 18 in order to allow a physician to
deliver a medication order prescribed for a particular patient.
Although it may not always be the case, the medication order is
generally routed through the pharmacy and the pharmacy information
system or PhIS 24 so that the medication can be physically prepared
and, if necessary, repackaged, reconstituted, and labeled with
identification for delivery. The medication order typically
includes instructions regarding the drug (drug name, concentration,
and amount such as volume, quantity, or mass), the patient, the
route of administration, and the prescribed time(s) of
administration or execution.
[0141] The MMU 12 includes a processing unit 36 and at least one
input/output device 38 as discussed above. When multiple
input/output devices are used, one input/output device 38 is
provided for monitoring the MMU 12 and medical devices 14 (pumps or
infusers and lines or channels thereof, for example) connected to
the MMU, entering clinical or expert decision rules, entering or
editing data to configure the MMU 12, running various programs
thereon, and extracting reports. In FIG. 24, the processing unit 36
is a computer server and a separate MMU console 38 connects or
communicates with it. The MMU console 38 is physically located in a
biomedical engineering area, although other locations including but
not limited to a nursing station, security desk, administrative
area, or physician's desk would be possible. Another input/output
device 38A in the form of a drug library editor (DLE) console
connects or communicates with the processing unit 36 to enter,
edit, import and export data relating to the drug library. Although
many locations within the health care facility are possible without
detracting from the invention, the DLE console 38A is physically
located in the pharmacy under the control of a licensed pharmacist.
One skilled in the art will appreciate that a standard personal or
laptop computer can function as both the processing unit 36 and one
or more of the input/output devices 38, 38A. The input/output
devices 38, 38A can also be provided as separate input and output
devices.
[0142] FIGS. 2, 4, 4A, 25 and 26 illustrate basic components of the
system, depict the flow of certain data within the system, and
depict the steps for automatically programming and monitoring the
medical device 14, an infuser or multi-channel pump in this
example. The entry of the prescribed drug order into the HIS 18 by
the physician (FIG. 24) causes a medication container 100 to be
selected or prepared by a pharmacist in the pharmacy using
information from the PhIS 24 and the HIS 18. Many modern drug
containers come from the manufacturer pre-filled and now include
machine-readable labels with drug identification information
thereon. Alternatively, the pharmacist provides drug identification
information on a PhIS computer generated machine-readable label for
attachment to the container. Typically, drug identification
information includes the drug name, concentration, and amount in
volume or mass. The manufacturer or pharmacist may supplement this
basic label information with additional information including
manufacturer name, expiration date, production lot, patient
identification, and other information in a format readable by a
machine or a human as required by the health care facility,
government agencies or industry practice. When ready, the container
100 with its label 102 is provided to the caregiver 114 or placed
in an appropriate storage area for later administration to the
patient.
[0143] As the time of scheduled administration approaches, the
caregiver 114 enters caregiver specific identification (caregiver
ID) with the input device 32, for example by scanning the
machine-readable indicator 116 on their badge or similar article at
step 300, to verify that the caregiver 114 is an authorized user.
At step 302, which is optional, the input device 32 gets from the
HIS 18 a list of task or orders the caregiver 114 is authorized and
scheduled to perform on various patients. This task list is
presented on the screen of the input device or PDA 32.
Alternatively, in other embodiments, it may be unnecessary to scan
the indicator 116 on the caregiver badge because the hospital has
elected not to track such information or the caregiver has already
identified themselves in another manner before using the input
device 32, including but not limited to logging in to the system or
device with an appropriate login user ID and password combination
or using a designated authorization code.
[0144] At the bedside, in step 304, the caregiver 114 enters the
patient-specific identification information by using the input
device 32 to enter, read or scan the machine-readable indicator 112
associated with the patient 110. In step 306, the input device 32
gets, displays, selects, or highlights a list of orders or tasks
associated with the specific patient 110 scanned. In step 308, the
caregiver 114 uses the input device 32 to scan the label 102 on the
drug container 100, which triggers the input device to select,
highlight or display a specific order or task on its display
screen. In step 310, the input device 32 uses the drug ID to get
the details of the specific order from the HIS 18.
[0145] In step 312, the caregiver 114 uses the input device 32 to
enter, scan or read the machine-readable channel/infuser ID
indicator 92, 96 on the channel 90, 94 of the medical device 14 to
be used to dispense the order. If the appropriate channel/infuser
has been selected and scanned, the input device 32 submits the
delivery order to the MMU 12 at step 314. Alternatively, the HIS 18
can submit the order directly to the MMU 12, preferably after
confirmation by the caregiver 114 at the PDA 32. At any rate, prior
to submission of the medication delivery order to the MMU 12 and
the medical device 14, up to seven "rights" of medication
management have been matched, verified, or validated as correct.
