U.S. patent application number 13/835779 was filed with the patent office on 2014-09-18 for apparatuses, systems, and methods for anticipating and delivering medications from a central pharmacy to a patient using a track based transport system.
The applicant listed for this patent is McKesson Automation Inc.. Invention is credited to Paul A. Brayford, Stefan Michael Elsener, Cody C. Henderson, James Kolozs, Michael P. Zarich.
Application Number | 20140261058 13/835779 |
Document ID | / |
Family ID | 51521545 |
Filed Date | 2014-09-18 |
United States Patent
Application |
20140261058 |
Kind Code |
A1 |
Henderson; Cody C. ; et
al. |
September 18, 2014 |
APPARATUSES, SYSTEMS, AND METHODS FOR ANTICIPATING AND DELIVERING
MEDICATIONS FROM A CENTRAL PHARMACY TO A PATIENT USING A TRACK
BASED TRANSPORT SYSTEM
Abstract
Provided herein are various apparatuses, systems, and methods
for transporting medication within a healthcare facility. Examples
of the invention may include a car for a track-based transport
system. The car may include a payload platform configured to
support a payload on a payload surface; a first tilt bracket
rotatably coupled to the payload platform and rotatable relative to
the payload platform about a first axis orthogonal to a plane
defined by the payload surface; a first bogie pivotably coupled to
the tilt bracket, where the bogie is configured to pivot about a
first pivot axis that is perpendicular to the first axis and
perpendicular to a direction of travel of the car; and a first
electric motor coupled to the first bogie and configured to receive
electric power through a bus bar disposed along a track on which
the car rides.
Inventors: |
Henderson; Cody C.; (Denver,
CO) ; Brayford; Paul A.; (Lakewood, CO) ;
Elsener; Stefan Michael; (Westminster, CO) ; Zarich;
Michael P.; (Longmont, CO) ; Kolozs; James;
(Denver, CO) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
McKesson Automation Inc. |
Cranberry |
PA |
US |
|
|
Family ID: |
51521545 |
Appl. No.: |
13/835779 |
Filed: |
March 15, 2013 |
Current U.S.
Class: |
104/288 ;
105/199.1 |
Current CPC
Class: |
A61G 12/001 20130101;
A61J 1/035 20130101; A61J 7/0084 20130101; B65B 5/103 20130101;
A61J 2205/30 20130101; A61J 2205/10 20130101 |
Class at
Publication: |
104/288 ;
105/199.1 |
International
Class: |
B61C 3/00 20060101
B61C003/00; B61F 5/50 20060101 B61F005/50 |
Claims
1. A car for a track-based transport system, the car comprising: a
payload platform configured to support a payload on a payload
surface; a first tilt bracket rotatably coupled to the payload
platform and rotatable relative to the payload platform about a
first axis orthogonal to a plane defined by the payload surface; a
first bogie pivotably coupled to the tilt bracket, wherein the
bogie is configured to pivot about a first pivot axis that is
perpendicular to the first axis and perpendicular to a direction of
travel of the car; a first electric motor coupled to the first
bogie and configured to receive electric power through a bus bar
disposed along a track on which the car rides; and a location
scanner configured to detect a position of the car along the
track.
2. The car of claim 1, further comprising: a second tilt bracket
rotatably coupled to the payload platform rotatable about a second
axis orthogonal to the plane defined by the payload surface; a
second bogie pivotably coupled to the tilt bracket, wherein the
second bogie is configured to pivot about a second pivot axis that
is perpendicular to the second axis and perpendicular to a
direction of travel of the car; and a second electric motor coupled
to the second bogie and configured to receive electric power
through a bus bar disposed along a track on which the car
rides.
3. The car of claim 1, wherein the first bogie comprises at least
one pair of rollers configured to ride along the track, and wherein
at least one roller of the at least one pair of rollers is
configured to be driven by the first electric motor.
4. The car of claim 3, wherein the first electric motor is
configured to drive the at least one roller by a belt drive.
5. The car of claim 4, further comprising a belt tension adjustment
configured to adjust the tension of the belt drive.
6. The car of claim 2, wherein the first bogie comprises at least
one pair of rollers configured to ride along the track, wherein at
least one roller of the at least one pair of rollers of the first
bogie is configured to be driven by the first electric motor,
wherein the second bogie comprises at least one pair of rollers
configured to ride along the track, and wherein at least one roller
of the at least one pair of rollers of the second bogie is
configured to be driven by the second electric motor.
7. The car of claim 1, wherein the first bogie comprises a first
pair of rollers configured to engage a top side of the track, and a
second pair of rollers configured to engage a bottom side of the
track.
8. The car of claim 7, wherein each roller of the first pair of
rollers includes an axis of rotation, and wherein the axis of
rotation of each roller of the first pair of rollers is configured
to be orthogonal to the plane defined by the payload surface.
9. The car of claim 8, wherein each roller of the second pair of
rollers includes an axis of rotation, and wherein the axis of
rotation of each of the second pair of rollers is orthogonal to the
plane defined by the payload surface.
10. The car of claim 9, wherein the axes of rotation of the first
pair of rollers are separated by the track, and wherein the axes of
rotation of the second pair of rollers are separated by the
track.
11. The car of claim 10, wherein the second pair of rollers are
displaceable relative to the track in a direction away from the
track, between an engaged position in which the second pair of
rollers is engaged with the track and a loading position in which
the second pair of rollers is disengaged from the track.
12. The car of claim 11, wherein the second pair of rollers is
configured to be locked in the loading position.
13. The car of claim 11, wherein the second pair of rollers is
biased toward the engaged position.
14. A car for a track-based transport system, the car comprising: a
payload platform configured to support a payload on a payload
surface; a first tilt bracket rotatably coupled to the payload
platform and rotatable relative to the payload platform about a
first axis orthogonal to a plane defined by the payload surface;
and a first bogie pivotably coupled to the tilt bracket, wherein
the bogie is configured to pivot about a first pivot axis that is
perpendicular to the first axis and perpendicular to a direction of
travel of the car, wherein the bogie comprises: a first roller
comprising a first roller surface configured to engage a first
surface of a rail along which the car travels, wherein the first
roller surface is disposed at an angle of between thirty degrees
and sixty degrees relative to an axis of rotation of the first
roller; and a second roller comprising a second roller surface
configured to engage a second surface of the rail along which the
car travels, wherein the second roller surface is disposed at an
angle of between thirty degrees and sixty degrees relative to an
axis of rotation of the second roller.
15. The car of claim 14, further comprising a first electric motor
coupled to the first bogie and configured to receive electric power
through a bus bar disposed along a track on which the car
rides.
16. The car of claim 14, further comprising a location scanner
configured to detect a position of the car along the track.
17. The car of claim 14, further comprising: a third roller
comprising a third roller surface configured to engage a third
surface of the rail along which the car travels, wherein the third
roller surface is disposed at an angle of between thirty degrees
and sixty degrees relative to an axis of rotation of the first
roller; and a fourth roller comprising a fourth roller surface
configured to engage a fourth surface of the rail along which the
car travels, wherein the fourth roller surface is disposed at an
angle of between thirty degrees and sixty degrees relative to an
axis of rotation of the second roller.
18. The car of claim 17, wherein in response to the car engaging
the rail along which the car travels, at least a portion of the
rail is disposed between a portion of each of the first roller, the
second roller, the third roller, and the fourth roller.
19. The car of claim 17, wherein the axis of rotation of at least
one of the third roller and the fourth roller are movable along a
direction parallel to the first pivot axis.
20. A car for a track-based transport system, the car comprising: a
payload platform configured to support a payload on a payload
surface; a first tilt bracket rotatably coupled to the payload
platform and rotatable relative to the payload platform about a
first axis orthogonal to a plane defined by the payload surface; a
first bogie pivotably coupled to the tilt bracket, wherein the
bogie is configured to pivot about a first pivot axis that is
perpendicular to the first axis and perpendicular to a direction of
travel of the car; a first roller comprising a first roller surface
configured to engage a first surface of a rail along which the car
travels; and a second roller comprising a second roller surface
configured to engage a second surface of the rail along which the
car travels; wherein the first bogie is configured to straddle the
rail along which the car travels.
Description
TECHNOLOGICAL FIELD
[0001] Embodiments of the present invention relate generally to
medication dispensing from the central pharmacy or medication
storage area in a healthcare facility to a patient. Embodiments may
include full or partial automation of the process and may include
mechanisms for improving the efficiency and accuracy of medication
dispensing.
BACKGROUND
[0002] Medication dispensing in healthcare facilities can be a
complex and time consuming process. With medication orders
changing, and with the significant potential ramifications of
dispensing the incorrect medication to a patient, the process of
delivering medication from the central pharmacy to the patient can
be a high-risk process in a healthcare setting.
[0003] Healthcare facilities generally dispense medications from a
central pharmacy to patients with a number of verification steps
performed along the way to ensure that the medication is of the
correct type and dose and that the appropriate patient receives the
medication. The verification steps may add complexity and time to
the process, thereby reducing the efficiency. Therefore it may be
desirable to implement apparatuses, systems, and methods which may
automate some or all of the process and which may increase the
efficiency with which medications are delivered to a patient.
SUMMARY
[0004] Embodiments of the present invention may provide various
apparatuses, systems, and methods for improving the efficiency of
medication distribution within a healthcare facility. In
particular, embodiments may provide for dispensing medications
needed and medications anticipated to be needed to an authorized
medical person for administration to a patient in a healthcare
facility. Medications that are anticipated to be needed may be
predicted based on a number of factors. The medications may be
gathered, transported, stored, staged, and dispensed using one or
more of the components described herein. Combinations of the
components may be implemented for a system to automate or partially
automate the dispensing of medications from a central pharmacy of a
healthcare facility to a patient.
[0005] An example embodiment of the present invention may provide a
car for a track-based transport system. The car may include a
payload platform configured to support a payload on a payload
surface; a first tilt bracket rotatably coupled to the payload
platform and rotatable relative to the payload platform about a
first axis orthogonal to a plane defined by the payload surface; a
first bogie pivotably coupled to the tilt bracket, where the bogie
is configured to pivot about a first pivot axis that is
perpendicular to the first axis and perpendicular to a direction of
travel of the car; a first electric motor coupled to the first
bogie and configured to receive electric power through a bus bar
disposed along a track on which the car rides; and a location
scanner configured to detect a position of the car along the track.
Cars of example embodiments may optionally include a second tilt
bracket rotatably coupled to the payload platform rotatable about a
second axis orthogonal to the plane defined by the payload surface;
a second bogie pivotably coupled to the tilt bracket, where the
second bogie is configured to pivot about a second pivot axis that
is perpendicular to the second axis and perpendicular to a
direction of travel of the car; and a second electric motor coupled
to the second bogie and configured to receive electric power
through a bus bar disposed along a track on which the car
rides.
[0006] According to some example embodiments, the first bogie may
include at least one pair of rollers configured to ride along the
track, and where at least one roller of the at least one pair of
rollers may be configured to be driven by the first electric motor.
The first electric motor may be configured to drive the at least
one roller by a belt drive. Example embodiments may further include
a belt tension adjustment configured to adjust the tension of the
belt drive. The first bogie may include at least one pair of
rollers configured to ride along the track, were at least one
roller of the at least one pair of rollers of the first bogie may
be configured to be driven by the first electric motor, where the
second bogie may include at least one pair of rollers configured to
ride along the track and where at least one roller of the at least
one pair of rollers of the second bogie may be configured to be
driven by the second electric motor.
[0007] According to some example embodiments, the first bogie may
include a first pair of rollers configured to engage a top side of
the track, and a second pair of rollers configured to engage a
bottom side of the track. Each roller of the first pair of rollers
may include an axis of rotation, and where the axis of rotation of
each roller of the first pair of rollers is configured to be
orthogonal to the plane defined by the payload surface. Each roller
of the second pair of rollers may include an axis of rotation, and
where the axis of rotation of each of the second pair of rollers
may be orthogonal to the plane defined by the payload surface. The
second pair of rollers may be displaceable relative to the track in
a direction away from the track, between an engaged position in
which the second pair of rollers is engaged with the track and a
loading position in which the second pair of rollers is disengaged
from the track. The second pair of rollers may be configured to be
locked in the loading position. The second pair of rollers may be
biased toward the engaged position.
[0008] Example embodiments of the present invention may provide
another embodiment of a car for a track based transport system. The
car may include a payload platform configured to support a payload
on a payload surface; a first tilt bracket rotatably coupled to the
payload platform and rotatable relative to the payload platform
about a first axis orthogonal to a plane defined by the payload
surface; and a first bogie pivotably coupled to the tilt bracket,
where the bogie is configured to pivot about a first pivot axis
that is perpendicular to the first axis and perpendicular to a
direction of travel of the car. The bogie of example embodiments
may include a first roller comprising a first roller surface
configured to engage a first surface of a rail extending along
which the car travels, where the first roller surface is disposed
at an angle of between thirty degrees and sixty degrees relative to
an axis of rotation of the first roller. Embodiments may further
include a second roller including a second roller surface
configured to engage a second surface of the rail along which the
car travels, where the second roller surface is disposed at an
angle of between about thirty degrees and sixty degrees relative to
an axis of rotation of the second roller.
[0009] According to some example embodiments, the car may include a
first electric motor coupled to the first bogie and configured to
receive electric power through a bus bar disposed on the track.
Embodiments may include a location scanner configured to detect a
position of the car along the track. Embodiments may optionally
include a third roller including a third roller surface configured
to engage a third surface of the rail along which the car travels,
where the third roller surface is disposed at an angle of between
about thirty degrees and about sixty degrees relative to an axis of
rotation of the first roller. Embodiments may also include a fourth
roller including a fourth roller surface configured to engage a
fourth surface of the rail along which the car travels, where the
fourth roller surface is disposed at an angle of between about
thirty degrees and about sixty degrees relative to an axis of
rotation of the second roller. In response to the car engaging the
rail along which the car travels, at least a portion of the rail
may be disposed between a portion of each of the first roller, the
second roller, the third roller, and the fourth roller. The axis of
rotation of at least one of the third roller and the fourth roller
may be movable along a direction parallel to the first pivot
axis.
[0010] According to another example embodiment of the present
invention, a car for a track-based transport system may include a
payload platform configured to support a payload on a payload
surface; a first tilt bracket rotatably coupled to the payload
platform and rotatable relative to the payload platform about a
first axis orthogonal to a plane defined by the payload surface; a
first bogie pivotably coupled to the tilt bracket, where the bogie
is configured to pivot about a first pivot axis that is
perpendicular to the first axis and perpendicular to a direction of
travel of the car; a first roller including a first roller surface
configured to engage a first surface of a rail along which the car
travels; and a second roller including a second roller surface
configured to engage a second surface of the rail along which the
car travels. The first bogie may be configured to straddle the rail
along which the car travels.
DESCRIPTION OF THE DRAWINGS
[0011] Reference now will be made to the accompanying drawings,
which are not necessarily drawn to scale, and wherein:
[0012] FIG. 1 illustrates an example embodiment of overpacks as
described herein using multiple sized bins of a common profile;
[0013] FIG. 2 illustrates another example embodiment of overpacks
including lidded containers of multiple sizes, each having a common
profile;
[0014] FIG. 3 illustrates another example embodiment of an overpack
including a flexible film pouch with a grasping loop;
[0015] FIG. 4 illustrates an example embodiment of bags used as an
overpack;
[0016] FIG. 5 illustrates multiple sized boxes as overpacks;
[0017] FIG. 6 illustrates automated loading of overpacks according
to an example embodiment of the present invention;
[0018] FIG. 7 illustrates another example embodiment of an overpack
including a card-stock backing;
[0019] FIG. 8 illustrates the storage of overpacks according to an
example embodiment of the present invention;
[0020] FIG. 9 illustrates a magazine containing a plurality of
stacked unit dose medications according to an example embodiment of
the present invention;
[0021] FIG. 10 illustrates a plurality of interconnected unit dose
medication packages;
[0022] FIG. 11 illustrates a system loading device including a
plurality of bins of multiple sizes and a common profile according
to an example embodiment of the present invention;
[0023] FIG. 12 illustrates an example embodiment of a system
configured to load overpacks and group loaded overpacks onto a tray
or cassette;
[0024] FIG. 13 depicts loading a magazine with a loaded overpack
according to an example embodiment of the present invention;
[0025] FIG. 14 illustrates another example embodiment of a system
for selecting and loading overpacks;
[0026] FIG. 15 illustrates a system for loading overpacks using a
carousel containing a plurality of unit dose magazines according to
an example embodiment of the present invention;
[0027] FIG. 16 illustrates an example embodiment of an apparatus to
organize and transport medication and supplies according to the
present invention;
[0028] FIG. 17 illustrates the example embodiment of FIG. 16
adapted to carry and transport larger items;
[0029] FIG. 18 illustrates an example embodiment of an apparatus
configured to transport overpacks from a central pharmacy to a unit
storage device;
[0030] FIG. 19 illustrates another example embodiment of an
apparatus configured to transport overpacks from a central pharmacy
to a unit storage device;
[0031] FIG. 20 illustrates a unit storage device supplied by an
apparatus configured to transport overpacks from a central pharmacy
according to example embodiments of the present invention;
[0032] FIG. 21 illustrates another unit storage device according to
example embodiments of the present invention;
[0033] FIG. 22 illustrates an example embodiment of a high-capacity
unit storage device;
[0034] FIG. 23 illustrates another unit storage device including a
retrieval device and a transport device according to an example
embodiment of the present invention;
[0035] FIG. 24 illustrates a unit storage device including a
loading device according to an example embodiment of the present
invention;
[0036] FIG. 25 illustrates a method for loading and dispensing
overpacks from a high-capacity unit storage device according to
example embodiments of the present invention;
[0037] FIG. 26 illustrates a unit storage device according to
another example embodiment of the present invention;
[0038] FIG. 27 illustrates a unit storage device according to yet
another example embodiment of the present invention;
[0039] FIG. 28 illustrates an example embodiment of a carrier
configured to carry overpacks and a shuttle configured to transport
the carrier;
[0040] FIG. 29 illustrates a transport device and a loading device
according to an example embodiment of the present invention;
[0041] FIG. 30 depicts a track-based transport system according to
an example embodiment of the present invention;
[0042] FIG. 31 illustrates a cross-section of a track used with
track-based transport systems of example embodiments of the present
invention;
[0043] FIG. 32 illustrates a pair of end caps configured to join
track sections together according to example embodiments of the
present invention;
[0044] FIG. 33 illustrates an example embodiment of a female end
cap used to join to join track sections together according to an
example embodiment of the present invention;
[0045] FIG. 34 illustrates an example embodiment of a male end cap
used to join track sections together according to an example
embodiment of the present invention;
[0046] FIGS. 35 and 36 illustrate a method of engagement of a male
end cap and a female end cap in order to join track sections
together according to example embodiments;
[0047] FIG. 37 illustrates a cross-section of the end caps of FIGS.
35 and 36 in an engaged position;
[0048] FIG. 38 depicts a female end cap including an alignment and
securing feature for aligning and securing together track sections
according to example embodiments of the present invention;
[0049] FIG. 39 illustrates an example embodiment of a car of a
track-based transport system traversing a corner;
[0050] FIG. 40 illustrates an example embodiment of a car of a
track-based system traversing an incline;
[0051] FIG. 41 illustrates the engagement of a bogie with a track
profile according to an example embodiment of a track-based
transport system of the present invention;
[0052] FIG. 42 depicts a bogie configured to be removed or loaded
onto a track of a track-based transport system of example
embodiments of the present invention;
[0053] FIG. 43 illustrates a track system for a transport device
according to an example embodiment of the present invention;
[0054] FIG. 44 illustrates a nurse server according to an example
embodiment of the present invention;
[0055] FIG. 45 illustrates a nurse server according to another
example embodiment of the present invention;
[0056] FIG. 46 illustrates a nurse server according to yet another
example embodiment of the present invention;
[0057] FIG. 47 depicts the overpacks and access provided thereto
within the nurse server of the embodiment of FIG. 46;
[0058] FIG. 48 illustrates a nurse server according to a further
example embodiment of the present invention;
[0059] FIG. 49 illustrates a nurse server user interface according
to an example embodiment of the present invention;
[0060] FIG. 50 illustrates a nurse server according to yet another
example embodiment of the present invention;
[0061] FIG. 51 illustrates an example embodiment of a nurse cart
supplied by proximate storage according to the present
invention;
[0062] FIG. 52 is a schematic illustration of a user terminal
according to an example embodiment of the present invention;
[0063] FIG. 53 illustrates a car for a track-based transport system
according to an example embodiment of the present invention;
[0064] FIG. 54 illustrates a clip for holding a medication overpack
according to an embodiment of the present invention;
[0065] FIG. 55 illustrates a carrier configured to carry a
plurality of clips with overpacks according to an example
embodiment of the present invention.
[0066] FIG. 56 illustrates a track-based transport system for
carriers of overpacks on clips according to an example embodiment
of the present invention; and
[0067] FIG. 57 illustrates an example embodiment of a reader and
release mechanism for use with the clips of the example embodiment
of FIG. 54.
DETAILED DESCRIPTION
[0068] Embodiments of the present invention may provide various
apparatuses, systems, and methods for improving the efficiency of
medication distribution within a healthcare facility. Some
embodiments and components of the present invention will now be
described more fully hereinafter with reference to the accompanying
drawings, in which some, but not all embodiments of the invention
are shown. Indeed, various embodiments of the invention may be
embodied in many different forms and should not be construed as
limited to the embodiments set forth herein; rather, these
embodiments are provided so that this disclosure will satisfy
applicable legal requirements.
