U.S. patent application number 13/525605 was filed with the patent office on 2012-10-11 for administering of medication.
This patent application is currently assigned to ADVANTAGE PHARMACY SERVICES LLC. Invention is credited to John Todd Barrett, Spencer K. Barrett, Fred P. Schoville.
Application Number | 20120259458 13/525605 |
Document ID | / |
Family ID | 42132431 |
Filed Date | 2012-10-11 |
United States Patent
Application |
20120259458 |
Kind Code |
A1 |
Barrett; John Todd ; et
al. |
October 11, 2012 |
Administering of Medication
Abstract
Apparatuses to facilitate administering of medication. Cassettes
of the apparatuses include several novel aspects.
Inventors: |
Barrett; John Todd;
(Madison, MS) ; Schoville; Fred P.; (Brighton,
MI) ; Barrett; Spencer K.; (Madison, MS) |
Assignee: |
ADVANTAGE PHARMACY SERVICES
LLC
Madison
MS
|
Family ID: |
42132431 |
Appl. No.: |
13/525605 |
Filed: |
June 18, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12554439 |
Sep 4, 2009 |
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13525605 |
|
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61110321 |
Oct 31, 2008 |
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Current U.S.
Class: |
700/237 ;
221/154; 221/186; 221/258 |
Current CPC
Class: |
G16H 20/10 20180101;
G16H 40/60 20180101; G06Q 10/00 20130101 |
Class at
Publication: |
700/237 ;
221/154; 221/258; 221/186 |
International
Class: |
B65D 83/04 20060101
B65D083/04; G06F 17/00 20060101 G06F017/00 |
Claims
1. A medication administering apparatus comprising: a housing
including a compartment and a first electrical connector
corresponding to the compartment; a cassette carried in the
compartment and including a housing carrying a second electrical
connector; and an electromechanical latch to selectively couple the
cassette to the housing; wherein when the cassette is engaged to
the housing, the second electrical connector couples to the first
electrical connector and the electromechanical latch locks the
cassette to the housing.
2. The apparatus of claim 1 wherein the electromechanical latch is
carried by the cassette housing.
3. The apparatus of claim 2 wherein the electromechanical latch
includes an actuator having a pin engaged in a first locking
aperture of the housing, wherein the pin includes a cam surface and
the housing includes a side portion that has a second locking
aperture and that engages the cam surface of the pin to displace
the pin from the locking aperture of the housing until the first
and second locking apertures align at which point the pin snaps
into engagement with the locking apertures to lock the cassette to
the housing.
4. The apparatus of claim 1 wherein the electromechanical latch is
carried by the housing.
5. The apparatus of claim 4 wherein the housing further includes a
backplane and the electromechanical latch is coupled to the
backplane.
6. The apparatus of claim 5 wherein the electromechanical latch
includes an electromechanical actuator coupled to the backplane and
including a pin, and a lever pivotably coupled to the backplane and
including a front end for coupling to the cassette and a rear end
coupled to the pin of the actuator.
7. The apparatus of claim 6 wherein the actuator is coupled to a
rear surface of the backplane, the front end of the lever extends
through an aperture of the backplane and terminates in a bayonet
having a cam surface and a barb for engaging the cassette.
8. The apparatus of claim 5 wherein the electromechanical latch
includes a motor and drivetrain coupled to the backplane and a
pivotable lever coupled to an output shaft of the drivetrain,
wherein the lever has a first leg to lock the cassette thereto and
a second leg to eject the cassette.
9. A medication administering apparatus comprising: a housing
including a compartment and a backplane carrying a first electrical
connector corresponding to the compartment; and a cassette carried
in the compartment and including a housing carrying a second
electrical connector, wherein when the cassette is engaged to the
housing, the second electrical connector couples to the first
electrical connector.
10. The apparatus of claim 9 further comprising a computer in
communication with the first electrical connector, wherein when the
second electrical connector couples to the first electrical
connector the computer recognizes the cassette.
11. The apparatus of claim 10 further comprising a biometric
security device coupled to the computer to verify at least one of
an identification of an administering attendant who is to
administer medication or a patient who is to receive administered
medication.
12. The apparatus of claim 11 wherein the biometric security device
identifies the administering attendant as he/she approaches the
administering apparatus as an initial security measure, and
receives access verification from the administering attendant as a
secondary security measure.
13. The apparatus of claim 10 further comprising a tamper device in
communication with the computer to alert personnel that security of
the apparatus is being compromised according to at least one of the
following three different alerts: 1) when an attempt is being made
to forcibly remove the cassette from the apparatus when the
cassette has not been unlocked, wherein the cassette will travel a
predetermined distance before a switch is tripped to set off an
alarm; 2) when an attempt is being made to forcibly remove
medication from the apparatus out of the cassette, wherein output
from a medication administering counter is sensed by the computer
when a material handler has not been triggered to move; or 3) the
apparatus has been tipped from its normal horizontal position,
wherein a level sensor is tripped to set off an alarm.
14. The apparatus of claim 10 further comprising a proximity
sensing device in communication with the computer to determine when
someone other than a presently authorized user is in a position to
view a touchscreen of the apparatus.
15. The apparatus of claim 9, wherein the backplane has an aperture
and the cassette is disposed on one side of the backplane.
16. The apparatus of claim 15, further comprising a locking
apparatus disposed on an opposite side of the backplane to
selectively couple the cassette to the housing, wherein the locking
apparatus includes a portion extending through the aperture in the
backplane to engage the cassette.
17. The apparatus of claim 16 wherein the locking apparatus
includes an electromechanical latch that includes a motor and
drivetrain coupled to the backplane and having an output shaft, and
wherein the electromechanical latch also includes a pivotable
element coupled to the output shaft and having a locking portion to
lock the cassette, wherein the motor is energized to cause the
pivotable element to pivot so that the locking portion unlocks the
cassette.
18. The apparatus of claim 17 wherein the pivotable element also
has an ejecting portion to eject the cassette and wherein the motor
is energized to cause the pivotable element to pivot so that the
ejecting portion pushes the cassette outward for removal.
19. The apparatus of claim 17 wherein the locking portion of the
pivotable element terminates in a bayonet having a cam surface and
a barb, and wherein the cassette includes a rear wall with a
locking aperture into which the bayonet of the pivotable element
extends so that the barb engages a rear inside surface of the rear
wall when the pivotable element locks the cassette.
20. The apparatus of claim 16 wherein the locking apparatus
includes an electromechanical latch that includes a motor and
drivetrain coupled to the backplane and having an output shaft, and
wherein the electromechanical latch also includes a pivotable
element coupled to the output shaft and having a barb to lock the
cassette, wherein the motor is energized to cause the pivotable
element to pivot so that the pivotable element unlocks the cassette
and so that the pivotable element pushes the cassette outward for
removal.
21. The apparatus of claim 16 wherein the locking apparatus
includes an electromechanical actuator coupled to the backplane and
including a shot pin, and a pivotable element pivotably coupled to
the backplane and having a front end that locks the cassette and a
rear end coupled to the shot pin of the actuator, wherein the
actuator may advance the shot pin to pivot the pivotable element so
that the front end unlocks the cassette so that the cassette may be
pulled away from the backplane.
22. The apparatus of claim 21 wherein the front end of the
pivotable element terminates in a bayonet having a cam surface and
a barb, and wherein the cassette includes a rear wall with a
locking aperture into which the bayonet of the pivotable element
extends so that the barb engages a rear inside surface of the rear
wall when the pivotable element locks the cassette.
23. A medication administering cassette for a medication
administering apparatus, comprising: a housing to carry medication;
and a material handler carried by the housing to convey a strip of
material out of the housing, and including a prime mover, a
transmission coupled to the prime mover, laterally spaced drive
elements coupled to the transmission, and laterally spaced driven
elements operatively coupled to the drive elements, wherein the
prime mover drives the transmission and the transmission drives the
drive elements and the drive elements engage the strip of material
against the driven elements to convey the strip of material along a
feed direction and to bias the strip of material in opposed
directions transverse to the feed direction.
24. The cassette of claim 23 wherein the drive elements and the
driven elements include opposed pairs of gears that are tapered to
bias the strip material in the opposed directions.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application claims the benefit and is a divisional of
U.S. patent application Ser. No. 12/554,439 filed on Sep. 4, 2009,
which in turn claims the benefit of U.S. Provisional Application
No. 61/110,321, filed Oct. 31, 2008, the contents of which
applications are incorporated herein by reference in their
entireties.
TECHNICAL FIELD
[0002] The field to which the disclosure generally relates includes
administering of medication.
BACKGROUND
[0003] In a typical inpatient setting, medication prescriptions are
generated by a physician and dispensed by a pharmacist according to
a dosing regimen (e.g. one pill twice daily or two pills twice
daily). Also, computerized medication administering carts are
frequently used in medical care facilities to administer medication
to patients on a patient-by-patient basis. For example, such carts
typically include a plurality of drawers or sections of drawers
corresponding to a plurality of patients, wherein each drawer or
drawer section is assigned to a particular patient and contains
multiple doses of medication specifically prescribed for and
assigned to the patient. Patients often leave the facility before
finishing their assigned supplies of medication on the cart or the
prescription may be terminated or changed and, thus, leftover
medication may be discarded. In a hospital setting, medication
typically is not discarded, but is usually recounted and replaced
into a pharmacy inventory in a labor intensive process.
BRIEF SUMMARY
[0004] The present disclosure is directed to a medication
administering apparatus that may be associated with a pharmacy, a
medication administering cassette for the medication administering
apparatus, a method of managing medication that may use the
administering apparatus, and a medication administering system.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] Exemplary embodiments of the invention will become more
fully understood from the detailed description and the accompanying
drawings, wherein:
[0006] FIG. 1 is a perspective view of a computerized medication
administering apparatus according to one exemplary embodiment, and
illustrating a cassette exploded out of a corresponding
compartment;
[0007] FIG. 2A is an exploded perspective view of an exemplary
embodiment of the cassette of the computerized medication
administering apparatus of FIG. 1;
[0008] FIG. 2B is a perspective right side view of the cassette of
FIG. 2A;
[0009] FIG. 2C is a perspective left side view of the cassette of
FIG. 2A;
[0010] FIG. 2D is an exploded perspective view of the cassette of
FIG. 2A;
[0011] FIG. 2E is a front view of the cassette of FIG. 2A;
[0012] FIG. 2F is a right side view of the cassette of FIG. 2A;
[0013] FIG. 2G is a rear view of the cassette of FIG. 2A;
[0014] FIG. 2H is a top view of the cassette of FIG. 2A;
[0015] FIG. 2I is a perspective view of a material handling
apparatus of the cassette of FIG. 2A;
[0016] FIG. 2J is a perspective view of an exemplary embodiment of
a locking apparatus and electrical connector of the cassette of
FIG. 2A;
[0017] FIG. 2K is a fragmentary view of an exemplary embodiment of
a shot pin for the locking apparatus of FIG. 2J;
[0018] FIG. 3A is an exploded perspective view of another exemplary
embodiment of the cassette of the computerized medication
administering apparatus of FIG. 1;
[0019] FIG. 3B is a rear perspective view of an exemplary
embodiment of a front cover of the cassette of FIG. 3A;
[0020] FIG. 3C is a rear plan view of the front cover of FIG.
3B;
[0021] FIG. 3D is a sectional view of the front cover of FIG. 3B,
taken along line 3D-3D of FIG. 3C;
[0022] FIG. 3E is a fragmentary side view of another exemplary
embodiment of a locking apparatus and electrical connector for the
cassettes of FIGS. 2A and/or 3A and the computerized medication
administering apparatus of FIG. 1;
[0023] FIG. 3F is a fragmentary perspective rear view of the
locking apparatus portion shown in FIG. 3E;
[0024] FIG. 3G is a fragmentary perspective front view of the
locking apparatus portion of FIGS. 3E and 3F and the electrical
connector portion of FIG. 3E;
[0025] FIG. 3H is a front view of an exemplary embodiment of a
portion of an alternative material handling apparatus for the
cassettes of FIGS. 2A and/or 3A;
[0026] FIG. 3I is a perspective view of an exemplary embodiment of
a portion of another alternative material handling apparatus for
the cassettes of FIGS. 2A and/or 3A;
[0027] FIG. 3J is a fragmentary perspective rear view of another
embodiment of a locking apparatus portion that may be used with the
cassette of FIG. 3A;
[0028] FIG. 3K is a fragmentary perspective front view of the
locking apparatus portion of FIG. 3J;
[0029] FIG. 4A is a schematic of one embodiment of electrical
connections for the computerized medication administering apparatus
of FIG. 1 and the cassette of FIGS. 2A-2K;
[0030] FIG. 4B is a schematic of another embodiment of electrical
connections for the computerized medication administering apparatus
of FIG. 1 and the cassette of FIGS. 3A-G;
[0031] FIG. 5 is a block diagram illustrating a computing system
according to one exemplary embodiment;
[0032] FIG. 6 is a flow chart illustrating a medication management
method according to one exemplary embodiment; and
[0033] FIG. 7 is a flow chart illustrating a medication management
method according to another exemplary embodiment.
DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
[0034] The following description of the embodiment(s) is merely
exemplary (illustrative) in nature and is in no way intended to
limit the invention, its application, or uses.
[0035] FIGS. 1-4 illustrate an apparatus according to exemplary
embodiments. As shown in FIG. 1, a computerized medication
administering apparatus 10, which, according to one embodiment, may
include a mobile cart as shown. For example, the disclosure of U.S.
Pat. No. 6,175,779 is incorporated herein by reference in its
entirety. A plurality of wheels 12 may be mounted to the apparatus
10 to permit transport of the apparatus 10 from room to room by a
medication administering attendant while making patient rounds. In
another embodiment, the apparatus 10 may be stationary, for
example, built into a workstation, cabinet, desk, or the like in
any suitable facility. In any event, the apparatus 10 may be
located remotely from a pharmacy with which the apparatus 10 may be
associated. For example, the apparatus 10 may be owned or leased by
a pharmacy. As used herein, the terminology administering attendant
includes a nurse, nursing assistant, physician, physician's
assistant, or any other suitable individual for administering
medication. As also used herein, the terms administer and
administrate are used interchangeably and include providing
medication specifically to a patient in contrast to the term
dispensing, which includes making medication generally available to
a patient for administering to that patient.
[0036] The apparatus 10 may include a touch screen monitor 14
mounted on the apparatus 10 for easy access and view by the
attendant. The touch screen monitor 14 may be further equipped with
a conventional mouse or keyboard or replaced with a conventional
monitor equipped with a conventional mouse or keyboard. The
apparatus 10 may include a housing (either for the mobile cart or
the stationary apparatus embodiments) including a plurality of
compartments 16 for receiving administering devices or cassettes
100 and conventional storage drawers 20. The conventional storage
drawers 20 may be used to store bandages and other types of medical
supplies as well as other medications that cannot be easily
packaged such as medications in liquid form, creams, lotions,
powders, etc. for administering to a patient. For security
purposes, such drawers 20 may be locked. The plurality of
compartments 16 may house a computer 50 and one or more batteries
18 for powering the computer 50, cassettes 100, EEPROM, release
mechanisms, and any other powered elements of the apparatus 10. Of
course, the apparatus 10 may be supplied with power in any other
suitable manner, including AC utility or generator power, or the
like.
[0037] In one embodiment, shown in FIG. 1, the cassettes 100 may be
loaded and unloaded from the cart or apparatus housing and used for
receiving, storing, and/or administering patient-unassigned
medication. As used herein, the term medication includes
prescription medication, vitamins, supplements, over the counter
medication, and/or the like. As also used herein, the term
patient-unassigned means that particular doses of medication have
not yet been assigned to any particular patient(s), but that
eventually may become so assigned. In other words, although a type
of medication generally may be approved for administering to a
particular patient, the medication is not assigned to the
particular patient until actually removed from the cassette(s) 100
for administration to the particular patient.
[0038] The cassettes 100 may be arranged in the apparatus 10 in an
array, as shown, or in any other suitable arrangement. In an array,
the cassettes 100 may be identified by column and row. For example,
as shown in FIG. 1, there are eight rows and fourteen columns that
may be identified alphanumerically. For instance, the rows may be
identified as rows A through N and the columns may be identified as
columns one through eight.
[0039] In any event, each cassette 100 corresponds to a particular
medication. For instance, a given cassette, say in location A1 of
the apparatus 10, may receive, store, and administer a particular
type or brand of analgesic, while another device, say N14, may
receive, store, and administer a specific type or brand of
antihistamine. One particular medication may correspond to more
than one cassette 100 on the apparatus 10. For example, a
medication may be so popular that several cassettes 100 may be
required to receive, store, and administer that particular popular
medication. Accordingly, the cassettes 100 of the administering
apparatus 10 need not be organized by patient and, thus, each
cassette 100 need not correspond to a particular patient. Rather,
the apparatus 10 is organized by medication, wherein the cassettes
100 correspond to particular medications.
[0040] In a particular example illustrated in FIG. 2A, the
exemplary cassette 100 includes a housing that may be comprised of
a main body 102 to provide support for other portions of the
cassette 100, a top cover 104 that covers the main body 102, and a
front cover 106 that frontally covers the main body 102 and
includes an outlet 101, for example a slit, through which
medication may be conveyed, and a rear cover or bracket 107 that
covers a rearward end of the main body 102. The main body 102
includes a base 108, sides 110 extending from the base 108, a front
112 to which the front cover 106 is coupled in any suitable manner,
and a rear 114. One or both of the sides 110 includes a locking
aperture 116 therethrough. The front cover 106 includes a front
portion 118, a rear portion 120 coupled to the main body 102, and
the outlet 101 extending therethrough. The top cover 104 includes a
top base 122 and flanges 124 extending therefrom, wherein the top
cover 104 is coupled to the main body 102 in any suitable manner.
For example, the sides 110 of the main body 102 may be frictionally
engaged to the flanges 124 of the top cover.
[0041] The bracket 107 may include a base 128, flanges 130
extending from the base 128 for coupling to the sides 110 of the
main body 102 of the housing, and an upper lip 131. One or both of
the flanges 130 may include a locking aperture 132 therethrough.
The bracket 107 may include a connector passage 134 in the base
128.
[0042] The apparatus 10 may also include an electromechanical latch
to selectively couple the cassette 100 to the cart or apparatus
housing and including a locking device 136, for example, a solenoid
that may be coupled to the bracket 107 in any suitable manner, for
example, with fasteners or the like. The electromechanical actuator
136 may include a shot pin 138 that is biased to a normally
extended position, for example by a spring. The pin 138 extends
through the locking aperture 132 of the bracket 107, and through
the locking aperture 116 of the body 102 when the bracket 107 is
assembled to the body 102. When the housing is pushed into the
compartment of the apparatus 10, an angled front flange 11 of a
structural member 9 of the cart or apparatus housing, for example,
a bracket or the like, engages the pin 138 so as to retract the pin
138 against the bias force of the spring and allow the cassette 100
to advance past the angled front flange 11 until the pin 138 snaps
into a locking aperture 8 of the structural member 9 of the cart
when the pin 138 and the aperture 8 align.
[0043] In the embodiment shown in FIG. 2K, the end of a pin 138'
may be provided with an angled or cam surface 139'. Therefore, if
the bracket 9 is provided with a straight edge instead of the
angled front flange 11, the straight edge may engage the cam
surface 139' of the end of the pin 138' so as to retract the pin
138' against the bias force of the spring and allow the cassette
100 to advance past the straight edge of the bracket until the pin
138' snaps into a locking aperture 8 of the structural member 9 of
the cart or housing when the pin 138' and the aperture 8 align.
This action locks the cassette 100 to the apparatus 10.
[0044] Thus, in one embodiment, the administering apparatus 10
includes locking cassettes. The cassette locking may be
accomplished using the spring force of the actuator 136 to advance
the pin 138, 138' into the locking aperture 8 of the cart or
housing, and unlocking may be accomplished by energizing the
solenoid to retract the shot pin 138, 138'. The cassette 100 will
remain in the locked state until the signal is sent from the
computer 50 of the administering apparatus 10 to the actuator 136
to unlock the cassette 100.
[0045] The cassette 100 also includes an electrical connector 140
that may be coupled to the bracket 107 in any suitable manner and
that may at least partially pass through the connector passage 134
of the bracket 107. The connector 140 engages an electrical
connector 141 of the apparatus 10 that corresponds to the
compartment 16 in which the cassette 100 is disposed. The connector
141 may be coupled to a backplane (not shown) of the apparatus 10
that, in turn, may be coupled in any suitable manner to the
computer 50. The computer 50 is in communication with the
connectors 141 and is programmed in accord with the array of
compartments 16. Accordingly, the location of the cassettes in the
compartments can be communicated to and stored in the computer 50
in any suitable manner. The connectors 140, 141 may be, for
example, blind hole low friction 15-pin connectors. Of course,
although not shown in the drawings, any suitable power and data
wires or the like may be coupled between the actuator 136 and
connector 141 and corresponding portions of the apparatus 10, such
as a power supply, computer, and/or the like. The low friction
connectors 140, 141 are constructed so that the cassette connector
140 is inherently guided into the mating cart connector 141 with
little to no effort, for example, 0.1 to 0.4 lbs of force and, more
specifically about 0.2 lbs of force. Also, the low friction
connectors 140, 141 are constructed so that the cassette connector
140 is easily disengaged from the mating cart connector 141 when
the cassette 100 is unlocked from the cart. In fact, the cassette
spring pressure is sufficient to automatically at least partially
advance the cassette 100 out of its corresponding compartment 16
upon being unlocked.
[0046] The cassette 100 also includes a memory device 142 disposed
at the front end 112 of the main body 102 and that may be coupled
to the rear 120 of the front cover 106 in any suitable manner. The
device 142 may be an EPROM or EEPROM device, for example, an
I-BUTTON brand device, or the like.
[0047] The cassette 100 further includes a switch 144 that may be
coupled to the housing in any suitable manner and that may
cooperate with any suitable portion of the apparatus 10 as the
cassette 100 is pulled out of the compartment 16 or fully closed
into the compartment 16. For example, the switch 144 may be coupled
to the rear 120 of the front cover 106 and may cooperate with a
front inside edge 13 of the cart or housing of the apparatus 10.
The switch 144 may indicate a status of the cassette 100, for
example, an open and/or closed position.
[0048] The cassette 100 additionally includes a material handling
apparatus or material handler 146 to move medication M out of the
housing. For example, the material handler 146 may feed or convey a
strip of packaged medication M out of the housing and through the
outlet 101. Although only one medication unit or dose is
illustrated, the strip may include a plurality of medication units
or doses and may be rolled or folded back onto itself in a compact
manner within the housing, or may be wound on a spool or reel, or
the like. As used herein, the term medication may include anything
for topical treatment or internal care of patients and in any form,
including but not limited to solids, liquids, powders, gels,
creams, lotions, ointments, syringes, sprays or sprayers, bandages,
gauze, or any other supplies. According to a liquid form
embodiment, the strip of the medication M may be produced according
to a FLUIDOSE brand unit dose packaging available from Medical
Packaging Inc. (MPI) of Ringoes, N.J. or according to any other
strip type of packaging available from MPI or any other suitable
source.
[0049] More particularly, the apparatus 146 may include a
powertrain 148 including a prime mover or motor 150 and a
drivetrain coupled to the motor 150 in any suitable manner and that
may include a transmission or gearbox 152 having an input coupled
to the motor 150 and drive elements 154 coupled to one or more
output shafts of the gearbox 152 to drive the strip of medication
M. The drive elements 154 may be toothed wheels or gears, or other
meshing elements, or any other suitable drive elements.
Accordingly, an attendant may use the computer 50 to administer
medication, for, example, by accessing a data file or record for a
patient to whom the medication is to be administered and
instructing the system 50 to send an appropriate signal to the
motor 150 to advance and convey a dose of the medication out of the
cassette 100. The attendant may instruct the system 50 in any
suitable manner, for example by keying in commands with a keyboard,
selecting an option with a pointing device, for example, a mouse,
touchscreen, or the like.
[0050] Although not shown, the motor 150 may include a drive worm
on an output shaft that is coupled to a driven worm gear of the
gearbox 152. The drive worm may drive the driven worm gear but the
opposite is not true. This provides an additional locking mechanism
for the cassette 100, because such unidirectional or one-way
operation of the powertrain prevents someone from pulling the
medication strip through the outlet 101. Once administering of a
unit is complete, and the powertrain stops, the transmission or
drivetrain locks. This may prevent tampering with the apparatus 10.
The drive/driven worm arrangement is just one exemplary one-way
powertrain configuration for the material handler 146 and any other
suitable one-way configurations also or instead may be used.
