Note: Descriptions are shown in the official language in which they were submitted.
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OVERRIDE HAVING BUILT IN AUDIT TRAIL FOR
MEDICATION DISPENSING AND ADMINISTERING SYSTEMS
[0001]
BACKGROUND OF THE INVENTION
[0002] A wide variety of apparatus are used in healthcare facilities for
the dispensing
and inventory of medications and medical supplies. For example, U.S. Patent
No. 5,520,450
discloses a supply station with an internal computer. The supply station is
comprised of a
cabinet having a plurality of lockable doors. Information is provided to a
computer which
unlocks the doors. The computer may be used to simultaneously and
automatically update a
patient's record, billing information and hospital inventory. The relevant
data may be displayed
on a display or printed on a sheet of paper by a printer connected to the
computer. Other
examples of computer controlled dispensing apparatus are found in U.S. Patent
No. 5,346,297,
U.S. Patent No. 5,905,653 and U.S. Patent No. 5,745,366.
[0003] Such computer controlled dispensing apparatus have been developed
in response
to a number of problems existing in hospitals and other healthcare
institutions. More
= particularly, computer controlled dispensing apparatus are operated
according to programming
that addresses problems such as the removal of medications by unauthorized
personnel,
dispensing the wrong medication for a patient, inaccurate record keeping, to
name a few.
[0004] The AcuDose-Rx dispensing cabinet available from McKesson
Automation Inc.
of Pittsburgh, Pennsylvania is an example of a computer controlled cabinet
programmed to
= address the aforementioned problems. The user must first logon to the
computer (thereby
identifying who is removing medications). The user then identifies a patient
and is presented
with a list a medications that has been approved for administering to the
identified patient
CA 02422587 2003-03-18
(thereby addressing the problem of incorrect dispensing). Records are kept for
each dispensing
event thereby creating an audit trail.
[0005] To ensure the safe and accurate dispensing and administration of
medications, a pharmacist reviews each prescription or medication order
against that
patient's medication profile and other relevant patient information to
identify such items
as therapeutic duplication in the patient's medication regimen;
appropriateness of the
drug, dose, frequency, and route of administration; medication allergies or
sensitivities;
potentially significant drug-drug, drug-food, drug-lab, and drug-disease
interactions;
contraindications to use; any organizational criteria for use; and other
relevant
medication-related issues or concerns. If a question or concern arises, the
pharmacist
contacts the person who prescribed the medication.
[0006] Many computer controlled dispensing apparatus have a "medication
order
profile interface" system that requires that all new medication orders for
patients be
entered into a pharmacy information system, where they are checked as
discussed above.
After the pharmacy information system completes the necessary clinical checks,
data
must be transmitted to the dispensing apparatus before the nurse is free to
access the
medication in the dispensing apparatus. That is done to ensure that
medications are not
dispensed and subsequently administered without a prior review by a
pharmacist.
[0007] Problems can arise, however, when a pharmacist is not available to
provide the necessary review. In many institutions, pharmacists are not
available around
the clock, although patients may be admitted at any time. Additionally, an
emergency
may arise or a doctor may write a STAT order. Under such circumstances, when a
healthcare provider, typically a nurse, must retrieve medication from the
dispensing
apparatus, the patient may not be recognized by the dispensing apparatus, or
the desired
medication may not yet be approved for the patient. As a result, to enable a
dispense to
occur, the nurse must exit the normal dispensing routine by entering an
override mode,
emergency mode, or the like. Unfortunately, in such alternative modes, control
is lost
over why the dispensing operation is needed, for whom, and the like. That loss
of control
and information has been recognized by the Joint Commission on Accreditation
of
Healthcare Organizations (JCAH0). In its proposed medication use standards,
JCAHO
provides that when a pharmacist is not on the premises, nurses can administer
any
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=
=
medication needed for the patient without a pharmacist's prior review if the
healthcare
institution has developed an alternative system for medication order review
that
minimizes the impact of skipping the pharmacist's review prior to
administration. At a
minimum, that must include the following: a retrospective review of the
medication
orders by the pharmacist as soon as a pharmacist is available; a review of the
medication
order by a qualified healthcare professional prior to administration of the
medication for
appropriateness against a database of information (e.g., drug interaction
reference and
drug profile); and an ongoing analysis and monitoring of the process for the
incidence of
medication errors as compared to the incidence of medication errors when the
pharmacy
is open. The need exists for a medication dispensing and administering
apparatus that
facilitates dispensing events in a controlled, traceable manner in situations
where an
event is requested for medication not approved for a patient.