[0069] Further, example embodiments of the present invention may
provide a method, apparatus, and computer program product which may
facilitate predicting the medications needed by a patient over a
period of time. While automation of the dispensing of medications
within a healthcare facility may improve efficiency of medication
distribution, incorporating a mechanism to predict the medication
needs for patients may allow automation to anticipate patient needs
and to have medications readily available for administration to a
patient when the patient requires the medications. Some medications
for a patient may be previously prescribed such that they are known
medications that will be needed for a patient. Other medications
that may later be prescribed may not be known in advance of when
they may be required. As such, a method of anticipating the
medications which may be needed may help to ensure that medications
are on hand when prescribed by a physician.
[0070] Embodiments of the invention configured to predict
medications which may be needed by a patient may predict the
medication based on a number of criteria. For example, the
medications which may be needed by a patient may be predicted based
on a knowledge of the patient's ailment, plurality of ailments, or
combination of ailments, and the predicted medication may be based
upon a conventional medication regimen for that ailment, plurality
of ailments, or combination of ailments. Further, the medication
regimen for the ailment, plurality of ailments, or combination of
ailments may be physician specific, such that the medication
regimen for ailments may be varied based upon the physician
treating the patient. As a basic example, a patient with heartburn
may be treated by one physician with a histamine antagonist
medication while another physician may prefer proton pump inhibitor
medication. The medication predicted for a particular patient may
be dependent upon the preferences and/or historical information
about the physician treating them.
[0071] Another criterion that may be used to predict medications
which may be needed by a patient over a particular period of time
may include a historical record of medication administered to the
patient. For example, if a patient has a chronic condition and is
on a maintenance medication, embodiments of the invention may
predict that the patient will require their maintenance medication
over the particular period of time. Further, a patient may have a
historical record of medications taken for a particular ailment,
such as in a prior visit to the healthcare facility. In such an
embodiment, the record of the prior visit, the prior ailment, the
prior medication administered, and the efficacy of the medication
may each be considered.
[0072] While the aforementioned criteria are primarily historical
correlations used for prediction of medication anticipated to be
needed, additionally or alternatively, embodiments of the invention
may implement an algorithm to predict the medication which may be
needed by a patient over a predefined period of time. For example,
if a patient has a combination of symptoms and/or particular
abnormal vital statistics (e.g., pulse, temperature, cholesterol,
blood sugar, etc.), an algorithm may take each of these variables
into consideration to determine a predicted medication or
medication regimen that the patient will need over a particular
period of time.
[0073] Medications may also require specific supplies to accompany
the medication such that supplies may be predicted in the same
manner as medications. For example, if a medication is administered
intravenously, a syringe may be a required supply to accompany the
medication. As such, when the medication is anticipated to be
needed, a syringe is also anticipated to be needed. Alternatively,
the supply could be predicted when a medication is ordered.
[0074] While the prediction of medication which may be needed by
patients over a particular period of time may increase efficiency
of medication distribution, having the predicted medication ready
for dispensing at or near the patient's location may further
increase the efficiency of medication dispensing and
administration. Such prediction and staging of medication may
increase the efficiency of an authorized medical person, such as a
nurse. For example, staging a medication proximate a patient and
dispensing a medication to an authorized medical person proximate
the patient may reduce the time needed for the authorized medical
person to walk to retrieve medications and wait for their delivery.
By reducing the time spent retrieving medications, additional time
is afforded to an authorized medical person for administration of
the medication or for care of a patient. This additional time may
allow for higher quality patient care and less time spent in
non-value added tasks of tracking down needed medications and
supplies for a patient. Additionally, automating all or part of the
distribution of medication in a healthcare facility may increase
medication accuracy by providing automated verification of the
medication type and dose at various stages of the distribution
process.
[0075] Example embodiments of the present invention may provide
various apparatuses, systems, and methods which may automate or
partially automate some or all of the process of medication
fulfillment and delivery from a central pharmacy to a patient.
Embodiments may be implemented in full or in part to increase the
efficiencies of the complex process of dispensing medications to a
patient. As such, components described herein can be used
individually or in combination with one another to achieve an
automated or partially automated system for dispensing medications
and supplies.
[0076] While embodiments of the present invention may be described
with respect to healthcare facilities, such as hospitals and
long-term care facilities, for example, embodiments of the
inventions described herein may be implemented in a variety of
types of facilities, not limited to those explicitly described
herein.
[0077] Healthcare facilities may include a central pharmacy in
which medications are stored and dispensed to areas throughout the
healthcare facility. Some healthcare facilities may rely on a
supplier, distribution center, or remote central pharmacy which
stores medications and supplies at a remote location and delivers
the medications and supplies on an as needed basis. In such an
embodiment, the medications from the supplier, distribution center,
or remote central pharmacy may be received by a healthcare facility
at a receiving area. While embodiments of the present invention may
be described as transporting and dispensing medication from a
central pharmacy, embodiments in which central pharmacies are
located remotely or embodiments using distribution centers may
implement embodiments of the inventions from the area in which
medications and supplies are received from the central pharmacy or
distribution center. The indication of medications anticipated to
be needed may be provided to the central pharmacy or distribution
center with sufficient lead time such that the healthcare facility
may receive the medications in advance of when they are anticipated
to be needed.
[0078] In some example embodiments of the present invention,
medications may be received from a remote central pharmacy in
overpacks (described further below) or packaged into overpacks in a
local central pharmacy. Overpacks may be means for packaging
medication into a package that is more conducive to automated
handling. The overpacks facilitate uniform handling to ease
distribution and tracking within a healthcare facility. The
medications in overpacks may be grouped together according to their
destination, and the grouped overpacks may be transported to their
destinations. The destination for the medication may include a unit
storage device which may serve as local storage for medication to
avoid having authorized medical personnel walk between their
healthcare facility unit and the central pharmacy to retrieve
medications. While storing medication locally in a healthcare
facility unit may allow authorized medical personnel to retrieve
medication locally for dispensing to patients on the unit,
additional automation to deliver the medication closer to the
patient may be implemented to further increase the efficiency of
medication distribution in the healthcare facility.
[0079] Medications located in the unit storage may be individually
selected and transported by an automated system to a location
proximate to a patient, such as a patient server or a nurse server.
A nurse server, according to example embodiments as will be
described further below, may be a location situated close to a
number of patients for which a nurse is responsible. The nurse
server may receive medications only for those patients and may have
controlled access restricted to authorized medical personnel.
Similarly, the patient server of example embodiments may be
disposed at a location proximate to a patient and be configured to
receive medications only for that patient. The patient server may
also have access restricted to authorized medical personnel.
[0080] Transport from the unit storage to the nurse server or
patient server may be accomplished in a number of ways as outlined
further below. Medications, which may be contained in overpacks, as
described further below, may be selected from the unit storage by a
retrieval device, and subsequently loaded onto a transportation
device configured to transport the medications to a location
proximate to the patient for whom they are intended. The transport
device may include a train, a shuttle, a pneumatic tube system,
etc.
[0081] Upon arrival of the medication at the nurse server or
patient server, the medication may be unloaded from the transport
device, or alternatively the transport device may remain with the
medication at the nurse server or patient server. The medication
may then be considered staged for retrieval by authorized medical
personnel. The staging of medication may be, for example, in an
overhead storage area disposed proximate a ceiling above the nurse
server or patient server, awaiting a request for dispensing. The
authorized medical person, which may be a nurse, technician,
physician, etc., may be alerted that the medication for a patient
is staged at the nurse server or patient server. When the
authorized medical person is ready to administer the medication to
the patient, they may access the nurse server or patient server,
and they may be required to provide authentication, such as an
identification card, an identification PIN, a biometric scan (e.g.,
retina, finger print, hand geometry, palm vein, facial recognition,
or voice analysis). In response to authentication of the authorized
medical person, the medication may be dispensed from the staging
area to the nurse server or patient server for retrieval by the
authorized medical person. Upon retrieval, the medication may be
administered to the patient.
[0082] While the above description provides a general summary of
some of the elements and operations of example embodiments of the
present invention, certain elements and operations will be
described further below.
Products to be Dispensed
[0083] Medications dispensed from a central pharmacy may be of a
variety of form factors from individual pills or capsules to
intravenous bags of a liter or more capacity. Other form factors
may include syringes, carpujects, vials, etc. Supplies, such as
intravenous medication tubing, empty syringes, etc. may be
dispensed from a separate medical supply distribution center within
a healthcare facility, or in some cases, the central pharmacy and
medical supply distribution operations may be combined. Both the
supplies and the medications may come in a variety of sizes and
shapes and may not easily and efficiently be transported in uniform
containers throughout a healthcare facility. For example, a
carpuject, ampoule, or a vial may be relatively fragile while a
unit dose of a medication, such as a tablet, may be relatively
durable. While the tablet may be stored and dispensed in a very
small package without substantial protection from transport, the
vials, carpujects, and ampoule may require larger, more durable
packaging. Similarly, intravenous medication bags may be durable
for transport, but may be easily punctured such that care must be
taken in storing, handling, and distributing such products.
[0084] While certain medications are configured to be dispensed in
vials where a syringe is a required supply to accompany the vial,
other medications may require a patient to consume food or a
beverage other than water. In such cases, the food or beverage to
accompany the medication may be treated as a supply, and such
supplies may also be dispensed as other supplies may be dispensed
as described herein.
[0085] In order to provide a more uniform form factor for
medications and supplies to be handled and dispensed throughout a
healthcare facility, overpacks or packaging that encases or holds
the medications or supplies may be used which provide a common
size, profile, shape, or grasping feature. Provided herein are
various embodiments of uniform or quasi-uniform overpacks or
secondary packaging for use with a variety of medications and
supplies with varying shapes, sizes, and handling requirements
(e.g., fragile, temperature sensitive, etc.). The overpacks
described herein may provide an aspect of uniformity to generally
non-uniform form factors. The uniformity may be in the profile of
the overpack, such as when the overpack includes a plurality of
various sized bins with uniform profiles, or the uniformity may be
in a locating/holding hole of a plurality of various sized bags
configured to hold the various form factors.
[0086] FIG. 1 illustrates an example embodiment of an overpack
according to example embodiment of the present invention using bins
of varying sizes with a common profile. Each of the illustrated
bins 102, 104, 106, and 108 are of a different size while
maintaining a common profile. The smallest bin 102 may be
configured to hold small items such as unit doses of oral
medication 110 (e.g., pills, capsules, tablets, etc.) while the
largest bin 108 may be configured to hold large items such as a one
liter intravenous bag 112 and/or intravenous tubing 114, each of
which may be too large to fit into any of the smaller bins 102,
104, or 106. The bins between the largest and the smallest (bins
104, 106) may be appropriately sized to hold medications and/or
supplies such as vials, syringes, 100 mL intravenous bags, or the
like. The uniform profiles of the bins may allow the bins to be
processed along a conveyor line configured to accommodate such a
profile. Further, the uniform profile bins may be stored on common
shelves with only the width of the shelf occupied varying between
bins of different sizes. While some embodiments of bins of varying
size may include a variable length, other embodiments may include a
common length and a variable depth. For example, each bin may
occupy the same width of a shelf, but the bin may extend further
back on the shelf to create added capacity.
[0087] In some example embodiments, the overpacks may be sealed or
closed to keep the contents of the overpack protected and/or
secure. For example, the various sized bins of FIG. 1 may include
lids which may be secured to the bins by a hook-and-loop fastener
system, a snap-on lid, or a heat or ultrasonically welded plastic
film seal. The type of closure used for the overpack may be
dependent upon the use of the overpack. For example, an overpack
for manual distribution (e.g., via a nurse cart) within a
healthcare facility may not require a closure, or may use a simple
snap-on closure. An overpack for automated distribution within a
healthcare facility, or an overpack for distribution through an
over-the-road delivery service may require a more secure closure
that is less likely to be inadvertently opened, such as a
heat-sealed film closure.
[0088] The closure may also depend upon the type of contents
contained within the overpack. For example, if the overpack
contains environmentally sensitive contents that should not be
exposed to humidity or moisture may benefit from a heat-sealed film
closure. Closures that are impervious to air and moisture may also
be used for overpacks used with oxygen sensitive contents where an
inert gas fills the overpack.
[0089] A closure for an overpack may also be selected based upon
whether the contents are government regulated, as in the case of
controlled substances, or if the contents are a high-value
candidate for theft. In such embodiments, a lockable closure may be
used to seal the overpack. FIG. 2 illustrates an example embodiment
of an overpack with a hinged closure. As illustrated, the overpacks
120 of FIG. 2 may include a common profile, but have varying widths
to accommodate medications and supplies of various sizes. The
overpack base 122 and hinged lid 124 may open in a clamshell
fashion to allow access to the interior cavity containing the
medication or supply. As shown, the overpack may include a divider
126 which may allow two articles to be carried within one overpack
without the two interfering with one another. The separation
afforded by the divider may help to reduce confusion or mistakes
when multiple medications are contained in an overpack for a
particular patient. Also illustrated in the overpacks of FIG. 2 are
a closure mechanism including a tab 130 received within latch 128.
The closure mechanism may be a locking mechanism requiring a key,
code, or biometric identifier. For example, authorized medical
personnel may have access to a key, such as a magnetic key kept on
their person or at a nurse station, which may unlock the latch 128.
Optionally, the latch may be a push-button release configured only
to maintain the lid 124 in a closed position during transport.
While closures and locks may be used to secure controlled
substances, security of controlled substances may additionally rely
upon security by obscurity, in which narcotics and other controlled
substances are not distinguished from non-controlled substances,
such that locating controlled substances among the plurality of
medication overpacks may be difficult.
[0090] FIG. 3 illustrates another example embodiment of an
overpack. The illustrated embodiment of FIG. 3 is a reusable
folding pouch style overpack which may be available in various
sizes to accommodate multiple sizes of medications and supplies.
The pouch 132 may be made of a pliable material 134 which may be
elastic to better hold the contents without shifting. The material
may also be substantially transparent to allow easy verification of
the contents of the pouch. The material 134 may have an adhesive
strip 136 around the perimeter such that when the sheet of material
134 is folded, a pouch 132 is formed. The adhesive strip 136 may be
a hook-and-loop type fastener or a releasable adhesive material to
allow the pouch to be easily opened and reclosed for reuse.
Optionally, the pouch style overpack may be designed for a
single-use and may include a non-releasable adhesive requiring the
pouch 132 to be torn open. Such a single-use type pouch may be
beneficial for embodiments requiring evidence of tampering. The
pouch 132 may also include a loop 138 or hook which may be used to
hang or grasp the pouch in transport and dispensing. As outlined
above, some overpacks may include a common sized and/or shaped
grasping feature, such as the loop 138 to aid automation or
efficient handling as opposed to, or in combination with, a common
size or profile.
[0091] Overpacks according to the present invention may be embodied
in other forms, such as envelopes or bags. FIG. 4 illustrates an
example embodiment of an overpack in the form of a bag 140
including a hole 142. The bag type of overpack may be of any
necessary size to accommodate the medication or supplies carried
therein, and the hole 142 may be used for holding, storing, and
grasping the bag 140. The bag or envelope style overpack may be
conducive to use in instances where the medication or supply is
received from a supplier as the cost of the overpack and material
used therein is relatively minimal. Further, pharmacy automation
tools, such as an automated dispensing system, may be configured to
package and dispense medications and supplies in such overpacks,
such that manual packaging of the medications or supplies into
overpacks may not be required, thereby increasing efficiency and
reducing cost. Some medications may be available from a supplier in
bulk quantities in such overpacks, such as the illustrated box 144
of unit dose blisters 146 supplied in bag style overpacks 140.
[0092] FIG. 5 illustrates another example embodiment of overpacks
according to embodiments of the present invention. The illustrated
embodiment includes various sizes of boxes, ranging from a small
box 147 to a large box 148. The small size and the large size may
be dictated by the sizes of medications and supplies to be handled
within a healthcare facility. In the illustrated embodiment, the
boxes 147, 148 include hinged doors on a front side of the box. The
doors may be hinged proximate the bottom of the front, opening
outward. The boxes may include a common depth such that the boxes
may be arranged in a stacked configuration 149 while each of the
doors to each of the boxes remain accessible.
[0093] Overpacks according to embodiments of the present invention
may also facilitate automation of medication order fulfillment. For
example, as illustrated in FIG. 6, empty bins 160 of various sizes
but of a common profile may be configured to be transported along a
conveyor 162 and be filled by a robot 164 or other form of
automation. The robot 164 may place a medication or supply 166 into
the bin 160 for dispensing to a patient. Embodiments of the present
invention may also be used with existing automated pharmacy
dispensing systems, such as Robot-Rx.TM. from McKesson.RTM. which
may distribute medications from an inventory to an overpack for
transport to a location proximate a patient.
[0094] Overpacks may be configured to contain only a single
medication (i.e., a unit dose), a medication and a related supply
(e.g., a vial of medication and a syringe), or the overpacks may be
configured to contain multiple medications destined for the same
patient. For example, if a patient requires five medications in the
morning, three in the middle of the day, and four medications in
the evening, an overpack may be filled with the five morning
medications, a second overpack may be filled with the three
middle-of-the-day medications, and another overpack may be filled
with the four evening medications. In such an embodiment,
individual tracking and control over unit dose medications may be
lost; however efficiencies may be gained by using only a single
overpack for each time of day that medication is required for the
patient.
[0095] According to some embodiments of the present invention,
overpacks may also include identifying indicia disposed thereon for
identifying the contents of the overpacks. In one embodiment, the
overpacks may include an overpack identification number which is
correlated with a medication or supply that is placed into the
overpack. The correlation between the overpack identification
number and the contents may be performed by an automated system
that loads the overpacks. Such a correlation would allow an
overpack to be scanned to determine the overpack identification
number, and then referenced in a database to determine the contents
of the overpack without requiring a person to review the contents
of the overpack. The database may be maintained by a server in the
healthcare facility configured to track and monitor medication
dispensing within the healthcare facility.
[0096] According to another embodiment, the overpack may include a
label that is written to for denoting the contents of the overpack.
FIG. 7 illustrates an example embodiment of a patient
identification label 172 that is printed and paced into an overpack
170. The illustrated overpack may be a blister pack, bag, or
envelope configured to receive a medication unit dose. The overpack
170 may further be configured with a hole 174 for uniform storage
and retrieval. While illustrated as a patient identification label
172, the label attached to an overpack may identify the contents of
the overpack without regard for a specific patient. In the
illustrated embodiment, the patient identification label may
include a barcode or other indicia identifying the patient and the
patient identification label 172 may be inserted into a pocket or
otherwise affixed to the overpack 170. The identification may also
be printed directly onto the overpack material rather than onto a
separate label.
[0097] FIG. 8 illustrates an example embodiment of the overpack 170
as carried on a rod 176. The overpack 170 may be carried on the rod
176 for automated distribution, transport, or storage. While the
illustrated patient identification label 172 includes a barcode and
name, embodiments may include a patient or overpack contents label
that includes a radio frequency identification (RFID) label
configured to be read by an RFID reader exclusive of or in addition
to other identifying indicia, which may include barcodes, text, or
other human or machine readable information. In some embodiments,
the label 172 may include an image of the medication that is
supposed to be contained within the overpack 170 to allow
authorized medical personnel to visually confirm the contents of
the overpack are correct. While identifying indicia may be printed
to a label, embodiments of the present invention may include
overpacks using electronic ink labels. Electronic ink labels may be
"printed" by programming such that when a medication or supply is
loaded into an overpack the electronic ink label is programmed to
display identifying indicia about the medication or supply
contained within the overpack. Electronic ink labels may function
in the same manner as conventionally printed labels (e.g. by
thermal printing, ink jet printing, laser printing, etc.) such that
they may be read by a user or by a reading device.
[0098] Additionally or alternatively, medications, such as blister
packs may include identifying information printed to the blister
pack. Overpacks may be configured such that the identifying indicia
of the medication packaging is readable through the overpack. For
example, a blister pack with identifying information thereon may be
placed into a bag through which the blister pack may remain
readable.
Input Organization
[0099] Medications or supplies, whether packaged in overpacks as
outlined above, or in their native containers (such as blister
packs for pills or intravenous bags), may be stored and transported
within the healthcare facility. Storage of the medication and
supplies may be within the central pharmacy or at a unit storage
device. While the central pharmacy may supply medications and
supplies to an entire healthcare facility, a unit storage device
may be located remotely from the central pharmacy and may be
configured to store medications and supplies only for patients
serviced in a particular unit of the healthcare facility as will be
described in further detail below. As such, there may be multiple
unit storage devices within a healthcare facility.
[0100] Transporting or moving medications and supplies within a
healthcare facility is inefficient when the medications are moved
individually or without regard for other medications that are bound
for the same or a similar destination. As such, logistics may be
implemented to optimize transport and to efficiently move groups of
medications to common locations, such as unit storage devices,
within a healthcare facility. Software may be used to group
together a plurality of medications or supplies in overpacks to be
sent to the same location. The software may be implemented on a
user terminal, as described further below, or across a network of a
healthcare facility. The software may determine which overpacks are
to be grouped, and route them to their appropriate destination. As
described herein "routing" of medication and supplies within a
healthcare facility includes generating a route or a planned route
for the medication and supplies. Routing is generally provided by
software, while the physical transport of the medication and
supplies is performed by hardware, or in some cases, people. For
example, a route may be established for an individual unit dose in
an overpack; however, that overpack may be transported together
with other overpacks that have the same, or a portion of the same
route.
[0101] Embodiments of the present invention may provide means for
organizing medication and/or medication overpacks for efficient
transportation from the central pharmacy. In order to efficiently
move medications and supplies or products within a healthcare
facility, the medications and supplies may be organized into groups
of medications and supplies that are bound for the same general
location, such as the same unit storage device. Further, individual
accessibility to, or identification of each of the medications or
supplies that are within a group may be desirable. Once the
medications and supplies arrive at their common destination, they
may need to be placed into a unit storage device or otherwise
distributed as appropriate. Therefore, organization of the
medications and supplies for transport to the unit storage devices
may increase efficiency of retrieval and local storage of the
medication and supplies.