[0051] The material handler 146 may also include driven elements
156 and an axle on a side of the medication M opposite that of the
drive elements 154. The driven elements 156 may be toothed wheels
or gears, or other meshing elements, or any other suitable driven
elements. The powertrain 148 may be coupled to the housing in any
suitable manner, for example, the elements 154, 156 may be mounted
on shafts or hubs 158 that may be supported by corresponding
apertures 160, 161 in the sides 110 of the main body 102. The upper
apertures 161 may be slots to accommodate up and down movement of
the driven elements 156. As shown in FIG. 2B, screws 157, 159 may
be coupled to the hubs 158 through the walls 110 of the body 102 to
retain the material handler 146 in a desired position within the
housing. The material handler 146 may further include guide springs
162 that may be operably coupled to the hub or shaft 158 of the
driven elements 156, for example, by engaging the screws 157, 159
outboard of the walls 110 of the body 102. As shown in FIG. 2I, the
springs 162 include lower arms 163 that may terminate in hooks,
loops, or the like located behind the heads of the lower screws 157
to couple the springs 162 thereto, and upper arms 165 that may
terminate in hooks, loops, or the like located behind the heads of
the upper screws 159 to coupled the springs 162 thereto.
Accordingly, the springs 162 are constructed and arranged to bias
the driven elements 156 in a direction away from the drive elements
154 so as to release the medication M when the top cover 104 is
lifted. When the top cover 104 is pressed down on the body 102 the
base 122 presses down on the driven elements 156, wherein the
medication M is gripped between the driven elements 156 and the
drive elements 154.
[0052] The material handler 146 additionally may include a
medication counting device or counter 164 that may be coupled in
any suitable manner to the housing so as to count the quantity of
medication doses that passes through the outlet 101. Accordingly,
the apparatus may administer medication on a unit dose,
unit-of-use, or dose-by-dose basis. The counter 164 may be coupled
to one or both of the sides 110 and may cooperate with one or both
of the drive elements 154 and/or the medication packaging to count
each dose of medication. For example, the counter 164 may be a
mechanical switch with an armature in contact with the drive
elements 154 to count a passing of each of several teeth. In
another example, the counter 164 may be an optical sensor to count
a passing of each tooth or spoke or the like of the drive element
154. In a further example, the counter 164 may be a switch, sensor,
or the like that may directly sense separable portions of the
packaged medication strip.
[0053] The cassette 100 may also include a protective cover 166 to
cover the wires or a circuit board (not shown) and a portion of the
material handler 146, and/or to guide the medication M. The cover
166 may include a base 168, which may be generally planar, and a
rear flange 170 extending rearwardly from the base 168 that may be
fastened or otherwise coupled to the lip 131 of the bracket 107.
The cover 166 may also include a front flange 172 extending
forwardly from the base 168 to cover the motor 150 and a tongue 174
extending forwardly from the front flange 172 to cover the gearbox
152. The front flange 172 may include guides 176 disposed on
lateral sides thereof. The guides 176 and the tongue 174 may assist
with guiding the medication M through the apparatus 146.
[0054] Finally, a biasing member 178 may be carried by any suitable
portion of the cart, for example, the bracket 9, to bias the
cassette 100 toward an opened position. In one example, the biasing
member 178 may include a spring-loaded pin device that may be
coupled to the bracket 9 with a portion of the pin device extending
between the brackets 9, 107. Accordingly, when the cassette 100 is
fully inserted into the compartment 16 of the cart and the actuator
136 locks the cassette 100 to the cart, the biasing member 178 is
loaded. Therefore, when the actuator 136 is energized to unlock the
cassette 100 from the cart, the bias force of the biasing member
178 acts on the bracket 107 of the cassette 100 to push the
cassette 100 in an outward direction from the cart. Accordingly,
the cassette 100 may "pop open" when the cassette 100 is unlocked
from the cart.
[0055] The pin 138 extends through the locking aperture 132 of the
bracket 107, and through the locking aperture 116 of the body 102
when the bracket 107 is assembled to the body 102. When the housing
is pushed into the compartment of the apparatus 10, an angled front
flange 11 of a structural member 9 of the cart, for example, a
bracket or the like, engages the pin 138 so as to retract the pin
138 against the bias force of the spring and allow the cassette 100
to advance past the angled front flange 11 until the pin 138 snaps
into a locking aperture 8 of the structural member 9 of the cart
when the pin 138 and the aperture 8 align.
[0056] FIGS. 3A-3G illustrate another exemplary embodiment of a
cassette 100' that may be used with the apparatus 10 of FIG. 1.
This embodiment is similar in many respects to the embodiment of
FIGS. 2A-2K and like numerals between the embodiments generally
designate like or corresponding elements throughout the several
views of the drawing figures. Additionally, the descriptions of the
embodiments are incorporated by reference into one another and the
common subject matter generally may not be repeated here.
[0057] In a particular example illustrated in FIG. 3A, the
exemplary cassette 100' includes a housing that may be comprised of
a main body 102' to provide support for other portions of the
cassette 100', a top cover 104' that covers the main body 102', and
a front cover 106' that frontally covers the main body 102' and
includes an outlet 101' through which medication may be conveyed,
and a rear cover 107' that covers a rearward end of the main body
102'. The top cover 104' may be identifiable as part number C1.5LG6
available from PANDUIT of Tinley Park, Ill. The top cover 104' also
may be custom molded, for example, using ALUMILITE brand molds and
techniques.
[0058] The main body 102' includes a base 108', sides 110'
extending from the base 108', a front 112' to which the front cover
106' may be coupled in any suitable manner, and a rear 114' to
which the rear cover 107' may be coupled in any suitable manner.
The main body 102' may be a drawer base identifiable by part number
FS1.5x3LG6NM available from PANDUIT of Tinley Park, Ill. The main
body 102' also may be custom molded, for example, using ALUMILITE
brand molds and techniques.
[0059] Referring also to FIGS. 3B and 3C, the front cover 106'
includes a front portion 118', a rear portion 120' coupled to the
main body 102', and the outlet 101' extending therethrough. The
front cover 106' may include flanges 121' extending from the rear
portion 120' for coupling to the sides 110' of the main body 102'
in any suitable manner for example via fasteners 119'. The front
cover 106' also may include a cross-member 123' extending from the
rear portion 120' and between the flanges 121'.
[0060] Referring to FIG. 3A, the top cover 104' includes a top base
122' and flanges 124' extending therefrom, wherein the top cover
104' is coupled to the main body 102' in any suitable manner. For
example, the sides 110' of the main body 102' may be frictionally
slidably interengaged to the flanges 124' of the top cover
104'.
[0061] The rear cover 107' may include a base 128', and flanges
130' extending from the base 128' for coupling to the sides 110' of
the main body 102' of the housing in any suitable manner for
example via fasteners 129'. The bracket 107 may include a locking
aperture 116' and a connector passage 134' extending through the
base 128'.
[0062] The cassette 100' further may include a circuit board 126'
having forward and rearward ends, which may be carried or engaged
in corresponding slots in the flanges 121', 130' of the front and
rear covers 106', 107' and supported by the base 108' of the body
102' by a bumper 111'. The bumper 111' may be a 1036 bumper
available from Action Fabricators of Grand Rapids, Mich. Those of
ordinary skill in the art will recognize that the design of the
board 126' may be application specific, and may be purchased from
any suitable source, for example, K&F Electronics of Fraser,
Mich.
[0063] The cassette 100' also may include an electrical connector
140' that may be coupled to the circuit board 126' in any suitable
manner and that may at least partially pass through the connector
passage 134' of the rear cover 107'. The connector 140' may be
identifiable as part number BTFW10R-3RSTAE1LF available from FCI of
Versailles Codex, France. The cassette 100' also may include a
memory device 142' coupled to the circuit board 126' for example
via a memory device mount 143'. The device 142 may be a MAXIM brand
memory chip, for example, with model number DS1972-F3#, and the
mount 143' may be KEYSTONE brand mount, for example, with model
number 101.
[0064] The cassette 100' additionally may include a material
handling apparatus or material handler 146' to move medication out
of the housing and through the outlet 101' of the front cover 106'.
More particularly, the apparatus 146' may include a powertrain 148'
including a prime mover or motor 150' and a drivetrain coupled to
the motor 150' in any suitable manner and that may include a
transmission or gearbox 152' having an input coupled to the motor
150'. The powertrain 148' may be identifiable as part number GM3
available from SOLARBOTICS of Calgary, Canada.
[0065] The apparatus 146' also may include drive elements 154'
carried on an axle and coupled to one or more output elements 153'
of the gearbox 152' to drive the strip of medication (not shown).
The drive elements 154' may be toothed wheels or gears, or other
meshing elements, or any other suitable drive elements. The
material handler 146' may also include driven elements 156' carried
on an axle on a side of the medication opposite that of the drive
elements 154'. The driven elements 156' may be toothed wheels or
gears, or other meshing elements, or any other suitable driven
elements.
[0066] The powertrain 148' may be coupled to the housing in any
suitable manner, for example, the elements 154', 156' may be
mounted on axles 158' that may be supported by corresponding
apertures 160' in the sides 110' of the main body 102'. Bushings
157' may be coupled to the axles 158' through the walls 110' of the
body 102' with washers 159' between the bushings 157' and the walls
110'. The bushings 157' may be identifiable as part numbers 318C
available from WCL of Industry, Calif. The material handler 146'
may further include a bracket 161' to couple the powertrain 148' to
the circuit board 126'.
[0067] The material handler 146' additionally may include a
medication counting device or counter 164' that may be coupled in
any suitable manner to the housing so as to count the quantity of
medication doses that passes through the outlet 101'. The counter
164' may be an encoder that may include, for example, an encoder
wheel and sticker 164a coupled to an output shaft of the gearbox
152' and an encoder sensor 164b coupled to the circuit board 126'
to count alternating portions of the encoder wheel and sticker
164a. The encoder sensor 164b may be identifiable as part number
EE-SX1106 available from OMRON of Kyoto, Japan, and the encoder
sticker may be identifiable as part number 2923 and available from
SIGNARAMA. The sticker may include alternating black and white
segments, for example, 18 black and 18 white segments. As shown,
the cassette 100' may include any suitable resistors as voltage
dividers to reduce voltage to the encoder sensor 164b.
[0068] The cassette 100' additionally may include a relay 179'
coupled to the board 126' and in communication with the powertrain
motor 150'. The relay 179' may have two functions; when the relay
179' is energized it may power the motor 150' for feeding the
packaged medication out of the cassette 100', and when the relay
179' is deenergized, it may act as a brake to keep someone from
pulling the packaged medication out of the cassette 100'. The relay
179' may be a model number G5V-2-DC12 available from OMRON.
[0069] The cassette 100' may also include a protective cover 166'
to cover the circuit board 126' and a portion of the material
handler 146', and/or to guide the medication. The cover 166' may
include a base 168', which may be generally planar, and a rear end
171' extending rearwardly from the base 168' that may be engaged in
slots in the flanges 130' of the rear cover 107'. The cover 166'
may also include a raised portion 173' extending forwardly from the
base 168' to cover the motor 150' and the gearbox 152'. The cover
166' further may include a front end 175' extending forwardly from
the base 168' that may be engaged in slots of the flanges of the
front cover 106'. The cover 166' may assist with guiding the
medication through the apparatus 146' and to the outlet of the
front cover 106'. Those of ordinary skill in the art will recognize
that the design of the cover 166' will be application specific, and
may be created, for example, using ALUMILITE brand molds and
techniques. The cover 166' may be composed of, for example, a
polymeric material, for instance, polystyrene.
[0070] FIG. 3E illustrates a fragmentary side view of another
embodiment of an electrical connecting and locking portion of a
medication dispensing apparatus 10' similar to that of FIG. 1. This
portion includes a rear cover 107' that may be used with the
cassette 100' (shown in phantom), a backplane 180' that may be
coupled in any suitable manner to internal framework of the housing
of the apparatus 10', and a cassette locking apparatus coupled to
the backplane 180' for cooperation with the rear cover 107' of the
cassette 100' to selectively couple the cassette to the cart of the
apparatus 10'.
[0071] The cassette electrical connecting portion includes an
electrical connector 140' that may be coupled to and carried by an
inside top surface of the circuit board 126' in any suitable
manner, for example, by soldered pins. In turn, the circuit board
126' may be carried by the housing of the cassette (not separately
shown). The apparatus 10' also includes an electrical connector
141' that may be coupled to the backplane 180' in any suitable
manner, for example, by soldered pins. The connector 141' may be
the counterpart connector for the cassette connector 140' and, for
example, also may be from FCI of Versailles Codex, France. In any
event, the connectors 140' and 141' are coupled to their respective
supports such that they align and engage with one another. The
connectors 140', 141' may be 10 pin connectors, and one or both may
incorporate a floating insertion feature that allows a male end of
the connector(s) to float horizontally and vertically making
insertion easier.
