MEDICATION ADMINISTRATION SYSTEM

SYSTEME D'ADMINISTRATION DE MEDICAMENTS

English Abstract

The present invention comprises a system and method for administering
medications to a plurality of patients in a medication institution. A
preferred system comprises a workflow program (70) for generating a scheduler,
wherein the scheduler coordinates the administration of medications to the
patients, a medicine cabinet (30), responsive to said scheduler, for storing
medications and dispensing the medications to an authorized user for
administration to the patients, the workflow program (70) providing the
cabinet (30) with patient specific information relating to said dispensation
of the medications including a physician order for each patient, and a
medicine cart (50), coupled to the medicine cabinet (30), for instructing said
authorized user in the administration of said medication to each of said
patients. The cart (50) comprises a plurality of patient specific cart drawers
(51) for storing the medication to be administered to each patient, wherein
each cart drawer (51) remains unidentified as patient specific until the
medication cart (50) receives said patient specific information, and a cart
processor, wherein the cart drawers are filled with medicine from the medicine
cabinet for each patient associated with each patient specific cart drawer
(51) in accordance with the respective physician order for each patient.

French Abstract

La présente invention concerne un système et un procédé pour administrer des médicaments à une pluralité de patients dans un établissement médical. Un système préféré comprend un programme de flux de travail destiné à générer un ordonnanceur, ledit ordonnanceur étant conçu pour coordonner l'administration de médicaments aux patients, une armoire à pharmacie, subordonnée audit ordonnanceur et destinée à stocker les médicaments et à les distribuer à un utilisateur autorisé pour l'administration aux patients, le programme de flux de travail communicant à l'armoire à pharmacie des informations spécifiques aux patients en rapport avec l'administration des médicaments, y compris l'ordonnance médicale pour chaque patient, et un chariot à médicaments, couplé à l'armoire à pharmacie et destiné à donner des instructions à l'utilisateur autorisé en rapport avec l'administration de ces médicaments à chacun desdits patients. Le chariot comprend une pluralité de tiroirs destinés à stocker des médicaments à administrer à chaque patient, mais aucun tiroir à médicaments n'est déterminé comme spécifique à tel ou autre patient jusqu'à ce que le chariot à médicaments reçoive des informations spécifiques au patient, et un processeur de chariot, les tiroirs du chariot étant remplis avec des médicaments provenant de l'armoire à pharmacie pour chaque patient associé à chaque tiroir de chariot spécifique au patient, en fonction de l'ordonnance médicale correspondante pour chaque patient.

Claims

WHAT IS CLAIMED IS:
1. A system for administering one or more medications to each of a plurality
of
patients comprising:
a workflow program for generating a scheduler, wherein the scheduler
coordinates the
administration of medications to each patient;
a medicine cabinet, responsive to said scheduler, for storing the medications
and
dispensing same to an authorized user for administration to each patient,
wherein the
workflow program provides the cabinet with patient specific information
relating to said
dispensing of the medications; and
a medicine cart comprising:
a plurality of cart drawers for storing the medications and transporting same
to each
patient, wherein each cart drawer remains unidentified until the medication
cart receives said
patient specific information, whereupon one or more of the cart drawers
becomes patient
specific; and
a cart processor for accessing a cart program that controls access to the
plurality of
patient specific cart drawers and assigns each patient one or more of the cart
drawers,
wherein the cart drawers are filled with the medications from the medicine
cabinet for each
patient associated with each patient specific cart drawer.
2. The system of claim 1, wherein said medicine cabinet comprises:
one or more frames, each of which comprises a plurality of cabinet drawers,
wherein
one or more of the cabinet drawers are designated medication specific; and
a cabinet processor for accessing a cabinet program that controls access to
the
plurality of medication specific cabinet drawers.
3. The system of either of claims 2 or 3, wherein said medicine cabinet
further
comprises a port for linking said medicine cart to said medicine cabinet.
4. The system of any one of claims 1 - 3, wherein said patient specific
information comprises a physician order for each patient.
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5. The system of claim 4, wherein said physician order comprises the
medication
to be administered to the respective patient and an electronic identification
means that
confirms the physician's order.
6. The system of any one of claims 2 - 5, wherein simultaneous access to a
medication specific cabinet drawer and medications included therein, and said
patient specific
cart drawer is granted to the authorized user by said cabinet program and said
cart program,
respectively, while each of the remaining plurality of cabinet and cart
drawers are
inaccessible to the authorized user.
7. The system of claim 6, wherein said cabinet program grants access to
another
one of the plurality of cabinet drawers and medications included therein,
wherein said access
is granted to the authorized user, one cabinet drawer at a time, when the
cabinet program
detects closure of a previously accessible cabinet drawer.
8. The system of claim 7, wherein said assigned patient specific cart drawer
is
closed and inaccessible upon detection by said cabinet program that all
patient medications
were dispensed and that all cabinet drawers are inaccessible.
9. The system of any one of claims 2 - 8, wherein access to a medication
specific
cabinet drawer or said patient specific cart drawer, or a combination thereof,
is denied to an
unauthorized user.
10. The system of any one of claims 2 - 9, wherein said one or more cabinet
drawers are designated patient specific cabinet drawers, each of which is
assigned by the
cabinet program to a patient.
11. The system of claim 10, wherein access to one of the plurality of patient
specific cabinet drawers and medications included therein, is granted to the
authorized user
by said cabinet program, each of the remaining cabinet drawers being
inaccessible to said
authorized user while said one of the plurality of patient specific cabinet
drawers is
accessible.
34

12. The system of any one of claims 1 - 11, wherein said cart further
comprises a
bar code reader for reading a patient identification to verify that the
correct patient is being
administered one or more medications.
13. The system of any one of claims 1 - 12, wherein said cart further
comprises a
common drawer for storing one or more medications not supplied in the patient
specific cart
drawer.
14. The system of claim 13, wherein said medications in said common drawer are
bar coded with a patient identification for each patient for whom the
medication is ordered
wherein said bar code reader reads said bar coded medications in said common
drawer to
confirm that the correct medication is being administered to the patient.
15. The system of any one of claims 1 - 14, wherein said cart program logs
administration information for each patient receiving medication.
16. The system of any one of claims 1 - 15, wherein said medicine cart further
comprises monitoring equipment for taking vital sign information of a patient
in accordance
with the patient specific information,
said vital sign information being transmitted to said workflow program.
17. The system of any one of claims 1 - 16, further comprising a plurality of
medicine carts, wherein the operation of each cart is coordinated by said
workflow program.
18. The system of any one of claims 4 - 17, further comprising:
a prescription program for assisting generation of the physician order for
each of said
plurality of patients; and
a mobile computer for accessing the prescription program.
19. The system of any one of claims 4 - 18, further comprising:
at least one workstation, coupled to a central server and said mobile
computer, for
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transmitting said patient specific information to said mobile computer,
receiving said
physician order from said mobile computer, and accessing the workflow program
to generate
the scheduler in response to receiving said physician order, said workflow
program accessible
to an authorized user using said workstation; and
the central server for coordinating the transmission of the patient specific
information
to the medicine cabinet and the medicine cart.
20. The system of claim 19, wherein said workstation further accesses said
prescription program.
21. The system of any one of claims 2 - 20, wherein said workflow program
calculates and maintains a running inventory of the medications in each of the
cabinet
drawers; whereby such inventory is continuously updated as the medications are
dispensed or
replenished by the authorized user.
22. The system of any one of claims 2 - 21, wherein said cabinet processor
accesses said workflow program for viewing an output of the workflow program
including
the scheduler and the inventory of the medications in said medicine cabinet.
23. The system of claim 22, wherein said mobile computer accesses said
workflow program.
24. The system of any one of claims 2 - 23, wherein at least one of the one or
more frames includes a refrigeration means for storing medications that
require refrigeration;
said refrigerated medication being bar coded with a patient ID for the patient
whom
the medication has been prescribed.
25. The system of any one of claims 2 - 24, wherein said medicine cabinet
further
comprises a bar code reader for reading a bar coded medication to verify that
the bar coded
medication is being dispensed correctly.
26. A method for administering one or more medications to each of a plurality
of
36