[0102] Provided herein are methods and apparatuses to organize and
transport medication and supplies from a central pharmacy or from a
remote pharmacy and/or from a central supply storage location to
local storage, such as at a unit storage device. The manner in
which the medications and supplies may be organized for transport
may facilitate automation and enhance the efficiency of their
distribution.
[0103] Commonly used medications, such as aspirin, may be provided
in cartridges or magazines where individual unit doses of
medication are available to be dispensed from the magazines. The
magazines or cartridges may be configured to be received by a local
storage device (e.g., a unit storage device) for distribution on an
as-needed basis. Magazines and cartridges allow for a high volume
of storage in a relatively compact form factor. The shape of the
medication package or overpack may also allow for efficient
one-at-a-time distribution of the medication from the magazine or
cartridge. Dispensing may be performed from the bottom of a
magazine or from the top using a variety of mechanisms to singulate
a unit dose or unit dose package of medication from the plurality
of unit dose packages of medication within the magazine. Cartridges
may also contain rolls of unit dose medication with individual
packages and perforations therebetween.
[0104] An example embodiment of a magazine is illustrated in FIG.
9. The illustrated embodiment depicts a medication package 60 which
may include a unit dose of medication. The illustrated medication
package 60 may be conducive to automated handling and may not
require an individual overpack; however, in some embodiments, such
as overpacks including various sizes of bins, the medication
package 60 may be dispensed to a an overpack bin for automated
transport. The medication package 60 may include a medication name,
dose, lot number, expiration date, or any similar identifying
indicia. The indicia may be in the form of text, barcode, or an
RFID tag. A plurality of medication packages 62 may be stacked and
inserted into a magazine 64. The cutaway of the magazine 64
illustrates the plurality of medication packages 62 disposed
inside. The magazine 64 may be filled at a central pharmacy, or the
magazine may arrive at the central pharmacy previously loaded with
unit dose medications ready for dispensing. A medication package 68
at the bottom of the stack of medication packages 64 may be
arranged proximate an opening 66 in the magazine 64, ready to be
pushed or drawn out of the magazine 64.
[0105] Systems according to example embodiments of the present
invention may include a device configured to remove a medication
package 68 from a magazine 64 automatically in response to an
indication for a need for the medication; however, magazines of
example embodiments may also be implemented in manual-fill
operations where a user may pull a medication from the magazine.
Example embodiments of automated systems for dispensing medication
packages from magazines are detailed further below.
[0106] Another example embodiment of an apparatus for packaging
commonly used or as-needed medications may include a "sausage-link"
type package as illustrated in FIG. 10. The sausage-link overpack
10 may include a tube of material, such as plastic, which may
receive a unit dose of medication 14 and be crimped 16 on either
side of the unit dose. The tube may be structured, such that it
holds its shape as in the case of a material such as low-density
polyethylene (LDPE), or it may be a flexible film, such as
polyvinylidene chloride (PVDC). The crimping may be performed, for
example, by heat or ultrasonic welding of the tube material between
the unit doses of medication 14. The crimps 14 may further include
perforations or other structurally weakening features to allow for
easy separation of a unit dose links. A plurality of linked unit
dose links may be stored in a spool or accordion style magazine
such that a link may be pulled out, separated, and the next link
containing a unit dose medication 14 is ready for use. The
sausage-link type package may include indicia written thereon,
and/or the sausage-link type package may include a blister pack
therein which may have identifying indicia written thereon. The
indicia of the blister pack may be readable through the
sausage-link type packaging such that additional indicia may not be
necessary.
[0107] Packaging of medications that may be stored in bulk in unit
storage devices may also include a two-dimensional array of unit
dose packages adhered to a backing. For example, a backing with a
releasable adhesive may receive thereon a plurality of unit dose
medications, such as blister packs of pills. When a unit dose is
needed, a nurse or other authorized medical person may remove one
or more of the unit doses from the two-dimensional array as
needed.
[0108] While some medications and supplies may be stored locally on
healthcare facility units for use as-needed, such as aspirin,
bandages, alcohol swabs, etc., other medications and supplies may
be distributed to healthcare facility units only in response to a
perceived or actual patient need, as described above with regard to
predicting medications which may be needed by a patient. In order
to distribute medications within the facility based upon an
indication that the medication may be needed, medications and
supplies may be grouped with other medications and supplies bound
for the same healthcare facility unit to be transported to the
healthcare facility unit. An example embodiment of such a grouping
may include trays configured to hold a plurality of bins as
described above with regard to the bins 102, 104, 106, and 108 of
FIG. 1. FIG. 11 illustrates an example embodiment of a plurality of
bins 150 of various sizes, but with a common profile, that may be
loaded onto a tray 152. The plurality of bins 150 may also be
covered, as a unit, with a single lid 154. The lid 154 may be
exclusive of, or in addition to individual closures on the
individual bins 150 themselves. The lid 154 covering all of the
bins 150 may provide security to the bins 150 to maintain them in
position on the tray 152 during transport, and the lid 154 may
discourage or prevent removal of an individual bin from the tray
when the tray is between the central pharmacy and the local
storage.
[0109] The tray 152 of example embodiments may be sized and shaped
to accommodate a plurality of overpacks and to hold them securely
to prevent shifting of the overpack during transport. As shown in
FIG. 11, the tray 152 is configured to receive a plurality of bins
150 with varying sizes. In order to maximize the use of the tray
152 and to help prevent shifting of the bins 150 within the tray,
the bins may fully occupy the tray. Since there are bins 150 of
varying sizes, some combinations of bin sizes will fully occupy the
tray 152, while others will fall short of occupying the full tray.
A software program may be configured to direct the bins that go on
each tray to maximize the use of each tray. For example, a software
program may recognize 50 bins that are to be transported to a
particular healthcare facility unit. The software may analyze the
size of each bin and compile groups of bins that fully utilize
trays to maximize the tray use and increase the efficiency of the
transportation. The software may be configured to provide
information to a person who is manually loading bins 150 onto the
tray 152, or alternatively, in an automated loading system, the
software may direct the placement of specific bins on specific
trays by an automated loading mechanism which loads the bins into
the trays. Once loaded, the trays are ready to be transported to
their destinations. The tray 152 may have features at regular
intervals, such as slots, detents, or dividers to prevent bins 150
from moving or shifting while on the tray.
[0110] The software described herein may be part of a suite of
software or a software with a plurality of functions including:
predicting the anticipated medications which may be needed by
patients; loading medications and supplies into overpacks; grouping
overpacks for transport to local storage; establishing a route for
overpacks to their appropriate destination; directing transport of
the overpacks to proximate storage; and dispensing medications and
supplies. The software may perform some or all of these functions
while tracking each medication throughout the healthcare facility.
The software may further be combined with other software used for
administering medications and tracking overall inventory
counts.
[0111] FIG. 12 illustrates an example embodiment of a system
configured to load overpacks and group the loaded overpacks onto a
tray or cassette. In the illustrated embodiment, a medication unit
dose 20, such as a blister pack, may be scanned using a reader to
identify the medication by barcode, RFID tag, or other identifying
indicia of the unit dose medication. The scanning may be performed
automatically or manually by a user. Upon scanning, the software
that recognizes the identity of the medication unit dose 20 may
identify the appropriate bin size. For example, a unit dose blister
may require only a small bin, while a 100 mL IV bag may require a
large bin. The software may present the appropriate size bin to the
user, direct the user to the appropriate bin, or simply indicate to
the user the bin size appropriate for the medication unit dose via
a user interface. In the illustrated embodiment, an empty bin 22 of
the appropriate size is pulled from a cassette 24 containing bins
of the appropriate size. Other cassettes 26, 28 may contain bins of
other sizes. The user may then place the unit dose medication 20
into the selected bin 22. Each bin may include unique identifying
indicia thereon, such as a serial number, which may be scanned to
correlate the medication placed therein with the overpack serial
number. Subsequent scanning of the overpack may reference a
database to determine the medication that is associated with that
particular overpack. Additionally or alternatively, a label may be
printed or electronically written to for the overpack such that the
overpack may have a label identifying the contents of the
overpack.
[0112] As shown in FIG. 13, after the unit dose medication 20 is
placed into the bin 22, the bin 22 is loaded into the back of the
cassette 24 from which it was dispensed. The user may continue to
scan medication unit doses and load them into bins until any of the
cassettes 24, 26, 28 are full (i.e, no more empty bins). The full
cassette may then be loaded to a transport device, such as a
transport cart as described further below, for transport to a unit
storage device.
[0113] FIG. 14 illustrates another example embodiment of a system
for loading overpacks. In the illustrated embodiment, a unit dose
medication 30 is scanned by a reader 32 configured to read one or
more of a barcode, an RFID tag, or other identifying indicia. The
identified unit dose medication may be displayed on user interface
34 allowing a user to confirm the identity of the medication. The
user interface 34 may display information regarding the unit dose
medication including an image thereof such that a user can confirm
that the unit dose medication matches the displayed image. An
appropriately sized bin may be automatically selected based on the
unit dose medication identified and the appropriate bin 36 may be
sent along conveyor 40 from a plurality of bins of varying sizes
38. Identifying indicia on the bin may be scanned upon being
transferred from the plurality of bins such that the identity of
the bin (e.g., a serial number) may be correlated to the unit dose
medication that is loaded into the bin. In such a manner, the unit
dose bin may be associated in a database with the medication
contained therein, such that identification of the bin anywhere
within the healthcare facility may also identify the contents,
including such information as medication type, dose, expiration
date, etc. The unit dose medication may then be loaded into the bin
36 as the bin is advanced to a device to load the bin onto a
transport device (e.g., a cart, pneumatic tube, elevator,
etc.).
[0114] Another example embodiment of loading unit dose medications
into bins may be similar to that illustrated in FIG. 14; however
the system may allow loading of multiple bins with the same
type/dose of medication at the same time to increase efficiency.
For example, if a user has seven unit doses of a particular
medication, the first unit dose may be scanned by reader 32, and a
quantity of unit doses may be entered on the user interface 34.
Subsequently, the corresponding number of appropriately sized bins
36 may be transferred from the plurality of bins 38 to the conveyor
40. The user may then load all of the bins substantially
simultaneously to increase efficiency by reducing the time
required.
[0115] FIG. 15 illustrates an example embodiment of filling bins
with unit dose medications automatically. A magazine 44 may be
loaded with a plurality of unit dose medications 42. The magazine
44, and/or the medications stored there in 42 may include
identifying indicia to identify the medication unit doses. Each
magazine may include an orifice 46 through which the unit dose
medications 42 are dispensed. A carousel 48 may include a plurality
of magazines 50 disposed about the carousel 48. An automated
dispenser 52 may be configured to dispense unit dose medications 42
from the plurality of magazines 50. As the carousel 48 rotates,
different magazines 50, containing different unit dose medications
(or optionally, additional supplies of a frequently used unit dose
medications) may be rotated into alignment with the dispenser 52
for dispensing to unit dose bins 54 advancing along conveyor 56.
The bins 54 may be identified by a reader configured to read
identifying indicia from the bins and a database configured to
correlate the dispensed unit dose medication with the appropriate
bin. A user interface 58 may be provided to allow user monitoring,
auditing, and intervention when necessary. In the example
embodiment of FIG. 15, bins 54 may be loaded substantially
automatically with little to no user input required.
[0116] FIG. 16 illustrates an example embodiment of an apparatus to
organize and transport medication and supplies from a central
pharmacy or from a remote pharmacy to local storage. The embodiment
of FIG. 16 illustrates a unit dose of medication 180, which may be
loaded into an overpack, in this case, a bag 184 using a bag
filling device 182. The bag 184 may then be loaded into a clip of a
carrier 188. The illustrated carrier includes a plurality of clips
(not shown) which each hold a bag 186 type overpack. Rather than a
tray as illustrated in FIG. 11, FIG. 16 uses a carrier in which the
bags are suspended. As will be appreciated, the carrier can
accommodate items of various sizes by receiving various sized bags
within the clips. Alternatively, as illustrated in FIG. 17, items
that are very large may be suspended by more than one clip. The
carrier 188 of FIG. 17 is illustrated carrying a large item in a
bag 190 with both ends of the bag suspended within clips 192.
[0117] Another example embodiment of organization of the overpacks
in preparation for transport to a unit storage device may include
bag-type overpacks that are disposed on a rod. FIG. 8 illustrates
an example embodiment of an overpack 170 that is carried by rod
176. The rod 176 may be independently movable while holding a
plurality of overpacks 170. For example, rod 176 may be received
within a peg-board style apparatus for storage or transport. The
rod 176 may include medications in overpacks for a single patient,
and/or the rod may include medications for patients in a particular
location. One advantage to an input organization apparatus of this
type may include that an automated dispensing system, such as
Robot-Rx.TM. may be configured to automatically load medications
onto the input organization apparatus in preparation for
distribution.
Transport to Unit Storage
[0118] According to example embodiments of the present invention,
upon organization of the medications and supplies in overpacks into
groups, the grouped articles need to be transported to a location
proximate the patients, or at least closer to the patients than the
central pharmacy, such as a unit storage device. The mode of
transportation may vary according to the type of overpacks used,
the type of input organization used, etc. Provided herein are means
for transporting medications and/or overpacks from a central
pharmacy to a unit storage device.
[0119] An example embodiment of an apparatus used for
transportation from the central pharmacy to the unit storage device
is illustrated in FIG. 18 in which a lidded tray 200 is received
within a transport cart 202. The lidded tray may be similar to that
which is illustrated in FIG. 11 in which bins of varying size are
received on a tray. While the illustrated embodiment shows a lidded
tray 200, transport carts 202 may be configured to receive other
types of overpacks and input organization devices.
[0120] The transport cart 202 may be configured with an RFID tag
reader configured to read RFID tags associated with overpacks. In
such an embodiment, the RFID tag reader or readers associated with
the cart 202 may read the RFID tags of each of the overpacks
received within the cart 202. Thus, the cart 202 may recognize the
inventory stored therein for transport to a unit storage device. In
some embodiments, the cart 202 may report the inventory via
wireless communications to a network which monitors the location of
the transport cart 202 and the contents therein. As such, an
inventory control system may be configured to recognize and track
the location of each overpack and unit dose medication or supply
stored therein throughout the healthcare facility. Example
embodiments of communication means and the networks over which such
a system may operate will be described further below.
[0121] Additionally or alternatively, trays 200 may include
identifying features such as RFID tags, barcodes, or other
identifying indicia. Embodiments of the present invention may
"build" a tray of overpacks by identifying the tray and filling the
tray with identified overpacks. In such an embodiment, the tray may
be tracked with an understanding of the contents of that specific
tray.
[0122] Transport carts according to example embodiments of the
present invention may be configured to be secure storage of the
medications and supplies contained therein while transporting the
articles from the central pharmacy to the unit storage devices. For
example, as illustrated in FIG. 18, each tray 200 may be configured
to be received within a shelf 204. The tray 200 may be configured
such that individual bins or overpacks may not be removed from the
tray 200 without the lid being removed. The shelf may include
features or may be sized such that when a tray 200 is received
within the shelf 204, the lid may not be removable. As such, the
individual bins or overpacks may not be accessible without removing
a tray 200 from the shelf 204. To prevent unauthorized removal of a
tray 200 from the shelf 204, the cart may include a security
feature to lock the trays into the shelves. The cart may include a
single security feature or lock to lock all trays within all of the
shelves simultaneously, or optionally, the cart 202 may include
individual locks 206 for each shelf 204. Individual locks 206 for
each shelf 204 may allow different authorized medical personnel
access to different shelves. For example a medical staff person
with a first level of authority may be authorized to remove trays
200 that do not contain controlled substances, while a medical
staff with a second, higher level of authority may be provided
access to shelves with trays containing the controlled
substances.
[0123] The security features of carts 202 of example embodiments,
whether for an entire cart or for specific shelves 204, may be
configured to require a key, identification card, PIN, or biometric
identifier to access the trays 200. In example embodiments in which
the cart 202 is in communication with a network, a notification of
access may be provided to the network in response to a tray being
accessed. The notification may provide the identification of a user
who accessed the tray to provide an audit trail of the medication
and/or supplies of the tray from the central pharmacy to the unit
storage device.
[0124] Transportation of carts from the central pharmacy to the
unit storage device may be performed manually or may employ
automation, or a combination thereof. For example, the cart 202 of
FIG. 18 may include a drive mechanism and guiding features that
allow the cart 202 to be an autonomous guided vehicle. The guiding
features may include an apparatus configured to detect guide wires
disposed within a floor of a healthcare facility, or the guiding
features may include software with a functional knowledge of a
healthcare facility layout and an ability to navigate the
healthcare facility, among other autonomous guiding features.
[0125] In some example embodiments, the cart 202 may not include
features to enable autonomous guidance and transport through the
healthcare facility, but an autonomous guided vehicle may engage
the cart 202 and guide the cart to the destination. In such an
embodiment, the autonomous guided vehicle may be a compact,
relatively flat device which slides under the cart 202 and guides
the cart from underneath, thereby not increasing the footprint of
the cart during transportation. In other embodiments, an autonomous
guided vehicle may engage the cart 202 from a side, and push the
cart through a facility to its destination.
[0126] Transportation of overpacks to a unit storage device may
also include automated loading and unloading of the overpacks to
the unit storage device. For example, a transport cart may engage a
unit storage device wherein overpacks or a tray containing
overpacks may be removed from the transport cart by a retrieval
device, as outlined below. Such automated loading and unloading may
allow transport carts to advance efficiently between unit storage
devices without having to wait for manual unloading.
[0127] FIG. 19 illustrates another example embodiment of an
apparatus for transporting medications and/or supplies from a
central pharmacy. The illustrated embodiment of FIG. 19 depicts a
cart 210 configured to carry a plurality of carriers 214. In such
an embodiment, the carriers may be suspended from shelves within
the cart 210. The cart 210 of the depicted embodiment includes
sliding doors 218 which may prevent unauthorized access by being
lockable. Unlocking of the sliding doors may require identification
of authorized medical personnel by identification card scanning,
biometric scanning, PIN entry, or keyed entry. As outlined above
with respect to FIG. 18, access to the cart 210 may be reported to
a network for tracking of contents therein and for an audit trail
related to the handling of the medication.
[0128] Example embodiments of cart-based transport devices may also
include inventory stored thereon for replenishing as-needed
medications and supplies in a unit storage device. Such inventory
may be used to restock medications that have a low level of
inventory at the unit storage device, or if expiring medications
need to be replaced.
[0129] While the above embodiments describe cart-based transport
from the central pharmacy to unit storage, other types of transport
may be implemented. For example, medication overpacks may be
transported to unit storage devices along track based transport
systems, tube based transport systems (e.g., pneumatic tubes),
elevators, or other transport systems which may be automated to
varying degrees. Each of these embodiments may transport one or
more overpacks at a time in dependence upon their
implementation.
[0130] The efficiency of dispensing of medications and supplies
within a healthcare facility may be improved by delivering the
medications and supplies, including those that are known to be
needed (e.g., previously prescribed) and those that are predicted
to be needed, in groups to a location closer to the patients than
the central pharmacy. This transportation maximizes resources, such
as transport carts, while minimizing the required number of trips
that must be made to deliver medications and supplies to units of a
healthcare facility. Upon arrival at the healthcare facility unit,
the medications and supplies may be dispensed to a local storage
device that may further enhance the efficiency of distributing the
medications and supplies to the patients.
Unit Storage
[0131] As outlined above, in order to more efficiently distribute
medications to patients in a timely manner, it may be desirable to
store medications for patients in a location closer to the patients
than the central pharmacy. Further, as the majority of medications
are used during only a portion of the day (e.g., 9 am-5 pm),
relying on the central pharmacy to fill and distribute all
medication orders directly to the patients may overburden the
central pharmacy during the peak hours. Providing remote, local
storage of medications for specific patients, as afforded by the
predictive nature of example embodiments outlined above, allows a
central pharmacy to fill medication orders and distribute
medications and supplies off peak hours, ahead of the peak need for
the medications. In order to support this method of distribution,
unit storage devices may be employed in areas of healthcare
facilities, such as in nursing units or hospital floors, for
example. Embodiments of the present invention may include means for
storing medications and/or overpacks at a location between the
central pharmacy and the patient. The means for storing medication
may also be configured with means for user interface and means for
dispensing of the medications from the storage means.
[0132] An example embodiment of a unit storage device 250 is
illustrated in FIG. 19 in which medications and supplies are
received at the unit storage device 250 using input organization
devices as outlined above. In the illustrated embodiment, carriers
212 with medications in bags 220 may be received at the unit
storage device 250 and loaded into the interior 216 of the unit
storage device. Each of the carriers 212 of the illustrated
embodiment may be individually accessible within the unit storage
device 250 such that medications for a particular patient may be
easily accessed at any time. Further, when medications need to be
removed from a carrier, or an entire carrier requires removal from
the unit storage device, the carrier may be directly accessed for
easy removal.
[0133] FIG. 20 illustrates another example embodiment of a unit
storage device 260 wherein a cart 270 transports trays 266 of
overpacks 268, in this case various sizes of bins with a common
profile. Upon removal of the tray 268 from the cart 270, the lid
264 may be removed, and the overpacks 268 may be loaded into the
shelves 262 of the unit storage device 260. In some embodiments,
the overpacks 268 may be removed from the tray 266 before loading
into the unit storage device 260, while in other embodiments, the
overpacks 268 may remain on the tray 266 to allow faster, more
efficient loading.
[0134] As outlined above, the cart 270 may include features which
allow the cart to report inventory to a network of the healthcare
facility. Upon access to a tray 266 or carrier 212, the a
communications interface of the cart 270 may provide an indication
that a tray 266 or carrier 212 has been accessed, and removed for
loading into a unit storage device. Similarly, the unit storage
device may be equipped with a communications interface and an
apparatus to detect the medications that are loaded therein. In
response to receiving a tray, carrier, or medication/supply
overpacks, the unit storage device may provide an indication to the
network of the contents received therein for inventory tracking
[0135] Unit storage devices according to embodiments of the present
invention may have controlled access such that only authorized
medical personnel may access the contents of the unit storage
device for loading, unloading, or accessing the medications and
supplies stored therein. Access may be granted to an authorized
medical person in response to identification of the authorized
medical person by identification card, PIN, biometric scan, or key.