[0072] The backplane 180' may include one or more circuit boards
operatively coupled to a computer (not separately shown) of the
apparatus 10' in any suitable manner. The backplane 180' may be
fastened to any suitable structural members or framework of the
housing of the apparatus 10'. Although not shown, any suitable hard
stops may be provided between the cassette 100' and the framework
of the apparatus housing to prevent the cassette 100' from damaging
the backplane 180', for example, in the event that the cassette 100
is slammed to its closed position.
[0073] The locking portion may include an electromechanical
actuator 136' that may be mechanically coupled to the backplane
180' in any suitable manner, for example, with fasteners or the
like. As shown, the actuator 136' may include a solenoid, and may
be powered and controlled in any suitable manner and may be
electrically coupled to the backplane 180' in any suitable manner,
for example, via an electrical connector 135' and wires (not
shown). The actuator 136' may include a shot pin 138' that is
biased to a normally retracted position, for example by a spring
137' that may be retained between a housing of the actuator 136'
and a circlip coupled to a rearward end of the shot pin 138'.
[0074] A forward end of the shot pin 138' may be coupled to a lever
145', which may be pivotably coupled to the backplane 180 via a
pivot bracket 147'. The bracket 147', in turn, may be coupled
directly to the backplane 180 in any suitable manner, for example,
by pins 149' extending therethrough as shown in FIG. 3E. As also
shown in FIG. 3E, the lever 145' includes a front end 151' having a
bayonet with a barb. The barb may be used to engage against an
inside surface of the rear cover 107' of the cassette 100. The
lever 145' may be pivotably fastened to the pivot bracket 154, for
example, with a screw, and includes a rear end 155' coupled to the
forward end of the shot pin 138' in any suitable manner. For
example, the shot pin 138' may extend through a passage in the rear
end 155' and the rear end 155' may be trapped between a push
circlip 167' coupled to the shot pin 138' and a pull cap 169'
coupled to an end of the shot pin 138' in any suitable manner.
[0075] In operation, an attendant may use a touchscreen of the
computer 50 to request unlocking of the cassette and, in turn, the
computer 50 may send any suitable signal(s) to the actuator 136',
for example, via a dedicated output for each cassette via an
input/output rack of the apparatus 10. The signal(s) serve to
advance the shot pin 138' against the bias force of the retracting
spring 137'. Accordingly, the push circlip 167' pushes on the rear
end 155' of the lever 145' to pivot the lever 145' so that the
front end 151' disengages from a rear inside surface of a rear wall
of the rear cover 107'. At this point, the cassette 100' may be
pulled away from the backplane 180' wherein the front end 151'
passes through an opening in the rear wall of the rear cover 107'
and the connectors 140' and 141' disengage. The solenoid signal(s)
may cease after a predetermined amount of time, or after the
computer senses disengagement of the electrical connectors 140',
141', and then the spring 137' retracts the shot pin 138' to return
the lever 145' to a lock-ready position. In this position, when the
cassette 100' is advanced toward the backplane 180' to a closed
position, a cam surface of the front end 151' contacts the rear
cover 107 at the opening thereof such that the front end 151'
raises and passes through the opening. As the cassette 100'
continues advancing and nears its closed position the connectors
140', 141' fully engage and the barb of the front end 151' drops
behind a portion of the rear wall of the rear cover 107' to lock
the cassette 100' in place.
[0076] At this point, the computer recognizes the cassette using,
for example, any suitable plug-and-play utility like USB, or the
like. In other words, the connectors 140', 141' may be configured
as part of a cassette presence detection device wherein the
computer recognizes that the cassette is engaged to the apparatus
10' when the connection between the connectors 140', 141' is made.
For example, the computer 50 may periodically poll the memory
devices 142 via the connectors 140', 141' and read serial numbers
and other data of the memory devices 142.
[0077] FIG. 3H illustrates a portion of a drivetrain particularly
configured to feed media in a straight path through the slot 101'
of the cassette 100' (FIG. 3A). The drivetrain includes the drive
elements 154' carried on a respective one of the drive axles 158,
and driven elements 156' carried on an driven axle and
cooperatively engaged with the drive elements 154'. The elements
154' and 156' may be configured to pull the media in opposing
directions transverse to the feed direction of the media. This
prevents the media from tracking to one side or the other and from
binding between inboard sides of the elements 154', 156'.
[0078] In one exemplary embodiment, as exaggerated in FIG. 3H,
outer surfaces of the drive elements 154' may be tapered at angles
A from larger diameters at inboard sides of the elements 154' to
smaller diameters at outboard sides of the elements 154'.
Conversely, outer surfaces of the driven elements 156' may be
tapered at angles B from smaller diameters at inboard sides of the
elements 156' to larger diameters at outboard sides of the elements
156'. Accordingly, the elements 154' and 156' are provided with
opposing tapers. According to this embodiment, the angles A and B
may be of the same magnitude, for example, two to five degrees. In
a variation of this embodiment, elements 154' and 156' may be
provided with like tapers, wherein the outer surfaces of the driven
elements 156' may be tapered from larger diameters at their inboard
sides to smaller diameters at their outboard sides. In another
embodiment, the outer surfaces of the elements 154', 156' may be
generally cylindrical instead of tapered and the gear teeth may be
helical, or disposed at an angle. Helix angles of the gear teeth
may be the same magnitude between the elements 154' and 156'. In
either embodiment, the elements 154', 156' may be composed of any
suitable material, for example, NYLON or any other suitable durable
plastic.
[0079] In a further exemplary embodiment of a drivetrain, FIG. 3I
illustrates drive elements 254' operatively coupled to driven
elements 256' for feeding a strip of packaged medication
therebetween. The drive elements 254' include a plurality of
circumferentially spaced and radially extending pegs 255' and the
driven elements 256' include annular grooves 257' to receive the
pegs 255' therein as the elements 254' rotate. Accordingly, the
elements 254' 256' may constitute a pinwheel type of drivetrain
having pinwheel drivetrain elements to feed a strip of packaged
medication.
[0080] FIGS. 3J-3K illustrate another exemplary embodiment of a
locking apparatus portion that may be used with the cassette 100'
of FIG. 3A. This embodiment is similar in many respects to the
embodiment of FIGS. 2A-3G and like numerals between the embodiments
generally designate like or corresponding elements throughout the
several views of the drawing figures. Additionally, the
descriptions of the embodiments are incorporated by reference into
one another and the common subject matter generally may not be
repeated here.
[0081] The locking apparatus portion of FIGS. 3J and 3K illustrate
an electromechanical actuator 236'. The actuator 236' may include a
motor and drivetrain coupled to the motor, wherein the motor may be
powered and controlled in any suitable manner and may be
electrically coupled to the backplane 180' in any suitable manner.
For example, the actuator 236' may include a GM 10 geared pager
motor product available from Solarbotics of Calgary, Canada. The
actuator 236' may be mechanically coupled to the backplane 180' in
any suitable manner, for example, with a bracket 247' having clip
portions 249' extending through the backplane 180' as shown in FIG.
3K. An output shaft of the drivetrain may be coupled to a lever
245'. As also shown in FIG. 3K, the lever 245' includes a first leg
251' having a bayonet end with a barb. The lever 245' also includes
a second leg 255' that may double as a reaction member and as a
cassette ejector.
[0082] In operation, when the actuator motor is energized it
rotates to cause the drivetrain shaft and, thus, the lever 245' to
rotate in a clockwise direction. As the motor, drivetrain shaft,
and lever 245' rotate, the first leg 251' of the lever 245' raises
and unlocks the corresponding cassette (not shown here), and also
causes the second leg 255' of the lever 245' to push the cassette
outward for removal.
[0083] When the actuator motor is de-energized, a spring 237'
biases the lever 245' back into a lowered or locked position
wherein the first leg 251' locks the cassette and the second leg
255' rests against a stop pin 269'. Accordingly, when the cassette
is reinserted into a corresponding compartment, the lever 245' will
raise and snap back against an inside surface of the rear cover of
the cassette to lock the cassette to the rest of the apparatus. In
one example, the spring 237' may be a torsional spring having one
leg, as shown, in contact with the stop pin 269' and another leg
(not shown) in contact with the lever 245'. However, any other
suitable spring arrangements may be used to bias the lever 245' to
a normally locked position.
[0084] In general, the components of the apparatuses 10, 10' may be
manufactured according to techniques known to those skilled in the
art, including molding, machining, stamping, and the like. Also,
the apparatuses 10, 10' may be assembled according to known
techniques. Likewise, any suitable materials can be used in making
the components, such as metals, composites, acetal polymers or
other polymeric materials, and the like.
[0085] FIG. 4A illustrates a schematic connector diagram including
the connector 140 of the exemplary cassette 100, and the locking
actuator 136, the cassette status switch 144, the counter 164, the
motor 150, and the memory device 142. Although not shown in FIGS. 2
and/or 3, any suitable power or data wires or the like may be
coupled between the aforementioned devices and the connector 140.
The connector 140 is adapted to be coupled to the apparatus
connector 141 of cart of the apparatus 10. The connectors 140, 141
may be configured as a part of a cassette presence detection device
wherein the computer 50 recognizes that the cassette 100 is engaged
to the apparatus 10 when the connection between the connectors 140,
141 is made. This may replace or supplement the functionality of
the cassette status switch 144.
[0086] FIG. 4B illustrates another schematic connector diagram
including the connector 140' of the exemplary cassette 100' adapted
to be coupled to the apparatus connector 141' of the cart of the
apparatus 10. The diagram illustrates example data paths between
the connectors 140', 141'.
[0087] Referring to FIG. 1, the computer 50 of the apparatus 10 may
interact with the touch screen monitor 14, and in some embodiments
a conventional mouse or keyboard, input/output cards, and includes
a central processing unit and memory. The computer 50 also may
include a conventional communications port that permits the
computer 50 to be coupled to a conventional modem or other
communication device in order to communicate with a pharmacy,
physician, and/or doctor's office and to download and/or upload
data or information to and/or from the pharmacy, physician, and/or
doctor's office. As used herein, the terms data and information are
interchangeable.
[0088] The administering apparatus 10 may be associated with a
pharmacy in any suitable manner. For example, a pharmacy may own or
lease the apparatus 10, or may be a service provider to the
apparatus 10.
[0089] The computer 50 may be communicated in any suitable manner
to any device of the cassettes 100, for example, switches, motors,
memory devices, etc. The computer 50 may also be constructed and
arranged to communicate with a shared computer server or to a
web-based application for communicating with a doctor's office,
physician, pharmacist, another case facility, nurse's station and
the like.
[0090] FIG. 5 shows one example of a system 400 to implement method
and/or apparatus aspects of the present disclosure. The system 400
may include one or more of the following subsystems, or system
elements or components: one or more physician or prescriber
computers 402 for receiving, processing, and transmitting data; one
or more pharmacy computers 404 for receiving, processing, and
transmitting data; one or more nurse or attendant computers 405 for
receiving, processing, and transmitting data; one or more
administering computers 406, which may include the aforementioned
computer 50, for receiving, processing, and transmitting data; one
or more web-hosting servers 408 that may host one or more websites
or network portals; and one or more communication networks 410,
which may include a wide area network (WAN), for example the
Internet 412, for providing communication among the various system
elements. Those of ordinary skill in the art will recognize that
the various computers 402, 404, 406, 408 may have hardware and
software aspects in common, which will not be repeated for each
computer description. Accordingly the descriptions of the various
computers are mutually incorporated by reference.
[0091] Although the system 400 may include computers, for purposes
of this disclosure, the system 400 may include any instrumentality
or aggregation of instrumentalities operable to compute, classify,
detect, display, handle, originate, manipulate, manifest, process,
record, reproduce, receive, retrieve, switch, store, or utilize any
form of data, information, intelligence for academic, business,
production, scientific, or other purposes. Although described in
connection with an exemplary computing system environment, the
disclosed methods may be operational with numerous other special
purpose computing system environments or configurations. The
computing system environment is not intended to suggest any
limitation as to the scope of use or functionality of the system or
method.
[0092] Moreover, the computing system environment should not be
interpreted as having any dependency or requirement relating to any
one component, or combination of components, illustrated in the
exemplary operating environment. Examples of well known computing
systems, environments, and/or configurations that may be suitable
for use include, but are not limited to, personal computers, server
computers, hand-held or laptop devices, multiprocessor systems,
microprocessor-based systems, set top boxes, programmable consumer
electronics, personal digital assistants, mobile telephones,
network PCs, minicomputers, mainframe computers, distributed
computing environments that include any of the above systems or
devices, and/or the like.