SUMMARY OF THE INVENTION
[0008] The present invention is directed to a method of
dispensing or administering
medications which requires prompting the user for a reason if the user wants
to dispense or
intends to administer a medication that is not on the patient's medication
profile. For example, a
patient may be in severe discomfort, or some other condition exists, that
requires dispensing and
administration of a medication not approved by a pharmacist for the patient.
The method
prompts the user to supply a reason (exception) for the dispensing or
administering that can be
used to create an audit trail. The method may include identifying a patient,
accessing a
medication profile for the identified patient, selecting a medication for the
identified patient, the
selected medication not having been reviewed against the patient's medication
profile, prompting
the user to identify an exception, and reviewing the exception to determine
its acceptability. If
the exception is acceptable, access to a dispensing apparatus' storage
compartment(s) for the
purpose of dispensing the medication may be granted and a record of the
dispensing event is
created, or the healthcare giver may administer the medication and a record of
the administration
is created. If the exception is not acceptable, a record of the request to
dispense or the request to
administer is created. The method may further include transferring the
override requests and
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override events to a database containing pharmacy orders. The requests,
events, and orders may
be sorted according to a predetermined criterion, and presented to a
pharmacist for review.
[0008a] In a first broad aspect of the present invention, there is
provided a method of
controlling the administration of a medication to a patient, the method
comprising the steps of:
permitting access to a computer controlled apparatus; permitting input at the
computer controlled
apparatus to identify a patient; receiving, at the computer controlled
apparatus, a selection of a
medication for the identified patient, the selected medication not appearing
on the patient's
medication profile, the selected medication having already been dispensed
prior to the selection;
prompting, at the computer controlled apparatus, a user to identify an
exception; reviewing the
exception to determine its acceptability according to a predetermined
algorithm executed by the
computer controlled apparatus; and authorizing administration of the
previously dispensed and
selected medication prior to pharmacist review in an instance in which the
exception is
determined by the algorithm to be acceptable.
[0008b] In a second broad aspect of the present invention, there is
provided a method of
controlling the administration of a medication to a patient when the
medication does not appear
in the patient's medication profile, comprising the steps of: receiving input
logging onto a
computer controlled dispensing device; receiving input, at the computer
controlled dispensing
device, identifying a patient; receiving, at the computer controlled
dispensing device, a selection
of a medication to administer in an override mode, the selected medication
having already been
dispensed prior to the selection; receiving, at the computer controlled
dispensing device, an
exception from the user after a medication is selected; reviewing the
exception to approve it
according to a predetermined algorithm executed by the computer controlled
dispensing device;
and when the exception is an approved exception according to the algorithm,
recording, at the
computer controlled dispensing device, the administration of the previously
dispensed and
selected medication to the patient with the administration occurring prior to
pharmacist review.
[0008c] In a third broad aspect of the present invention, there is
provided a computer
readable medium for storing computer-readable code for execution by a computer
to perform a
method comprising the steps of: receiving, at the computer, information
identifying a user;
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comparing, at the computer, the received information to stored information
about the user;
receiving, at the computer, information identifying a patient; receiving, at
the computer,
information identifying a medication, the selected medication having already
been dispensed
prior to the selection; prompting, at the computer, the user to enter an
exception when the
medication does not appear on a list of approved medications for the patient;
reviewing the
exception to determine its acceptability according to a predetermined
algorithm executed by the
computer; and authorizing administration of the previously dispensed and
selected medication
prior to pharmacist review in an instance in which the exception is determined
by the algorithm
to be acceptable.
[0008d] In a fourth broad aspect of the present invention, there is
provide a computer
readable medium for storing computer-readable code for execution by a computer
to perform a
method comprising the steps of: receiving, at the computer, information
identifying a user;
comparing, at the computer, the received information to stored information
about the user;
receiving, at the computer, information identifying a patient; displaying, at
the computer, a
medication profile for the identified patient; receiving, at the computer,
information identifying a
mode in which medications other than those listed on the profile may be
selected; displaying, at
the computer, a list of medications available for selection; receiving, at the
computer,
information identifying a selected medication, the selected medication not
appearing on the
patient's medication profile, the selected medication having already been
dispensed prior to the
selection; prompting, at the computer, the user to enter an exception;
evaluating the exception to
determine its acceptability according to a predetermined algorithm executed by
the computer;
and authorizing administration of the previously dispensed and selected
medication prior to
pharmacist review in an instance in which the exception is determined by the
algorithm to be
acceptable.