Further, the access may be reported via a communications interface
to the healthcare facility network as appropriate.
[0136] FIG. 21 illustrates another example embodiment of a unit
storage device 280 which may be loaded from a side of the unit
storage device. In the illustrated embodiment, a tray of overpacks
282 may be inserted into a side 284 of the unit storage device 280
accessible through a door 286. One advantage to the illustrated
unit storage device 280 may include that it has a shallow depth
relative to a wall. For installation of unit storage devices into
existing facilities, space in which to locate a unit storage device
may be scarce. As such, when locating a unit storage device 280 in
an existing hallway, a shallow depth may be imperative. Further,
allowing the unit storage device to be loaded from a side 284 may
allow the unit storage device to be loaded without encroaching into
the hallway.
[0137] Unit storage devices of example embodiments may be
configured to store medications and supplies in overpacks
specifically designated for individual patients and they may be
configured to store bulk medications which are not designated for
individual patients. For example, a unit storage device may include
the predicted medications for the patients in a unit of a
healthcare facility needed over a particular period of time;
however, certain as-needed medications may not be included in the
predicted medications. Medications such as aspirin, antacids, etc.
may be stored in unit storage devices for dispensing on an
as-needed basis. Such medications may be provided to an authorized
medical person at the unit storage device, or transported to a
nurse server or patient server as detailed further below. The
as-needed medication may be stored within a unit storage device in
magazines, cartridges, spools of unit dose packages (e.g.,
separated by perforations), or the like.
[0138] Unit storage devices according to embodiments of the
invention may have an inventory monitor or control, which may be
implemented at the unit storage device, or remotely implemented
configured to monitor inventory and information about the
medication stored within the unit storage device. In this manner,
the inventory monitor may monitor medications stored in the unit
storage device for patients, and monitor inventory information
regarding as-needed medication and supplies. For example, as-needed
medications and supplies stored within the unit storage device may
include lot numbers, manufacture dates, expiration dates, or the
like. Inventory levels may be monitored for purposes of reordering
medications and/or supplies to be delivered to the unit storage
device. The inventory monitor may be configured to monitor a
plurality of unit storage devices and monitor the use of particular
medications or supplies at the various unit storage devices.
[0139] Medication that may be stored in unit storage devices for
use on an as-needed basis, as opposed to patient-specific
medication, may be stored in a unit storage device for a period of
time. During storage, a particular as-needed medication may
approach an expiration date. In response to approaching the
expiration date, an inventory monitor may evaluate other unit
storage devices to determine if any other unit storage devices
within a healthcare facility use the particular as-needed
medication at a higher rate. For example, an intensive-care unit
may use more pain medication than a cardiac unit. In response to
determining a higher rate of use of the particular as-needed
medication at another unit storage device, the inventory monitor
may be configured to direct a transfer of the medication
approaching the expiration date to the unit storage device with a
higher use rate of that medication. Such a transfer may reduce
waste of medications that have expired and may reduce inventory
costs.
[0140] An inventory monitor may also be able to predict upcoming
shortages of a particular medication. For example, an urgent care
unit may have a supply of flu vaccines. In response to an increase
in flu cases, the inventory monitor may determine an increased need
for flu vaccines and predict demand to outstrip current supply. In
response, the inventory monitor may initiate a request for
additional flu vaccines to be provided to the unit storage device.
The request may be sent to a central pharmacy, for example. Should
the central pharmacy not have sufficient inventory to meet the
demand, the inventory monitor may initiate an order from a remote
facility or distribution center.
[0141] Unit storage devices according to example embodiments of the
present invention may also be configured to provide refrigerated
storage. Some medications require refrigerated storage until they
are ready to be administered. According to embodiments in which
medications are temporarily stored at the unit storage device, such
refrigerated storage may increase the shelf life of the medication
and may allow the unit storage device to store refrigerated
medications for a longer period of time than otherwise
possible.
[0142] FIG. 22 illustrates an example embodiment of a high-capacity
unit storage device 960. The illustrated embodiment includes two
banks 962 of shelves configured to hold a plurality of medication
or supply overpacks. The overpacks of the illustrated embodiment
may include a common profile (e.g., frontal width and/or frontal
height) while having various sized depths to accommodate different
sizes of items. For example, each of the overpacks may be a bin
with a width of about four inches, and the depths may be two, six,
or twelve inches. The banks may have a depth of about 24 inches,
and each bank may have a plurality of compartments 964 configured
to receive the overpacks. Each compartment 964 may hold overpacks
totaling 24 inches in depth. In some example embodiments, overpacks
may be grouped together in compartments of the banks according to
the patient for whom they are intended. Additionally or
alternatively, overpacks may be grouped together in compartments of
the banks according to the size of the bins. For example, all
twelve-inch deep bins may be stored in a particular area of the
banks, while six-inch and two-inch deep bins may be grouped in a
respective area of the banks. A compartment may hold two
twelve-inch deep overpack bins, four six-inch deep overpack bins,
or twelve two-inch deep overpack bins.
[0143] The illustrated embodiment of FIG. 22 may further include
storage of blister packs separate from the common-profile overpack
bins. In the illustrated embodiment, blister pack storage 968 may
be configured to hold in each compartment a tray of unit dose
medications, each stored in a blister pack. As blister-packs are
relatively common form factors, and since packaging a blister pack
in an overpack bin may be less spatially efficient, the blister
pack storage may allow more unit dose storage of blister packs in a
smaller footprint.
[0144] The unit storage device of FIG. 22 further includes user
interface 966 which may be used by authorized medical personnel to
verify inventory, place medication orders, review medication order
histories, etc. The user interface may allow orders to be placed
for distribution to other locations, and may provide alerts and
messages as will be described further below.
[0145] The illustrated embodiment of FIG. 22 may further include
storage of as-needed medication. Such storage may be in the form of
magazines (e.g., as shown in FIG. 9) or as-needed medication may be
stored in compartments in the overpack bins. For example, aspirin
may not be a medication that is specified on a medication order,
but may be administered to patients on an as-needed basis. As such,
one or more compartments of blister pack storage may be configured
to hold unit-doses of aspirin. Such as-needed medication may be
dispensed on request, with or without other medication orders.
[0146] While the unit storage devices illustrated in FIGS. 19-22
are configured to hold trays of overpacks or carriers, other
example embodiments of unit storage devices are provided herein.
For example, in an embodiment in which the input organization
comprises a rod, as illustrated in FIG. 8, the unit storage device
may include a peg-board style receiving area in which rods may be
inserted for storage within the unit storage device. Unit storage
devices according to further example embodiments may also be
configured to use carousels which may include shelves, rods, or
other storage means to accommodate the overpacks provided. Unit
storage devices according to embodiments of the present invention
may further be configured to receive overpacks without trays or
carriers. For example, overpacks may be loaded onto shelves of a
unit storage device as detailed further below.
Unit Storage Loading/Unloading
[0147] Unit storage devices according to example embodiments of the
present invention may be configured to retrieve requested
medications automatically in response to a request. For example
once a unit storage device is loaded with the medications which are
needed, or predicted to be needed on a unit during a period of
time, the medications may be requested, or delivered in
anticipation of a request, to a nurse server or patient server. In
some embodiments, the unit storage device may be configured to
dispense medications and supplies directly to authorized healthcare
personnel at the unit storage device.
[0148] Embodiments of the present invention may include a means for
retrieving requested medications in response to a request and means
for loading medications onto or into a transport device.
Embodiments of the present invention may provide a retrieving
device for retrieving the requested medication or supply overpack
from the unit storage device and a loading device to load the
retrieved medication onto a transport device configured to
transport the requested medication or supply to the nurse server or
patient server. The retrieval device may be embodied in a number of
different forms. FIG. 23 illustrates an example embodiment of a
unit storage device 300 containing overpacks 302 of medication
and/or supplies. The overpacks 302 of the illustrated embodiment
are variable width bins; however, overpacks of many forms may be
implemented with embodiments of the unit storage device and
retrieval device described herein. The overpacks 302 are situated
on shelves 304 within the unit storage device 300.
[0149] Additionally, while the illustrated embodiment of FIG. 23
illustrates a single layer of overpacks available for retrieval,
further embodiments may include multiple layers of overpacks such
that overpacks may be behind the first layer, requiring overpacks
on the first layer to be moved to access the second layer, as shown
in FIG. 22. In still other embodiments, the unit storage device may
be two sided, such that two layers of overpacks are directly
accessible to be retrieved by virtue of being arranged on both
sides of the retrieval device.
[0150] The overpacks 302 of the illustrated embodiment of FIG. 23
may include identifying indicia disposed on the exposed, front
side, such as barcodes, text, etc. The overpacks 302 may optionally
include RFID tags for identification. The unit storage device 300
may determine the overpacks 302 stored therein by reading the RFID
tags of the overpacks or by reading other identifying indicia of
the overpacks when the overpacks are initially loaded into the unit
storage device. As shown, the overpacks 302 may be arranged on a
substantially vertical plane whereby each of the overpacks 302 is
individually accessible and retrievable without requiring removal
or movement of other overpacks.
[0151] The retrieval device of the illustrated embodiment includes
an X-Y robot 310 configured to traverse the substantially vertical
plane on which the overpacks 302 are arranged. The X-Y robot 310 of
the retrieval device may include a retrieval unit 306 disposed on
an X-axis arm 312. The retrieval unit 306 may be configured to move
laterally along the X-axis arm 312 to access the width of the unit
storage device 300. The retrieval unit may be configured with a
drive mechanism to advance laterally along the X-axis arm. For
example, the retrieval unit may include a pinion gear that is
rotated by an electric motor, where the pinion gear of the
retrieval unit 306 engages a rack gear disposed along the length of
the X-axis arm. A rack-and-pinion gear arrangement would afford the
retrieval unit 306 precise indexing capabilities desirable for
repeatably retrieving overpacks accurately. Alternatively, the
X-axis arm may include a belt or chain-drive mechanism which
advances the retrieval unit 306 along the X-axis arm as a carriage.
Such an embodiment may move the drive mechanism from the retrieval
unit to a mechanism located on the X-axis arm, providing a smaller,
potentially more nimble retrieval unit.
[0152] The X-axis arm may be movable along the Y-axis along a pair
of vertical columns 308. While the illustrated embodiment includes
a pair of vertical columns 308, embodiments may implement a single
vertical column. Further, the vertical columns 308 illustrated are
disposed at the distal edges of the unit storage device 300;
however, the vertical columns 308 could be disposed anywhere along
the width of the unit storage device. The X-axis arm may be
configured to move vertically along the columns 308 by one or more
pinion gears disposed on the X-axis arm, engaging one or more rack
gears disposed on one or more of the columns 308. Optionally, the
X-axis arm may be advanced along the columns 308 by a chain or belt
drive disposed in or on the columns 308 moving the X-axis arm as a
carriage.
[0153] While the above described and illustrated embodiment of an
X-Y robot retrieval device includes stationary columns 308 and a
movable X-axis arm, example embodiments may include a movable
Y-axis arm and one or more stationary X-axis arms arranged at the
top and/or bottom of the unit storage device.
[0154] The retrieval unit 306 may be configured with a scanning
device configured to scan identifying indicia of the overpacks 302.
The scanning device may include a barcode scanner, an image
detection device, or an RFID tag reader, for example. The retrieval
unit 306 may be configured to identify the overpacks and their
locations within the unit storage device upon loading of the
overpacks into the unit storage device. For example, when a tray of
overpacks is loaded into a shelf of the unit storage device, in
response to the unit storage device being closed (i.e., a loading
door being shut), or in response to a user command, the retrieval
device may advance along the shelves of the just-loaded overpacks
and scan each of the overpacks for identifying indicia. Upon
identifying an overpack, the retrieval device may store the
location and contents of the overpack.
[0155] The X-Y robot 310 and retrieval device 306 may also be
configured to organize or arrange overpacks within the unit storage
device. For example, upon loading of the unit storage device,
software may determine a more appropriate layout for the overpacks
contained within the unit storage device. Some medications may
require refrigeration, in which case those overpacks may be moved
to a refrigerated section. Further, overpacks may be grouped
according to a time frame in which the medications contained
therein may be needed. As such, the X-Y robot 310 may optimize the
layout of the overpacks to increase the efficiency of retrieval and
distribution of the medications.
[0156] In response to receiving an indication of the need of a
particular medication, or all of the medications for a particular
patient or group of patients, the retrieval device may commence the
retrieval process in which the required medications are retrieved.
The retrieval device may advance along the X and Y-axes of the unit
storage device to the location of the first overpack to be
retrieved. Upon arrival at the location of the first overpack to be
retrieved, the retrieval unit 306 may scan the identifying indicia
of the overpack to confirm it is the correct overpack intended to
be retrieved. In response to a positive confirmation, the retrieval
unit may retrieve the overpack from the location. The retrieval may
be in the form of pulling the overpack from the shelf and sliding
the overpack onto a holding surface of the retrieval unit 306.
Optionally, the retrieval unit may be configured with a grasping
device configured to grab and hold the overpack to advance the
overpack to the transport device, described further below.
[0157] In response to retrieving the first overpack to be
retrieved, the retrieval unit 306 may be advanced by the X-Y robot
to a location within or adjacent to the unit storage device for
loading onto a transport device 320. Optionally, the retrieval unit
306 may position the retrieved overpack in a staged position ready
to be placed onto a transport device as illustrated at 322. In the
example embodiment of FIG. 23, the transport device 320 may be
located above the unit storage device 300, configured to advance
along a channel proximate the ceiling as will be described further
below.
[0158] In some example embodiments, the retrieval device may
retrieve the overpack and place the overpack in a staged position
awaiting the transport device. In such an embodiment, a loading
device may be configured to load the overpacks onto the transport
device. The loading device may be as simple as a mechanism by which
overpacks are pushed or pulled onto the transport device.
Additionally or alternatively, the transport device may include the
loading device, whereby the transport device is configured to load
the overpacks onto the transport device. The retrieval device may
also operate as the loading device, configured to retrieve the
overpacks and load them directly onto the transport device.
[0159] While the illustrated unit storage device is configured to
temporarily store overpacks of medications and supplies awaiting
delivery to a location proximate a patient, embodiments of the unit
storage may also include devices arranged to load transport devices
with overpacks upon their arrival at the unit storage. For example,
as illustrated in FIG. 24, the unit storage device 330 may be
implemented as a loading device to load a transport device. The
illustrated embodiment includes a unit storage device 330 including
a conveyor system 332 configured to receive a carrier 334 holding a
plurality of overpacks 336. Once the carrier 334 is loaded into the
conveyor system 332, the conveyor advances the carriers 334 toward
a shuttle 338. The shuttle 338 is configured to advance the
carriers along a path defined by a track along which the shuttle
338 rides. The track may be disposed within an area proximate the
ceiling of a healthcare facility unit and may be enclosed as
illustrated at 340.
[0160] FIG. 25 illustrates another view of the example embodiment
of the high-capacity unit storage device with one of the banks 962
omitted for ease of understanding. In the illustrated embodiment,
an end-of-arm-tool (EOAT) is configured to be attached to a
mechanism, such as a robot arm or an X-Y robot, and moved into
alignment with any of the compartments 964 of the banks 962. The
mechanism for moving the EOAT between compartments is not shown in
the illustrated embodiment. The EOAT of the illustrated embodiment
is configured to be a retrieval device arranged to withdraw
overpacks 972 from their respective compartment 974. As shown, the
EOAT has retrieved four medium sized overpacks 972 from compartment
974.
[0161] In practice, a request for medication and/or supplies may be
received at the unit storage device 960. The request may be
received automatically from a network entity configured to request
medications in anticipation of their need. Requests may also be
received from the user interface 966 of the unit storage device
960, a nurse server, patient server, nurse cart, workstation, or
mobile device. Upon receipt of the request, the unit storage device
may be configured to fill the medication order by retrieving each
of the medications and supplies that are requested. The EOAT may be
moved into alignment with a compartment 964, 974 containing one or
more of the requested medications or supplies. The EOAT may
retrieve the overpacks 972 of the compartment, which may include
overpacks that do not contain medication or supplies that are part
of the order. The EOAT 970 may move the retrieved overpacks 972 to
a dispensing area 976 of the unit storage device 960. The
dispensing area 976 may include a mechanism for removing the
overpacks 972 containing medications or supplies that are part of
the order from the EOAT 970. Overpacks 972 containing medications
or supplies that are not part of the order may remain on the EOAT
970. The EOAT 970 may then return the overpacks 972 not needed, and
retrieve any additional overpacks from any additional compartments
which may contain medication or supplies that are part of the
medication order. The additional overpacks may be grouped with the
previously retrieved overpacks until all of the overpacks
containing medication or supplies in the request are retrieved.
[0162] The overpacks containing the medication or supplies in the
request are grouped and may be transported to a nurse server or
patient server by a transport device as described further below, or
dispensed from the unit storage device to an authorized medical
person. While the above described embodiment includes grouping the
overpacks, in another example embodiment, the overpacks containing
the medication and/or supplies may be emptied at the dispensing
area 976 to a patient-specific container 978. The emptied overpacks
may then be returned to their compartment with any unused
overpacks, or alternatively, returned to an empty-overpack return
area for subsequent return to the central pharmacy. The patient
specific container 976 may be transported to a nurse server or
patient server, or optionally, dispensed from the unit storage
device to an authorized medical person.
[0163] FIG. 26 illustrates another example embodiment of a unit
storage device 600 which is configured to load a transport device
606 with overpacks for transport to a location closer to the
patient for whom the medication or supplies are intended. The unit
storage device 600 of FIG. 26 may not be configured for static
storage of overpacks, but instead receives a plurality of overpacks
and queues them for transport to a nurse server or patient server.
In the illustrated embodiment, a serpentine conveyor 602 advances
overpacks received at the unit storage device 600 to a staging area
604 where the overpacks await a transport device 606 to transport
the overpacks to the appropriate nurse server or patient server.
Embodiments according to the illustration of FIG. 26 may be
configured to be very narrow and thus may be used in facilities in
which floor space is limited. The embodiment of FIG. 26 may
protrude only minimally from the wall to allow installation in
hallways or quarters where minimal space is available.
[0164] Overpacks may be loaded into the unit storage device 600
grouped according to their destination such that they may be loaded
onto transport devices in groups. Optionally, in embodiments in
which the overpacks are not grouped according to destination, a
scanner within the unit storage device 600 may scan identifying
indicia of the overpack to determine destination, and subsequently
load each overpack onto a transport device destined for that
destination. The unit storage device may assign a destination to a
transport device once enough overpacks to fill the transport device
have been scanned. Alternatively, if there are not enough overpacks
to fill a transport device and the time waiting for enough
overpacks has exceeded a predefined threshold, the overpacks may be
loaded to a transport device and sent to their destination without
the transport device being full.
[0165] FIG. 27 illustrates another example embodiment of a unit
storage device 610 which may be transportable from the central
pharmacy to the unit of the healthcare facility. In the illustrated
embodiment, a cart including a carousel that rotates as shown by
arrows 620 may include a plurality of bins 614 or locations where
overpacks may be loaded at the central pharmacy. The unit storage
device 610 may be mobile such that upon loading at the central
pharmacy, the device 610 may be transported (e.g., manually or via
AGV) to a unit of the healthcare facility. A unit storage device
receiver 622 may be located on the unit configured to receive the
unit storage device 610 therein. The unit storage receiver 622 may
include a door or may be substantially closed off in response to
receiving the unit storage device 610. The unit storage receiver
may also include spindles 618 configured to be received within
bores 616 of the unit storage device. The spindles 618 may rotate
within the bores 616 to turn the carousel. The carousel may be
rotated to provide access to each of the overpacks stored therein.
An automated retrieval device, such as the X-Y robot described
above, or potentially a single-axis robot, may retrieve the
overpacks from the carousel and load them onto a transport device
for transport to a location proximate the patient to whom the
medication or supplies are to be administered.
[0166] While the illustrated embodiment depicts a mobile unit
storage device 610 including a carousel, embodiments may include
only a cart with the overpacks stored thereon, where the cart may
be received at a unit storage receiver and a retrieval device may
retrieve the overpacks from the unit storage device as needed.
Further, while the embodiment of FIG. 27 relies on the rotating
mechanics of the spindles 618 to be disposed in the unit storage
receiver 622, further embodiments may include a motive mechanism
within the unit storage device 610. The unit storage receiver 622
may provide power, such as an electrical connection, to power the
motive mechanism of such a unit storage device.
[0167] Further example embodiments of unit storage devices may
include dynamic shelves (i.e., movable shelves) that may be loaded
as outlined above with respect to static shelves. While an X-Y
robot may be employed to load/unload static shelves in a unit
storage device as outlined below, dynamic shelves, such as a
carousel with a vertical axis of rotation, may allow a robot
configured only to move in a Y-axis to access all of the shelf
locations of the unit storage device as the carousel rotates.
[0168] Unit storage devices according to example embodiments of the
present invention may also be configured to present overpacks
directly to an authorized medical person in response to receiving a
request. For example, a nurse may be aware of an immediate need for
a medication for a patient and may be near the unit storage device.
The nurse may request the medication via user interface or via a
remote device (e.g., a mobile device or nurse cart). The unit
storage device may be configured to present the requested
medication to the nurse in response to receiving the request.
Transport to Proximate Storage
[0169] As outlined above with regard to the carrier including a
plurality of bag-type overpacks, a shuttle may be configured to
advance the carrier to a second location, which may include a nurse
server or a patient server as will be detailed further below. The
shuttle 338 of FIG. 25 may be configured to advance along a track
to the nurse server or patient server, each of which will be
detailed further below.