[0093] In general, the administering computer 406 may receive input
from the various devices of the administering apparatus 10 and/or
other computers 402, 404, 408, at least partially enable or carry
out method steps disclosed herein, and transmit output to the
various devices of the administering apparatus 10 and/or the
various other computers 402, 404, 408. To facilitate such
functionality, the administering computer 406 may have a processor
414, one or more memory devices 416 in communication with the
processor 414 such as an internal memory and/or an external memory,
an input/output device interface 418, a network interface 420, and
a communications module 422.
[0094] The communications module 422 may be any type of suitable
module including a system bus, which may couple one or more of the
various above-described system components or modules. The system
bus may provide for data transmission internally between the
elements in the computer and externally between the internal
elements of the computer 406 and any other elements external of the
computer 406.
[0095] The processor 414 may be configured to execute instructions
or control logic that provides at least some functionality of the
disclosed methods. In this respect, the processor 414 may encompass
one or more processing units, controllers, microprocessors,
micro-controllers, discrete logic circuit(s) having logic gates for
implementing logic functions upon data signals, application
specific integrated circuits (ASIC) with suitable logic gates,
complex programmable logic devices (CPLD), programmable or
field-programmable gate arrays (PGA/FPGA), any combinations of the
aforementioned, and the like. As used herein, the term processor
may also include any ancillary devices such as clocks, power
supplies, and the like.
[0096] The memory 416 may include computer readable storage or
media in the form of removable and/or non-removable, volatile
memory and/or non-volatile memory. Exemplary volatile memory may
include random access memory (RAM), static RAM (SRAM), dynamic RAM
(DRAM), and the like, for running software and data on the
processor. Exemplary non-volatile memory may include read only
memory (ROM), erasable programmable ROM (EPROM), electrically
erasable programmable ROM (EEPROM), dynamic read/write memory like
magnetic or optical disks or tapes, and static read/write memory
like flash memory, for storing software and data.
[0097] The input/output device interface 418 may be used to
communicate the administering computer 406 with user selection
devices or one or more input peripheral devices 419. Such devices
may include a pointing device (e.g., a mouse, trackball, pen, touch
pad, touchscreen, or the like), keyboard, modem, internal card
reader, and the like, that may be used to enter commands and data
into the computer 406. Other input devices (not shown) may include
a microphone, joystick, satellite dish, wireless communication
device, proximity sensor, scanner, or the like. The input/output
interface 418 may connect the above described input devices, and
possibly other input devices, to the processor 414 via the system
bus 422, but may connect via other interfaces and bus structures,
such as a parallel port, Universal Serial Bus (USB), infrared
device, or the like.
[0098] The input/output device interface 418 may be used to
communicate the administering computer 406 with one or more output
peripheral devices (not shown). The output peripheral devices may
include a printer, a monitor, or other type of display device or
other peripheral device such as speakers (not shown), and the like,
and also may be connected to the system bus 422 via the
input/output interface, which may be any suitable printer, video,
etc., type of interface. One example of a combined input/output
peripheral device includes the touch screen monitor 14 of the
administering apparatus 10.
[0099] The network interface 420 may include any suitable
communication device such as a wired or wireless telephone device,
dial-up modem, cable modem, or the like for communicating the
computer 406 with the communications network 410. The network
interface 420 may enable transmission and reception of voice, data,
fax, and/or like transmissions to and from the network 410.
[0100] As used herein, the term interface broadly means any
suitable form of electronic device or adapter, or even a software
module or adapter, which enables one piece of equipment to
communicate with or control another. Any of the interfaces
disclosed herein may conform to any suitable protocols such as
Ethernet or field buses such as Profibus, Interbus, Devicenet,
RS-232, parallel, small computer interface, USB, wireless protocols
such as Bluetooth, infrared, and the like, and any other suitable
input/output (I/O) protocols.
[0101] As shown, the computer 406 may operate in a networked
environment, in communication with one or more remote computers,
which may include the prescriber and/or pharmacy computers 402,
404. In any case, the remote computers may be personal computers,
servers, routers, network PC's, peer devices, other common network
nodes, and the like. In a networked environment, software and/or
data used by the computer, or portions thereof, may be stored in
the remote computer or a remote memory storage device (not shown)
associated therewith or connected thereto. By way of example, and
not limitation, remote application programs/data may reside in
memory of the remote computer(s).
[0102] At least some portion of the disclosed methods may be
practiced locally or in a distributed computing environment where
tasks may be performed by the various computers 402, 404, 406, 408
that are linked through the communications network 410. In a
distributed computing environment, programs may be located in both
local and remote computer storage media including memory storage
devices. It is therefore to be understood that the presently
disclosed methods may be at least partially performed by any
computing devices suitable for executing one or more of the
specified functions, using any media and being located
anywhere.
[0103] Computer programs or software may include executable
instructions for implementing logical functions and can be embodied
in any computer-readable medium for use by or in connection with
the processor 414, which may retrieve and execute the instructions.
The software may include, but is not limited to routines, modules,
objects, components, data structures, and the like, for performing
particular tasks and/or implementing particular abstract data
types. General examples include software programs comprised of
instructions in source code, object code, executable code or other
formats; firmware programs; or hardware description language (HDL)
files; and the like. Specific examples include assembler, C, C++
objects, C# sharp, object oriented programming, Visual Basic,
Visual C++, XML, Java, and Microsoft.RTM. (MS) Foundation Classes,
Microsoft.net, visual.net, PERL, PHP, SQL, and/or the like.
[0104] In general, the communication network 410 may be any
suitable local area network, wide area network including the
Internet 412, or the like. The communication network 410 may
include a wireless system, land network, any combination thereof,
or the like, that is adapted to transmit and receive signals to and
from one or more of the prescriber computers 402, pharmacy
computers 404, administering computers 406, and or web hosting
server 408.
[0105] In one specific implementation, the communication network
410 may include a wireless carrier system including a wireless
communications carrier, a mobile telephone system, satellite
broadcast system, or the like, that may incorporate any type of
telecommunications in which electromagnetic waves carry signals
over part of or an entire communication path. For example, the
wireless carrier system may be implemented as a CDMA, GSM, or other
cellular communication system, or any other suitable wireless
system.
[0106] In another specific implementation, the communication
network 410 may also or instead include a land network used to
connect the computers 402, 404, 406, and web-hosting server 408. As
such, the land network may be a public-switched telephone network
(PSTN), an Internet protocol (IP) network, wired network, optical
network, fiber network, and/or any combination thereof. The land
network may be connected to one or more landline telephones,
facsimile machines, computers, or the like.
[0107] The network 410 may include a local area network (LAN)
and/or a wide area network (WAN), but may also include any other
suitable networks, connections, and/or protocols. The LAN and/or
WAN may be a wired network, a wireless network, a combination
thereof, and the like. When used in a local area networking
environment, the computer is preferably connected to the LAN
through the network adapter or interface 420. When used in a wide
area networking environment, the computer preferably includes the
modem or any other means for establishing communications over the
WAN. The modem, which may be internal or external, is preferably
connected to the system bus via the input interface, or other
appropriate arrangement. The network connections shown are
exemplary and other means of establishing a communications link
between the computers 402, 404, 406 may be used.
[0108] The web-hosting server 408 may include one or more
communication devices for communicating with the communication
network 410, and one or more server computers. The web-hosting
server 408 may be directly connected by phone lines, cable lines,
fiber optic cable, and/or wirelessly to any suitable land network
or wireless network, for example, via the communications network
410. The web server computer may be implemented as any suitable
hardware and software capable of providing Internet services to
receive and transmit data from and to the computers 402, 404, 406.
In an exemplary implementation, the web server 408 may include a
computer for executing and storing computer applications, data
files or records, and/or databases for managing and storing data
supplied by the computers 402, 404, 406.
[0109] In various embodiments, the system 400 may be equipped to
utilize a variety of communication platforms including the Internet
Protocol Suite (commonly TCP/IP) which is the set of communications
protocols used for the Internet and other similar networks. The
Internet Protocol Suite, like many protocol suites, may be viewed
as a set of layers. Each layer solves a set of problems involving
the transmission of data, and provides a well-defined service to
the upper layer protocols based on using services from some lower
layers. Upper layers are logically closer to the user and deal with
more abstract data, relying on lower layer protocols to translate
data into forms that can eventually be physically transmitted.
[0110] RS232 is one exemplary protocol that may be utilized which
is an asynchronous serial communication method. The word serial
means, that data is sent one bit at a time. Asynchronous tells us
that the data is not sent in predefined time slots. Data transfer
can start at any given time and it is the task of the receiver to
detect when a message starts and ends. Asynchronous communication
has some advantages and disadvantages which are both discussed in
the next paragraph.
[0111] Bluetooth may be utilized which is a wireless protocol
utilizing short-range communications technology facilitating data
transmission over short distances from fixed and/or mobile devices,
creating wireless personal area networks (PANs).
[0112] Wireless communication such as WCTP may be utilized. WCTP is
called a "transfer" protocol in that it is transferring data
content between wire line and wireless systems. The manner in which
the WCTP-defined operations are transported between a pair of
systems is independent of WCTP syntax. Although any number of
transport protocols may be used to move WCTP operations between
systems, for example HTTPS, secure socket layer (SSL), or the like,
the Hypertext Transfer Protocol (HTTP) has been selected as the
recommended transport protocol for WCTP. HTTP was selected because
it is already in use.
[0113] USB communication may be utilized. Universal Serial Bus
(USB) is a serial bus standard to interface devices to a host
computer. USB was designed to allow many peripherals to be
connected using a single standardized interface socket and to
improve the plug-and-play capabilities by allowing hot swapping,
that is, by allowing devices to be connected and disconnected
without rebooting the computer or turning off the device. Other
convenient features include providing power to low-consumption
devices without the need for an external power supply and allowing
many devices to be used without requiring manufacturer specific,
individual device drivers to be installed.
[0114] RSS may be utilized. RSS is a family of Web feed formats
used to publish frequently updated works such as blog entries, news
headlines, and podcasts in a standardized format.
[0115] Secure File Transfer Protocol may be utilized. The Secure
File Transfer Protocol, or SFTP, is a completely distinct file
transfer specification developed by the Secure Shell Working Group
and SSH Communications Security Corp. Built on the Secure Shell
(SSH) Protocol, the purpose of the protocol is to provide the
ability to have secure, efficient, file transfer occurring over an
SSH encrypted pipe or tunnel. The general idea is to connect to a
remote SSH/SFTP server on port 22, perform a secure SSH v2
handshake with the remote server, and then all future
communications would take place through the existing encrypted
tunnel. No new connections would need to be established, as they
are when using FTP. Alternatively, Secure Sockets Layer (SSL)
protocol may be used, or any other suitable secure protocol.
[0116] Another example protocol that may be used is Web-based
Distributed Authoring and Versioning (WebDAV), which is a set of
extensions to the Hypertext Transfer Protocol (HTTP) that allows
users to edit, publish, and manage files collaboratively on remote
World Wide Web servers.
[0117] In one embodiment, the administering apparatus 10 may
include a biometric security device coupled to the administering
computer 406 to verify proper identification of an administering
attendant who is to administer medication or a patient who is to
receive administered medication. The biometric security device(s)
may be represented by one or more of the system input devices (419,
FIG. 4) and may be used to identify the administering attendant as
he/she approaches the administering apparatus 10 as an initial
passive security measure, and to receive access verification from
the administering attendant (e.g. a password, or a biometric input)
as a secondary active or passive security measure. The biometric
security device may operate using physiological and/or behavioral
criteria. Examples follow.
[0118] In a first example, an algorithm may be provided to analyze
the relative position, size, and/or shape of the eyes, nose,
cheekbones, and jaw. These features are then used to search for
other images with matching features used to identify distinctive
features on the surface of a face, such as the contour of the eye
sockets, nose, and chin.
[0119] In a second example, fingerprint identification security may
be provided. The three basic patterns of fingerprint ridges are the
arch, loop, and whorl. An arch is a pattern where the ridges enter
from one side of the finger, rise in the center forming an arc, and
then exit the other side of the finger. The loop is a pattern where
the ridges enter from one side of a finger, form a curve, and tend
to exit from the same side they enter. In the whorl pattern, ridges
form circularly around a central point on the finger.
[0120] In a third example, the major Minutia features of
fingerprint ridges are: ridge ending, bifurcation, and short ridge
(or dot). The ridge ending is the point at which a ridge
terminates. Bifurcations are points at which a single ridge splits
into two ridges. Short ridges (or dots) are ridges which are
significantly shorter than the average ridge length on the
fingerprint. Minutiae and patterns are very important in the
analysis of fingerprints since no two fingers have been shown to be
identical.