The right caregiver will be administering the right drug to the
right patient at the right time, in the right dosage, through the
right route/device, and through the right device channel.
[0146] One skilled in the art will appreciate that the
pre-submission steps 300-312 can be done in any order necessary to
conform to hospital practices and desired workflow. For example,
the caregiver 114 can scan the drug container label 102 (step 308)
before scanning the patient ID 112 (step 304). Step 304, which
includes entering the patient ID 112, may be done prior to the step
300 of entering the caregiver ID 116. In that case, for security
and patient privacy purposes, the system would delay the display of
the order list for the patient until after the caregiver's
authorization has been verified. Although it is contemplated that
the HIS 18 is the most efficient place to perform the above date
comparisons, one skilled in the art will recognize that the
necessary comparisons between the scanned caregiver, patient, drug
and device specific delivery information and the originally entered
infusion order may take place at the PDA 32, the MMU 12, the HIS 18
or some combination thereof.
[0147] The MMU 12 translates the order at step 316 into a format
that the medical device 14 can recognize. Then the MMU 12 submits
the order to the medical device 14 at step 318. In step 320, the
medical device 14 confirms the order with the MMU. The pump can
automatically confirm the order or, more preferably, a caregiver
can verify and confirm the order at the pump. The medical device 14
communicates the status of the infusion to the MMU 12 in real-time
or at periodic intervals in step 322. As desired by the caregiver
or other authorized users, the input device or PDA 32 can poll the
MMU 12 for the status of the infusion at step 324. The MMU 12 can
respond to this request, polling, or "pull" of information at step
326 as illustrated by the dashed line in FIG. 26, or the polling
step 324 can be eliminated and MMU 12 can "push" the infusion
status to the PDA 32 or another computer associated with the system
at predetermined times or stages of infusion completion. The PDA 32
can share the infusion status data with the HIS 18 or the HIS 18
can receive the data from the MMU 12.
[0148] From FIGS. 2, 24, 25 and 30, it will be understood that the
MMS 10 can include a MMU 12 and a DLE 38A, 38B that are deployed on
separate computers (terminals) or on the same machine. The DLE
(drug library editor) 38A, 38B includes a user interface 37 and a
drug library database 39 formulated and editable using a
conventional database management software platform such as SQL
Server or SQL Desktop Engine by Microsoft of Redmond, Wash., USA.
The drug library editor communicates with the MMU 12 and performs
various functions related to the drug library, including but not
limited to importing, maintaining or editing, and exporting the
final drug library (FDL). The drug library can be stored in a local
or network storage location 40, 328, with local storage being
understood to be in a memory or storage medium 40 of the MMU or DLE
and network storage 328 being understood to be in a location remote
from the MMU or DLE and connected thereto by the electronic network
76 (FIG. 4). The MMU 12 includes a web browser 41 for producing
various predetermined and user customizable views and reports. The
MMU 12 further includes a business logic unit 43 and a reporting
engine 45. The logic unit 43 and reporting engine 45 communicate
with and interact with the web browser 41 and a MMU database 47
formulated using any conventional database management software,
such as Microsoft SQL Server 2000. When the MMU 12 and DLE 38A are
deployed on separate machines, as shown in FIG. 30, the drug
library can be edited in the DLE 38A and the updated or final drug
library version (FDL) can be exported into storage 40, 328 and then
imported in the MMU 12 for eventual download to medical devices.
Utilizing separate machines or terminals for the MMU console 38 and
the DLE console 38A is advantageous in that control, maintenance
and editing of the drug library can be done by licensed pharmacists
or doctors in one physical location, while monitoring of the MMU 12
and thus the pumps 14 in communication with the MMU 12 can be done
by less costly caregivers in another physical location, such in the
patient's ward where they can respond quickly to any problems.
Alternatively, the storage 40, 328 can be a database that is shared
by the MMU 12 and the DLE 38A or 38B. This database can be managed
by a database management software package, such as Microsoft SQL
Server 2000. In such a situation, the MMU console 38 and the DLE
console 38A can still be in two separate locations and connected to
the same common database, which can be stored on any machine in the
network, including but not limited to on the same machine as MMU
console 38 or DLE console 38A, for exporting a drug library from
DLE to MMU 12. This would allow the export/import of the drug
library from DLE to MMU to be done with or without user
intervention.