[0170] Embodiments of the present invention provide various means
for transporting medications and overpacks from unit storage to a
location proximate a patient, such as a nurse server or patient
server. Embodiments may further include means for transporting
medications and overpacks from the central pharmacy to a location
proximate the patient. Such transport means as described herein may
provide a substantially automated mechanism for moving medications
and overpacks throughout a healthcare facility.
[0171] FIG. 28 illustrates an example embodiment of the carrier 334
of FIG. 25 illustrated with a plurality of receivers 342, each
configured to receive a clip (not shown). In some embodiments, the
clips may be integrally formed with the carrier and not be
removable. In other embodiments, such as the illustrated
embodiment, the clips may be removable from the receivers 342 of
the carrier 334.
[0172] The illustrated embodiment of the shuttle 338 includes a
trapezoidal shaped projection 346 configured to be received within
the trapezoidal recess 344 of the carrier 334, similar to a
dove-tail joint. In this regard, the carrier 334 may be received on
the shuttle 338 by a laterally sliding movement. The carrier 334
may be locked or latched onto the shuttle 338; however, a lock or
latch may be unnecessary if the rate of movement of the shuttle and
the lateral movement of the shuttle is below a degree in which the
carrier would slide on the shuttle. When the shuttle 338 moves
along the track in the direction of arrow 348, or opposite arrow
348, the carrier is precluded from movement relative to the shuttle
in the direction of arrow 348 or opposite arrow 348 by the shape of
the joint formed by the projection 346 and recess 344.
[0173] The shuttle 338 may be configured to be advanced along a
track 350 by a variety of mechanisms. For example, as shown in the
illustrated embodiment, the shuttle 338 may include rollers 352
attached to a portion of the shuttle 338, and the rollers 352 may
be configured to ride along a track 350. The shuttle 338 may be
suspended from the track 350 and advanced by the rollers 352 along
the track. The rollers 352 may be driven by, for example, an
electric motor, which may receive power from a battery pack, or
alternatively from one or more bus bars extending along the track
350. Alternatively, the shuttle 338 may be advanced along the track
350 by a cable or belt arranged proximate or inside of the track
configured to pull the shuttle 338 along the track 350. In some
embodiments, the shuttle may be configured to advance along the
track 350 using magnetic levitation or mag-lev. As will be
appreciated, a variety of mechanisms may be employed to advance the
shuttle 338 along the track 350.
[0174] As shown in FIG. 25, the track along which the shuttle 338
and carrier 334 may ride may be enclosed by enclosure 340 to
preclude unauthorized access to the medications during transport
and to prevent external interference with moving shuttles,
carriers, and the overpacks carried therewith. Example embodiments
of transport devices that use tracks may enjoy advantages over
conventional transport means as the tracks may be disposed
proximate a ceiling, out of the way of patients, nurses, and
physicians in a healthcare facility. As embodiments of the present
invention may be implemented in existing facilities which were not
originally designed to accommodate such transport devices,
positioning the track and enclosure 340 proximate a ceiling may
enable a facility to implement the transport device while not
interfering with areas used by people, wheelchairs, and other
portable medical equipment. While example embodiments may be
implemented in existing facilities, example embodiments may also be
accommodated in the designs of new structures, allowing the
transport devices to travel above a ceiling or between floors of a
healthcare facility.
[0175] FIGS. 25 and 28 illustrate an example embodiment of a
shuttle that is loaded with a carrier; however further example
embodiments of the present invention may provide for alternative
transport devices that may be used to move medications from a unit
storage device to a location proximate a patient. For example,
pneumatic tube systems may be implemented as a transport device to
advance medications as directed by a software system and/or a user
interface.
[0176] In a pneumatic tube system of example embodiments, a
pneumatic tube carrier may be loaded, either automatically or
manually, at a unit storage device, and transported through a
pneumatic tube network to the destination proximate a patient. In
some embodiments, the overpack for the medication and/or supplies
may be a pneumatic tube carrier, or configured to be received
within a pneumatic tube carrier.
[0177] Another example embodiment of a transport device which may
be used with example embodiments of the present invention may
include a train system that is configured to carry overpacks to a
location proximate a patient. As described above with regard to the
shuttle and carrier, a track-based system may be implemented in
which a vehicle is advanced along the track. The train may include
a single car or multiple train car embodiment which carries
overpacks to their destination.
[0178] Referring back to FIG. 23, the retrieval device 306 of the
X-Y robot of the illustrated embodiment may be configured to
retrieve overpacks from the unit storage and transport them to
either a transport device 320 or a staging area 322. The retrieval
device may also be configured to load the retrieved overpacks onto
the transport device 320, or alternatively, a separate loading
device may be implemented to load the retrieved overpacks onto the
transport device 320. In the illustrated embodiment of FIG. 23, a
car may be configured to receive the overpacks from the retrieval
device 306. A single car may be configured to hold a plurality of
overpacks, and additional cars may be coupled together for the
transport of a greater number of overpacks.
[0179] The retrieval device 306 of FIG. 23 may also be configured
to unload empty bins from the transport device 320. For example,
after dispensing the contents of a reusable overpack, such as a
bin, the empty bin may be returned to the unit storage 300, and the
retrieval device 306 may retrieve the empty bin and move it to an
area from which empty bins may be retrieved for return to the
central pharmacy.
[0180] The car of example embodiments may be configured to propel
itself along the track by an electric motor, for example. The car
may include one or more driven wheels which contact the rail, and
either by frictional engagement or by toothed engagement (such as a
pinion gear of the train engaged with a rack gear of the track),
the driven wheel(s) may advance the train along the track.
[0181] FIG. 29 illustrates an example embodiment of a car 400
according to example embodiments of the present invention. In the
depicted embodiment, a plurality of overpacks 402, in this case
bins of a common profile but differing widths, are staged in a
staging area proximate the unit storage device (e.g., staging area
322 of unit storage device 300 of FIG. 23). The car may include a
plurality of loading devices 408 configured to draw the overpacks
402 onto the car. The loading devices 408 may also be configured to
unload the overpacks 402 from the car by pushing them off to a
staging area, nurse server, or patient server. The loading devices
408 of the illustrated embodiment may each be sized according to
the width of the smallest overpack 402 such that a single loading
device 408 may be used to load and/or unload one of the smallest
overpacks. Larger overpacks may use more than one loading device
408 for loading and unloading. For example, an overpack that is
twice the width of the smallest overpack may use two loading
devices 408 for loading and unloading.
[0182] While the illustrated embodiment includes the loading
devices 408 on the car 400, further example embodiments may include
one or more loading devices disposed at the location where a car is
to be loaded or unloaded, thereby removing the loading devices and
their related structure from the mobile car 400.
[0183] The depicted embodiment of a car 400 further includes a
scanner 404 configured to scan the identifying indicia on the
overpacks 402. As outlined above, the identifying indicia may
include a barcode, RFID tag, text, or the like. As such, the
scanner may include a barcode scanner, an RFID reader, an image
capture device, etc. to scan the indicia to read the identifying
information contained therein. The scanner 404 may provide an
indication of the contents of the overpacks to software controlling
the car 400 and the loading devices 408 such that the loading
devices 408 load only the overpacks 402 that are to be transported
on the car 400.
[0184] While the staged overpacks 402 are described above as being
disposed proximate the unit storage device, in some example
embodiments, as further outlined below with regard to the nurse
server and patient server, there may be staging areas proximate the
patient.
[0185] In any of the above referenced track or tube based transport
devices, sensors may be disposed along the length of the track to
determine where a car may be located. Sensors may be disposed at
specific locations proximate to the unit storage device and
proximate to the car destination to facilitate accurate positioning
of the car at the unit storage device and nurse server or patient
server. Sensors may include optical sensors, proximity sensors,
RFID sensors (which may also determine the identity of the car), or
contact sensors. Additionally or alternatively, sensors may be
disposed on the car and they may be configured to detect specific
markings or way points disposed along the track to determine their
position.
[0186] Another example embodiment of a track-based transport system
is illustrated in FIG. 30 which depicts a car 440 engaged with a
track 442. The illustrated car 440 includes a payload platform 444,
a first bogie 446, and a second bogie 448. The car 440 further
includes a reader 450 configured to obtain location information by
reading a location identifying tape 452 which extends along the
length of the track 442. Bracket 454 is illustrated as an example
embodiment of a support which may be used to support the track 442
in an elevated, suspended position.
[0187] The track 442 may be of a variety of profiles to accommodate
various car and bogie designs. FIG. 31 illustrates the
cross-section or profile of a track according to an example
embodiment of the present invention. The illustrated embodiment
includes substantially square profile with chamfered corners 462
creating surfaces, some or all of which may be engaged by rollers
of the bogies as described further below.
[0188] According to some embodiments of the present invention, bus
bars 460 may be disposed along the length of the track in order to
conduct electricity for providing power to a drive system for a car
riding along the track, to provide power for any processing
capabilities which may be implemented on the car (e.g.,
positioning/locating, loading/unloading, reading overpack indicia,
etc.). Bus bars 460 of example embodiments may also be configured
to provide a communications channel to and from the car or cars
riding along the track. As the bus bars 460 necessarily are
electrically conductive, and as the track may be made of an
electrically conductive material (e.g., extruded aluminum), the bus
bars 460 may require electrical insulation from the track 442.
[0189] The track profile of the illustrated embodiment further
includes a channel 456 in which one or more bus bar insulators 458
may be received. While the illustrated embodiment includes two bus
bar insulators 458, embodiments may include one bus bar insulator,
or more than two bus bar insulators dependent upon the number of
bus bars and the number of bus bars accommodated by each bus bar
insulator 458. The bus bar insulators 458 are configured to receive
therein one or more bus bars 460 and are made of a material that is
a poor conductor of electricity, such as a plastic. In some
embodiments, the bus bars 460 may be mechanically held in place by
the bus bar insulators (e.g., by frictional engagement or by
snapping the bus bars into place) or the bus bars 460 may be
adhered to the bus bar insulators by an adhesive or the bus bars
460 may be heated and pressed into the insulators such that the
insulator material softens, conforms around the edges, and holds
the bus bars in place. The bus bar insulators 458 may be held in
the channel 456 by a deformable snap 461 received into a channel
462. The deformable snap may be that of a Christmas-tree fastener
or other push-in clips. The deformable snap 460 may extend along
the length of the bus bar insulator 458, or the deformable snap 460
may be disposed at intervals along the length of the bus bar
insulators, sufficient to secure the bus bars and bus bar
insulators to the track.
[0190] The profile of the track 442 of FIG. 31 further illustrates
a location identifying tape 452 which is received along the length
of the track 442. The location identifying tape may be continuous
along the entire length of the track, or may be disposed
periodically along the track. Location identifying tape according
to embodiments of the present invention may include demarcations
along the length of the track. Such demarcations may be read by a
reader (such as reader 450 of FIG. 30) to ascertain the location of
the car along the track. The demarcations may be located proximate
(i.e., at short intervals) to one another to afford greater
accuracy to location determination; however, embodiments of cars
configured to engage the track may be configured to accurately
discern distance traveled such that the demarcations may serve to
re-calibrate or verify the location of a car along the track. In
such an embodiment, the demarcations may be disposed along the
track at greater intervals. Additionally or alternatively, while
the illustrated embodiment includes a location identifying tape
along the length of the track, in some example embodiments, the
location identifying tape may be disposed along a wall of the
enclosure in which the track-based transport device travels, or a
wall of the facility along which the track extends.
[0191] Example embodiments of a track profile may further include
one or more alignment slots, such as dovetail slots 464 and 466.
Such alignment slots may be configured to receive alignment tabs,
as detailed further below, and/or to receive locking or securing
members configured to facilitate locking or securing of track
sections together. Track profile embodiments may further include
one or more grooved channel, such as grooved channel 468. The
grooved channel 468 may include grooves that are arranged to engage
a particular size and thread-pitch of fastener, such as an M6, M8,
M10, M12, 1/4-20, 1/4-28, 3/8-16, 3/8-20, or any such threaded
fastener. The dovetail slots 464, 466, and/or the grooved channel
468 may also be configured for use as mounting location for
mounting a bracket thereto. The bracket may be used to mount the
track to a wall or other surface to suspend the track as necessary
for routing through a facility.
[0192] Track profiles according to example embodiments of the
present invention may be configured to accommodate lateral bends
(e.g., left and right turns) such that a track may follow contours
of a facility. Further, track profiles may also be configured to
accommodate vertical bends (e.g., up-hill, down-hill) to
accommodate changes in elevation which may be necessary. The bends
of the track may be accomplished in a number of manners. For
example, in the case of an extruded aluminum track, the track may
be mandrel bent to the degree necessary. Further, while straight
track sections may be made of a first material (e.g. extruded
aluminum), bends may be made of a second material which may be more
flexible. For example, a bend may be made of a polymer such as
high-density polyethylene (HDPE) which may not be suitable for
long, straight runs between supports, but the HDPE sections may be
well suited for lateral or vertical bends, where supports may be
more closely spaced. Track sections made of more flexible
materials, such as plastics, may include a structural member
inserted there through to provide rigidity. For example, if a bend
were to be made of HDPE, a rib, such as a steel rod or tube of the
same radius and degree of bend may be inserted into a cavity in the
track section, such as cavity 470 of FIG. 31. A flexible length of
track may also be bent to the appropriate bend and injected with a
material into cavity 470 which may cure to render the track section
relatively rigid. Track sections made of non-conductive materials,
such as plastics, may not require the bus bar insulators 458 and
may have channels for the bus bars formed directly onto the track
section.
[0193] As outlined above, a track-based transport system may use a
track that is formed in sections. However, the sections of the
track may require secure joints there between that align the track
sections and maintain electrical continuity of bus bars extending
along the track. FIG. 32 illustrates an example embodiment of a
pair of end caps which may be used to join together sections of
track securely while maintaining alignment and electrical
continuity of the bus bars. The first end cap 472 is configured to
be attached to the end of a first section of track 476 and the
second end cap 474 is configured to be attached to the end of a
second section of track 478. The first end cap 472 is a female end
cap while the second end cap 474 is a male end cap. The first
section of track 476 and the second section of track 478 each
include channels 477, 479 for bus bars. These channels may be
disposed, for example, on bus bar insulators 458 as illustrated in
FIG. 31. Each of the end caps 472, 474 also include channels 473,
475 configured to receive the bus bars. As can be seen on the first
end cap 472, the channels extend parallel and aligned with the
channels 477 of the first section of track 476, and continue, at an
angle substantially perpendicular to the length of the track
section, around a face 488 of the first end cap 472. While not
visible in FIG. 32, the channels 475 of the second end cap 474
similarly extend across a face of the second end cap, substantially
perpendicular to the length of the second track section 478. The
end caps 472, 474 may be made of a material, such as a plastic,
such that the channels 473, 475 do not require separate bus bar
insulators. Further, as described in detail below, end caps made
from a plastic may allow deformation of features that may engage
the track sections to provide a more secure engagement.
[0194] Each of the first end cap 472 and the second end cap 474 of
the illustrated embodiment include a first tab 480 and a second tab
482 configured to be received within the section of track to which
they are engaged. The first tab 480 is configured as a dovetail to
engage the top dovetail groove as illustrated in FIG. 31 as 464.
The second tab 482 of each end cap is configured to be received in
the grooved channel 468 of the track profile of FIG. 31. In order
to hold the end cap to the end of the track sections, the dovetail
tab 480 may include deformable elements configured to be deformed
as the dovetail tab 480 is inserted into the dovetail groove 464.
The second tab 482 may be configured to be wider than the narrowest
portion of the grooved channel (i.e., between the peaks between the
grooves) and narrower than the widest portion of the grooved
channel (i.e., between the bottoms of the grooves). In this manner,
the ridges between the grooves may "bite" into the second tab 482
as it is inserted into the grooved channel 468.
[0195] The protrusion of the second, male end cap 474 may be
configured to be received within the recess of the first, female
end cap 472. The second end cap may also include an alignment ridge
484 while the first end cap may include an alignment channel 486.
As shown in FIG. 32, the first, female end cap 472 may include
channels 488 disposed across the face or width of the end cap 472
for receiving therein one or more bus bars.
[0196] FIG. 33 illustrates two perspective views of the female
first end cap 472 including the bus bar channels 473, the first tab
480, the second tab 482, and the alignment channel 486. Also
illustrated are the deformable members 481 of the first tab 480,
and the recess 490 that receives the second end cap 474. FIG. 34
illustrates two perspective views of the male second end cap 474
including the bus bar channels 475, the first tab 480, the second
tab 482, and the alignment ridge 484. Also illustrated are the
deformable members 481 of the first tab 480, and the protrusion 492
that is received within the recess 490 of the first end cap 472. As
illustrated, the first end cap includes an alignment channel at
both the top and bottom of the recess 490 while the second end cap
includes an alignment ridge at both the top and bottom of the
protrusion 492.
[0197] FIGS. 35 and 36 illustrate how the first end cap 472 and the
second end cap 474 cooperate to align the first track section 476
and the second track section 478. The first end cap of FIGS. 35 and
36 is shown as transparent for illustration purposes. As shown in
FIG. 35, the first track section 476 and the second track section
478 are misaligned laterally with the alignment ridge 484 of the
second end cap 474 aligned with the alignment channel 486 of the
first end cap. The alignment ridge 484 is received within the
alignment channel 486, and as the first track section 476 and the
second track section 478 are brought into alignment (aligning their
lengths to be substantially collinear) as shown in FIG. 37, the
protrusion 492 of the second end cap 474 is received within the
recess 490 of the first end cap 472. As the first end cap 472 and
the second end cap 474 align the first rack section 476 with the
second track section 478, the bus bars extending across the face of
the first end cap 472 (within the recess 490) are brought into
engagement with the bus bars extending across the face of the
second end cap 474 (around the protrusion 492). FIG. 37 illustrates
a cross section of the first track section 476 and the second track
section 478 joined together by the first end cap 472 and the second
end cap 474, with the bus bars 494, 496, engaged along their
lengths that extend across a respective end cap. Also visible in
the cross-section of FIG. 37 is a biasing ridge 498 configured to
bias the bus bars 496 of the second end cap 474 into engagement
with the bus bars 494 of the first end cap.
[0198] FIG. 38 illustrates an example embodiment of a mechanism for
securing the track sections together once aligned and engaged with
the first end cap 472 and the second end cap 474. The second end
cap and second track section are omitted from FIG. 38 for ease of
illustration. As shown, the first track section 476 includes the
bus bars 494 which extend around the end cap 472, across the face
of the end cap, substantially across the width of the track
profile. The mechanism for securing the track sections together
includes a dovetail insert 904, a plate 902, and threaded fastener
906. A second threaded fastener is shown received within the
grooved channel of the first track section 476. The dovetail insert
904 is configured to be inserted into the lower dovetail groove
(dovetail groove 466 of FIG. 31) of the first track section 476,
prior to engagement with the second track section. The dovetail
insert can be inserted before or after the first end cap 472 is
engaged with the first track section. The first end cap 472 is
configured with a dovetail groove that aligns with the lower
dovetail groove 466 of the first track section.
[0199] When initially inserted, the dovetail insert is received
fully within the first track section 476 and the first end cap 472,
not extending beyond the first end cap. Alternatively, the dovetail
insert 904 could be inserted into the second track section 478 and
the second end cap 474. After assembling the first track section
476 with the first end cap 472 to the second track section 478 with
the second end cap 474, the lower dovetail grooves of the first
track section, the first end cap, the second track section, and the
second end cap, are aligned. The dovetail insert 904 may then be
slid within the aligned dovetail grooves to extend from the first
track section to the second track section. The plate 902 may then
be aligned with the dovetail insert 904 and threaded fasteners 906
may be inserted through the plate 902 and into threaded holes of
dovetail insert 904. The threaded fasteners may then engage the
threaded holes of the dovetail insert and be tightened. The first
track section and the second track section may then be secured by
the tightened threaded fasteners 906. The dovetail insert resists
lateral movement between secured track sections, thereby precluding
the first end cap 472 and the second end cap 474 from disengaging
from one another laterally along the alignment ridge 484 and the
alignment channel 486.
[0200] Referring back to FIG. 30, example embodiments of
track-based transport systems may include a car 440 configured to
advance along the track 442. FIG. 39 illustrates an example
embodiment of a car 440 including a payload platform 444, a first
bogie 446, and a second bogie 448. In order to turn lateral bends
of a track 442 as shown, each of the first bogie 446 and the second
bogie 448 may be rotatably coupled to the payload platform 444. In
the illustrated embodiment, each bogie includes a tilt bracket 914,
916 that is rotatable relative to the payload platform about a
rotation axis 910, 912. The axes about which the tilt brackets 914,
916 rotate are orthogonal to a plane defined by the payload
platform 444. In this manner, the tilt brackets 914, 916 may turn
relative to the payload platform 444 as the car 440 advances along
the track 442 around a bend.
[0201] FIG. 40 illustrates an example embodiment of a car 440
according to the present invention configured to traverse vertical
bends to transition from traveling on a flat section of track to
traveling on an incline or decline. As shown, the car 440 includes
a payload platform, a first bogie 446 and a second bogie 448. The
first bogie is rotatably coupled to the payload platform 444 by
tilt bracket 914 and the second bogie is rotatably coupled to the
payload platform 444 by tilt bracket 916 as shown in FIG. 39. The
first bogie 446 is pivotably connected to the first tilt bracket
914 by pin 920 which defines a first pivot axis. The second bogie
is pivotably connected to the second tilt bracket 916 by pin 922
which defines a second pivot axis. The first pivot axis is
perpendicular to the first rotation axis about which the first tilt
bracket 914 rotates relative to the payload platform 444 (i.e.,
about rotation pin 910). The second pivot axis is perpendicular to
the second rotation axis about which the second tilt bracket 916
rotates relative to the payload platform 444 (i.e., about rotation
pin 912). The ability of the bogies 446, 448 to pivot relative to
the payload platform along the pivot axes enables the car 440 to
transition between flat track sections and inclines or
declines.