patients comprising the steps of:
generating a scheduler, using a workflow program, which coordinates the
administration of medications to each patient;
providing patient specific information to a medicine cabinet, controlled by a
cabinet
program, which cabinet stores the medications therein;
dispensing the medications to a medicine cart by an authorized user in
response to
said scheduler and said patient specific information;
assigning each patient one or more cart drawers upon the cart receiving said
patient
information, wherein each assigned cart drawer becomes patient specific;
controlling access to the medications in the patient specific cart drawer by a
cart
program; and
administering the medications to each patient from the patient specific cart
drawer.
27. The method of claim 26, further comprising designating in said medicine
cabinet one or more of a plurality of cabinet drawers as medication specific.
28. The method of either of claims 26 or 27, further comprising generating a
physician order for each patient, wherein said physician order is included in
said patient
specific information.
29. The method of either of claims 27 or 28, further comprising simultaneously
granting access to a medication specific cabinet drawer and medications
included therein and
said patient specific cart drawer to the authorized user, by said cabinet
program and said cart
program, respectively, while each of the remaining plurality of cabinet and
cart drawers are
inaccessible to the authorized user.
30. The method of claim 29, further comprising granting access to another one
of
the plurality of cabinet drawers and medications included therein, wherein
said access is
granted, one cabinet drawer at a time, when the cabinet program detects
closure of a
previously accessible cabinet drawer.
31. The method of claim 30, further comprising closing said patient specific
cart
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drawer upon detection by said cabinet program that all patient medications for
that patient
have been dispensed.
32. The method of any one of claims 26 - 31, further comprising designating
said
one or more cabinet drawers as patient specific, each one or more patient
specific cabinet
drawers being assigned by the cabinet program to a patient.
33. The method of any one of claims 26 - 32, further comprising reading a
patient
identification to verify that the correct patient is being administered
medication using a bar
code reader.
34. The method of any one of claims 26 - 33, further comprising:
designating one or more drawers in the cart as a common drawer;
bar coding said medications in said common drawer with a patient
identification for
whom the medication is ordered; and
reading said bar coded medication in said common drawer to confirm the correct
medication is administered to the patient.
35. The method of any one of claims 26 - 34, further comprising logging
administration information for each patient receiving medication.
36. The method of any one of claims 26 - 35, further comprising:
taking vital sign information of a patient in accordance with the patient
specific
information using monitoring equipment; and
transmitting said vital sign information to said workflow program.
37. The method of any one of claims 26 - 36, further comprising:
calculating a running inventory of the medications in each of the cabinet
drawers; and
updating said inventory as the medications are dispensed or replenished by an
authorized user.
38. The method of any one of claims 26 - 37, further comprising reading a bar
38

coded medication to verify that the bar coded medication is dispensed
correctly.
39

Description

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MEDICATION ADMINISTRATION SYSTEM
CROSS REFERENCE TO RELATED APPLICATIONS
This application is a continuation in part of US Patent Application No.
09/706,572 filed November 7, 2000; and PCT Patent Application No.
PCT/ILO1/01030 filed
November 6, 2001, which are each herein incorporated in its entirety, and
further claims all
priorities accorded US Patent Application No. filed herewith.
BACKGROUND OF THE INVENTION
~ The present invention relates to medication administration systems. More
specifically, the present invention relates to medication administration
systems in a medical
facility.
Automated medication dispensing systems have been in use for many years.
The initial purpose of such systems was to reduce the high rates of medication
errors
associated with manual distribution and the high cost of maintaining a large
amount of
inventory. The literature indicates that medication errors occur in the
following areas: 13% at
prescribing, 42% at administering, 27% at documentation, 17% at dispensing and
1% at
monitoring (Summary of Information Submitted to MEDMARXTM in the Year 2000).
The
current automated systems present more sophisticated advantages, including:
lower costs
associated with pharmaceutical distribution, reduction of personnel, inventory
control,
substance control, automated documentation, further reduction of errors, and
relieving
professional pharmacists and nursing personnel of many tasks.
There are two types of methods and currently two ways of dispensing
medications employed in medical facilities: centralized systems, and
decentralized systems.
The centralized systems are based on the transfer of the physician's
orders/prescription to the central pharmacy of the medical facility. These
systems facilitate
the transfer of orders/prescriptions to the central pharmacy after being
reviewed by personnel
in the ward/floor, whereupon the orders/prescriptions are reviewed, authorized
and filled by a
pharmacist, sent as a unit dose to the ward, where every patient has a
personal container,
usually at a central location, that contains all his medicine for the next 24
hours, and then
dispensed to the appropriate patient according to each individual hospital's
routines.