[0008e] In a fifth broad aspect of the present invention, there is
provided an apparatus
comprising a computer configured to: receive input to identify a patient;
receive a selection of a
medication for the identified patient, the selected medication not appearing
on the patient's
medication profile, the selected medication having already been dispensed
prior to the selection;
prompt a user to identify an exception; review the exception to determine its
acceptability; and
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authorize administration of the previously dispensed and selected medication
prior to pharmacist
review in an instance in which the exception is acceptable.
[0009] The present invention prevents dispensing and warns against
administering medications when the medication has not been approved for the
patient and no
acceptable reason exists for not waiting until a pharmacist can make the
necessary review. If an
acceptable reason exists for dispensing/administering before the necessary
review by a
pharmacist has taken place, the present invention provides documentation and
an audit trail of
the reasons for the event. With electronic collection and distribution of
events or requests for
events, it is intended that efficiencies and cost savings are enabled.
Further, that information can
be sent to centralized 24/7 pharmacies that provide after-hours services to
institutions that are not
staffed in off hours, thereby insuring compliance even with reduced hours and
staff. Those
intended advantages and benefits, and others, will be apparent from the
description below.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] For the present invention to be easily understood and readily
practiced, the
present invention will now be described, for purposes of illustration and not
limitation, in
conjunction with the following figures, wherein:
[0011] FIG. 1 is a diagram illustrating the relationship between a
centralized storage
location and., among other things, a plurality of storage locations;
[0012] FIG. 2 is one example of apparatus located at a decentralized
location
implementing a closed system for performing dispensing operations;
[0013] FIG. 3 is a flow chart illustrating a method of dispensing for a
patient according to
the present invention;
[0014] FIG. 4 is an exemplary screen illustrating one way of prompting a
user for
information;
[0015] FIG. 5 is an illustration of a type of handheld
scanner/administration device with
which the present invention may be used;
[0016] FIG. 6 is a flow chart illustrating a method of administering for a
patient which
may be used in conjunction with the device of FIG. 5; and
[0017] FIG. 7 is a flow chart illustrating a method of communicating and
processing
override events.
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DESCRIPTION OF THE INVENTION
[0018] FIG. 1 is a diagram illustrating the relationship between a
centralized storage
location 10 and various inventory destinations, including a plurality of
decentralized storage
locations 12-1, 12-2 through 12-n, patients 13, and a remote facility 14. Each
of the
decentralized storage locations 12-1 through 12-n is capable of dispensing
items stored at the
location. The items may include medications, controlled medical supplies,
medical supplies or
items of a nature consistent with the facility in which the system illustrated
in FIG. 1 is located.
Items may be dispensed directly from centralized storage location 10 to
patients 13, or from the
centralized storage location 10 to a remote facility 14. Data typically flows
from the
decentralized storage locations 12-1 through 12-n to the centralized storage
location 10. In
response to that data, items are typically moved from the central storage
location 10 to the
decentralized storage locations 12-1 through 12-n or to the remote facility 14
to restock such
locations to either replenish dispensed items or to stock new items.
Decentralized locations
could include satellite pharmacies, computerized medication cabinets,
stationary/mobile
medication carts, nurse servers, remote hospital pharmacies, supply closets,
supply cabinets, etc.
Supplies can be reordered from distributors based on levels of stock in the
centralized storage
location 10.
[0019] FIG. 2 illustrates one example of an apparatus that may be
located at any of the
decentralized locations 12-1 through 12-n. The apparatus illustrated in FIG. 3
is comprised of an
AcuDose-RxTm cabinet 26 and an AcuDose-RxTm auxiliary cabinet 28 available
from McKesson
Automation Inc. A supply tower 30 is also illustrated. A control computer 32
controls the
operation of the cabinet 26, auxiliary cabinet 28, and supply tower 30. The
control computer 32
is also in communication with a central database (not shown). The reader will
understand that
the present invention is not limited to the AcuDose-RxTm cabinet 26, but
rather the method of the
present invention may be implemented on any type of computer controlled
dispensing apparatus.