[0202] While the example embodiment of FIG. 40 can transition to
inclines and declines, the distance between the bogies, the degree
to which the bogies pivot, the grip of the drive wheels on the
track, the power of the drive motors, the weight of the car, and
the weight of the payload each contribute to determine the degree
of transition that can be traversed by the car. Each of these
factors can be configured according to the track layout for a
particular facility. Further, the tilt brackets 914, 916 may be
adjustable relative to the payload platform 444 to adjust the
distance between the tilt brackets.
[0203] FIG. 41 illustrates a view of the car of FIGS. 39 and 40
engaged with a track section 442 as viewed through a cross-section
of the track. As shown, the car 440 includes the tilt bracket 914
and bogie 446 coupled together by pin 920. A second pin may couple
the bogie 446 to the tilt bracket 914 on the opposite side of the
track 442; however, that pin is not visible in the illustrated
view. The bogie 446 may include a first pair of rollers 924, 926
with each roller configured to engage an opposing surface of the
rail, such as the lower surfaces 462 of the chamfered corners
illustrated in FIG. 31. The bogie 446 may also include a second
pair of rollers 930, 932 with each roller configured to engage an
opposing surface of the rail, such as the upper surfaces 462 of the
chamfered corners of FIG. 31. As shown, each of the rollers is
separated from an adjacent roller, at least in part, by the track.
The axis of rotation of each of the rollers is configured to be
substantially orthogonal to the plane defined by the payload
platform 444 when the car 440 is on a flat track surface. Each of
the rollers includes a roller surface that is disposed at an angle
relative to the axis of rotation of the roller, where the angle is
between about thirty degrees and about sixty degrees.
[0204] According to some embodiments, one or more of the rollers
may be configured to be a driven roller. In the illustrated
embodiment, one roller 930 of the bogie 446 is configured to be
driven. The driven roller 930 of the illustrated embodiment is
driven by an electric motor 934 with a belt drive 936 arranged
between the motor 934 and the driven roller 930. In the illustrated
embodiment, the motor has an axis of rotation that is parallel to
that of the driven roller 930 and the other, idler rollers 924,
926, and 932. While some example embodiments of a car 440 may
include a power source such as a battery to drive the motor, the
illustrated embodiment taps electrical current from the bus bars of
the track. FIG. 41 depicts a series of rollers 928 configured to be
electrically coupled to the bus bars. Each bus bar is contacted by
one or more conductive rollers, and the conductive rollers are
engaged by a brush or contact to create an electrical connection
between the bus bars and the car 440. The car may use one or more
of the bus bars to provide current to the electric motor 934 and
drive the car 440 along the track 442.
[0205] FIG. 42 illustrates the bogie 446 of FIG. 41 as viewed from
the opposite side, with the track removed. As shown, the bogie 446
includes roller 924, 926, 930, and 932. The bogie may also include
another pair of rollers 938, 940, which may provide additional
stability to the bogie relative to the track. Each of rollers 938
and 940 may also engage the lower surfaces 462 of the track. The
rollers configured to engage the lower surfaces 462 of the track
may ride on carriages 942, 944 configured to move laterally away
from the track, along arrows 952, 954. Moving the rollers 924, 926,
938, and 940 away from the track enable the bogie 446, and thus the
car to be lifted off of the track. In the illustrated embodiment,
the carriages 942 and 944 may include biasing elements, such as
springs 950 configured to bias the carriages 942 and 944 toward the
track, and thus drive the rollers 924, 926, 938, and 940 into
engagement with the lower surfaces 462 of the track, in an engaged
position. Lock pins 946 and 948 may be used to retain the carriages
942, 944 and the associated rollers in a loading position, wherein
the bogie may be free to be loaded and unloaded from the track.
[0206] While the aforementioned transport devices include
track-based transport systems, further transport devices may also
be used to transport overpacks to locations proximate a patient.
For example, another embodiment of a transport device may include a
continuous conveyor mechanism to which carriers or train cars are
coupled when they are ready for transport, and the carriers or
train cars may be de-coupled from the conveyor mechanism when they
reach their destination along the path of the continuous conveyor.
A conveyor may be configured to continuously move along a transport
path of a unit of a healthcare facility (e.g., in an overhead
transport enclosure) and overpacks may be arranged to be loaded and
unloaded from the conveyor by a loading device. For example, an
overpack that is to be transported from a unit storage facility to
a location proximate a patient may be pushed onto a moving
conveyor. The conveyor may advance along its path toward the
location proximate the patient. A scanner at the location proximate
the patient may scan the identifying indicia of the overpack and
recognize the overpack as being destined for the location proximate
the patient. A loading device at the location proximate the patient
may unload the overpack from the conveyor, either to a staging area
proximate the patient or to a patient or nurse server. Similarly,
the loading device at the location proximate the patient may load
an empty overpack to the conveyor for return to the unit storage
device or to a location specifically configured for the return of
empty or unneeded overpacks.
[0207] While above example embodiments of transport devices may can
be implemented in existing facilities by mounting a track and
enclosure 340 proximate a ceiling, other transport devices may not
require a track or enclosure to transport medication to a location
proximate a patient. For example, an automated guided vehicle may
transport medications and supplies from a unit storage device to a
location proximate a patient while traveling along hallways shared
with patients, nurses, and physicians. An automated guided vehicle,
or AGV, may arrive at a unit storage device and may be loaded
either manually or automatically with medications and supplies. The
AGV may then transport the medications and supplies to the location
proximate the patient, by guiding themselves along the hallways of
the healthcare facility. The AGVs may be configured to advance
along conductive tracks embedded into the floors, or the AGVs may
be programmed with facility layouts to guide themselves through
hallways. In either embodiment, the AGVs may be capable of
detecting obstacles and people to slow down or stop to avoid
contacting an obstacle or person. The detection capabilities may be
in the form of proximity sensors, optical sensors, contact sensors,
etc. The AGVs of example embodiments may be powered by batteries
which may be rechargeable.
[0208] The aforementioned transport devices may be configured to
transport medication and supplies from a unit storage device to a
location closer to a patient, which may be in the form of a staging
area proximate a patient, a nurse server, or a patient server,
embodiments of which are described herein below. While the
aforementioned transport devices may be described with respect to
transporting medication from the unit storage device to a location
closer to a patient, embodiments may include transport devices
configured to transport medications directly from the central
pharmacy to a location proximate a patient. Such an embodiment may
be implemented where the central pharmacy includes various features
described above with respect to the unit storage device. For
example, a central pharmacy may include a pneumatic tube system or
track-based transport system which may be loaded and sent directly
to a location proximate the patient.
Proximate Storage
[0209] Embodiments of the present invention as described above may
be configured to transport medication and supplies from a unit
storage device, via a transport device, to a location proximate a
patient. Embodiments of the present invention may provide means for
staging and or storing medication at a location proximate a
patient. The location proximate to a patient may include a location
that is disposed between the unit storage device and the patient
bed. Example embodiments of the location proximate the patient may
be referred to herein as proximate storage, including a staging
area proximate the patient, a nurse server, and a patient
server.
[0210] Proximate storage embodiments including a staging area may
be used in conjunction with a nurse server or patient server. The
staging area may be configured to receive medication and supplies,
such as in the overpacks described above, and temporarily store the
overpacks while awaiting dispensing to authorized medical
personnel. As illustrated in FIG. 29, the staging area may be
arranged adjacent to the track of a track-based transport device
such that the transport device may transport the overpacks from the
unit storage device to the staging area proximate the patient and
leave the overpacks at the staging area while the transport device
delivers additional overpacks to additional staging areas. The
staging area used for proximate storage may allow a transport
device to continue to transport overpacks, thereby improving the
efficiency with which the transport device is operating. Further,
staging proximate a nurse server or patient server may reduce
delivery time of medications.
[0211] As outlined above, the track-based transport device may be
configured to travel along a track that is enclosed (e.g.,
enclosure 340 of FIG. 25) proximate a ceiling of a unit of a
healthcare facility. The track may also be disposed in an area
above the ceiling, or below the floor of a unit of a healthcare
facility. As such, a staging area may similarly be disposed in an
enclosure proximate a ceiling, in an area above a ceiling, or in an
area below the floor in dependence upon the location of the
track-based transport device. The staging areas may be arranged at
locations proximate to patients and proximate to a nurse server or
patient server.
[0212] An example embodiment described above with respect to FIG.
29 included loading and unloading overpacks from a train car 400,
some embodiments of track-based transport devices may use the
transport device for storing or staging the overpacks proximate to
the patient. FIG. 43 illustrates an example embodiment of a
track-based transport system which includes a main track 420 and
loops 426 extending from the main track. In the illustrated
embodiment, each of the track loops 426 extend proximate a patient
server or nurse server 424. A transport device, such as a train car
422, may be advanced from a unit storage device bound for a patient
server 424. Upon arrival at the track loop 426 proximate the
appropriate patient server, the train car may be diverted to the
track loop of that patient server. The train car may be diverted by
a conventional switch 432 used in track-based or rail-based
transport devices. The diversion of the train car may be
controlled, for example, by logistics software that tracks and
directs transport devices to their appropriate locations.
Additionally or alternatively, the car may be programmed to be
autonomous with destination information. In such an embodiment, the
car may be configured to control track switches as needed, or to
select a track path without the use of switches.
[0213] FIG. 43 illustrates a train car 428 staged at a patient
sever 424 ready to dispense the contents of the overpacks on the
train car 428 to the patient server. Since the track loop 426 is
arranged off of the main track 420, train car 422 may travel along
the main track 420 uninterrupted to its destination. While the
illustrated embodiment depicts track loops 426, embodiments may
also include track spurs 430. The track spurs 430 may require fewer
switches 432; however, the track spurs 430 also require the train
cars to be reversed to enter back onto the main track 420. Track
loops 426 also may offer additional staging space for multiple
train cars 428.
Nurse Servers and Patient Servers
[0214] While staging of overpacks may be performed track-side or
along the track with a track-based transport device, staging may
also be performed at or in nurse servers or patient servers. A
nurse server is a device configured to be accessed by a nurse (or
other authorized medical personnel) for the retrieval of medication
and supplies for a plurality of patients served by that nurse. A
patient server is a device configured to be accessed by a nurse (or
other authorized medical personnel) for the retrieval of medication
and supplies for a single patient.
[0215] While the term nurse server implies access by a nurse, any
authorized medical person may access the nurse server. For example,
a doctor, a laboratory technician, anesthesiologist, a
phlebologist, or a phlebotomist may be considered an authorized
medical person which may be authorized to access one or more nurse
servers as will be described further below.
[0216] The number of patients served by a nurse server may vary,
and may be all of the patients for whom a nurse has responsibility
or for a subset of the patients for whom a nurse has
responsibility. As the nurse server is configured to provide
medication and supplies for a plurality of patients, the nurse
server may be located in an area close to the patients served by
the nurse server. This location may be closer to the patients
served than the unit storage device outlined above.
[0217] On the other hand, a patient server may be configured to
serve only a single patient. The patient server may be accessed by
authorized medical personnel as outlined above and described
further below. As the patient server serves only a single patient,
the patient server may be located close to that patient. A patient
server may be located in the patient's room or nearby for
convenient access by the authorized medical personnel. Generally, a
patient server is not intended to be accessed by a patient, but
rather by the medical personnel caring for the patient.
[0218] While example embodiments of patient servers and nurse
servers differ in the number of patients they are configured to
serve, their function may be substantially similar. However, some
features may be better suited to one or the other as will be
appreciated by one of skill in the art.
[0219] As outlined above medication and supplies may be received at
a nurse server or patient server and staged to await dispensing to
authorized medical personnel. Medication and supplies may also be
received in response to a request such that they are dispensed upon
arrival rather than staged. In still other embodiments, medication
and supplies may be delivered to the nurse server or patient server
for just-in-time (JIT) dispensing to authorized medical
personnel.
[0220] Medications and supplies may be dispensed from the nurse
server or patient server in a variety of manners. In one example
embodiment, when the medication needed by a patient arrives at the
nurse server, a message may be sent to the appropriate authorized
medical person that is responsible for retrieving and administering
the medication to the patient. In such an embodiment, an overpack
may arrive at the nurse server or at a staging area proximate the
nurse server, and upon scanning of the identifying indicia, an
alert or message may be sent, for example via a wireless network or
near-field communication protocol, to a device carried by the
authorized medical person. The device may include a pager, a phone,
a tablet computer, or any other portable device able to receive and
present the alert or message.
[0221] In another example embodiment, described with respect to the
nurse server 500 illustrated in FIG. 44, an authorized healthcare
person may arrive at the nurse server, and using a user interface
502, which may include a touch screen, keypad, display, etc.,
request medications and supplies for a particular patient. The
authorized medical personnel may first be required to provide
identification of themselves to confirm that they are an authorized
medical person, then the authorized person may enter a patient's
identification. After receiving the patient's identification, the
medication and related supplies may be dispensed, for example, to
dispensing area 504. In an embodiment in which the server 500 is a
patient server, the authorized medical person may only need to
identify themselves and ok the dispensing of medication, as the
patient server would not require the identification of the patient
since it is configured to only dispense for a single patient.
[0222] In some example embodiments, the dispensing area 504 may
include a bin 506 which may then be taken by the authorized medical
person to the patient for administering the medication. The bin 506
may then be returned to the nurse server 500. The medication and
supplies may be dispensed to the dispensing area 504 from a staging
area above the nurse server 500 or they may be dispensed directly
from a transport device above the nurse server. The medications and
supplies may be gravity fed from the staging area or the transport
device to the dispensing area.
[0223] FIG. 45 illustrates another example embodiment of a nurse
station 520 which includes a user interface 522 and a medication
dispensing drawer 530. In the illustrated embodiment, a track based
transport device, such as the illustrated carrier 526, may arrive
at the nurse server 520 or be staged above the nurse server
awaiting dispensing. In response to a request, or ahead of an
anticipated request, the carrier 526 may be advanced down thru the
nurse server to a dispensing area 524, which includes a viewing
window in the illustrated embodiment. After authorization of the
authorized medical person, the medication and supplies overpacks
may be dispensed to the dispensing drawer 530. The authorized
medical person may then remove the medications and supplies for
administering to a patient. The embodiment of FIG. 45 may also be
implemented as a patient server configured to dispense medication
only for a single patient.
[0224] FIG. 46 illustrates another example embodiment of a nurse
server 540 according to an example embodiment of the present
invention. The illustrated embodiment depicts an enclosure 542
proximate the ceiling of the healthcare facility unit. The
enclosure 542 may enclose a track for a track-based transport
device to transport overpacks of medications and supplies to the
nurse server 540 ahead of or in response to requests for medication
or supplies. The illustrated embodiment may be well suited for the
overpacks of FIG. 5. Upon receipt of the overpack boxes, an X-Y
robot within the nurse server, similar to the X-Y robot described
with regard to the unit storage device above, may place the
overpack boxes on shelves within the nurse server 540. The nurse
server may include a user interface 544 and a plurality of doors
546, and larger doors 548, each configured to be individually
openable.
[0225] In response to the authorization of an authorized medical
person, and a request for medication for a particular patient, the
doors arranged in front of the overpack(s) containing the
medication requested may be unlocked allowing the person to open
the doors, or the doors may be configured to open automatically.
The authorized medical person may then access the contents of the
overpack. FIG. 47 illustrates an example embodiment of how a nurse
server according to FIG. 46 may operate. In the illustrated
embodiment, an overpack containing the requested medication is
advanced from the plurality of overpacks available 552 to the
plurality of doors 554. In response to the overpack 550 being
placed at a subset of the plurality of doors (namely doors 556),
the doors become unlocked or unlatched. The doors may then be
opened as illustrated to access the contents of the overpack 550.
Doors that are not arranged in front of the selected overpack 550
may remain locked, precluding access to the plurality of overpacks
552 other than the selected overpack 550. The selected overpack 550
may be advanced, for example, by the X-Y robot or by actuators
disposed in the nurse server arranged to present selected overpacks
to an authorized person.
[0226] Referring back to FIG. 46, the nurse server 540 may include
larger doors 548 arranged to provide access to larger overpacks, or
alternatively, the large doors 548 may provide access to manually
loaded bins containing medications and supplies not provided to the
nurse server by the automated transport device. Medications such as
as-needed medications or supplies that may be used on an as-needed
basis may not be predicted by a system of example embodiments such
that a supply of as-needed supplies and medications may be
maintained at a nurse server or patient server.
[0227] FIG. 48 provides another example embodiment of a nurse
server 560 according to the present invention. The illustrated
nurse server 560 may be a fully integrated nurse server that is
recessed into a wall of a healthcare facility; however, embodiments
may also include units extending from the wall in facilities where
the wall does not provide sufficient room, or in embodiments where
the nurse server and transport devices are added after construction
of the facility. The depicted embodiment includes a user interface
562 and a plurality of drawers 564. The drawers may be patient
specific such that all of the medication and supplies needed by a
patient may be contained within a single drawer 564. In the case of
a patient server, each of the drawers 564 may be time-specific for
the patient served by the patient server, such that one drawer may
contain medications needed for the morning, one for mid-day, and
one for evening.
[0228] While the drawers 564 of the illustrated embodiment of FIG.
48 may be manually loaded, example embodiments of the present
invention may provide for automatic loading of the drawers 564 via
a transport device as described above. A transport device may move
medications and supplies from a unit storage device to the nurse
server 560 along, for example, a track, and upon arrival at the
nurse server, the overpacks carried by the transport device may be
moved to the appropriate drawer by a lift 566 which may be
integrated into a wall of the facility or alternatively integrated
into a nurse server projecting from the wall.
[0229] Each of the example embodiments of nurse servers described
above may include an area configured to receive medications and
supplies delivered to the nurse server but not needed or empty,
returnable overpacks. The return area of the nurse server may be a
drawer, bin, or other receiving area which is arranged to receive
articles for return to the unit storage device or to the central
pharmacy. The return area of some embodiments may stage overpacks
for retrieval by a transport device for automated return of the
overpacks, or alternatively, returns may be manually collected for
return to the unit storage or the central pharmacy.
[0230] FIG. 49 illustrates another example embodiment of a nurse
server according to embodiments of the present invention. In the
illustrated embodiment, a user interface 570 is disposed on an
articulated arm 576 which may include spring or weight
counter-balancing to enable the user interface 570 to be easily
positioned in a raised position as shown, or in a lowered position,
accessible by authorized medical personnel. A nurse or other
authorized medical person may arrive at the nurse station, pull the
user interface 570 down to an accessible position, and upon
authorization, provide a request for medication or supplies. The
medication or supplies may be staged nearby, such as in the
overhead storage 572 which may be track-side storage as outlined
above. In response to the authorized request, the medication or
supplies may be dispensed to a retrieval area 574. The authorized
medical person may then retrieve the medication or supplies for
administration to a patient. When the dispensing is complete, the
user interface 570 may be moved back to a raised position, out of
the way. The example embodiment of FIG. 49 may be implemented in
healthcare facilities where hallway widths do not allow for
additional, permanent structures to project from the walls.
[0231] FIG. 50 illustrates another example embodiment of a nurse
server which may include a user interface 582 and an openable
access panel 580. In response to an authorized medical person being
identified at the user interface, the access panel 580 may be
unlocked or automatically opened to provide access to the contents
therein. The panel 580 may provide a work surface 586 when in the
open position. The authorized medical person may retrieve
medications and supplies for a patient from a retrieval area 584
disposed behind the access panel 580. The medication or supplies
may be dispensed to the retrieval area by an automated transport
device as described above. Unneeded medication or supplies, or
returnable/reusable overpacks may be deposited in the return slot
588 for return to the unit storage device or to the central
pharmacy.
[0232] FIG. 51 illustrates another example embodiment of a nurse
server which may be embodied as a portable cart 596. The portable
cart may be assigned to a nurse for use during their shift. Through
a user interface, such as a user interface 598 on the cart 596, a
nurse or authorized medical person may request medications and
supplies for a patient or for a plurality of patients. The request
may be transmitted, e.g. via a healthcare facility network, to a
unit storage device. The unit storage device may load the
medication overpacks onto a transport device for transport to a
location proximate to the requesting nurse. Upon arrival, the nurse
may be signaled that the medication has arrived. The alert may be
received, for example, at the user interface 598, or other device,
such as a pager or portable communication device carried by the
nurse, or a healthcare facility unit dashboard (e.g., a screen
displaying information at a nurse station). The nurse may then go
to the proximate storage location 592 where the medications are
staged, which may be, for example, in an overhead enclosure where
the transport device may be disposed. The nurse may provide
identification at the proximate storage location 592 through a user
interface at the location, or through the user interface 598 of the
cart 596, after which the medication overpacks 590 may be lowered
to a location from which the nurse may retrieve them. The overpacks
590 may then be loaded into the cart for administration of their
contents to the appropriate patient. The illustrated overpacks 590
may be patient specific or may be unit dose overpacks. In patient
specific overpacks 590, the overpack 590 may include all of the
medications needed for a patient at a particular time.
[0233] Nurse servers or patient servers according to the
aforementioned embodiments may include a scanner configured to scan
the medication or supplies, and/or the overpacks containing the
medication or supplies. The scanner may scan identifying indicia to
confirm retrieval of the scanned objects from the nurse server or
patient server. The scanning may further provide an additional
verification step that confirms that the appropriate medication or
supply is being dispensed from the nurse server or patient
server.
[0234] Nurse servers or patient servers according to the
aforementioned embodiments may further include a printer. While
medications transported to the nurse server or patient server may
be designated for a particular patient, the patient information may
not be presented on the medication, particularly since the
medication or supply may be returned to the central pharmacy if it
is not needed by the patient, such as if the patient is discharged
before the medication is administered. As such, a printer at the
nurse server or patient server may be configured to print patient
information to a label to be affixed to the medication or supply,
thereby designating the patient for which it is intended. The
printer may print patient information in response to a scan of the
medication as described above, or it may print the labels in
response to the authorized medical person accessing the nurse
server and retrieving the medication or supply.