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Centralized systems are used primarily in the U.S.A. They are costly and very
inefficient,
mainly because of the use of a large trained staff.
Decentralized systems are based on ward stocks managed by trained nursing
personnel in conjunction with pharmacists from the hospital pharmacy. The
dispensing
procedure traditionally proceeds as follows:
The nurse receives from the physician the prescriptionls stating the
medication, time of delivery, and route (p.o., LV., etc.).
At the appropriate time, the nurse retrieves the appropriate medicatioi~/s for
the patients according to a list of orders, places the medications into a
receptacle, usually with
an attachment that indicates the patient's name, places the receptacles on a
tray, and then
dispenses the receptacles to the patients in the ward.
The foregoing traditional method is subject to a number of disadvantages
including: (1) possible confusion between patient files; (2) errors in brand
or dosage when
retrieving medications from the medicine cabinet; (3) errors in identifying
individual patients;
(4) errors in receptacle identification; (5) a demand on much of the nurse's
time; (6)
possibility of mistakes in inventory record keeping and pharmacy ordering; and
(7) very low
degree of control, even though expensive and/or narcotic drugs are involved.
A report from the Institute of Medicine (IOM) of the National Academies
released in November 1999 in the U.S.A. calls on Congress to create a national
patient safety
center to develop new tools and systems, the reason being alarming figures
regarding the
human cost of medical errors. Deaths from medical errors are estimated,
according to
different studies, to be between 44,000 to 98,000 people in the U.S. hospitals
each year,
which is more than those from highway accidents, breast cancer or AIDS. The
report states
that illegible handwriting, and the non-coordinated treatment of patients by
several
practitioners who do not have complete information about the medicines
prescribed and the
patient's illnesses, are part of the basic flaws in the way the health system
is presently
organized. William Richardson, chairman of the committee, is quoted as saying
"It may be
part ~of human nature to err, but it is also part of human nature to create
solutions, find better
alternatives, and meet the challenges ahead."
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Medication management devices generally fall under three categories: (a)
automated devices in the central pharmacy area; (b) automated devices in the
patient care
unit; and (c) point-of care information systems.
The primary goal of using centrally-located devices is to replace or improve
the current manual process for filling unit dose containers. These devices
offer the advantage
of a lower, single, centralized inventory. Disadvantages of such devices
include large size,
high cost, and reliance on efficient delivery systems from the central
pharmacy.
Many systems have been proposed and are described in the literature for
minimizing or eliminating the above-described disadvantages of the existing
systems.
Examples of such recent developments are described in US Patents: 6,032,155;
6,021,392;
5,912,818; 5,314,243; 5,564,803; 6,003,006; 6,068,156; 5,842,976; 5,797,515;
5,014,875;
5,460,294; and 5,713,485.
However, prior to the present invention there has been a very pressing need to
provide a flexible medication dispensing system which utilizes both the
centralized and
decentralized methods of dispensing medication, and meets at least the
following goals: (1)
provides secure and reliable medication dispensing; (2) permits more efficient
workflow; (3)
allows for the collection of vital signs (e.g., temperature, pulse rate and
blood pressure); (4)
maximizes automation and employs computerized paperless operation; (5)
automates
management of drug inventory in each department; (6) protects against "drug
abuse" by
medical and para-medical personnel; and (7) offers special protection for
narcotic drugs.
SUMMARY OF THE INVENTION
An object of the present invention is to provide a medication dispensing
system, and also a medicine cabinet structure and enabling attaining one or
more of the
foregoing goals.
Accordingly, the present invention comprises a system and method for
administering medications to a plurality of patients in a medication
institution. A preferred
system comprises a workflow program for generating a scheduler, wherein the
scheduler
coordinates the administration of medications to the patients, a medicine
cabinet, responsive
to said scheduler, for storing medications and dispensing the medications to
an authorized
user for administration to the patients, the workflow program providing the
cabinet with
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patient specific information relating to said dispensation of the medications
including a
physician order for each patient, and a medicine cart, coupled to the medicine
cabinet, for
instructing said authorized user in the administration of said medication to
each of said
patients. The cart comprises a plurality of patient specific cart drawers for
storing the
medication to be administered to each patient, wherein each cart drawer
remains unidentified
as patient specific until the medication cart receives said patient specific
information, and a
cart processor, wherein the cart drawers are filled with medicine from the
medicine cabinet
for each patient associated with each patient specific cart drawer in
accordance with the
respective physician order for each patient.
BRIEF DESCRIPTION OF THE DRAWING
The invention is herein described, by way of example only, with reference to
the accompanying drawings. With specific reference now to the drawings in
detail, it is
stressed that the particulars shown are by way of example and for purposes of
illustrative
discussion of the preferred embodiments of the present invention only, and are
presented in
the cause of providing what is believed to be the most useful and readily
understood
description of the principles and conceptual aspects of the invention. In this
regard, no
attempt is made to show structural details of the invention in more detail
than is necessary for
a fundamental understanding of the invention, the description taken with the
drawings
making apparent to those skilled in the art how the several forms of the
invention may be
embodied in practice.
Fig. 1 is a block diagram illustrating the various components of a preferred
embodiment of a medication dispensing system constructed in accordance with
the present
invention.
Fig. 2 is a block diagram illustrating the central (or ward) computer in
accordance with the preferred system of Fig. 1.
Fig. 3 is a diagram more particularly illustrating an exemplary form of a
medicine cabinet in accordance with the preferred system of Fig. 1.
Fig. 4 is a diagram of a lock and spring mechanism in accordance with the
preferred embodiment of the present invention.
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Fig. 5 is a diagram illustrating the construction of the mobile cart in the
system
of Fig. 1.
Fig. 6 is a diagram more particularly illustrating the portable computer for
the
physician and/or pharmacist in the system of Fig. 1.
S Figs. 7 is an exemplary illustration of a frame of the prescription program
which allows a physician to input his/her authorization information in
accordance with a
preferred embodiment of the present invention.
Fig. ~ is an exemplary frame of the prescription program which illustrates a
list of patients in accordance with a preferred embodiment.
Fig. 9 is an exemplary frame of the prescription program which is a graphical
illustration of the vital signs of a patient in accordance with a preferred
embodiment.
Fig. 10 is an exemplary frame of the prescription program which is a tabular
illustration of the vital signs of a patient in accordance with a preferred
embodiment.
Fig. 11 is an exemplary illustration of a frame of the prescription program
which allows a physician to review a patient's prescriptions in accordance
with a preferred
embodiment.
Fig. 12 is an exemplary illustration of a frame of the prescription program
which allows a physician to add new medications to a patient's prescription in
accordance
with a preferred embodiment.
Fig. 13 is an exemplary illustration of a frame of the prescription program
which displays details of a newly prescribed medication in accordance with a
preferred
embodiment.
Fig. 14 is an exemplary illustration of a frame of the prescription program in
accordance with a preferred embodiment.
Fig. 15 is an exemplary illustration of a medication preparation frame of the
cabinet program in accordance with a preferred embodiment.
Fig. 16 is an exemplary frame of the cabinet program which displays a
patient's name, m and medications to be administered.
Fig. 17 is an exemplary frame of the cabinet program which illustrates
instructions for dispensing medications from the cabinet.
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DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The Overall System
A preferred embodiment of the present invention will be described in relation
to the drawing figures wherein like numerals represent like components
throughout.
Fig. 1 is a block diagram illustrating the main components of a preferred
embodiment of a medication dispensing system 10 constructed in accordance with
the present
invention as may be provided in a medical institution having one or more
wards. The
illustrated system includes a central server, generally designated 20, one or
more worlc
stations) 70 for each ward; one or more medicine cabinets to serve one or more
wards,
generally designated 30, and one or more medication carts, generally
designated 50. Each
medication cart 50 is preferably adapted to accommodate a plurality of
compartments,
generally designated 51, 52, one or more for each patient in the respective
ward and/or
medication. System 10 further includes a plurality of hand-held, portable
computers, each
generally designated 60, for use by physicians, authorized personnel and/or
pharmacists,
when writing and/or authorizing prescriptions for individual patients.
As will be described more particularly below, a preferred system comprises
server 20, medicine cabinet 30, cart 50, work station 70, and hand-held P~E
computer 60
enable information involved in the dispensing, replenishing and record-keeping
operations to
be performed electronically without requiring the attendant medical personnel
to access to
patient's written files. Such a system therefore minimizes the possibility of
error, and also
relieves the nurses or other healthcare attendants of many tasks required in
the conventional
medication dispensing system. In addition, described system 10 enables the
healthcare