[0149] Referring to FIG. 27, the MMU 12 of this invention allows a
user 330 to select one or more medical devices 14, such as infusers
or pumps, at step 332 and launch or initiate a drug library
download at step 334. The MMU 12 downloads a drug library to a
communication engine or network interface 122 associated with the
infuser 14. Although hard-wired communication is possible, the MMU
12 and the interface 122 preferably communicate wirelessly.
Although other locations are possible, the interface 122 is
preferably attached to or, more preferably, internal to the infuser
14 ("internal" should be understood as having a majority of its
circuit board residing inside the housing of the infuser). The
interface 122 communicates the status of the drug library download
back to the MMU 12 at step 338, reporting whether any errors were
encounter or verifying that the download was successfully received.
As mentioned above with respect to FIG. 4A, the infuser or pump 14
includes the interface 122 that includes or communicates with a
cache memory 126A to store the new drug library information so the
pump 14 may continue to use an existing drug library to complete an
infusion. At step 340, the interface 122 notifies the infuser 14
that a drug library update has been received. An alert or notice,
in visual or audible form, that a drug library update has been
received may be communicated to the infuser user interface. A
triggering event at step 342, including but not limited to the
consent of a caregiver 114, causes the new drug library to be
pulled from the cache memory 126A, which is associated with the
interface 122 and pump 14, in step 344. Thus, the new drug library
replaces the existing active drug library in the infuser when the
triggering event occurs. The infuser 14 also reports its status,
including which active drug library it is using, to the MMU 12
through the network interface at steps 346 and 348. Detailed logs
of the actions of the pump 14 and the interactions of the caregiver
114 with it are uploaded from the pump 14 to the MMU 12 in step
350. After the logs have been uploaded to the MMU 12, the network
interface 122 may erase the logs in the pump 14 at step 352, if
desired, to save space in the memory of the medical device 14.
[0150] Similarly, as best understood in view of FIGS. 2 and 4A, the
MMU 12 includes respective programs 61, 63 for downloading or
updating pump software code and managing a master drug ID map. The
medical device 14 includes respective programs 131, 133 for
receiving downloads of this code and information. The download pump
software programs 61, 131 allow the MMU user to download a
particular version of device-specific overall system operating code
to the processing unit 36 of one or more medical devices. Thus,
when the manufacturer releases a new version of operating system
software with various enhancements for the medical device 14, the
new code can efficiently be loaded onto machines in the field, as
an alternative to being returned to the factory for upgrade. The
manage drug map programs 63 and 133 allow the MMU 12 and medical
device 14 to recognize and cross-reference drug information from a
variety of drug manufacturers, HIS vendors and other sources, for
example, including but not limited to Abbott Laboratories, Hospira,
Inc., Cerner Multum, First Data Bank and other similar sources.
[0151] One skilled in the art will appreciate that drug library,
pump software, or drug map downloads as described above are
"pushed" from the MMU 12 to the medical device 14. Alternatively,
the MMU 12 only manages the latest version of the information and
any one of those downloads can be "pulled" or initiated by the user
at the user interface on the medical device 14, using the network
interface 122 as a pass through device or as an intermediate cache
device. Of course, the medical device 14 could also be programmed
to automatically pull the most recent information from the MMU 12
at startup or under other predetermined conditions, including but
not limited to a specific day, date, time of day, etc., without
operator input.
[0152] FIG. 28 shows a couple of possible ways the MMU 12 can
receive uploads regarding the status of an infusion. In the upper
half of FIG. 28, the information about the status of an infusion is
pushed from the infuser 14 to the MMU 12 through the network
interface 122 in steps 354 and 356. In the lower half of FIG. 28,
the network interface 122 pulls information by querying the pump 14
about the status of the infusion at step 358. The pump 14 responds
to this call by providing in step 360 the status of the infusion,
which is then sent to the MMU 12 in step 362. Although such steps
are not shown in order to avoid overcomplicating the figures with
alternative or optional steps, one skilled in the art will
understand that either of the two status update processes shown in
FIG. 28 and described above can be preceded by the step of the MMU
12 querying or polling the pump 14 through network interface 122
for its status.