[0020] Turning now to FIG.6, a flow chart illustrating a method
which may be practiced
on the handheld device 65 illustrated in FIG. 5 is shown.*** To perform a
dispensing operation
a user logs onto the control computer 32 at step 36. In that manner, the
computer receives
information identifying the user. The user information is compared to stored
information at step
38. At step 40 a patient is identified. The information could be entered on a
keypad, either by
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name or by an ID number, the information could be scanned, selected from a
pick list, or any
other known method of entering the patient information. In that manner, the
computer receives
information identifying the patient.
[0021] At step 42 a medication profile for the patient is displayed. The
display may
include all of the medications which have been approved by a pharmacist for
administration to
the patient. For a normal dispensing event, not shown in detail but
represented by the box 43,
the user then selects from the displayed medications. However, if the
medication has been
ordered on a STAT or emergency basis, it may not be displayed at step 42. The
user then selects
at step 44 an override mode. The use of the phrase "override mode" is not
intended to limit the
present invention. In the vernacular of the AcuDose cabinet, when a user
wishes to select a
medication not in the patient's medication profile, the override mode is
enabled. Sometimes a
patient has not yet been admitted on the system, thus requiring creation of a
patient record prior
to proceeding. In those cases, the user is taken directly to the list of
medications available for
dispensing. Other cabinet manufacturers may use other terminology. The concept
is that the
user wishes to select a medication for dispensing which is not on the
patient's medication profile
or, in other words, the user wishes to dispense a medication prior to review
by a pharmacist or
other qualified healthcare provider, regardless of whether that is referred to
as an override mode,
an emergency mode, or any other phrase specific to a particular manufacturer.
[0022] At step 46, the control computer 32 displays a list of medications
available for
dispensing. The list could include all of the medications in the various
cabinets, auxiliary
cabinets, supply towers and the like under the control of the control computer
32, or some set of
that list for which the particular user has authority to dispense. At step 48,
the user selects the
desired medication or medications. Selection could be via a touch screen,
entry through a
keypad, or any other known method of entering information for enabling the
selection. In that
manner, the control computer receives information identifying a medication to
dispense. At step
50 the user is prompted to enter information. The information being entered
may be variously
described as an "exception" to the general rule that a medication cannot be
dispensed unless the
order has been reviewed by a pharmacist or the "reasons" why the dispense is
necessary. There
are two recognized exceptions for when an nurse can dispense prior to a
pharmacists review, e.g.
in the override mode. The first is a situation in which a physician or other
qualified healthcare
provider controls the ordering, dispensing and administration of the
medication, such as in an
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operating room, endoscopy suite, or an emergency room. The second exception is
for those
emergencies when there is not sufficient time to obtain the necessary review.
Those include
STAT orders or those orders where the clinical status of the patient would be
significantly
compromised by the delay that would result from waiting for a pharmacist's
review. Not all first
orders meet these criteria.
[0023] An example of an exemplary screen 60 used to prompt the user to
provide the
required information is illustrated in FIG. 4. In FIG. 4, two exceptions
acceptable to an
organization such as JCAHO are illustrated: physician controlled dispensing 62
and STAT order
64. The curser may be placed in the appropriate box and a keystroke entered.
However, the
information may be input in any known way such as selecting a reason or
exception from a pick
list, or the like. The exceptions or reasons shown to the user may be hard
coded by the
manufacturer, soft coded to allow the user to create the text, or customizable
hard code, where
the user selects which exceptions from among numerous exceptions will be
displayed, or any
other known manner.
[0024] In addition to a listing of various exceptions a text box 66 may be
provided. The
text box may be used to record textual information which the nurse wishes to
add to the record.
In an alternative embodiment, the textbox may be used in place of a list. In
that embodiment, the
text in the text box is subjected to character recognition followed by a
search for keywords to
determine if the exception or reason for the dispense is adequate. A reason
for dispensing each
medication selected at step 48 must be provided at step 50.