[0121] In a fourth example, hand geometry readers may be provided
and identifies users by the shape of their hands. Hand geometry
readers measure a user's hand along many dimensions and compare
those measurements to measurements stored in a file.
[0122] In a fifth example, keystroke dynamics uses the manner and
rhythm in which an individual types characters on a keyboard,
touchscreen, keypad, or any other suitable input device. The
keystroke rhythms of a user are measured to develop a unique
biometric template of the users typing pattern for future
authentication. Raw measurements available from most every keyboard
can be recorded to determine dwell time (the time a key pressed)
and flight time (the time between "key down" and the next "key
down" and the time between "key up" and the next "key up"). The
recorded keystroke timing data is then processed through a unique
neural algorithm, which determines a primary pattern for future
comparison.
[0123] In a sixth example, hand vein identification may be
provided. The dorsal venous network of the hand is a network of
veins formed by the dorsal metacarpal veins. It is found on the
back of the hand and gives rise to veins such as the cephalic vein
and the basilic vein.
[0124] In a seventh example, iris recognition means may be provided
that uses pattern recognition techniques based on high-resolution
images of the irises of an individual's eyes. The only biometric
authentication technology designed for use in a one-to many search
environment, a key advantage of iris recognition is its stability,
or template longevity as, barring trauma, a single enrollment can
last a lifetime.
[0125] In an eighth example, retinal scan identification may be
provided and used to map the unique patterns of a person's retina.
The blood vessels within the retina absorb light more readily than
the surrounding tissue and are easily identified with appropriate
lighting. A retinal scan is performed by casting an undetectable
ray of low-energy infrared light into a person's eye as they look
through the scanner's eyepiece. This beam of light outlines a
circular path on the retina. Because retinal blood vessels are more
sensitive to light than the rest of the eye, the amount of
reflection fluctuates. The results of the scan are converted to
computer code and stored in a database.
[0126] In a ninth example, signature identification means may be
provided. A signature is a handwritten (and sometimes stylized)
depiction of someone's name, nickname or even a simple "X" that a
person writes on documents as a proof of identity and intent. The
writer of a signature is a signatory. Like a handwritten signature,
a signature work describes the work as readily identifying its
creator.
[0127] In a tenth example, voice identification means may be
provided. Speaker recognition (also known as voice recognition) is
the computing task of recognizing people (which may involve
identifying them and/or authenticating their identity) from their
voices. Such systems extract features from speech, model them, and
use them to recognize the person from his/her voice.
[0128] In an eleventh example, facial thermograph identification
means may be provided. Infrared thermography, thermal imaging, or
thermal video, is a type of infrared imaging science. Thermographic
cameras detect radiation in the infrared range of the
electromagnetic spectrum (roughly 900-14,000 nanometers or 0.9-14
.mu.m) and produce images of that radiation.
[0129] In twelfth example, odor identification means may be
provided. An odor is a volatilized chemical compound, generally at
a very low concentration, which humans and other animals perceive
by the sense of olfaction. Odors are also called smells, which can
refer to both pleasant and unpleasant odors.
[0130] In a thirteenth example, DNA identification may be provided.
Deoxyribonucleic acid (DNA) is a nucleic acid that contains the
genetic instructions used in the development and functioning of all
known living organisms and some viruses. The main role of DNA
molecules is the long-term storage of data. DNA is often compared
to a set of blueprints or a recipe, since it contains the
instructions needed to construct other components of cells, such as
proteins and RNA molecules. The DNA segments that carry this
genetic information are called genes, but other DNA sequences have
structural purposes, or are involved in regulating the use of this
genetic information.
[0131] In a fourteenth example, gait identification means may be
provided. Gait analysis is the study of animal locomotion,
including locomotion of humans.
[0132] In one embodiment, tamper devices and alarms may be designed
into the system to alert personnel that security of the
administering apparatus is being compromised. Such peripheral
equipment may be represented by one or more of the input devices
(419, FIG. 5). The alarm may be set off by one or more of three
different alerts: 1) when an attempt is being made to forcibly
remove a cassette from the administrating apparatus when the
cassette has not been unlocked, wherein the cassette will travel a
predetermined distance before a switch is tripped to set off an
alarm; 2) when an attempt is being made to forcibly remove
medication from the apparatus out of the cassette, wherein output
from the medication administering position counter is sensed by the
computer 50 when the material handler has not been triggered to
move and the output from the counter is used to set off an alarm;
or 3) the administering apparatus has been tipped from its normal
horizontal position, wherein a level sensor is tripped to set off
an alarm. For example, the level sensor may include a merque level
sensor that monitors that the cart is level with the horizontal
plan of the earth.
[0133] In one embodiment, the administering apparatus 10 may
include or be coupled to a care proximity sensing device, which may
be one of the input devices (419, FIG. 5). Proximity sensing is the
ability of the administering apparatus to tell when a person, other
than someone who has present authorized access to the apparatus, is
near/in front or the administering apparatus. One or more proximity
sensors may be placed on the apparatus 10 in any suitable positions
to avert sensing of someone who has present authorized access to
the apparatus and to actually sense someone other than the
presently authorized user and who may be standing behind or to the
side of the authorized user in a position to view the touchscreen
of the apparatus. This sensing leads to power down of the
touchscreen to keep patient information from being read off the
touchscreen by people passing by. A photoelectric, electromagnetic,
or the like, proximity sensor may be used and may include a
light-beam generator, a photo detector, a special amplifier, and a
microprocessor. The light beam reflects from an object and is
picked up by the photo detector. The light beam is modulated at a
specific frequency, and the detector has a frequency-sensitive
amplifier that responds only to light modulated at that frequency.
This prevents false imaging that might otherwise be caused by lamps
or sunlight.
[0134] Referring now to FIG. 6, one embodiment includes a method of
managing medication that may be at least partially enabled or
carried out as one or more computer programs within the operating
environment of the apparatus 10 and system 400 described above with
respect to FIGS. 1-5. Those skilled in the art will also recognize
that a method according to any number of embodiments may be carried
out using other engine systems within other operating environments.
In FIG. 6, an exemplary method 500 is illustrated in flow chart
form. As the description of the method 500 progresses, reference
may be made to the apparatus 10 and system 400 of FIGS. 1-5.
[0135] At step 502, a patient in a medical facility may be
medically assessed. The patient may be received as a transfer
patient, as a new or intake patient, and with or without complaint
of a pre-existing condition. In one example, a medical attendant,
for example, a nurse, nursing assistant, physician's assistant, or
the like, may initially assess the patient to determine one or more
medical conditions of the patient. Also, documentation of a patient
assessment may be generated. For example, the medical attendant may
generate hardcopy or electronic documentation detailing the one or
more medical conditions.
[0136] Actual patient data may be stored in computer memory, for
example as patient data files or records in the memory 416 of the
administering computer 406 or any other suitable computer memory of
the system 400. For example, medical data or information of the
patient may be stored in Electronic Medical Record (EMR) or
electronic Medical Administration Record (eMAR) format. EMR may
include demographics, historical medical information, patient
allergies, X-rays, physicals results, nursing notes, physician
notes, billing, current and historical medications, procedural
information about the patient, or any other suitable patient
information. Example information may include, but is not limited
to, an actual picture of the patient, a complete list of all
medications with or without pictures of medications, a complete
history of medication and supplements taken, alterations and
adjustments, compliance and deliveries and confirmations adherence
reporting, current medication orders, and schedule/calendar
documentation. Similarly, eMAR data may include specifics as to who
administered what medication to whom and when and in what quantity.
In particular, such eMAR data may be entered into the administering
computer 406, for example, as or after medication is administered
to a patient from the administering apparatus 10. In one
embodiment, eMAR and/or EMR system integration may be provided,
wherein eMAR and/or EMR data including information used by doctors
or physicians may be electronically transferred to the patients'
data files or records. Typical records may include: initial
medication schedules, alterations and adjustments, refills, missed
medications, and patient responses to questions, and/or the
like.
[0137] The eMAR and/or EMR data and corresponding eMAR/EMR software
programs may be loaded to any of the system computers and, in any
event, may be available to any or all of the system computers via
the network connections. For example, an eMAR program and database
may be loaded to the administering computer 406 for use by an
attendant and may be available to the pharmacy computer 404 for use
by a pharmacist.
[0138] Further, a prescribing medical professional ("prescriber")
may evaluate whether to issue a medication prescription or order to
a patient. As used herein, the term prescriber may include a
physician, medical doctor, or any agent thereof, for example, a
physician's assistant, or any other individual authorized to
prescribe medication or the like. For example, a physician or
medical doctor may be notified and may review the assessment
documentation and may consult with the nurse, caregiver, or patient
before prescribing treatment. The terminology medication
prescription is typically used in an outpatient setting, whereas
medication order is typically used in an inpatient setting. As used
herein, the terms may be interchangeable.
[0139] At any or all of steps 504 through 510, if a prescriber or
prescribing medical professional determines that a patient needs a
current medication order or requires an order change, then a
medication order may be generated or changed and a corresponding
order or change order may be submitted to a pharmacy in any
suitable manner. The medication order or change order may include a
dosing regimen specific to the patient. An example dosing regimen
includes one pill of a given medication, taken thrice daily.
[0140] In a first example, in step 504, a prescriber may generate
and submit a medication order or change order electronically over a
network to a pharmacy in a network online embodiment. In a more
specific example, the prescriber may use the computer 402 at the
prescriber's location (e.g. office, hospital, nursing home,
assisted living center, or clinic) to connect via the network 410,
and generate and submit the medication order via the network for
review and further action by the pharmacist via the pharmacy
computer 404 connected to the network 410.
[0141] In this example, the prescriber may have remote access to
patient files or records stored in memory 416 of the administering
computer 406. Accordingly, the prescriber may access eMAR and/or
EMR data, including access to attendant's or nurse's notes about
the patient, and to make changes in medication therapy, and the
like. More specifically, the prescriber may remotely change
medication type, dose, strength, frequency, and the like, and may
remotely add or discontinue medication. Accordingly, a prescriber
may not only generate a new medication order, but also may change
an existing medication order or submit a change order to update the
existing medication order.
[0142] In a second example, a prescriber may generate a
prescription and place a telephone call to the pharmacy to
communicate the prescription to the pharmacy as shown in step
506.
[0143] In third and fourth examples, a requester (a nurse,
administering attendant, or other medical professional, for
example) at a medical facility may request a medication refill
pursuant to a standing prescriber order. An example would be where
a nurse at a nursing home may determine that a patient needs a
particular medication reordered. Another example would be where a
nurse visiting patients on a room-by-room basis with the exemplary
administering apparatus 10 of FIGS. 1-4, finds a particular
medication order needs to be refilled and may submit the request
from the administering apparatus 10.
[0144] In the third example, at step 508, an administering
attendant may submit an order via a medication administering
apparatus to a pharmacy to administer prescribed medication to a
patient according to a dosing regimen of the patient's medication
order. For instance, the request may be a network online request
over a computer network. More specifically, the requester may use
the administering computer 406 at the medical facility to connect
to the network 410 to generate and submit the refill order via the
network 410 for review and further action by a pharmacist using the
pharmacy computer 404 connected to the network 410. In one
embodiment, the requester or attendant may use a keyboard and/or a
pointing device of the administering computer 406 to submit a new
order for eventual authorization by the pharmacy. In another
embodiment, the requester or attendant may use any computing device
in any suitable manner to connect to the network 410 to submit the
new order.
[0145] In a fourth example, a requester (e.g. a nurse) at a medical
facility may request an existing prescription to be refilled using
a fax machine, as shown in step 510. Of course, the nurse may
submit the order via telephone as shown in step 511, or by email,
verbally, etc, and such a request is considered a network offline
request.
[0146] At step 512, a medication order may be received at a
pharmacy by online network request, by fax, email, or any other
suitable manner.
[0147] At step 514, a medication order may be entered into a
pharmacy computer. For example, a pharmacy technician or pharmacist
may enter the data or information from any of steps 506-510 into
the pharmacy computer 404 of FIG. 5.
[0148] At step 516, a medication order may be checked for
interactions with other medications that may be associated with the
patient for whom the prescription or order was placed. For example,
the pharmacist at the pharmacy may cross-reference all medications
being taken by the patient to make sure there are no undesirable or
significant drug interactions.
[0149] At step 518, a medication order may be verified. For
example, the pharmacist at the pharmacy verifies that the order
from step 514 was entered correctly. If there is a discrepancy,
then the method proceeds to step 519, otherwise to step 520.