[0153] Similarly, FIG. 29 illustrates a couple of possible ways the
MMU 12 can receive event logs with detailed information regarding
the actions of the pump 14 and the interactions of the caregiver
114 with it. The event log information can include, but is not
limited to, pump status, pump activity, alerts, alarms, and
caregiver activity such as keystrokes and alarm overrides. In the
upper half of FIG. 29, the event log information is pushed from the
infuser 14 to the MMU 12 through the network interface 122 in steps
363 and 364. In the lower half of FIG. 28, the network interface
122 pulls event log information by querying the pump 14 at step
366. The pump 14 responds to this call by providing in step 368 the
event log information, which is then sent to the MMU 12 in step
370. Although such steps are not shown in order to avoid
overcomplicating the figures with alternative or optional steps,
one skilled in the art will understand that either of the two event
log upload processes shown in FIG. 29 and described above can be
preceded by the step of the MMU 12 querying, requesting, or polling
the pump 14 through network interface 122 for its event log.
[0154] Referring again to FIG. 24, the flow of information in the
present invention is summarized. As mentioned earlier, the
information can be transmitted wirelessly, by hard-wired connection
of the components, or by some combination of hard-wired and
wireless connections. As shown and discussed above relative to FIG.
4, the HIS 18 and MMU 12 can be hard-wired and stationary, while it
is preferable that the point-of-care (POC) input device or means 32
and the medical device 14 be mobile and equipped to transmit and
receive communication wirelessly. The point of care input device 32
can be personal digital assistant (PDA), a notebook or laptop
computer, a tabletop or cart-mounted personal computer, a bar code
point-of-care (BPOC) scanning device, or other similar active or
passive data input means. For example, in the embodiment disclosed
in FIG. 24, the POC input device is a PDA equipped with a bar code
scanner.
[0155] The physician enters or inputs a medication (infusion) order
into the HIS 18 through means of the physician order entry (POE)
computer 26. The medication order specifies or prescribes that a
specific patient is to receive a particular dosage of a specific
medication or drug at a particular time via a prescribed
administration route. An authorized caregiver 114 uses the POC
device 32 to provide caregiver identification and to request or
receive a list of tasks to be accomplished. The list may include
medication orders for various patients under the caregiver's care.
The caregiver enters or scans the machine-readable indicia 112 on a
patient 110 with the POC device 32 and is able to access a list of
one or more medication orders for the specific patient scanned. The
caregiver 114 enters or scans the machine-readable indicia 102 on
the drug container 100 and the machine-readable indicia 92, 96 on
the particular channel of the medical device or infusion pump 14 to
be used for the infusion. The caregiver 114 can then confirm with
POC device 32 and the HIS 18 that the information scanned matches
the medication order. The POC device 32 transmits a medication
delivery order including but not limited to some or all of the
identification information discussed above and an infusion rate to
the MMU 12.
[0156] The MMU 12 translates the simple infusion rate of the
delivery order into delivery programming code or information
suitable for automatically programming the designated pump 14 and
further checks the delivery order and delivery programming code
against a variety of drug library parameters (including but not
limited to hard and/or soft limits for drug delivery rates),
patient-specific safety factors, and clinical decision support
rules. The MMU 12 can be configured by the user at the MMU console
to monitor the status of the pump 14 and the infusion (including
alarms, event logs, and pump user interface inputs), generate
reports, and control the distribution of drug library and operating
code updates to one or more pumps 14. A drug library editor
deployed as a part of the MMU 12, its console 38, or on a separate
computer 38A, enables the user to import, export and edit whole
drug libraries and individual drug library values to control and
customize a drug library according to hospital preferences.
[0157] The MMU 12 saves the caregiver time by automatically
populating or programming data entry fields in the pump 14 that
previously had to be entered manually. The medication management
system 10 of this invention enhances patient safety by minimizing
manual entries. The system 10 also enhances patient safety by
screening drug delivery orders for conformance with established
hospital practices, expert or clinical decision support rules and
recommendations before (more preferably immediately before) the
pump 14 begins to execute the order. The system 10 can provide
alerts in various locations, including but not limited to at the
POC device 32 or at the medical device 14, when the clinical
decision rules are not met. The alerts can take many possible
forms, including but not limited to visible or audible alarms. The
caregiver 114 is provided with a least one and preferably several
opportunities to catch a medication error before it happens. For
example, the caregiver 114 can confirm the order at the POC device
32 and/or before pressing the start button on the pump 14. The
system is flexible enough to permit human interventions and
overrides, but tracks such events for documentation purposes.
Whereas the invention has been shown and described in connection
with the embodiments thereof, it will be understood that many
modifications, substitutions, and additions may be made which are
within the intended broad scope of the following claims. From the
foregoing, it can be seen that the present invention accomplishes
at least all of the stated objectives.
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