[0025] At step 52, an evaluation is made to determine if the reasons input
at step 50 are
sufficient. For example, if one of the reasons is an exception recognized by a
committee such as
JCAHO, and the box 62, 64 next to that reason has been selected, then the
process continues at
step 54 where the "override" event is stored and a dispensing event takes
place at step 58. It
should be recognized that the analysis performed at step 52 will depend to a
large degree on the
type of information input at step 50. For example, if at step 50 the user's
only options are to
choose amongst acceptable exceptions, then perhaps the only analysis that
needs to be performed
at step 52 is whether one of the exceptions has been selected. If, however, at
step 50 the user is
prompted to select from a list of numerous exceptions, some of which are
acceptable and some
of which are not, it may be necessary at step 52 to determine if an acceptable
exception has been
selected. In yet another embodiment, where all that is provided is a text box,
at step 52 it may be
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necessary to perform character recognition, and then perform an analysis upon
the recognized
characters to determine if the proper keywords or phrases have been used for a
recognized
exception. The present invention is not to be limited by the manner in which
the user is
prompted to input reasons at step 50 and the manner in which those reasons are
evaluated at step
52.
[00261 It should also be noted that code may be provided for
disabling steps 50 and 52.
For example, in a hospital or other healthcare institution in which procedures
are already in place
to properly document dispenses in an "override" mode, the institution may
choose to disable
steps 50 and 52 and proceed directly to storage of the override event 54 and
dispensing at step 58
as soon as the user selects the medications at step 48.
[0027] Assuming that the reasons were acceptable at step 52, as
noted the override event
is stored at step 54. Thereafter, a dispensing event occurs at step 58 and the
process returns to
step 56. If the reasons were unacceptable at step 52, the override request is
stored at step 60 and
the process continues with step 56.
[0028] After an override request has been stored at step 60, or
a dispensing event has
occurred at step 58, one important aspect from the healthcare institution's
perspective is to have
a pharmacist review either the override request or the override event as soon
as possible. That
may be implemented in at least two ways. First, the records of the override
requests and override
events may be printed, for example, at a pharmacy computer, or if an
electronic pharmacy
system is available, the records of the override requests and override events
may be forwarded to
= the phannacy system, as will be described in greater detail in
conjunction with FIG. 7.
[0029] The previous paragraphs describe how a dispensing event
for a patient may be
performed in conjunction with a medication not listed on the patient's
profile. A similar
situation may arise when a medication which is not on a patient's profile is
to be administered.
The administration of medication may be controlled through the use of a
scanner/administrating
device 65 of the type illustrated in FIG. 5. Such devices are commercially
available. An
= example of one such device is sold under the name AcuScan-Rx by McKesson
Automation Inc.
of Pittsburgh, Pennsylvania. The device 65 is capable of receiving information
about a patient,
for example through scanning a patient's bracelet, selecting a patient from a
pick list, or entering
patient ID information. The device 65 may include an RI transmitting device
allowing the
device 65 to be in real time communication with a database which may be
located at the
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centralized location, hospital pharmacy, or other location. Other types of
scanner/administrating
devices may require docking in a base station before communicating with the
database.
[0030] Turning now to FIG.6, a flow chart illustrating a method which may
be practiced
on the handheld device 65 illustrated in FIG. 5 is shown. To perform an
administering operation
a user logs into the computer controlled handheld device 65 at step 86. In
that manner, the
computer (not shown) of the device 65 receives information identifying the
user. The handheld
device 65 displays a patient list at step 88. At step 90 a patient is
identified. The information
could be entered on a keypad, either by name or by an ID number, the
information could be
scanned, selected from a pick list, or any other known method of entering the
patient
information. In that manner, the computer of the handheld device 65 receives
information
identifying the patient.
[0031] At step 92 a medication profile for the patient is displayed. The
display may
include all of the medications which have been approved by a pharmacist for
administration to
the patient. For a normal administering event, not shown, the user then
selects from the
displayed medications. However, if the medication has been ordered on a STAT
or emergency
basis, it may not be displayed at step 92. The user then selects at step 94 an
override mode. The
use of the phrase "override mode" is not intended to limit the present
invention. In the
vernacular of an AcuScan Rx handheld device, when a user wishes to select a
medication not in
the patient's medication profile, the override mode is enabled. Sometimes a
patient has not yet
been admitted on the system, thus requiring creation of a patient record prior
to proceeding. In
those cases, the user is taken directly to the list of medications available
for administering.