[0235] In some embodiments, nurse servers may include temperature
controlled areas. For example, in the embodiment of FIG. 48, one or
more of the drawers 564 may include a refrigerated compartment to
maintain refrigerated medications at the appropriate temperature
until dispensed. In such an embodiment, a printer may be configured
to print a label for the medication upon dispensing which
identifies the time at which it was dispensed, which may correspond
to the time the medication was removed from refrigerated storage.
In such an example, the medication may have a maximum shelf-life
outside of refrigerated storage after which the medication is no
longer fit for administration to a patient. The time after which
the medication must be disposed may be printed to the label when
the medication is dispensed from the nurse server. Optionally,
"printing" may be performed by writing to an RFID tag or writing to
an electronic ink label.
[0236] As outlined above, some medication may require refrigeration
to maintain its efficacy. Such medications may be given a maximum
shelf-life outside of refrigeration. The shelf-life of such a
medication may be a time since the medication was initially removed
from refrigeration, or a cumulative time of the medication outside
of refrigeration. According to embodiments of the present
invention, as transportation and storage of medications may be
automated and controlled, the logistics software for routing (i.e.,
mapping out a route for) and dispensing of medications may be
configured to monitor the time of a medication outside of
refrigerated storage. For example, a medication may be outside of
refrigerated storage between the central pharmacy and the unit
storage device. At the unit storage device, the medication may be
maintained in a refrigerated storage area. The medication may again
be outside of refrigerated storage during transport to proximate
storage near a patient. Upon arrival at the proximate storage, the
medication may or may not be stored in a temperature controlled
location. As such, the software may monitor the cumulative length
of time the medication is outside of refrigerated storage. If the
medication is outside of refrigerated storage longer than the
shelf-life outside of refrigerated storage, the medication may be
automatically routed back to the unit storage device and/or to the
central pharmacy. If the medication has shelf-life remaining at the
time of dispensing, the time remaining may be displayed to a nurse
on a user interface of a nurse server or patient server, or
optionally printed to a label for the medication.
[0237] According to example embodiments of the invention,
temperature sensitive medications or supplies may be packaged in
overpacks that include temperature monitoring capabilities. The
temperature monitoring may be performed by a temperature monitoring
strip which displays the time that the strip or the products
attached thereto, have been exposed to temperatures exceeding a
threshold. Temperature monitoring may also be performed by an RFID
tag configured to generate a temperature profile which may be
analyzed when the information is read from the tag. Use of
temperature monitoring may allow inventory monitors or controls to
determine if a medication has exceeded a maximum temperature or
exceeded a maximum time above a threshold temperature, in which
case the medication would be returned to a central pharmacy for
disposition.
[0238] Overpacks may also be configured to maintain a temperature
of a medication. For example, an overpack may be insulated and may
contain a cold-pack configured to keep the temperature inside the
overpack below a threshold value. Overpacks may also include
material, such as a phase change material, configured to maintain
overpack contents at or around a desired temperature. Such
overpacks may be used to extend the shelf-life of a medication or
to allow transportation of medications outside of refrigerated
storage for a longer period of time.
[0239] As noted above, embodiments of the present invention may
require identification of the authorized medical person before
providing access to the medication or supplies dispensed by the
nurse server or patient server. Identification of appropriate
medical personnel may be accomplished by the scanning of an
identification card which may include a barcode or RFID tag.
Alternatively, identification of authorized medical personnel may
be accomplished by biometric scanning, such as a scan of a person's
retina, finger print, hand geometry, palm vein, face, or voice to
determine the identification of the person. Identification may also
be provided by a personal identification number (PIN), or any
combination of the aforementioned mechanisms.
[0240] Appropriate identification of medical personnel may be
important to preclude unauthorized access to medications and to
satisfy regulatory requirements. Requiring medical personnel to
properly identify themselves may also preclude a nurse from
accessing the wrong nurse server by limiting the medical personnel
authorized to access a particular nurse server or patient server.
Further, requiring identification of medical personnel may provide
an audit trail to identify who retrieved medication for a
particular patient.
[0241] Nurse servers or patient servers as described above may be
configured to provide an estimated time of arrival for medications
or supplies at a nurse server or patient server. For example, a
nurse may enter a request for a medication or supply to be
dispensed from a nurse or patient server, and the user interface
may provide an estimated time of arrival for the medication or
supply at the nurse or patient server. According to some
embodiments, the medication or supply may be staged for immediate
dispensing; however, some medications or supplies may not be
present at the patient server or nurse server. Providing an
estimated time of arrival for the medication or supply may allow an
authorized medical person to perform other tasks while awaiting
delivery of the medication or supply. As embodiments described
above may include substantial automation of the retrieval and
delivery of medications and supplies to locations proximate to a
patient, logistic software configured to route the medication and
supplies may be able to provide a very accurate estimated time of
arrival of the requested medication or supply at the nurse server
or patient server.
[0242] As described above, the nurse server or patient server may
be used to interface with a network of a healthcare facility to
ensure accurate dispensing of medications to authorized personnel.
The automation and the transfer of data and information may be
implemented in various embodiments of the present invention. As
used herein, where a computing device is described herein to
receive data from another computing device, such as receiving an
indication of medication required, it will be appreciated that the
data may be received directly from the another computing device
and/or may be received indirectly via one or more intermediary
computing devices, such as, for example, one or more servers,
relays, routers, network access points, and/or the like. Similarly,
where a computing device is described herein to send data to
another computing device, it will be appreciated that the data may
be sent directly to the another computing device or may be sent to
the another computing device via one or more interlinking computing
devices, such as, for example, one or more servers, relays,
routers, network access points, and/or the like.
[0243] In some example embodiments, processes and steps of the
invention may be carried out by computing devices that may be in
communication with a network, such as an information network of a
healthcare facility. The computing devices may include nurse
servers, patient servers, portable communications stations, or the
like. Such a network may be embodied in a local area network, the
Internet, any other form of a network, or in any combination
thereof, including proprietary private and semi-private networks
and public networks. The network may comprise a wire-line network,
wireless network (e.g., a cellular network, wireless local area
network, wireless wide area network, some combination thereof, or
the like), or a combination thereof, and in some example
embodiments comprises at least a portion of the Internet.
[0244] In some example embodiments, computing devices configured to
perform various operations of the invention may include computing
devices, such as, by way of non-limiting example, a server,
configured to access a network and/or server(s). In some example
embodiments, computing devices may be implemented as a distributed
system or a cloud based entity that may be implemented within a
network. In this regard, a computing device according to the
present invention may comprise one or more servers, a server
cluster, one or more network nodes, a cloud computing
infrastructure, some combination thereof, or the like. Additionally
or alternatively, embodiments may be implemented as a web
service.
[0245] Further example embodiments of the present invention may
include a system comprising any number of user terminals. A user
terminal may be embodied as a laptop computer, tablet computer,
mobile phone, desktop computer, workstation, nurse server, patient
server, or other like computing device.
[0246] The computing device of example embodiments may include
processing circuitry. The processing circuitry may be configured to
perform actions in accordance with one or more example embodiments
disclosed herein. In this regard, the processing circuitry may be
configured to perform and/or control performance of one or more
functionalities of the handling, transporting, storing, or
distributing of medications and/or supplies in accordance with
various example embodiments. The processing circuitry may be
configured to perform data processing, application execution,
and/or other processing and management services according to one or
more example embodiments. In some embodiments, computing device or
a portion(s) or component(s) thereof, such as the processing
circuitry, may be embodied as or comprise a circuit chip. The
circuit chip may constitute means for performing one or more
operations for providing the functionalities described herein.
[0247] A schematic illustration of an apparatus which may be
implemented as a nurse server, patient server, or user terminal in
a central pharmacy or unit storage device is illustrated in FIG.
52. As shown, in some example embodiments, the processing circuitry
may include a processor 700 and, in some embodiments, may further
include memory 710. The processing circuitry may be in
communication with, include or otherwise control a user interface
720 and/or a communication interface 730. As such, the processing
circuitry may be embodied as a circuit chip (e.g., an integrated
circuit chip) configured (e.g., with hardware, software, or a
combination of hardware and software) to perform operations
described herein.
[0248] The processor 700 may be embodied in a number of different
ways. For example, the processor may be embodied as various
processing means such as one or more of a microprocessor or other
processing element, a coprocessor, a controller, or various other
computing or processing devices including integrated circuits such
as, for example, an ASIC (application specific integrated circuit),
an FPGA (field programmable gate array), or the like. Although
illustrated as a single processor, it will be appreciated that the
processor may comprise a plurality of processors. The plurality of
processors may be in operative communication with each other and
may be collectively configured to perform one or more
functionalities of a system for handling, storing, transporting, or
distributing medication as described herein. The plurality of
processors may be embodied on a single computing device or
distributed across a plurality of computing devices. In some
example embodiments, the processor may be configured to execute
instructions stored in the memory or otherwise accessible to the
processor. As such, whether configured by hardware or by a
combination of hardware and software, the processor may represent
an entity (e.g., physically embodied in circuitry--in the form of
processing circuitry) capable of performing operations according to
embodiments of the present invention while configured accordingly.
Thus, for example, when the processor is embodied as an ASIC, FPGA,
or the like, the processor may be specifically configured hardware
for conducting the operations described herein. Alternatively, as
another example, when the processor is embodied as an executor of
software instructions, the instructions may specifically configure
the processor to perform one or more operations described
herein.
[0249] In some example embodiments, the memory 710 may include one
or more non-transitory memory devices such as, for example,
volatile and/or non-volatile memory that may be either fixed or
removable. In this regard, the memory 710 may comprise a
non-transitory computer-readable storage medium. It will be
appreciated that while the memory 710 is illustrated as a single
memory, the memory may comprise a plurality of memories. The
plurality of memories may be embodied on a single computing device
or may be distributed across a plurality of computing. The memory
may be configured to store information, data, applications,
instructions and/or the like for enabling embodiments of the
present invention to carry out various functions in accordance with
one or more example embodiments. For example, the memory may be
configured to buffer input data for processing by the processor.
Additionally or alternatively, the memory may be configured to
store instructions for execution by the processor. As yet another
alternative, the memory may include one or more databases that may
store a variety of files, contents, or data sets. Among the
contents of the memory, applications may be stored for execution by
the processor to carry out the functionality associated with each
respective application.
[0250] A user interface 720 of example embodiments, such as the
user interface of a nurse server or patient sever, may be in
communication with the processing circuitry to receive an
indication of a user input at the user interface and/or to provide
an audible, visual, mechanical, or other output to the user. As
such, the user interface may include, for example, a user input
interface 720 such as a keyboard, a mouse, a joystick, a display, a
touch screen display, a microphone, a speaker, and/or other
input/output mechanisms. As such, the user interface may 720, in
some example embodiments, provide means for user control of
embodiments of the present invention. In some example embodiments
in which the invention is embodied as a server, cloud computing
system, or the like, aspects of user interface may be limited or
the user interface may not be present. In some example embodiments,
one or more aspects of the user interface may be implemented on a
user terminal. Accordingly, regardless of implementation, the user
interface may provide input and output means to facilitate
handling, storing, transporting, or delivery of medication in
accordance with one or more example embodiments.
[0251] The communication interface 730 may include one or more
interface mechanisms for enabling communication with other devices
and/or networks. In some cases, the communication interface may be
any means such as a device or circuitry embodied in either
hardware, or a combination of hardware and software that is
configured to receive and/or transmit data from/to a network and/or
any other device or module in communication with the processing
circuitry. By way of example, the communication interface 730 may
be configured to enable embodiments of the present invention to
communicate with application server(s) and/or networks and/or
information databases. Accordingly, the communication interface
may, for example, include supporting hardware and/or software for
enabling communications via cable, digital subscriber line (DSL),
universal serial bus (USB), Ethernet, or other methods.
A First Example Embodiment of a System
[0252] While various components of a system for automating the
dispensing of medications and supplies to patients within a
healthcare facility have been described above, an example
embodiment using components of the system is described herein to
further illustrate the functionality of such a system.
[0253] The example embodiment system described herein is described
with respect to a healthcare facility including multiple units,
such as an intensive care unit, a long-term care unit, a
psychiatric unit, a maternity unit, etc. Embodiments may include a
central pharmacy configured to dispense medication to patients in
each of the units of the healthcare facility. As such healthcare
facilities may provide medication and supplies to hundreds of
patients, each requiring a unique medication regimen, automation of
medication distribution can be difficult. Further, medication
regimens can change based on a patient's changing conditions or a
patient's response to previously administered medications.
Automated systems to dispense medications in such an environment
may require flexibility to change medication regimens for
individual patients as needed, and also provide medication as it is
needed, where it is needed in the healthcare facility.
[0254] Embodiments of systems according to the present invention
may provide a system for predicting the medications which may be
needed by a patient over a specific period of time. The prediction
may be performed by software which may be configured to use a
variety of methods to determine what medications and supplies may
be required over a specific period of time. The predicted
medication and any known medication (e.g., medication previously
prescribed) may constitute a medication order. The medication order
may be sent (e.g., by a healthcare facility network), to a central
pharmacy for fulfillment.
[0255] The central pharmacy of a healthcare facility may be
configured to receive a medication order and to fulfill the
medication order by picking the medications of the medication order
from a supply of medications. The picking may be performed manually
by a pharmacist or pharmacy technician, or the picking may be
performed automatically by an automated dispensing system, such as
a Robot-Rx.TM. from McKesson.RTM.. The medication, whether picked
manually or automatically, may be packaged into overpacks, if not
already in a suitable package for automation. For example, the
types of packages handled by the Robot-Rx.TM. may be compatible
with some embodiments of automation such that repackaging is not
necessary. In other embodiments, the medication, if contained in a
package, such as a blister pack, may require packaging in an
overpack that is compatible with specific automation systems. In
the instant embodiment, picked medications are loaded into bins,
such as the bins 102-108 of FIG. 1, which are configured to be
compatible with various automation components and systems described
herein.
[0256] Supplies may also be part of the medication order as
determined by the software (e.g., a syringe of a given size may be
known by the software to accompany a medication vial of a given
size). Optionally, supplies may be added to a medication order
manually, for example when authorized medical personnel recognize a
need (e.g., a patient's IV tubing is punctured requiring new IV
tubing to be ordered). In example embodiments in which the central
pharmacy and the central supply store are collocated, or in close
proximity to one another, after medications are loaded into
overpacks, the requisite supplies may also be loaded into the
overpacks before the overpacks are grouped and transported to the
unit storage device. Additionally or alternatively, particularly in
embodiments in which the central supply store and the central
pharmacy are not in close proximity, supplies may be loaded to
separate overpacks. The overpacks of supplies may be grouped
according to location and transported accordingly. The unit storage
device may be configured to associate a supply with a medication
for distribution to an authorized medical person.
[0257] The medications for a medication order for a patient may
each be loaded into separate bins, such that the bins each contain
a unit dose of medication. Supplies may also be loaded into
individual bins. In some cases, supplies which correspond to a
particular medication may be loaded into the same overpack bin as
the medication to which they are associated. The overpacks may be
loaded manually by a pharmacy technician or pharmacist, or the
overpacks may be loaded automatically, as illustrated in FIG. 6.
Appropriately sized bins may be selected based upon the size of the
medications or supplies to be received therein. In some
embodiments, software may designate the size of bin to be used for
a particular medicine or supply, which may be preferred in
embodiments implementing an automated overpack fill.
[0258] A label may be applied to each overpack to identify the
contents received therein and/or to identify the patient for whom
the overpack is intended. The overpack label may include
identifying indicia such as a barcode, text, picture, etc.
Optionally, an RFID tag on the overpack may be written to by an
RFID encoder. The RFID tag may be written with the patient
information, patient location, medication information, etc. Labels
for overpacks which are intended for multiple uses may be
temporarily affixed such as with a releasable adhesive, a
hook-and-loop fastener system, or received within a label receiving
area of the overpack, such as a transparent pouch.
[0259] Including only a single dose of medication in each overpack
may allow each labeled overpack to be individually manipulated
throughout the dispensing process. For example, when the overpack
is at the central pharmacy, transported to the unit storage, at the
unit storage, in proximate storage, or at the nurse server or
patient server, the unit dose overpack may be identified by the
label and manipulated as needed. In an embodiment in which a
particular medication was removed from a person's medication
regimen, the unit dose of that medication may be removed and routed
for return to the central pharmacy at various points during the
dispensing process.
[0260] In some embodiments wherein each overpack contains a unit
dose medication, each overpack may be individually routed to the
patient for whom it is intended. For example, upon determining that
a medication is anticipated to be needed by a patient, logistics
software may plan a route for the individual unit dose between the
central pharmacy and the proximate storage. The route may be the
same as other medications destined for the same patient; however,
as each medication unit dose is individually traceable and
manipulated, each overpack may have an individual route that is
assigned to it. Grouping of overpacks with similar destinations may
be another function of the logistics software; however, each
overpack maintains its unique identity and route. As such, if a
group of medications is separated during loading/unloading or
transport, each of the overpacks will still arrive at the
appropriate destination. Further, if an individual medication is
flagged for removal from the patient's medication order, the route
of that medication may be changed to re-route the medication back
to the central pharmacy.
[0261] Individual routing of medications may allow individual
control of the medications, such as when a medication must be
removed from a patient's regimen due to a lot recall, expiration of
medication, a change associated with the patient status (e.g.,
improving/worsening condition, discharge of patient, movement of
patient to another location, etc.), a more urgent need for a
medication for another patient, etc.
[0262] Embodiments may use unit-dose overpacks; however,
additionally or alternatively, all of the medications and supplies
for a patient that may be needed over a specific time period may be
grouped together into a single overpack. Such an embodiment may
reduce the overall number of overpacks needed for a facility and
may increase the efficiency of dispensing the medications and
supplies; however the ability to individually manipulate unit doses
automatically may be lost. Some medications may be grouped together
by their purpose, for instance a medication that includes nausea as
a side effect may be grouped with an anti-nausea medication. As
such, removing the medication with a side effect removes the need
for the nausea medication, such that the medications may be grouped
together in a single overpack without the need to track them
individually.
[0263] While the above embodiment has been described with respect
to a central pharmacy of a healthcare facility, the central
pharmacy role may be removed from the healthcare facility and may
be implemented in a remote location. A remote central pharmacy may
be a pharmacy which serves multiple healthcare facilities and may
benefit from economies of scale, particularly when servicing
smaller healthcare facilities. As such, embodiments of the above
may be implemented at a remote central pharmacy where the overpacks
are prepared off-site, and subsequently delivered to a healthcare
facility for distribution to healthcare facility units and/or
patients.
[0264] The overpack bins of the above described embodiment may be
staged in a location at the central pharmacy (or at a receiving
location within a healthcare facility) and may be grouped according
to their destination. For example, overpacks that are designated to
go to a patient on the long-term care unit may be grouped together,
while overpacks designated to go to an intensive care unit (ICU)
may be grouped together. The grouping of overpacks together may be
performed automatically, for example by the logistics software that
routes medications to the appropriate patients. Optionally, the
grouping of overpacks may be performed manually.
[0265] The grouping of overpacks may include placing the bins on a
tray, as illustrated in FIG. 11. The bins may be lidded bins, or a
lid may be placed over the group of bins on the tray as
illustrated. The grouped overpacks may then be loaded onto a
transport cart, as shown in FIG. 18, for transport to the
appropriate local storage or unit storage device.
[0266] The transport cart may be moved automatically, for example,
using an automated guided vehicle, or the cart may itself be an
automated guided vehicle. In other embodiments, the cart may be
moved manually to the unit storage device in the appropriate unit
of the healthcare facility.
[0267] Upon arrival at the unit storage device, as shown in FIG.
20, a tray containing the overpacks may be removed from the cart,
and loaded into the unit storage device. The lid from the tray may
be removed, and the tray may be loaded into the unit storage
device. Optionally, the overpacks may be loaded into the unit
storage device without the tray, and the tray and lid may be
returned to the cart for return to the central pharmacy.
[0268] The transport cart may include only medications and supplies
for a specific unit of a healthcare facility, or optionally, the
transport cart may include trays of overpacks for different units
of a healthcare facility. In such a case, the trays designated for
a first unit storage device may be loaded into the first unit
storage device, while trays designated for a second unit storage
device may be loaded into a second unit storage device as the
transport cart makes rounds delivering the appropriate trays to the
appropriate unit storage device.
[0269] The unit storage device may be configured with a retrieval
device as illustrated in FIG. 23, which may include an X-Y robot
arranged to traverse the unit storage device. The overpacks may
each be accessible to the retrieval device as the X-Y robot moves
the retrieval device across the unit storage device. As outlined
above, the medications for a medication order may be needed for a
specific time period. The medications may be stored within the unit
storage device until such time as the medications are anticipated
to be needed, or when they are actually needed. In an example
embodiment, the medications of a medication order are retrieved in
advance of the time at which they are anticipated to be needed. The
overpacks may be staged proximate a transport device, such as the
train of FIG. 23. Before the time that the medications are
anticipated to be needed, a loading device may load the overpacks
containing the medication order onto a transport device.
[0270] A transport device according to example embodiments of the
present invention may include a train car with one or more bogies
adapted to ride along a rail. FIG. 53 illustrates a side view of an
example embodiment of a train car 800 configured to advance along
track 810. The train car 800 includes a load surface 812 arranged
to carry medication and supply overpacks. The load surface 812 may
be configured to carry any specific kind of overpack securely. For
example, in the case of the bin-type overpacks, the train car may
be equipped with a top that is arranged proximate the top of the
bins loaded into the train car. The top may be configured to
prevent shifting and moving of the overpacks as the train car
travels along the rails. The illustrated train car 812 further
includes bogies 814 which are configured to ride along the rail
810. The bogies may each include at least one top roller 816
adapted to ride along the top of the rail 810, and a pair of side
rollers 818 arranged on either side of the rail 810 and adapted to
keep the bogie 814 centered on the track 810. The bogies 814 may
each be pivotably connected to the load surface 812 by pivot points
820. The pivot points 820 may allow the bogies 814 to turn relative
to the load surface 812 such that the train car can advance around
bends. The length of the train car 800 (or the length between the
bogies) and the pivotability of the bogies 814 may determine the
minimum radius track turn that can be used in a system using the
train cars 800.