attendants to enter vital signs of the patient into the records in order to
provide updated
information of the patient's medical condition.
Central Server
Central Server 20, provided in a medical institution, is coupled to medicine
cabinet 30 and workstation 70 and comprises a database 22 and a server
processor 23. It
should be noted that a "medical institution," as defined herein, includes
elderly homes,
hospitals and overnight medical facilities or clinics of all sizes, which
administer medications
on-site, such as those facilities having only a few beds, as well as hospitals
having one or
more wards, each ward having a plurality of beds. "Ward" is generically
defined herein and
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means an institution or an area of an institution that is named for the type
of patients that are
admitted therein, for example, the maternity ward, cardiology ward and the
like. Server 20
may also be coupled to a pharmacy computer and an institution's legacy system,
such as a
hospital information system (HIS), each to be disclosed below. It is known
that an
institution's legacy system includes patient information from institution
labs, an Admission
Dismissal Transfer (ADT) database, and the like.
Server processor 23, coupled to database 22, executes a server software
program, which stores and transfers an electronic record of a plurality of
predetermined
events and automatically transmits and synchronizes system 10 and its
components,
(comprising cabinet 30, cart 50, one or more work stations) 70 and one or more
POE
computers) 60). Events, as disclosed herein, refer to any action conducted by
an authorized
physician or healthcare attendant at a medical institution. Server processor
23 also transfers
data transmitted from and data to be transmitted to medicine cabinet 30, the
institution legacy
system and/or the pharmacy computer between system 10 components, as will be
disclosed in
greater detail below.
Although, server 20 is preferably separate from other components, the
functionality of server 20 may reside on a workstation 70. Workstation 70 will
be disclosed
in greater detail below. Also, although server 20 is shown to be coupled to
cabinet 30 and
workstation 70, in an alternative embodiment, server 20 may communicate with
all system
components through a wire connection or wireless RF or IR connection.
Medicine cabinet
As disclosed above, server 20 is coupled to medicine cabinet 30 and work
station 70. Information received by, and stored on, server 20 is transmitted
to medicine
cabinet 30 through a communication link 36 included in medicine cabinet 30.
Medicine
cabinet 30 is coupled to server 20 and medicine cart 50 and comprises the
communication
link 36, a control unit 33, which includes a cabinet processor 38 for
accessing a cabinet
program that operates cabinet 30, and a plurality of compartments 31 for
storing, for
example, supplies of the different kinds of medications to be accessed by a
healthcare
attendant, which are used for preparing individual dosages to be delivered to
the respective
patients. Medicine cabinet 30 further acts as a communication link between
cart 50 and server
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20 for recording information in server 20, e.g:, vital signs of the respective
patients as may be
taken during rounds, as well as other information, as will be disclosed in
greater detail below.
In a preferred embodiment of medicine cabinet 30, as shown in Fig. 3, cabinet
30 comprises a housing in which the medication compartments are in the form of
drawers 31
arranged in an array 130, referred to herein as a frame, preferably comprising
one or more
horizontal rows and vertical columns. As shown, the housing is rectangular,
and drawers 31
are arranged in a rectangular frame 130. However, medicine cabinet 30 need not
be limited
to a specific size or shape.
Each frame 130 is preferably organized according to different drawer sizes. It
should be noted that drawers 31 of medicine cabinet 30 may be either
medication-specific,
patient-specific or a combination of medication and patient-specific. Those
drawers 31 that
are patient specific each comprise a display, such as an LCD display that
displays the name
of the patient assigned to the drawer 31. Each medication and patient specific
drawer 31 also
preferably includes a lock mechanism (not shown), which normally locks the
drawer in its
closed position, but which is selectively actuatable to unlock and spring
forward the drawer
to enable a pre-authorized healthcare attendant to access the medication
supply within the
drawer. An exemplary lock mechanism is illustrated in Fig. 4, but other such
mechanisms
would be known to one skilled in the art.
As shown in Fig. 4, each lock and spring mechanism for each drawer 31 is
activated by an "open" signal from the cabinet's processor 38, as will be
disclosed in
additional detail below. When the lock mechanism receives the "open" signal
from processor
38, the lock mechanism springs drawer 31 forward, exposing the medication
stored therein to
the healthcare attendant who has opened the drawer.
As shown, the exemplified lock mechanism comprises a solenoid coil 323, a
solenoid 324, a solenoid cylinder 325, a snapper 326, and a mainspring 329.
However, any
of a variety of lock mechanisms known to one of ordinary skill in the art may
be used to
maintain drawer security and operation as exemplified herein.
As shown in Fig. 4, exemplified cabinet drawer 31 comprises a drawer quiclc
release mechanism 310 and a linear slide bearing 320. In operation, cabinet
process 38
initiates an open signal and switches on a DC voltage supply (not shown) of 9-
11 volts on
solenoid 324. Solenoid 324 then applies a magnetic field on solenoid coil 324,
which results
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_ _ ________.
in the movement of solenoid coil linearly upward. As solenoid coil 324 moves
upward,
solenoid cylinder 325 is pulled upward, releasing snapper 326.
Once snapper 326 is released, mainspring 329 springs drawer 31 forward.
Drawer 31 is then opened allowing medication therein to be dispensed or
medication to be
placed therein, as will be disclosed in greater detail below.
After the medication is taken out of or placed into drawer 31 as required,
drawer 31 is preferably pushed back to the closed position. As drawer 31 is
being pushed
back, snapper 326 is pushed against solenoid cylinder 325, which is being
pushed up. Once
the snapper clears solenoid cylinder 325, solenoid coil 324 pushes solenoid
cylinder 325
downward, locking drawer 31 in its original locked position, whereupon snapper
326 is held
in place by solenoid cylinder 325.
Referring back to Fig. 3, the exemplified and illustrated medicine cabinet 30
further comprises an integrated touch screen 34 coupled to control unit 33, a
communication
link 36 for linking to central server 20, and communication link 37 for
linking to one or more
carts) 50. Such communication links 36, 37 are schematically shown as
connectors for
wired communication, but could also be transmitters and receivers (e.g., RF,
IR, acoustical)
for wireless communication as would be recognized by one of ordinary skill in
communication technologies. In addition to the data that is input via the
communication
links 36, 37, data is inputted manually via a virtual keyboard included in
touch screen 34.
Communication link 36 is a direct connection to server 20 and allows medicine
cabinet 30 to
interface with the database 22 on server 20, for real-time updates. It also
facilitates providing
necessary information to guide the pre-authorized healthcare attendant in the
preparation of
patient medications, intravenous solutions and the like, to be disclosed
hereinafter. In an
alternative embodiment, an actual keyboard or keypad may replace the functions
of touch
screen 34.
Information sent to and received from medicine cabinet 30 by server 20 is
processed by server processor 23. In one preferred embodiment, the cabinet
program is not
directly compatible with database 22. Accordingly, server processor 23
preferably converts
the information to a usable format for database 22 when transmitted from
cabinet 30 and to a
usable format when transmitted to cabinet 30. In another embodiment, the
cabinet program is
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directly compatible with database 22, wherein server processor 23 stores the
information until
transmitted by cabinet 30 or database 22.
The foregoing components of medicine cabinet 30, illustrated in Fig. 3, are
electrically powered, e.g., by a power supply, which preferably also includes
a back-up unit
in the event of power interruption or failure.
Such a cabinet 30 has a capability of accommodating a large number of
different medications, although not all drawers or compartments 31 must be
used at any point
in time. If needed, however, a ward may be provided with more than one frame
130. Such
an additional frame or frames 130a would provide additional drawers 31, but
would include a
cable connection to control unit 33 of cabinet 30 in order to enable each
additional frame
130a to share its display 34.
It should be noted that the sections of the medicine cabinet configured for
"special" medications, e.g., those medications too large for the medication or
patient specific
drawers, those requiring storage at a special temperature, and/or special
protective measures
to control access (IV fluids, refrigerated medicines, narcotics, etc.) may be
provided in an
additional frame 130a. In a preferred embodiment, frame 130a is specifically
configured to
support the "special" medications. For example, a frame 130a for medicine
cabinet 30 may
be configured to provide for the storage of "special" medications, along with
the "non-
special" medications. Where cooling is required, frame 130a includes one or
more
refrigeration unit(s). Where special security measures are required, such as
for narcotics, a
secure section of the array is secured by an additional locking system. For
example, it may
be unlocked only when a proper identification means, such as a valid password,
a biometric
identification or a personal identification is inputted using the touch screen
34 or keypad.
Although, the storage of "special " medications has been disclosed as being
handled by an additional frame, storage may in the alternative be provided in
frame 130
which may include a sections) for storage of such special medications, or by
other
arrangements linked thereto. It is preferable, though, that refrigerated
medications and
narcotics reside in separate frames.
During a system failure only, an electronic backup system may be operated to
open all the drawers 31 in cabinet 30, which then, in fact, transforms cabinet
30 into a
completely manual cabinet. The backup operation is initiated, for example, by
pressing a