Other manufacturers may use other terminology. The concept is that the user
wishes to select a
medication for administering which is not on the patient's medication profile
or, in other words,
the user wishes to administer a medication prior to review by a pharmacist or
other qualified
healthcare provider, regardless of whether that is referred to as an override
mode, an emergency
mode, or any other phrase specific to a particular manufacturer.
[0032] At step 96, the handheld device 65 displays a list of medications
available for
administering. The list could include all of the medications in the various
cabinets, auxiliary
cabinets, supply towers and the like in communication with the handheld device
65, or some set
of that list for which the particular user has authority to administer.
Typically, at this point, the
healthcare worker has already dispensed or otherwise obtained the medication
that is to be
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administered. At step 98, the user selects the desired medication or
medications from the list.
Selection could be via a touch screen, entry through a keypad, or any other
known method of
entering information for enabling the selection. In that manner, the handheld
device 65 receives
information identifying a medication to be administered.
[0033] At step 100 the user is prompted to enter information.
The information being
entered at step 102 may be variously described as an "exception" to the
general rule that a
medication cannot be administered unless the order has been reviewed by a
pharmacist or the
"reasons" why the administering is necessary. There are two recognized
exceptions for when an
nurse can administer prior to a pharmacists review, e.g. in the override mode.
The first is a
situation in which a physician or other qualified healthcare provider controls
the ordering,
dispensing and administration of the medication, such as in an operating room,
endoscopy suite,
or an emergency room. The second exception is for those emergencies when there
is not
sufficient time to obtain the necessary review. Those include STAT orders or
those orders where
the clinical status of the patient would be significantly compromised by the
delay that would
result from waiting for a pharmacist's review. Not all first orders meet these
criteria. The
exemplary screen 60 illustrated in FIG. 4 and described in conjunction with
the process of FIG. 3
may also be used in conjunction with the process of FIG. 6.
[0034] At step 104, an evaluation is made to determine if the
reasons input at step 102
= are sufficient. For example, if one of the reasons is an exception
recognized by a committee
such as JCAHO, and the box 62,64 (see FIG. 4) next to that reason has been
selected, then the
process continues at step 106 where the "override" event is stored and an
administering event
= takes place at step 108. It should be recognized that the analysis
performed at step 104 will
= depend to a large degree on the type of information input at step 102.
For example, if at step 102
the user's only options are to choose amongst acceptable exceptions, then
perhaps the only
analysis that needs to be performed at step 104 is whether one of the
exceptions has been
selected. If, however, at step 100 the user is prompted to select from a list
of numerous
exceptions, some of which are acceptable and some of which are not, it may be
necessary at step
104 to determine if an acceptable exception has been selected. In yet another
embodiment,
where all that is provided is a text box, at step 104 it may be necessary to
perform character
recognition, and then perform an analysis upon the recognized characters to
determine if the
proper keywords or phrases have been used for a recognized exception. The
present invention is
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not to be limited by the manner in which the user is prompted at step 100 and
inputs reasons at
step 102 and the manner in which those reasons are evaluated at step 104.
[00351 It should also be noted that code may be provided for disabling
steps 100, 102 and
104. For example, in a hospital or other healthcare institution in which
procedures are already in
place to properly document administerings in an "override" mode, the
institution may choose to
disable steps 100, 102 and 104 and proceed directly to storage of the override
event 106 and
administering at step 108 as soon as the user selects the medications at step
98. In other
circumstances, for example if computer controlled dispensing devices are used
in a healthcare
facility, it may not be necessary or desirable to duplicate the audit trial at
the time of
administering if an audit trial was created at the time of dispensing.
[0036] Assuming that the reasons were acceptable at step 104, as noted the
override
event is stored at step 106. Thereafter, an administering event occurs at step
108 and the process
returns to step 110. If the reasons were unacceptable at step 104, the
override request is stored at
step 112 and the process continues with step 110.
[0037] After an override request has been stored at step 112, or an
administering event
has occurred at step 108, one important aspect from the healthcare
institution's perspective is to
have a pharmacist review either the override request or the override event as
soon as possible.
That may be implemented in at least two ways. First, the records of the
override requests and
override events may be printed, for example, at a pharmacy computer, or if an
electronic
pharmacy system is available, the records of the override requests and
override events may be
forwarded to the pharmacy system, as will be described in greater detail in
conjunction with FIG.
7.