[0150] At step 519, a change or clarification in an medication
order may be requested. For example, a change in the order from
step 518 may be requested from and received at the pharmacy at step
512.
[0151] At step 520, it may be determined whether or not medication
is compensable by a third party. If so, the method proceeds to step
521, otherwise to step 522.
[0152] At step 521, payment for a medication order may be approved
by or otherwise resolved with a third party, for instance, an
insurance company, Medicare, Medicaid, or the like. Any suitable
third party payment approval or resolution process may be used.
Once approved, or otherwise resolved, then the method proceeds to
step 522.
[0153] At step 522, it may be determined whether or not the
medication for which the requested order was provided is actually
loadable to an administering apparatus at a medical facility. For
example, some medication may be too bulky or otherwise unloadable
to the administering apparatus 10. If not, the method proceeds to
step 524, otherwise the method proceeds to step 526.
[0154] At step 524, unloadable medication may be packed and shipped
to a medical facility for administration in a conventional manner.
Thereafter, the method may proceed to step 532, which is described
further below.
[0155] At step 526, it may be determined whether or not ordered
medication is available on or loaded to a medication administering
apparatus. For example, a cart database or computer file of the
administering computer 406 may be consulted to evaluate the
inventory of the medical facility and/or the medication
administering apparatus 10, and the location of the medication in
the facility and/or on the apparatus 10 may be identified. For
example, a pharmacy may poll one or more administering apparatuses
at a medical facility. The computers of the polled apparatuses may
store data received from and/or associated with the cassettes, or
may poll cassette memory to receive such data, which may include
medication inventory. The cart database may be updated with data
from the cassette memory devices. Accordingly, the pharmacy can
determine if medication is available at the medical facility and in
what quantity. If it is determined that the medication is not
available in a suitable quantity, then the method may proceed to
step 552.
[0156] At step 527, medication and patient data is updated and/or
medication may be loaded to a dispensing apparatus. For example,
the pharmacy may use the pharmacy computer 404 to update a patient
profile or record and indicate that a patient is to begin or
continue receiving ordered medication, wherein the supply of
medication on the administering apparatus 10 is to be shared with
the patient. The pharmacy may add the ordered medication for the
patient to the patient's profile or record, for example, in eMAR
software program loaded to the pharmacy computer 404 or to the
administering computer 406.
[0157] When the patient profile or record is updated, the pharmacy
may prospectively charge or bill a predetermined quantity of doses
of the ordered medication to the patient or third party, for
instance, based on anticipated use over a time period, for example,
the following month (i.e. calendar month or next 30 days). For any
doses billed before consumption by the patient but not actually
consumed by or assigned to the patient, the patient or the third
party payer may be retroactively credited for such unused doses.
Retroactive crediting may be initiated, for example, upon a change
in dosage of medication for a patient, upon patient discharge from
the facility, upon discontinuation of medication for the patient,
or the like. Such events may be entered manually into the system or
may be automatically monitored in any suitable manner.
[0158] Also when the patient profile or record is updated, a
software program running, for example, on the pharmacy computer 404
or administering computer 406 may include a routine to generate a
data file for use by the cart database of the administering
computer 406 that may be an SQL database. The data file may include
any suitable data, for example, patient name, medication
description, GCN code, dosage, and/or the like. For example, an
eMAR program may include a routine to generate an XML data file
with such data fields. Those of ordinary skill in the art will
recognize that such a routine may access such data stored in memory
of the pharmacy computer 404 or elsewhere, arrange such data in any
suitable format, and save such data as an XML file or the like. The
routine may be initiated, for example, whenever the patient profile
or record is updated by a sign off or authorization step in an eMAR
program. The eMAR program may be PioneerACMS available from New
Tech Computers of Shreveport, La., or any other suitable eMAR
program. The eMAR program includes its own eMAR database that may
be kept separate from the cart database and may also be an SQL
database. The eMAR database may include and separately receive
facility data, prescriber data, pharmacy data, medication inventory
data, patient data, and/or the like.
[0159] In another example, the patient profile or record or other
patient data may be updated from a location remote from the
pharmacy, for example, via a WAN, to allow administration of the
medication. For instance, a physician or other suitable
professional at a hospital, physician's office, or from a
physician's mobile computing device, or the like, may update the
patient profile or record to authorize dispensing of the medication
to the patient.
[0160] In a similar example, a patient's medical record or other
patient data may be read or updated from a remote location by a
pharmacist, physician, physician's assistant, or the like, for
example, via a WAN. In any event, updated patient data may be
communicated via the system 400 to the computer 406 of the
administering apparatus 10. Also, once the patient data is updated,
for example, by the pharmacist and/or physician or other suitable
professional, the administering apparatus 10 can provide a
notification to an administering attendant that the ordered
medication is to be administered to the patient.
[0161] In cases where a new cassette has been received from the
pharmacy, that cassette may be loaded to the dispensing apparatus
10.
[0162] At step 528, an administering attendant (e.g. a nurse) may
administer medication to one or more patients at a medical facility
using a medication administering apparatus. For example, the
attendant may use the touch screen 14 or any other input apparatus
to activate the appropriate cassette 100 of the apparatus 10. More
specifically, the attendant may log on to the computer 406 in any
appropriate manner, for example, using the touch screen 14 to enter
username and password or the like. Then, the attendant may use any
suitable software (e.g., eMAR software) loaded to the computer 406
to select, look up, or the like a patient from among a plurality of
patients at the medical facility. Once the patient is selected, the
touch screen 14 may display the medications which are to be
administered to the patient at that time. Thereafter, the attendant
may select those medications, for example, by tapping on the
displayed medications, checking a checkbox with a pointing device,
or the like. Once all of the medications are selected, the
attendant may instruct the apparatus 10 to convey the selected
medications out of their respective cassettes 100, for example, by
tapping on an object, soft button, or the like on the touchscreen
14. Software for documenting administration of medication is well
known to those of ordinary skill in the art and any suitable such
software may be used and/or modified for use. Examples may include
such software available from MDI Achieve of St. Louis, Mo., or
Artromick International, Inc of Columbus, Ohio.
[0163] The administering computer 406 may periodically poll for
data files generated by the eMAR program, and may upload or
transfer such data files for use with the cart database. For
example, the administering computer 406 may run a
"FileSystemWatcher" function using a .Net protocol. Once the eMAR
file is generated and found, it may be decoded or parsed in any
suitable manner for use in scanning the cart database to assess
whether or not the authorized medication is available and to
determine the location of the medication on the cart.
[0164] After receipt of the selections and instructions from the
attendant and confirmation of medication on the cart, the computer
406 may send the appropriate signals to the material handlers of
the appropriate cassettes 100, for example, via the connectors 140,
141. In general, communication and control between computing
devices of medication administering equipment and actuators of such
equipment is well known to those of ordinary skill in the art. In
response to receiving the signals from the computer 406, the
material handlers advance the selected medications out of the slots
101 of the cassettes 100 and, the attendant may then tear or
otherwise remove the medication from the cassettes 100. Once the
medication has been conveyed out of the cassette 100, the material
handler of the cassette 100 inherently locks, for example, by
virtue of the worm drive arrangement. The medication M may be
provided in strip form with perforations between each unit of
medication so that one unit of medication can be removed from the
cassette 100 at a time. In the event the perforated strip of
medication is insufficient to prevent tampering by itself, the
locking material handing apparatus may further prevent someone from
pulling additional medication out of the slot 101 of the cassette
100.
[0165] A patient in a nursing home or other medical facility may
have one or more prescriptions that are dispensed, tracked, and/or
serviced in any other way by the pharmacy, and administered by
someone at the nursing home. Medication from the pharmacy is stored
in and carried by the administering apparatus 10 and is unassigned
to any given patient until it is administered. In other words, the
administering apparatus 10 stores and administers one or more doses
of patient-unassigned medication.
[0166] At step 530, administered medication may be tracked. For
instance, the dose(s) of medication administered in step 528 may be
assigned to the patient to whom it was administered. In one
example, the attendant may manually identify and record
administered medication in the administering computer 406. In
another example, the administering apparatus 10 may automatically
verify that a dose of medication was actually administered. For
instance, the counter 164 may be coupled to the computer 406, which
may increment or decrement a database or computer file to track
medication in the cassette from which the medication is
administered. In assigning the dose to the patent, a computer file
or record associated with the patient and stored in the system 400
may be updated to indicate that medication was actually
administered to that patient.
[0167] The administered dose(s) may be tracked so that the patient
or third party is "net" billed only for actually administered
doses. In some situations, the patient may have changes in billing
status throughout the month, wherein the third party payer for the
patient could be Medicare for a couple of days, then revert to
Medicaid or some other payer. Accordingly, by tracking actually
administered medication on a dose by dose basis, this system 400
may enable separate and distinct billing of different third party
payers on a dose by dose basis. Although, the protocol and
procedure for billing third party payers for dispensed medication
is generally known, the ability to bill third party payers for only
those doses actually taken is not believed to be known. Those of
ordinary skill in the art will now recognize that net billing of
third party payers for only those doses actually taken may be
accomplished by modifications to existing billing systems and
software and the like in accordance with the present teachings.
[0168] The administration of the dose(s) may also be communicated
from the computer 406 of the apparatus 10 to the eMAR database of
the pharmacy computer 404 or administering computer 406 in any
suitable manner. For example, the communication may include setting
a bit of file data associated with the eMAR database, or may simply
be availability to the pharmacy computer 404 of the updated patient
computer file via the network 410. In another example, the
apparatus computer 406 may send a notification, for example, an
email or network message to the pharmacy computer 404 in any
suitable manner in response to the updating of the patient computer
file. In any event, an administration event file (e.g. in XML
format) may be generated from the cart database and archived to
memory of the computer 406 to include, for example, patient name,
room number or other facility location data, drug identification,
dosage, quantity, GCN number, NDC number, lot number, date and time
of administration, cart identification, cassette identification,
and/or the like. The event file may be transmitted from the
computer 406 to the pharmacy computer 404 or may be made available
to the pharmacy computer 404 via the system 400 in any suitable
manner.
[0169] The doses also or instead may be tracked to compare a
cumulative quantity of administered doses to an authorized quantity
of doses under the patient's prescription. For example, variables
in a patient's computer file may include the authorized quantity of
doses, and the cumulative quantity of administered doses which may
be updated in any suitable manner and then compared to the
authorized quantity each time the patient is administered a dose.
When the cumulative quantity of administered doses equals or
exceeds the authorized quantity, then the computer 406 can prevent
further administration of that medication to the patient. For
example, a flag can be set to prevent operation of the
administering cassette that carries the particular medication when
administering to the particular patient.
[0170] An attendant or other suitable personnel at the medical
facility may generate a request for a refill under the particular
patient's prescription or order with the pharmacy using the
apparatus computer 406, which then may be used to transmit the
request over the network 410 where it is received at the pharmacy
on the pharmacy computer 404. For example, the transmitting and
receiving of the prescription refill request may be facilitated by
an Internet website served on the portal 408.
[0171] At step 532, inventory of a medication administering
apparatus may be updated. For example, a database or computer file
may be decremented in any suitable manner to record the
administering of medication from step 528. More particularly, one
or more medication inventory computer files may be stored on the
dispensing apparatus computer 406 or any other system computer and
the file(s) may be updated whenever medication is administered.
[0172] At step 534, it may be determined whether an alternative or
substitute medication is available on an administering apparatus.
For example, it may be determined whether other medication that is
similar or better than ordered medication may already be loaded to
the administering apparatus 10.
[0173] If so, at step 536, a medication change request may be
submitted to a prescriber. For example, an administering attendant
may submit the request using the system 400 via the administering
computer 406, and a prescriber may approve the request using the
system 400 via the prescriber computer 402.
[0174] At step 538, it may be determined whether the change request
from step 536 is approved. For example, the administering attendant
may receive approval via the computer 406 of the administering
apparatus 10 over the network 410. If so, then the method loops
back to step 512. If not, for example, because the alternative is
preapproved, and/or the patient pays cash, has an account with the
pharmacy, and/or otherwise does not require third party approval
and/or payment, then the method proceeds to step 540.
[0175] At step 540, it is determined whether or not there is
availability on an administering apparatus to accept a new or
replacement cassette. If so, then the method proceeds to step 542
wherein the pharmacy packs medication into a cassette, and then on
to step 524 wherein the medication is prepared for shipment and
shipped. But if not, then the method proceeds to step 544 wherein
the pharmacy packs medication into a box and, thereafter, to step
524 and on to step 527.