CA 02509787 2005-06-13
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covered push button (not shown), which opens all the drawers 31 of a given
frame 130.
Preferably, access to the button is simple, with each frame 130 having a
sliding cover that
when open, unveils the push button. In an alternative embodiment, access to
the button will
be accessible only by a key or other manual unlocking mechanism.
In the event of an electrical system failure, system 10 will be backed up by a
UPS system for several hours, which is very unlikely in patient care settings.
If no electricity
is available, the back of each frame 130 may be opened, and the drawers 31
released
manually by a procedure that involves the release of a latch mechanism on each
drawer 31,
drawer by drawer, after which operation of the cabinet is completely manual.
In a centralized system, medicine cabinet 30 may alternatively be located in
the central pharmacy, wherein all medications inventoried in the medical
institution are
stored. In this alternative embodiment, medicine cabinet 30 would operate in
the same
manner as disclosed above in the preferred embodiment and comprise a plurality
of frames
130,130a.
Although cabinet 30 has been exemplified and illustrated as a wired
connection to server 20, another embodiment of cabinet 30 may include a
wireless
communication link between cabinet 30 and server 20.
Medicine Cart
As stated above, cabinet 30 is coupled to one or more medicine carts) 50
through communication link 36. In a preferred embodiment, medicine cart 50, as
exemplified
and illustrated in Figure 5, comprises a plurality of compartments 51, 52,
preferably in the
form of drawers; a display or touch screen 54; a cart processor (not shown), a
communication
link 55 for linking to medicine cabinet 30; a keyboard 56, preferably a
virtual keyboard on
touch screen 54; a bar code reader 57; and a communication link 53 to
monitoring equipment.
In a preferred embodiment, cart 50 further comprises one or more chargeable
batteries (not
shown). In an alternative embodiment of cart 50, the monitoring equipment is a
part of cart
50 or separate, but coupled to the cart processor through link 53.
The plurality of drawers 51, coupled to the cart processor, include a display
screen 510, and are controllably locked by a locking and spring mechanism (not
shown), such
as the lock and spring mechanism 32 disclosed above and illustrated in Fig. 4.
Each of
drawers 51, 52 are adapted to receive medications for administration to
patients. As
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exemplified and illustrated in Fig. 5, cart 50 comprises drawers 52 of
differing sizes; the
larger drawers 52 also being controllably locked by the locking mechanism,
which is
controlled by the cart processor. While cart 50 is not coupled to medicine
cabinet 30 and in
an idle state, display 510 of each drawer 51 is blank indicating that each of
drawers 51 is
unidentified, resulting in a generic medicine cart 50.
Preferably, cart 50 is in communication with server 20 through
communication link 55 coupled to medicine cabinet 30. As exemplified and
illustrated in
Fig. 5, communication link 55 is preferably positioned in the lower rear
portion of cart 50 in
order to allow for the coupling of mobile cart 50 to medicine cabinet 30.
Although
communication link 55 is preferably located in the lower rear of cart 50, the
communication
link 55 may be positioned any place on mobile cart 50, so long as the link is
accessible to
medicine cabinet 30. Preferably, communication link 55 and communication 37
are coupled
by a wire. In another embodiment, however, the coupling of communication links
55 and 37
is wireless, such as by an infra-red (IR) or radio frequency (RF) connection.
It should be
noted that communication link 37 of medicine cabinet 30 preferably includes a
charger for
charging the batteries (not shown) which operate cart 50 when the cart is in
use away from
medicine cabinet 30.
When cart 50 is coupled to cabinet 30 at the initiation of rounds, the cart
program assigns one or more specific drawers) to each patient receiving
medication during
the rounds, resulting in the conversion of cart 50 from a generic medicine
cart to a patient
specific cart. For each drawer assigned a specific patient, the patient's name
is displayed on
the patient specific drawer display 510. Once the healthcare provider has
finished the rounds,
patient specific drawer display 510 for each patient is deleted, resulting in
the return of cant
50 to a generic medicine cart. More specific information regarding the
administration of
medication to patients is disclosed below.
The cart processor, is coupled to bax code reader 57, the plurality of drawers
51, 52, touch screen 54, communication link 55, keyboard 56, and communication
link 53.
The cart processor accesses the cart program in order to operate cart 50 in
accordance with a
preferred embodiment. For example, the cart program assigns the drawers 51 to
specific
patients, controls the access to drawers 51, 52 and instructs the health care
attendant in the
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filling of cart 50 and the administration of medications to the patients.
Other functionality of
cart 50 will be disclosed below.
Information transmitted to medicine cabinet 30 from server 20 is preferably
transmitted to cart 50 through communication link 55. This information is
utilized by the cart
program to instruct the healthcare attendant in the administration of
medications to the
patients. While operating cart 50, the healthcare attendant is preferably
required to log each
event that is requested by the cart program and/or conducted by the healthcare
attendant, e.g.,
taking of the medication by the patient, refusal of medication by the patient,
absence of the
patient, and the like.
Other information is also input to the cart program, such as real-time vital
sign
information. This information is taken by the healthcare attendant using the
patient
monitoring devices of cart 50, as disclosed above. For those devices that are
located at the
patient's bedside, communication link 53 facilitates the communication between
the
monitoring devices and cart 50, such as through a standard RS-232 link. This
information is
later transmitted to server 20.
Bar code reader 57, coupled to the cart processor, is preferably used to
identify
a patient, medication and dosage verification, and the like. When the
healthcare attendant
arrives at the patient's bedside, the healthcare attendant preferably scans
the patient's
wristband. The time at which this event takes place is preferably logged by
the cart program
and later transmitted to server 20.
Keyboard 56, which as indicated above is preferably a virtual keyboard, may
be used as an alternative means of inputting patient information, as well as
for inputting
information required by the cart program as it relates to the administration
of medication to
the patient by the authorized healthcare attendant. Keyboard 56 may also be
used to input
any necessary identification means.
In an alternative embodiment, the cart program also controls the charging of
the one or more rechargeable batteries, such that, when coupled to the
medicine cabinet 30,
the cart program determines whether the batteries need to be charged. If the
remaining
battery life of the batteries is below a predetermined level, the cart program
activates the
charging process. Otherwise, the cart program disengages the charging process,
enabling
efficient use of the cart batteries.
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As exemplified and illustrated in Fig. 5 and stated above, the information
stored in the cart processor is transmitted to server 20 through communication
55 to link 37
of cabinet 30. Similar to cabinet 30, the information transmitted by cart 50
is processed by
server processor 23 and stored therein until database 22 retrieves the
information therefrom.
In another embodiment, the information transmitted from and transmitted to
cart 50 is
compatible with that which is stored in database 22, wherein the information
is directly
transmitted to, or transmitted from, database 22.
Although cart 50, in a preferred embodiment, is illustrated and disclosed as
communicating with server 20 through cabinet 30, in another embodiment, cart
50 may
communicate directly with server 20 through a direct network connection or
through a
wireless 1R or RF connection. Cart 50 may alternatively communicate with
cabinet 30
through a wireless 1R or RF connection.
The preferred embodiment of cart 50 allows the healthcare attendant to log
real-time information related to drug administration at the point-of care
(i.e., at the patient's
bedside), resulting in accurate and complete information.
Although cart 50 has been disclosed as communicating with server 20 through
cabinet 30, in an alternative embodiment, cart 50 communicates directly with
server 20 using
a wired communication means on a wireless IR or RF communication means.
Work station
Referring back to Fig. 1, one or more workstations) 70, coupled to server 20
and hand-held Physician Order Entry (POE) computer 60, preferably accesses a
workflow
program that supports management and operational functions including time
related taslcs,
pharmacy and inventory control and intelligent decision capabilities to aid
the physicians and
health care professionals. It should be noted that the term "physician order
entry" computer
is generic and should not be used to limit either the location of the
computers or who may use
the computer. The term "workstation" is also generic and means a single
computer at a
single location, a plurality of computers at a plurality of locations, and/or
a plurality of
computers at a single location. Accordingly, when the term workstation is used
herein, it
should not be limited to any one definition.
Fig. 2 is a block diagram illustrating the main components of workstation 70
as would be provided in a ward, group of wards, nursing station(s), an office,
and the like.
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Workstation 70 includes a conventional CPU (central processor unit) 71; an
input 74 from
handheld POE computer 60 (Fig. 1); an input 79 from an LD. badge or other
identification
reader; and one or more manual inputs 75, such as a keyboard, touch screen,
mouse, and the
like. The workstation processor 71 includes an output a display 77 and a
printer 78, e.g., for
printing inventory records, patient medical records, physician orders,
management reports,
etc. The workstation 70 preferably does not have a direct output to cart 50
since it
communicates with carts) 50 via server 20. Alternatively, however, when the
functionality
of server 20 resides on a workstation 70, a direct link to carts) 50 may be
provided, such as
through a wired connection or wireless IR or RF connection.
A main task of the workflow program is to manage (open, update and store)
all patient entries for a respective ward, with every entry comprising, for
example, the
following information for each respective patient: name; identification
corresponding to a bar
code printed on the wristband worn by the patient; referring and treating
physicians; relatives;
allergies; medication orders, including an electronic signature or other
electronic means by
both the physician and/or the authorizing pharmacist; the vital signs of the
respective patient
as collected and stored during rounds, e.g., during a vital signs round and/or
medication
dispensing round; information about all medications prescribed and delivered
to the patient
while he/she is in the respective ward; and additional information that may be
required by an
institution. These patient entries are preferably opened, updated and stored
in a database,
such as a Medication Administration Record (MAR) and Mini-Patient's Medical
Record
(MMR). The patient entry also includes a status flag indicating whether the
respective entry
is active or deactivated (e.g., by the release or transfer of the patient to
another ward or by
discharge of the patient). The MAR and MMR databases preferably allow system
10 to
access patients that have been discharged from the institution. In a preferred
embodiment,
preferably this information is retrieved from an Admission Dismissal Transfer
(ADT)
database, known in the art, located on the institution's legacy system.
When a patient is admitted, a healthcare attendant logs the patient's name and
information into the institution's legacy system. The patient's information is
then preferably
transmitted to server database 22 for retrieval by the workflow program.
Provided with the
above information, as well as physician order entries for patients in the
ward, the worlcflow