[0038] In FIG. 7, a flow chart illustrating another method according to
the present
invention is illustrated. In FIG. 7, records for each override request stored
at step 60 in FIG. 3
or step 112 in FIG. 6, and records of each override event stored at step 54 in
FIG. 3 and step 106
in FIG. 6, are monitored at step 68. A decision is made at step 70 if a
pharmacy workstation 110
exists. If there is no pharmacy workstation 110, then the override requests
and override events
are printed at step 72, preferably at a pharmacy printer 112, so that they may
be reviewed by a
pharmacist as soon as practicable. If there is a pharmacy workstation 110,
then the records
representative of the override requests and override events are added to the
workstation queue at
step 74.
CA 02422587 2013-06-12
[0039] The workstation, queue may be created, in the first instance, by
commercially
available products such as the Pyxis Connect product available from Pyxis
Corporation or the
MedDirect product available from McKesson. Automation, Inc. as represented by
block 76. The
MedDirect product is an automated system for communicating medication orders
and for
managing documents. Using imaging technology, the MedDirect product delivers
clear, scanned
medication order images directly to the hospital pharmacy, where they can be
viewed
simultaneously with the pharmacy information system. Once the order is
reviewed and approved
by a pharmacist, it is entered in the pharmacy information system and made
available for profile
dispensing and administering by, for example, the AcuDose cabinet 26 (FIG. 2)
or the AcuScan
Rx handheld device (FIG. 5), respectively. At step 74, certain logic or rules
may be applied to the
queue to sort or reorder the queue. For example, records representative of
override events may be
placed at the front of the queue.
[0040] At step 78, the user selects a record from the queue to review. At
step 80, a user,
typically a pharmacist, will review the override events and/or approve
override requests. The
pharmacist may optionally input orders into a pharmacy information system. At
step 82, the
override requests and override events are archived for later review by a
decision support system
or the like as represented by step 84.
[0041] A hospital may receive a type I recommendation from an organization
such as
JCAHO because nurses are accessing medication dispensing and administering
apparatus for
first doses of medication. Implementation of the present invention provides a
hospital with
evidence that policy and procedures are being adhered to, as well as providing
an audit trail of
all override activities associated with computer-controlled medication
dispensing and
administering apparatus.
[0042] Having the present invention integrated into computer-controlled
medication
dispensing and administering apparatus provides an electronic transfer of the
information
inmediately, or based on a time delay, to a location where a pharmacist is
available, thus intending
to create efficiencies and cost savings. With electronic collection and
distribution of the override
information, that information can be sent to centralized 24/7 pharmacies that
provide after-hours
services to institutions that are not staffed in off hours, thereby insuring
compliance even with
reduced hours and staff. Electronic communications systems can be attached,
such as cell phones,
beepers, and e-mail to provide notification to pharmacists of the need to
address override
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CA 02422587 2013-06-12
events and/or requests. More sophisticated wireless PDAs (personal digital
assistants)
can actually be connected to such systems, alerting pharmacists of the need to
address
override events and/or requests, allowing them to review the collected
information, and
providing approval transactions from remote locations.
[0043] Patient safety is ultimately intended to be enhanced when computer-
controlled
medication dispensing and administering apparatus incorporate the present
invention so as to
aid caregivers during, overrides. Providing the means of enforcing and
auditing hospital
policy and procedures is intended to directly contribute to overall patient
safety in
compliance with JCAHO recommendations.
[0044] Many hospitals may have both systems in place, that is, computer
controlled
medication dispensing and administering apparatus. The caregiver may
foreseeable have to go
through the override process twice, That is, they may have to override at the
dispensing
cabinet and override again at the handheld device for administering. This may
result in the
creation of two records. Some institutions may choose to have two records:
Other institutions
may choose to Suppress the second record. The choice to suppress a record may
be an option
of the handheld device 65 provided to the user at step 100 in Fig. 6.
[0045] While the present invention has been described in conjunction with
illustrative
embodiments thereof, those of ordinary skill in the art will recognize that
many
modifications and variations may be implemented while still failing within the
scope of the
present invention.
Other types of dispensing and administrating devices may be used, and process
steps may be
substituted for those described in the illustrative embodiment while remaining
within the scope
of the present invention. The description of presently illustrative
embodiments is not intended
to limit the scope of the present invention, which is defined by the following
claims.
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