[0271] The train car 800 may be advanced along the track by a drive
wheel, which may be one or more of the top rollers 816 and/or side
rollers 818. Embodiments may include a local energy source disposed
on the train car, such as a battery, which may drive an electric
motor to turn the drive wheels. Optionally, the track may include
bus bars to conduct electricity along the track from which the
train car 800 may tap into. As such, the track may provide power to
the motor which drives the drive wheels. Other mechanisms for
advancing the train car along the track may include a cable
disposed within or proximate to the track which may pull the train
car along the track. A cable disposed within the track may be
configured in a continuous loop through the track disposed in an
overhead location of a healthcare facility unit. The cable may move
substantially constantly, and the train may be adapted to engage
the cable to advance the train, and disengage the cable to stop the
train. Other embodiments may include a magnetic levitation system
adapted to advance the train car along the track.
[0272] The transport device may receive the overpacks as outlined
above, and then transport the overpacks to proximate storage. The
overpacks may be staged at the proximate storage, or at a nurse or
patient server as outlined above. In some embodiments, the
transport device is staged along with the overpacks.
[0273] As illustrated and described above with reference to FIG.
29, a train car according to example embodiments may include a
scanner 404 configured to read the identifying indicia of the
overpacks. The scanner may be disposed on the train car configured
to scan overpacks to be loaded; however, scanners may also be
implemented at the proximate storage staging area, the unit storage
device, and the nurse server. Scanners may be implemented to
provide additional tracking and confirmation of the arrival of
medications at particular locations. For example, a proximate
storage location may include a scanner which scans the overpacks on
a transport device that has arrived at the proximate storage
location, and direct unloading of the overpacks that are to be
staged at the proximate location.
[0274] Embodiments of a transport device according to the present
invention may include a system for tracking the location of the
transport device. Such a system may include radio frequency beacons
disposed along the track and an RFID tag on the car. Such a system
could identify the location of the car anywhere along the track
with high accuracy. Other embodiments may include sensors disposed
along the track configured to detect the presence of a car and to
scan an identity of the car to determine and track the car's
location. In other embodiments, location codes may be disposed
about the track. The location codes may be in the form of RFID
tags, barcodes, or other indicia which may be read by a scanner of
a car. The car may scan the indicia along the track and provide
that information to a system tracking the location of the car. As
such, the specific location of a car and the contents thereon may
be known throughout the transport process.
[0275] When an authorized medical person is prepared to administer
medication to a patient, they may access a nurse server or patient
server according to any of the embodiments described above. The
authorized medical person may access the user interface of nurse
server or patient server by identifying themselves and the nurse
server confirming that they are an authorized medical person. In an
example embodiment in which no user interface may be present, such
as the nurse server of the embodiment of FIG. 51, the staged
medication may be dispensed to the authorized medical personnel. In
an example embodiment in which a user interface is present on the
nurse server, the authorized person may select the patient or
simply accept the medication that is staged awaiting dispensing.
Thereafter, the medication may be dispensed to the authorized
medical person.
[0276] To dispense the medication from the overpacks of the
aforementioned example embodiment, the bins may be tilted or
"dumped" to have the contents dispensed from the nurse server. The
nurse server may include structure sufficient to slow the descent
of the medications and supplies to accommodate a relatively soft
landing at the dispensing area of the nurse server. Alternatively,
the overpack bins may be lowered through the nurse server and
presented to the authorized medical person for retrieval of the
medications and supplies. The empty overpacks may be returned to
the nurse server, which may return the overpacks to the transport
device, or to the staging area configured to be retrieved by the
transport device. The transport device may return empty overpacks
or overpacks containing unused or unneeded medications back to the
unit storage device. The empty overpacks and unneeded medications
may be retrieved and returned to the central pharmacy for
reuse.
A Second Example Embodiment of a System
[0277] Another example embodiment of a system incorporating various
components outlined above is described herein. According to an
example embodiment, a system may be configured to deliver
medications that are anticipated to be needed by a patient ahead of
the anticipated need. In one embodiment, a system may be configured
to predict the needs of patients in a healthcare facility. The
system may predict the anticipated medication needed by the patient
using a variety of manners, such as one or more of a conventional
medication regimen for a particular ailment, a physician specific
medication regimen for a particular ailment, a historical record of
unit dose medications, or an algorithm. The algorithm may predict
the anticipated medications needed by a patient by factoring in
patient conditions, symptoms, patient information (e.g., gender,
age), etc. The algorithm may determine a medication or plurality of
medications which may be used to treat a patient with the
combination of symptoms and conditions.
[0278] Upon predicting the medications anticipated to be needed by
a patient, the medication order, including each of the anticipated
medications, may be sent to a central pharmacy. The central
pharmacy may manually or automatically fulfill the medication
order. For example, a Robot-Rx.TM. automated dispensing system may
receive the medication order and dispense each of the medications
anticipated to be needed by the patient. The medications may be
loaded into overpacks; however, in the case of an automated
dispensing system, the medications may already be contained in
packages which are suitable for automated dispensing. As such, the
medications dispensed by an automated dispensing system may be
ready to be loaded into a carrier according to example embodiments
of the present invention. Medications which may not already be
packaged in packaging suitable for automated manipulation may be
packaged into such overpacks. In the example embodiment, the
overpack may include a bag, such as the bag illustrated in FIG. 4.
The bag may include a hole 142 to provide a grasping and holding
location for automated devices.
[0279] The medication, which is now packaged into overpack
packaging suitable for automated handling, may be loaded into an
apparatus which may be compatible with further automated handling
and transporting of the medications. FIG. 54 illustrates an example
embodiment of a clip 840 including a clip body 842 and a hook 844.
The clip 840 may be configured to securely hold an overpack 846,
such as the bag overpack described above and illustrated in FIG. 4.
The overpack 846 may contain a unit dose medication 848, or
alternatively, a plurality of unit dose medications each
anticipated to be needed by a single patient. In such an
embodiment, the overpack is patient-specific rather than
medication-specific. The clips of example embodiment may be
configured to be manually loaded by, for example a pharmacy
technician, or alternatively, the clips may be automatically loaded
by a device configured to insert the overpacks 846 into the clips
840.
[0280] The clip 840 of the illustrated embodiment may include
identifying indicia 850 disposed on an area of the clip which will
remain visible during transport such that the identifying indicia
can be scanned. Optionally, the identifying indicia may be stored
in an RFID tag which may be readable without being visible. The
clip 840 of FIG. 54 further includes a release recess 852 as will
be described further below. FIG. 55 illustrates an example
embodiment of a carrier 860 configured to carry a plurality of
clips 854 with overpacks 856. The clips may be received into
recesses of the carrier which securely hold the clips 854 in place
during transport of the carrier. The clips may be manually or
automatically loaded into the carrier.
[0281] Each carrier may be designated as bound for a specific
location within a healthcare facility. For example, a carrier may
be routed to the intensive care unit. Carriers may be configured to
hold medications for a plurality of patients proximate their
destination, or alternatively, particularly when a patient has a
large number of medications, a carrier may be configured to hold
only medications for a single patient. The carriers may be loaded
onto a transport cart, as illustrated in FIG. 19 for transport to a
unit of the healthcare facility. As illustrated in FIG. 19, upon
arrival at the appropriate unit, the carriers for that unit may be
unloaded from the transport cart and loaded into a unit storage
device. The unit storage device may be any of the unit storage
devices outlined above that are compatible with carriers as
described herein. For example, carriers may be loaded into a unit
storage device as illustrated in FIG. 25.
[0282] As described above with respect to FIG. 28, the carriers may
be configured to be loaded onto a shuttle for transport to a
location proximate a patient. The carriers may be temporarily
stored at the unit storage device. A carrier may be stored until
such time as a request is received for a medication unit dose
contained in an overpack attached to the carrier. Optionally, the
logistics software may anticipate the time that a medication is
needed at a location proximate the patient and advance the carrier
toward a transport device for transport to the location proximate
the patient in advance of the anticipated need.
[0283] According to some embodiments, the unit storage device may
only be configured to load the carriers onto a transport device,
and not provide staging at the unit storage device. In such an
embodiment, carriers may be moved to a location proximate the
patient when a transport device is available rather than awaiting a
request for a medication or a prediction of a need for the
medication. Once the carrier is loaded onto a transport device, for
example, as shown in FIG. 28, the transport device may advance the
carrier to a location proximate the patient or patients for whom
the medication of the overpacks of the carrier are for. The carrier
may be staged at the location proximate the patient, which may be
in proximate storage, at a nurse server, or at a patient
server.
[0284] FIG. 56 illustrates an example embodiment of several
carriers 870 staged in proximate storage near a nurse server which
receives medications along track 878. The proximate storage may be
a location track side away from track 880 to allow other carriers
874 to move along the track 880. The track-side storage may be on a
track spur or track loop as outlined above, or the carriers may be
moved off of shuttles into a storage or holding area by a
loading/unloading device at the proximate storage location. The
track 880 and the proximate storage location for the carriers 870
may be enclosed in an overhead location, such as by enclosure 872
to keep the medications secure, to keep noise to a minimum, and to
avoid potential interference with the carriers and shuttles.
[0285] Authorized medical personnel may be alerted that medication
is staged at the proximate storage and ready for dispensing. The
alert may be in the form of a light at the proximate storage or
nurse station indicating that staged medication is present and
ready to be dispensed. Optionally, an alert may be sent via
wireless network to a portable device, such as to a pager, a nurse
cart, a tablet computer, handheld computer, etc. The authorized
medical person responsible for administering the medication to the
patient may respond to the alert in due course.
[0286] Upon arrival at the nurse server or patient server, the
authorized medical person may identify themselves to confirm to the
patient server or nurse server that they are, indeed authorized.
The identification may be performed as outlined above with regard
to the various embodiments of a nurse station. In response to
confirming the identity of the authorized medical person, the nurse
server or patient server may provide an indication of the
medications available for dispensing, or an indication of the
patients for whom medications are available for. The authorized
medical person may select the medications and/or patients to
initiate the dispensing of the medications.
[0287] FIG. 56 illustrates a scanner 876 located near the proximate
storage, and FIG. 57 illustrates a detail view of the scanner 876.
The scanner 876 may include a reader 892 which is configured to
read the identifying indicia of the clip 890. The identifying
indicia may be a barcode, text, image, or RFID tag such that the
reader 892 may include a barcode scanner, image capture device, or
RFID reader. The identifying indicia may either specify the
medication 884 in the overpack 882, or alternatively, the
identifying indicia may reference a database where the
identification of the clip 890 is correlated to a medication
attached thereto, where the database is populated when the
medication is loaded onto the clip 890. The clip 890 may be scanned
upon arrival at the proximate storage, or just before dispensing
the medication in response to an authorized request for the
medication. The reader 892 may confirm the identity of the clip and
medication thereon to confirm that the requested medication matches
the medication 884 of the overpack 882 attached to the clip 890.
Provided the medication is the anticipated medication, a release
mechanism 894 may extend into release recess 886. In response to
the release mechanism 894 extending into the release recess 886,
the overpack 882 may be released from the clip 890 and hook 888,
allowing the overpack and medication contained therein to fall from
the clip. The medication may be configured to fall into a tray 896
as illustrated in FIG. 56, and the tray may be configured to move
down track 878 for presentation of the medications to the
authorized medical person. After a carrier is emptied of
medication, or if the medication on the carrier is no longer needed
(e.g., when a patient is discharged), the carrier may be advanced
by a shuttle back to the unit storage device for retrieval and
return to the central pharmacy.
A Third Example Embodiment of a System
[0288] As described above, various components may be implemented
together to create a system which automates, or enables at least
partial automation of the dispensing of medications and supplies to
a patient. Another example embodiment of such a system is described
herein.
[0289] Embodiments described herein may provide for unit-dose
overpacks to be prepared for distribution to patients. Such
overpacks have also been described to be configured to receive
supplies which may accompany certain medications, such as a syringe
to accompany a medication vial in a single overpack. While
overpacks may be unit-dose specific and/or unit-dose and supply
specific, overpacks may also be patient-specific. For example, a
single overpack may include unit dose medications for a particular
patient for a particular period of time (e.g., for a nurse shift,
or for a 24-hour period, etc.). Such an overpack may be a bin which
is configured to hold multiple unit-dose medications and may also
be configured to hold supplies to accompany the unit-dose
medications. The bin may be selected based upon the number and size
of medications and/or supplies that it is to be filled with for the
particular patient. In some embodiments, the unit-dose medications
and/or supplies may be in individual unit-dose overpacks that are
loaded into a patient-specific overpack. For example, a unit-dose
overpack may include a bag as illustrated in FIG. 4 and a plurality
of unit-dose overpacks may be received in a bin, as illustrated at
FIG. 1.
[0290] Unit-dose medications and supplies may be loaded to a
patient-specific overpack by a variety of means including manually,
automatically, or a combination of manual and automatic loading.
For example, a robot, as shown in FIG. 6, may be configured to load
unit-dose medications to a patient-specific overpack. In another
example embodiment, as shown in FIG. 14, a user may retrieve the
unit-dose medications for a patient, they may scan the unit doses
with reader 32, and may load the unit-dose medications in a patient
specific bin, such as bin 36. In still another embodiment, a
patient-specific overpack may be filled by unit-doses from
magazines as illustrated in FIG. 15. In some example embodiments, a
patient-specific overpack, such as a bin or an envelope, may be
filled by an automated dispensing system such as the Robot-Rx.TM..
The patient-specific overpacks may be configured with security
mechanisms, such as the latch 128 of the overpack of FIG. 2.
Lockable overpacks may be useful in environments in which control
over the overpacks may not be maintained between a central pharmacy
(or remote central pharmacy) and the patient. In such an
environment, a mechanism to preclude access to patient-specific
overpack contents may be desirable.
[0291] Upon filling a patient-specific overpack, the overpack may
be transported to a unit storage device, or a staging location
closer to the patient for whom the medications are intended.
Transport to the unit storage device may be performed by a
track-based transport system, pneumatic tube system, or other such
automated system. In other embodiments, the patient-specific
overpacks may be loaded onto a cart. A cart, such as the cart 202
of FIG. 18, may be configured to receive patient-specific overpacks
either individually, or on trays, such as tray 200. While the
overpack may include a mechanism to preclude access to the contents
as described above, the cart or other transport mechanism used to
transport the patient-specific overpacks to the unit storage device
may include a mechanism for precluding access to the contents of
the overpacks. For example, the transport cart may include doors or
latches to prevent removal of overpacks from the cart. Access may
be granted to authorized medical personnel upon authentication of
their identities, such as through biometric identification.
[0292] Once the patient-specific overpacks have been transported to
a unit storage device, the overpacks may be unloaded. The unloading
may include an automated removal of overpacks from a cart, or a
manual removal. In an example embodiment in which a track-based
transport system or pneumatic tube system is used to transport the
patient-specific overpacks, a loading device may be configured to
unload the overpacks from the transport device and load the
overpacks to a staging area, which may be a unit storage device.
The unit storage device of example embodiments may include any of
those illustrated in FIGS. 20-25. Optionally, staging may occur in
an overhead storage location along a transport route along which
the patient specific overpacks are transported to a patient-server
or nurse-server for dispensing.
[0293] The patient-specific overpacks described above may be filled
in response to a medication order received at a central pharmacy,
or in response to a system configured to predict the medications
anticipated to be needed by a patient over a particular period of
time. The overpacks may also be filled by a combination of a
medication order and predicted medications, where the medication
order includes medications known to be needed by the patient and
the predicted medication is medication that the system anticipates
may be needed by the patient. The request that a patient-specific
overpack be filled may be automated to be generated once or more
each day, or the request may come from an authorized medical
person. For example, a nurse may request a patient-specific
overpack for a patient under their care. Orders generated by a
nurse may be sent from a mobile communications device (e.g., a
tablet computer, a hand-held computing device, etc.), from a nurse
cart (e.g., a computer-on-wheels (COW) or workstation-on-wheels
(WOW)), or from a nurse-server, patient-server, or other device in
communication with a healthcare facility network.
[0294] Once the patient-specific overpacks are received at a
proximate storage location or staging area, such as a unit storage
device or overhead storage location, for example, the
patient-specific overpacks may be ready for transport to an
appropriate patient or nurse server. Authorized medical personnel
may be alerted to the arrival of a patient-specific overpack at the
unit storage device or staging area by an alert sent to a mobile
device, a nurse cart, a nurse server, a patient server, etc. Such
an alert may advise the authorized medical person that the
patient-specific overpack is ready for transport to a location for
retrieval by the authorized medical person.
[0295] When medications and/or supplies are needed for a patient,
the patient-specific overpack may be requested by an authorized
medical person. The request may be generated by the authorized
medical person using a mobile communications device, a nurse cart,
a patient server, a nurse server, or a workstation, for example.
The request may be patient-specific, such that an authorized
medical person may request the medications for a specific patient.
Optionally, a request may include a request for patient-specific
overpacks for a plurality of patients, such as all of the patients
under a particular authorized medical person's care, or all of the
patients in a particular location within the healthcare facility.
The request may also specify the desired destination for the
patient-specific overpacks. For example, a nurse may request the
medications for two patients located in different rooms. The
request may indicate that the patient-specific overpacks for both
patients should be sent to a location closest to where the nurse
is, or is planning to be. Once the request is sent for the
patient-specific bin or bins, an estimated time-of-arrival (ETA) of
the patient-specific overpacks at the specified location may be
generated. The ETA may be provided to the requesting authorized
medical person on a mobile device, on their nurse cart, on a
patient server or nurse server, or otherwise communicated to the
authorized medical person.
[0296] The patient-specific overpack(s) may then be transported
from the unit storage device or staging area by any one of number
of transport devices. For example, a patient-specific overpack may
be retrieved by a retrieval device of an X-Y robot, as illustrated
in FIG. 23, and loaded, by a loading device, onto a transport
device. The transport device may include a car, such as car 320,
for transport along the track to the location specified by the
authorized medical person. While a track-based transport device is
described, other transport devices, such as pneumatic tubes,
conveyors, or the like may be used to advance the patient-specific
overpacks from the unit storage device or staging area.
[0297] Upon arrival of the patient-specific overpacks at the
location specified by the requesting authorized medical person, an
alert may be generated. The alert may be sent to a mobile device,
nurse cart, patient or nurse server, etc. The alert may be an
audible alert, a visible alert, or a combination thereof. For
example, an audible alert may be provided via the mobile device,
and a visible alert, such as a light, may be illuminated at the
location where the patient-specific overpacks are to be retrieved.
In order to access the patient-specific overpacks requested, the
authorized medical person may be required to authenticate their
identity at the location where the patient-specific overpacks are
to be retrieved. For example, a nurse server including a user
interface may allow an authorized medical person to identify
themselves through a biometric scan, passcode entry, or
key/identification card scan. Once the authorized medical person is
identified and authenticated, the patient-specific overpacks may be
presented to the authorized medical person.
[0298] A variety of mechanisms may be employed to present the
patient-specific overpacks to the authorized medical person. For
example, the patient-specific overpacks may be awaiting retrieval
in an overhead location proximate a nurse server, as shown in FIG.
51. Upon authentication of the authorized medical person, the
patient-specific overpacks 590 may be lowered to a retrieval
position from which the authorized medical person may retrieve
them. Other embodiments of mechanism for presenting the
patient-specific overpacks may be used to ensure that the
patient-specific overpacks and/or the contents therein, are
inaccessible except to an authorized medical person after
authentication. The patient-specific overpacks may be held in an
inaccessible location or remain in a locked position until such
time as the appropriate authorized medical person is authenticated
and the patient-specific overpacks are released for retrieval.
[0299] An authorized medical person may retrieve one or more
patient-specific overpacks in dependence upon the system employed.
For example, a nurse may retrieve a plurality of overpacks for a
plurality of patients, and load them into a nurse-cart. The nurse
may then distribute medications from the patient-specific overpacks
as each patient is visited and attended to. Optionally, the
patient-specific overpack may be dispensed to an authorized medical
person for immediate use, such as using a patient-server in or near
a patient room. Upon dispensing of a patient-specific overpack at a
patient server, the authorized medical person may administer the
medication, and return the overpack.
[0300] In example embodiments in which an overpack is re-used and
not disposed of, the overpack may be returned via a nurse-server or
patient-server, and transported by transport device back to a unit
storage device. Optionally, used overpacks may be returned directly
to a unit storage device. The used overpacks may be retrieved from
the unit storage device, for example, when new patient-specific
overpacks are distributed to the unit storage device. Whether the
new overpacks are transported by track-based transport, pneumatic
tube systems, or transport carts, while the transport device is at
the unit storage device, empty overpacks may be loaded to the
transport device for return to the central pharmacy.
[0301] Many modifications and other embodiments of the inventions
set forth herein will come to mind to one skilled in the art to
which these inventions pertain having the benefit of the teachings
presented in the foregoing descriptions and the associated
drawings. Therefore, it is to be understood that the inventions are
not to be limited to the specific embodiments disclosed and that
modifications and other embodiments are intended to be included
within the scope of the appended claims. Moreover, although the
foregoing descriptions and the associated drawings describe example
embodiments in the context of certain example combinations of
elements and/or functions, it should be appreciated that different
combinations of elements and/or functions may be provided by
alternative embodiments without departing from the scope of the
appended claims. In this regard, for example, different
combinations of elements and/or functions than those explicitly
described above are also contemplated as may be set forth in some
of the appended claims. Although specific terms are employed
herein, they are used in a generic and descriptive sense only and
not for purposes of limitation.
* * * * *