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program actively schedules and alerts clinical staff regarding the
administration of
medication, inconsistencies with data for prescriptions, and the like.
The workflow program allows an institution to set authorization levels. For
example, an institution may implement a hierarchical authorization scheme,
wherein
healthcare attendants are granted access to conduct certain tasks based in
part on their level of
experience, level of employment, and the like, e.g., a doctor may have access
to prescription
operations, to work station 70, and medicine cabinet 30, whereas an entry-
level nurse may
only have access to medications in medicine cabinet 30 that are non-narcotic.
The scheme
and rules used by the workflow program are determined by the institution.
Alternatively, the
scheme and rules may be embedded in the workflow program based on industry
standards or
a medical institution's predetermined policy.
The workflow program also permits a hierarchical set up regarding individuals
with the authority to authorize others to have access to certain components or
operations
within system 10, and therefore allows input by the individual with the
authority to authorize.
For example, the head nurse may have the authority to allow or deny access to
another nurse
under his/her supervision. As above, this hierarchical scheme is determined by
the medical
institution's policy.
In accordance with a hospital's policies, work station 70, in various
embodiments using the workflow program, also manages on-demand medications,
such as
stat medications, and PRN (per re nata), per request, medications. This
necessitates opening
certain drug specific drawers, and permitting the immediate administration of
medications to
a patient, even though a prescription may not have been issued. Authorization
for the
dispensed on-demand and PRN medication is subsequently requested to provide
the
necessary record of the action. As disclosed above, when the medication is
aclininistered to
the patient, the healthcare attendant is preferably required to log the event
and the reason
therefor.
The workflow program also independently calculates and maintains a running
inventory of the contents of medicine cabinet 30, including, for example, a
special count for
narcotic medications. Such inventories are continuously updated as the
medications are
dispensed and logged by the healthcare attendant, and as the medications are
replenished and
logged. The workflow program also maintains a list of the different kinds of
medications and
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'their locations in the matrix of drawers in the respective cabinet.
Workstation 70 also assists
in stock management, allowing for the addition of a new medication to be
dispensed, or the
removal of a medication no longer required. For example, computer 70 manages
"multiple
use" medications, e.g., bottled medications, eye drops, ointments, and the
like, such that as
the medications are assigned and used by a patient, computer 70 ensures that
the proper
amount of medication is remaining for the patient's subsequent use, and will
notify the
attendant accordingly.
Also, the workflow program assists in the maintenance of common stock
medications which may be assigned and administered to a patient. As those
skilled in the art
know, common stock medications are routinely maintained in medicine cabinet 30
for
administration to a patient. Common stock medications may include, but are not
limited to,
"multiple use" medications, as well as over the counter drugs, such as eye
drops and bottled
syrups. Accordingly, a common stock medication is assigned to a patient when
authorized by
someone authorized to prescribe such medication. For example, eye drops may be
commonly
stocked in medicine cabinet 30. When a patient is prescribed the eye drops,
the workflow
program transmits this information to the cabinet program which assigns the
eye drops to the
patient and instructs the healthcare attendant to place the eye drop container
in the patient
specific cabinet drawer 31, or instructs the attendant to bar code the eye
drop container with
the patient's patient m and leave the eye drops in the common stock drawer.
For first dose medications that fall outside of the regular administration
rounds
or stat medication for a patient, the prescriptions for such medications may
be filled at cabinet
through workstation 70. This eliminates problems associated with physicians
telephoning
in prescriptions, with accurate maintenance of the medication inventory, and
efficient time
management, thereby getting the medication requested to the patient in a fast
and safe
25 manner.
The management of the expiration dates for medications stored in medicine
cabinet 30 is also done by the workflow program. Preferably, all medications
stored in
medicine cabinet 30 have been bar coded, scanned and stored by the workflow
program,
wherein the bar code includes, at least, the expiration date, batch number and
name of the
30 medication. Alternatively, the expiration date, name and batch number of
the medication is
inputted to the program manually using keyboard 75 as will disclosed below.
The workflow
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program, then, automatically checks the expiration dates of all medications
stored in
medicine cabinet 30. An authorized healthcare attendant is warned through
workstation 70
and an alert sounded at cabinet 30, when a medication is nearing the
expiration date.
The workflow program also produces, if so requested by an authorized
attendant, a wide variety of reports and records, including, but not limited
to: current
inventories in each ward cabinet, e.g., graphical displays of inventory
levels, as well as the
display of consumption of each drug over time and discrepancies in inventory
count; the
replenishing level of each medication; information concerning patient files,
individually and
collectively; information concerning patient vital signs, e.g., for graphic
display; information
regarding all dispensing and replenishing of medications from the medicine
cabinets,
including date, time, names, and the like; replenishing forms to be directed
to the pharmacy
for replenishing a medication (a task which can also be performed by linking
to the pharmacy
computer); forms for emergency medication; and summaries of all the
medications received
by a particular patient during the stay in the respective ward, including
billing, etc. This
capability of the workflow program further supports patient accounting and
reimbursement.
As indicated above, the workflow program provides, for example, the
inventory of medications and their locations in cabinet 30, the names of the
patients and their
prescribed medication dosages; the type and quantities of medications as
dispensed and as
replenished; and the vital signs data with respect to the patients, each of
which is inputted
manually during a routine check by a nurse or other health care practitioner,
such as physical
therapists, inhalation therapists, radiologists and the like, or by a pre-
authorized individual
dispensing a medication to the patient.
It should be noted that a medical institution may utilize more than one work
station 70, wherein each workstation 70 is coupled to server 20 and provides
authorized users
with access to the workflow program. When a plurality of workstations 70
exist, they may be
located in one area or spread throughout the medical institution. For example,
a work station
70 may be located at a nursing station in the maternity ward, as well as in
the office of the
head nurse of the same ward, or each nursing station in each ward of an
institution may
include a work station 70, etc. Nevertheless, for the purposes of this
disclosure, if a plurality
of workstations are used, they will be referred to herein simply as "work
station," so long as
each of the plurality is linked. Hospital policy preferably dictates how many
work stations 70
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are included in system 10, who is authorized to access the work station 70,
and his/her level
of access to the information provided therein.
POE Computer
A system for the safe and efficient administration of medication requires a
computerized patient file containing, at least, the details of the patient and
the medication the
patient is to receive. This data may be hand-entered in the server 20 through
work station 70,
from hand-written notes, e.g., prepared at the time of the physician rounds.
However, in a
preferred alternative a hand-held POE computer 60, is illustrated in Fig. 6,
which includes
prescription software to allow the physician to prescribe medications at the
point of care (i.e.,
at the patient's bedside).
As indicated above, POE computer 60 is preferably coupled to workstation 70.
POE computer 60 includes a large display 62, preferably of the touch screen
type to enable
inputting information, and a communication link 63, which may be wired or
wireless, to
establish communication with server 20. In an alternative embodiment, hand
held POE
computer 60 further comprises a bar code scanner, for identifying a patient to
be examined.
Such POE computer 60 executes a prescription program that allows the physician
to prescribe
medications through the system, or change the medications or their dosages,
and check drug
interactions and patient allergies at the time of prescribing. Preferably, a
commercial
product, such as First Data, is utilized to verify drug interactions after a
medication is
prescribed by the physician for a patient. The validation program informs the
physician
regarding any negative interactions. The prescription program also facilitates
the receipt and
retention of the physician's, and/or the pharmacist's electronic signature or
other electronic
identifying means, together with the rest of the data collected.
The prescription program alternatively allows the institution, in accordance
with the institution's policies, to limit the physician's ability to prescribe
certain medications.
The limitations may be based on the economics of dispensing a certain
medication as
compared to a similar medication, or inventory in the institution, for
example. It is preferable
for this alternative to allow the physician to override the limitations by the
institution when
he/she see fit, as long as the physician explains the reason for the override,
which explanation
is prompted by the prescription program. The prescription program will time
and date stamps
the explanation and store this information.
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At the end of the rounds, the hand-held POE computer 60 may be coupled to
work station 70 through input 24 to permit the transmission of all of the
information collected
in the hand-held POE computer 60, including the electronic signature or other
electronic
identifying means of the physician and/or pharmacist. This information is
entered into the
record of each respective patient by the prescription program. Hand-held POE
computer 60
may also be used for entering and/or displaying patient specific information,
for example, the
vital signs, sensitivities, drug interactions and any other pertinent data
taken while the patient
is hospitalized.
Hand-held POE computer 60 and its ability to link to the program significantly
reduces human error due to transcription and poor legibility, and helps reduce
insurance and
liability costs to the physician and institution.
In an alternative embodiment, the functionality of each component program
may be accessed by any other system 10 component. For example, the workflow
program
may be accessed by medicine cabinet 30 or POE computer 60. When the scheduler
of the
workflow program alerts medicine cabinet 30 of the start of a round, medicine
cabinet 30
accesses the cabinet program and the workflow program.
Although system 10 has been disclosed in accordance with a preferred
embodiment illustrated in Fig. 1, any one of the components of system 10 may
communicate
directly with any other component by wireless communication such as RF or IR
communication means, wherein each components comprises a means of
communicating in a
wireless environment.
OPERATION
The described system 10 may be used in performing a number of processes
including, but not limited to the following:
Initial Data Entry
As indicated above, each of the disclosed components is coupled to ward
computer 20, providing a closed loop computerized work flow system which
manages the
patient care including, for example, including, for example, prescribing to
the dispensation,
administration and reporting of activities.
When a patient enters the medical institution (i.e., for admission to the
extent
that drugs or medications will be administered to the patient), patient
information is