[0176] At step 542, patient-unassigned medication is packed at a
pharmacy into a cassette to be used in a administering apparatus
located at a medical facility. Information about the packed
medication and the cassette in which the medication is packed is
entered into the pharmacy computer 404. Step 542 may correspond to
or include steps 602-608 described below.
[0177] At step 544, medication may or may not be assigned to a
patient and is packed into a box instead of a cassette. The boxed
medication may be loaded to a conventional drawer in the
administering apparatus 10 or may be loaded to a cassette on site
at the medical facility.
[0178] Referring now to FIG. 7, a method 600 of managing medication
may be provided.
[0179] At step 602, medication may be prepackaged. For example,
individual pills may be individually packaged in individual
compartments of a continuous packaging strip having perforations
between the compartments to permit unit by unit administering of
medication through the slits 101 of the apparatus 10. The
medication may be packaged using any suitable materials and
equipment. For example, the medication may be packaged using a
paper strip backing thermoformed to a cellophane strip cover using
any suitable machinery. The machinery may include a model RX30
produced by G.S. Anderson Manufacturing Co., Inc. of Millbrook,
N.Y. and serviced by Norton and Associates of Roswell, Ga., or an
AUTO-PRINT brand unit dose packaging system available from Medical
Packaging Inc. (MPI) of Ringoes, N.J.
[0180] At step 604, medication may be loaded into a medication
cassette. For example, the prepackaged medication from step 602 may
be packed into one of the cassettes 100 of the administering
apparatus 10. However, the medication need not be prepackaged and
loose or unpackaged medication may be packed into a cassette.
[0181] At step 606, data associated with medication loaded to a
cassette may be associated with the cassette. For example, a
pharmacist at the pharmacy may enter the data into the pharmacy
computer 404. The data may include generic and/or brand name(s) of
the medication, manufacturer, lot number, medication description,
lot identification, strength of the medication, expiration date,
National Drug Code (NDC), a Generic Code Number (GCN), an
identifier of a cassette in which the medication will be loaded,
the quantity of medication to be initially loaded to the cassette
100, the quantity trip point, and/or the like.
[0182] At step 608, data may be associated with a loaded cassette.
For example, the data from step 606 may be transmitted to and
received by the memory device 142 of the cassette 100 in any
suitable manner. For example, the pharmacy computer 404 may be
coupled to the connector 140 of the cassette 100 via any suitable
cable and connector and data may be downloaded from the computer
404 to the memory device 142 in any suitable manner. In one
embodiment, the cassette 100 may be docked in a docking station
that mimics a corresponding compartment of the dispensing apparatus
10 and that has a connector corresponding to the cassette connector
and coupled to the pharmacy computer 404 in any suitable manner. In
a further example, where the device 142 is a device that
communicates wirelessly, the computer 404 may download data to the
device 142 wirelessly via any suitable wireless communication
device(s). In another example, an identification of the cassette
100 may be recorded and associated with the data entered in step
606. For instance, the cassette identification may be recorded
manually by the pharmacist viewing an identifier like a serial
number or the like on the cassette 100 and entering the identifier
into the pharmacy computer 404. Or the identification may be
recorded automatically by the pharmacist scanning a barcode, or
electronic reader, or the like of the cassette 100 into the
computer 404. Such peripheral equipment may be represented by one
or more of the input devices (419, FIG. 5). In one embodiment, each
cassette 100 in the administering apparatus 10 may have the memory
device 142 loaded with a serial number making each cassette 100
unique through the entire supply chain. The pharmacy computer 404
may include all pertinent information regarding the medication for
administering in the memory device 142 of the cassette 100.
[0183] At step 610, a cassette loaded with medication may be sealed
and/or otherwise prepared for shipment or transfer to a medical
facility. This step may be the same or similar to step 524
discussed above. The loaded and prepared cassette then may be
transferred in any suitable manner to the medical facility
including, for example, courier, mail, or the like.
[0184] At step 612, a cassette loaded with medication may be
received at a medical facility and loaded to an administering
apparatus.
[0185] At step 614, a received and loaded cassette may be
identified and associated with an administering apparatus to which
the cassette is loaded. For example, the administering attendant
(e.g. nurse) may manually record and enter the identification of
the cassette 100 and the location of cassette 100 in the
administering apparatus 10 (e.g. A1 or N14). In another example, a
barcode, RFID, read/write, EPROM or EEPROM device, or the like of
the cassette 100 may be scanned and entered into the computer 406.
In another example, the cassette 100 may be coupled to the
administering apparatus 10 so that the memory device 142 may be
accessed and cassette data may be uploaded automatically into the
administering computer 406 upon full insertion of the cassette 100
into its corresponding compartment of the apparatus 10. All records
of the cassette 100 and the medication therein may be stored in the
administering computer 406 and/or pharmacy computer 404. Such
exemplary peripheral equipment enabling this step may be
represented by one or more of the input devices (419, FIG. 5).
[0186] At step 616, inventory of medication in a cassette may be
monitored. An original count of medication loaded to the cassette
100 may be entered into the pharmacy computer 404 separately or as
associated with the identification of the cassette 100. Also,
medication administered from the cassette 100 may be tracked at the
administering apparatus 10. For instance, an automatic counting
mechanism, for example, a mechanical, electrical, optical, or
magnetic switch, may count each pill or packaged pill administered
from the cassette. More specifically, the counter 164 may be
coupled to the computer 406, which may increment or decrement a
database or computer file to track medication in the cassette 100
from which the medication is administered. Or, an administering
attendant may manually record each such administered unit into the
administering computer 406.
[0187] Also, before an attendant conducts a medication pass
("med-pass"), the attendant may request the dispensing apparatus 10
to compare quantities of medications to be dispensed during the
med-pass to actual quantities of those medications actually present
on the apparatus 10. In this way, the attendant may ensure that the
entire med-pass can be carried out without a need to refill the
apparatus before the med-pass is completed. Those of ordinary skill
in the art will recognize that the term med-pass means, for
example, a discrete round of dispensing medication to one or more
recipients. For instance, a med-pass may be a lunchtime med-pass
wherein an attendant makes a round through a unit of a facility to
dispense medications to various patients in the facility.
[0188] At step 618, an anticipated date of depletion of inventory
of one or more medications carried on an administering apparatus
may be estimated. Accordingly, replacement of one or more cassettes
in the administering apparatus may be estimated. For instance, the
anticipated depletion and/or replacement date may be estimated
based on a patient's historical medication usage, historical usage
of medication in the medical facility, anticipated medication usage
of patients currently in the medical facility, or projected
anticipated use based on patients' current medication orders, or
any other suitable criteria, or some combination of the above.
[0189] In a first example, a predetermined low level, par value, or
trip point may be used to trigger replacement. More specifically,
when a count of medication in a cassette falls below the
predetermined low level, a replacement estimate notification may be
initiated. The medication count may be tracked by any suitable
hardware and/or software counting device(s). For example, the
counter 164 may be used to decrement a software counter for each
cassette each time a unit of medication is administered.
[0190] In a second example, a variable low level or trip point may
be varied in response to a multiple day or multiple dose rolling
average corresponding to usage of a particular medication to
estimate when the administering apparatus 10 is expected to be
depleted of that medication. More specifically, the low level may
be increased as the rolling average increases, and may be decreased
as the rolling average decreases. For instance, if a three day
rolling average increases to an example 20 pills per day from an
example 10 pills per day, then the low level may be increased to an
example 60 pills from an example 30 pills. This may facilitate
maintaining a desired quantity of days supply (e.g. three days) on
the administering apparatus 10 at any give time, regardless of
increasing or decreasing demand.
[0191] According to the first two examples, the estimate may be
communicated online over the network 410 using the system 400. But
in a third example, an administering attendant may manually
estimate replacement by using professional judgment and by calling,
emailing, or faxing the pharmacy with the replacement information.
In a fourth example, the estimate may be communicated automatically
offline by email, for example. In this example, each time a drug is
dispensed, an SQL database in the administering computer 406, for
example, may be scanned for the medication dispensed. If that
medication is below a predetermined reorder trip point, then an
email message may be sent back to the pharmacy via network 410 or
Internet 412, for instance, via a wireless communications card of
the administering computer 406. For instance, the cart database may
be monitored by any suitable routine that checks for cassette's
whose medication quantity has fallen below the trip point and
communicates a file for use by the eMAR software, which then may
automatically generate and transmit an email message to the
pharmacy indicating that the cassette is low on medication. Also,
the information sent in the email may include facility
identification, facility wing, unit, or floor identification,
medication identification, GCN code, NDC number fill requirement,
and cassette serial number.
[0192] At step 620, the replacement estimate may be communicated to
a pharmacy, for instance, to facilitate reordering or the like. For
example, where the estimate is carried out at the medical facility,
the estimate may be communicated from the administering computer
406 to the pharmacy computer 404 via the network 410. However, it
is also contemplated that the estimate may be carried out at the
pharmacy computer or any other suitable location and need not take
place on the administering computer 406. In any case, the estimate
may include identifiers for the administering apparatus 10 and the
cassette 100, for example, serial numbers. The estimate may also
include a replacement quantity, and one or more identifiers for the
medication needing replacement.
[0193] At step 622, an administering apparatus in a medical
facility may be polled for cassettes that may need replacing and/or
for unused cassettes. For example, an administering attendant may
poll the apparatus 10 at the medical facility, or an individual at
some remote location, for instance, a pharmacist at a pharmacy, may
poll the cassette 100 via the system 400, or the like. As used
herein, the terminology medical facility includes hospital, nursing
home, assisted living center, or clinic, or the like. For example,
the attendant may manually take inventory of the administering
apparatus 10 or may run a routine using the computer 406 to check
current inventory levels stored in memory.
[0194] At step 624, it may be determined whether or not an unused
cassette is present on any administering apparatus in a medical
facility. For example, a pharmacy may make the determination via
the system 400. If so, then at step 626, the pharmacy may send a
replacement cassette for the currently unused cassette.
[0195] At step 628, it may be determined whether or not a cassette
in need of refilling is present on an administering apparatus. For
instance, the pharmacy may make the determination via the system
400. For example, if the quantity of the medication in a given
cassette falls below a low limit (par) value, then the method loops
back to step 602. Otherwise, a subsequent administering apparatus
may be polled for potential replacement of cassette as indicated at
step 630.
[0196] The methods 500, 600, or any portion thereof, may be
performed at least in part as one or more computer programs and the
various method steps or instructions may be stored in memory as a
look-up table or the like. The computer program(s) may exist in a
variety of forms both active and inactive. For example, the
computer program(s) can exist as software program(s) comprised of
program instructions in source code, object code, executable code
or other formats; firmware program(s); or hardware description
language (HDL) files. Any of the above can be embodied on a
computer usable medium.
[0197] One or more of the embodiments above may provide one or more
of the features to one degree or another. May provide a unique
medication distribution system integrated with a pharmacy, a
medical facility (e.g. hospital or nursing home), physician's
office, and medication administering apparatus. May enable
pharmacists to dispense prescriptions onsite at a medical facility
from an offsite pharmacy, pursuant to a physician's medication
order. Medication dispensing and packaging may be automated based
on each patient's current medication profile, and/or collective
medication needs of a group of patients. May allow for actual use
packaging, thereby saving labor costs on packaging medication that
may never get used. Medications may be made immediately available
to a nurse for administration. Medications may be administered as
based upon actual need with little or no waste. May enable
automatic online documentation of medication administration,
antipsychotic behaviors, side effects, etc., by onsite nurse, that
may be accessible online by nursing staff, remote pharmacy, and
physician's office. May enable online entry and sharing of trending
of antipsychotic behaviors and side effects. May enable automated
documentation of PRN (as needed) medications as well as required
results of administration. May enable recording and tracking of
dates and times of administration of medications. May enable
electronic billing with ability to net bill a payor for only those
doses actually administered. May enable charges for actual doses
given to be submitted to proper payor based on coverage at time of
administration. May decrease nursing time during the medication
pass/administration. May decrease pharmacist time in entering and
verifying prescriptions. May decrease pharmacist time in checking
prescriptions to be dispensed. May provide automatic documentation
of missed doses. May enable medications to be labeled individually
at the pharmacy with expiration date and lot number. May eliminate
the need for returned medication and associated labor (in those
states where mandated or allowed). May eliminate need to transfer
orders from the Physician's Orders to the MAR at a nursing home.
May automate required medication formulary changes at the point of
prescribing. May incorporate direct order entry in the physician's
office. Use of common database may eliminate transcription errors.
May allow nurse to reorder non-unit dose medications during the
pass as needed. May allow nurse to immediately update and transmit
to pharmacy changes in patients' Level of Care.
* * * * *