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preferably entered into the institution's legacy system by an authorized
healthcare attendant
or via interfacing with patient information already stored in a central
admissions system, such
as the ADT described hereinabove. The institution legacy system transmits the
ADT
information for the admitted patient to system 10. The patient information
includes
demographic information, which is then included in a patient file. Once the
patient file is
opened, a bar code is preferably generated using the institution's patient ID,
generated by the
legacy system during admission, or using a patient ID generated by system 10,
which is
indicative of a patient code that is associated with the patient. A print
signal is preferably
sent to a printer (not shown). The printed bar code is then preferably placed
on a wrist band
that the patient wears on his/her wrist until discharge from the ward. This
patient code is
preferably used as the means of ensuring the accuracy of the identification of
the patient by
any of the healthcare professionals.
A treating or attending physician on rounds, for example, preferably uses POE
computer 60 as disclosed above to review the information therein in order to
evaluate a
patient's current condition. For example, when the physician axrives at the
patient's bedside,
the physician logs onto the POE computer 60 by entering in his/her
authorization information
using an identifying means disclosed above. An exemplary frame of the handheld
POE
computer 60 for entering the physician's authorization information is
illustrated in Fig. 7.
Once the physician has logged onto handheld POE computer 60, a list of
patients is displayed
by room number, in alphabetical order, or those patients attended to by the
physician, for
example, as exemplified in Fig. 8. The physician then chooses the patient's
name of the
patient he/she is attending or scans the patient's wrist band, automatically
selecting the
patient. The selection of the patient's name results in a display of the
vitals and information
for that patient, which have been previously input by an authorized attendant
or physician.
An illustration of an exemplary frame showing graphical and tabular vital
information is
shown in Figs. 9 and 10. Each of these exemplary frames also comprises
multiple keys or
tabs.
As exemplified in Fig. 10; the physician may then choose to review the
patient's current prescriptions and his/her respective details by selecting
the RX tab. The
physician may also choose to view the clinical data and instructions by
selecting the
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appropriate tab on the screen, which displays that information, for example,
the patient's
allergies and symptoms.
The physician is able to fmd and prescribe new medications for the patient
using the RX tab as illustrated in Fig. 12. As stated, a physician is able to
review the
medications a patient is currently taking by selecting the RX tab which frame
exemplified in
Fig. 9. Once in the RX tab, the physician is able to view the details for each
prescribed
medication. This tab also provides the physician with a means of prescribing a
new
medication.
To prescribe a new medication, the physician first selects the "new" button
included in the exemplary RX frame. As a result, for example, an Add New
medication
frame is displayed, such as that which is illustrated in Fig. 12. Although not
shown in Fig.
12, a physician may choose medications from multiple listings. For instance,
illustrated in
Fig. 12 is a list of generic medications that are located within the hospital
that the physician
may choose from if the patient is required to have generic medications due to
insurance
restrictions, if the patient requests generic medication to be used, or if a
physician requests a
generic medication in accordance with hospital policy. The physician, though,
may choose to
prescribe brand name medication that is equivalent to the generic drug, in
which case, the
physician may select the "Commercial Names" tab to view a list of brand name
medications.
For those medications that are rarely prescribed, the physician may select
from a national
database that includes all medications available for prescribing, such
selected medications
would then have to be ordered. For those medications located in the inventory
of the
hospital, the physician is able to filter a list based on the location of the
medication, e.g., ward
or pharmacy, whether it is a special medication or an order set. Although the
medications
have been listed by name, it should be noted that the medications can be
listed by system,
e.g., nervous system, respiratory system, etc.
As described above, the POE computer 60 allows the physician to prescribe
medication in accordance with a hospital policy that has been set up to ensure
that the
prescribed medication is the best medication for the patient and most
economical for the
hospital. Accordingly, the POE computer 60 preferably provides the physician
with the
recommended medication to be prescribed in response to the physician's
selection. If
permitted by the hospital, a physician may override the recommendation of
computer 60, and
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prescribe the physician selected medication. If the physician is unable to
overnde computer's
60 recommended medication, the recommended medication is prescribed.
Once the physician has selected the medication, the physician preferably must
enter the details of the order of the administration of the medication, such
as dose, duration,
schedule and frequency, as well as other pertinent information that will be
used by the
authorized healthcare attendant. The physician may also use defaults that are
set by the
hospital, which include the medication dose, duration, schedule and frequency.
Also,
treatment protocols may be prescribed by the physician, which may comprise
several
different medications and other orders, such as fasting, and the like. For
example, after hip
surgery, a patient may receive a predetermined medication and diet regimen
that is used for
most hip surgery patients. An example of the frame for entering the details of
the newly
prescribed medication is illustrated in Fig. 13.
Once the physician has completed the examination of the patient and
prescribed the necessary medications, the physician may then exit the Add
Medication frame.
Upon exiting, POE computer 60 conducts a clinical screening of the medications
prescribed
for the patient and verifies that there are no known negative interactions
between medications
and that there are no known negative interactions between the medication and
the patient's
allergies or safety concerns. A typical and commonly used and accepted
database for such
procedure is, for example, First Data Bank or Micro Medics. The order entered
by the
physician is then automatically compared against predetermined standards to
assure that the
dosage is correct, and undergoes screening against the patient's medical
history, including
drug allergies and multiple drug interactions. It should be noted that the
physician may look
up the drug interaction, and side effect while prescribing medications by
selecting this option
on POE computer 60. Nevertheless, even if this option is selected by the
physician, a check
is automatically conducted after prescribing all medications for the patient.
A confirmation screen is then displayed to confirm the physician's orders. An
exemplary confirmation screen is illustrated in Fig. 14. Preferably, the
physician must then
confirm the orders that have been entered for the patient by selecting the
'Yes' button, which
results in the display of another confirmation screen, thereby further
eliminating a point of
error. The physician is then asked to input his/her identification means,
which causes
handheld POE computer 60 to generate the physician's electronic signature, or
other
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electronic identifying means, verifying that the physician is authorized to
make such a
prescription. The physician may then continue with rounds, visiting the next
patient and
repeating the process as necessary. Once the physician's rounds have been
completed, the
physician preferably attaches handheld POE computer 60 to input 24 (i.e., a
docking station)
coupled to work station 70. Work station 70 transmits the information input by
the physician
to server 20. Once the information is transmitted to server 20, all
information is preferably
deleted from handheld POE computer 60, which protects the information from
being
accessed by unauthorized individuals who may, without authorization, access
POE computer
60. When POE computer 60 is to be used by a physician, information for each
patient in the
ward is preferably transmitted by POE computer 60.
In an alternative embodiment, and in accordance with governing law, any new
prescription information that is transmitted to the pharmacy computer for
clinical screening
by an authorized pharmacist. The pharmacist reviews the medications prescribed
and the
patient information, and verifies that no negative implications would result
therefrom. Also,
the pharmacist confirms that the dosage of prescribed medicine is valid for
the patient
receiving it. If the pharmacist does not confirm the prescription, the
prescribing physician is
contacted. This is preferably accomplished by interfacing with pre-existing
pharmacy
software on the pharmacy computer. Alternatively, this is done by providing
the pharmacy
with a work station that accesses the workflow program, or by providing the
pharmacy
computer with access to the workflow program.
In a wireless setting, the physician orders may be transmitted by the
physician
to the pharmacy computer and the workflow program. In a alternative
embodiment, the
prescribing program may be accessed from a remote location, such as the
Internet and the
like.
When the new orders arrive at workstation 70 the attendant is alerted by the
workflow program to verify the new orders. Each attendant verifies his/her
patients' new
instructions by reading them and deploying them to the rounds times according
to the
frequency ordered by the physician. The workflow program in response to the
deployment of
all the new orders, along with the already existing orders, creates a
scheduler for the ward for
the day, and for the following days. The scheduler displays all orders to be
performed
according to the time at which they are to be performed. The orders may also
be displayed
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by patient and his/her orders are spread over the prescheduled times) for
administration. It is
this scheduler which alerts the attendant to start a medication round or vital
sign collection
round, or administer a specific medication to one patient, to be disclosed
below.
Preparing Dosages
At the prescheduled time for dispensing medications, or when the dispensing
of medication is otherwise needed, work station 70 preferably alerts a
healthcare attendant
using display 77. In a preferred operation, work station 70 transmits to
cabinet 30 the list of
patients to receive medication at that time, and when required, it identifies
each patient, the
medication, and the dosage for that patient. The alert continues until the
authorized attendant
selects the task for which the alert was sent.
Once medicine cabinet 30 has received the information from the workflow
program, touch screen 34 displays a medication preparation screen, such as
that which is
exemplified in Fig. 15. Preferably, the healthcare attendant assigned to
administer
medications to the patients in the ward associated with medicine cabinet 30
must identify
himself or herself in order to access medicine cabinet 30 using an
identification means, such
as a password code, a personal identification means or a biometric
identification means.
Preferably, this information is input using cabinet touch screen 34. When the
con ect
identification information has been entered, medicine cabinet 30 may be
accessed by the
authorized attendant.
As disclosed hereinabove, an authorized healthcare attendant administers
scheduled medications to the plurality of patients in the ward using mobile
cart 50.
Accordingly, it is preferable that cart 50 be coupled to, and in communication
with, cabinet
through communication link 37 of cabinet 30 and communication link 55 of cart
50.
Once server 20 has verified the attendant's authorization information, the
25 cabinet program initializes the instructions for the attendant to fill cart
50 for administration
of medications to the respective ward patients. Since a ward may have more
than one
medication cart 50 available for administering medications, the authorized
healthcare
attendant is asked to select and identify the medication cart that is to be
filled.
Once the attendant has selected the cart to be used during the rounds, a
patient
30 is chosen from the list of patients in the ward that are to receive
medication and the chosen
patient's name, m and medications to be administered is displayed on display
34, as

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exemplified in Fig. 16. To ensure that in each case the correct medication is
administered to
the appropriate patient in the right amount, the cabinet program displays
instructions that the
healthcare attendant is to follow on screen 34 of cabinet 30 in filling cart
50. Cabinet
processor 38 controls the healthcare attendant's access to the medication in
the respective
medication specific drawers 31 of cabinet 30 and access to drawers 51 of cart
50 via the
cabinet program. Accordingly, once the patient has been selected, the
medication to be
dispensed is then selected and the healthcare attendant instructed on
dispensing the
medication into cart 50. An exemplary illustration of the selection of the
medication and the
instructions related thereto is shown in Fig. 17.
Processor 38 forwards the selected patient to cart processor 52, which assigns
a specific drawer 51 of medication cart 50 for the selected patient and
displays the name of
the patient assigned to the assigned drawer 51 on display 510 of the selected
drawer 51. The
assignment of the drawer by cart processor 52 changes the identification of
cart 50 from an
unidentified cart to a dispensing cart comprising a plurality of patient
specific drawers.
After patient specific drawer 51 has been assigned by cart processor 52,
processor 38 forwards an open drawer signal simultaneously to both a cabinet
medication
specific drawer 31 and cart processor 52. The medication specific drawer 31,
which has the
selected medication stored therein, receives the open signal and unlocks and
springs forward
the medication specific drawer 31, all other drawers of cabinet 30 preferably
remain locked
and closed. Simultaneous to the opening of medication specific drawer 31 of
cabinet 30, cart
processor 52 receives the open signal from cabinet processor 38, sends an open
drawer signal
to the patient specific drawer 51 assigned to the selected patient, causing
patient specific
drawer 51 to unlock and spring forward, all other drawers of cart 50 remaining
locked and in
a closed position.
In at least one embodiment, the authorized healthcare attendant, having
opened medication specific drawer 31 and patient specific drawer 51 open,
follows the
directions displayed on display 34 of cabinet 30 to fill open patient specific
drawer 51. For
example, in practice, the attendant takes the appropriate dose of a medication
from an open
medication specific drawer 31 of cabinet 30 and preferably scans the bar code
label of the
medication. This verifies that the correct medication has been retrieved from
cabinet 30.
Alternatively, and preferably in addition, the attendant verifies the
medication visually.
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When the correct medication has been retrieved, the medicine is placed in open
patient
specific drawer 51 of cart 50. Following the instructions displayed, the
attendant then closes
medication specific drawer 31 of cabinet 30.
Processor 38 of cabinet 30 detects the closing of medication specific drawer
31. If there is another medication that is to be dispensed to the selected
patient, cabinet
processor 38 identifies the next medication for the selected patient, and
forwards another
open drawer signal to the medication specific drawer that has the selected
medication stored
therein. Again, a medication specific drawer of cabinet 30 receives the signal
from the
cabinet processor 38, unlocking and causing the drawer to spring forward. The
attendant
repeats the steps disclosed above for removing the medication from cabinet 30
and places the
appropriate amount of the identified medication in already open patient
specific drawer 51 of
cart 50, as disclosed above.
The foregoing process continues until all specified medication for the
respective patient has been removed from the cabinet 30 and placed into the
patient's patient
specific drawer 51. It should be noted that the medication selected by cabinet
processor 38
may be stored in a patient specific drawer of cabinet 30. Accordingly, cabinet
processor 38
forwards an open signal to the patient specific drawer located in cabinet 30
assigned to the
selected patient, which is then opened. As disclosed above, the cabinet
patient specific
drawer is used to store medications that are not generally stored in the
medication specific
drawers of cabinet 30. Special medications, stored in the special compartments
of cabinet 30,
are also dispensed to the patient specific drawers of cart 50 in the manner
disclosed above. If
narcotics are to be administered, the attendant is preferably required to re-
enter his/her
identification means. It should be noted that requirements for administering
narcotics are
dependant on the medical institution's policies or governmental requirements.
For those
medications, if any, that cannot fit within the open patient specific drawer
51, the attendant is
instructed to bar code the medications and place the medication into cart
drawer 52. These
medications are preferably labeled with the patient ID barcode for positive
identification
during administration of the medication.
Once all of the medications for the selected patient have been placed in open
cart drawer 51, 52, cabinet processor 38 then instructs the attendant to close
the open patient
specific drawer 51. The system then repeats the foregoing operations with
respect to all of the
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other patients list, to receive medications at that time each patient being
assigned a separate
drawer in cart 50 and his/her respective medications placed therein. Each
patient specific
drawer displays the name of the respective patient assigned to the drawer on
the display of
the respective drawer as disclosed above.
At any time during this process, if the prescribed medication is not available
in
cabinet 30, cabinet 30 guides the authorized attendant via its display to
order the medication
from the central pharmacy; at the same time, work station 70 issues an order
form to the
central pharmacy, or otherwise orders the appropriate medication through its
commuxucation
with the central pharmacy.
In a centralized system comprising a central pharmacy, medicine cabinet 30 is
utilized to store unit dose medications for each patient, the unit dose for a
24 hours period.
Patient specific drawers 31 of cabinet 30 are assigned to each patient wherein
the unit dose
medications for each patient are stored and accessed to fill cart 50 each
round. The patient
specific drawers are then replenished at the end of the 24 hour period with
the unit dose
medications for the next 24 hour period. If there are changes to the orders or
new PRN or stat
medication, the requested medication is dispensed from the medication specific
drawers 31 of
cabinet 30.
Although it is preferable that cart 50 is filled before each round and emptied
after each round, cart 50 is alternatively filled with 24 hours of patient
medications and used
for each round within the 24 hours. Cart processor 52 assigns the cart patient
specific drawer
51 to each patient in the respective ward once every 24 hours. Patients that
are admitted to
the ward during the 24 hour period are also assigned to a patient specific
drawer by cart
processor 52.
Alternatively, cart processor 50 assigns a patient specific drawer to each
patient, wherein the assigned drawer remains assigned to the patient until the
patient is
transferred from the ward associated with the cart or discharged from the
institution.
Accordingly, after the all medications for the 24 hour period have been
administered to the
patients assigned to cart 50, containers including each patient's medications
for the next 24
hours is used to refill each patient specific drawer. The manner upon which
each drawer is
filled is similar to the method disclosed above regarding the filling of the
cart from
medications stored in the medicine cabinet. Display 54 of cart 50, displays,
for example, the
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patient's name, allergies, medications, dosages and instructions on filling
the patient's
drawer.
Delivery of Medications to the Patients
After cart 50 has been filled for each patient receiving medication, the
authorized healthcare attendant wheels cart 50 to the patients in the ward for
administration
of their respective medications. The attendant preferably delivers the
medications to the
patients in the following manner-for each:
When the attendant arrives with cart 50 at the patient's bedside, the
attendant
preferably uses bar code reader 57 to scan the patient's wristband. Cart
processor 52 detects
the patient code input by bar code reader 57, compares the received code to
the patient codes
stored therein, associates the code with a patient, and causes the patient's
specific drawer 51
to be unlocked and pushed forward, wherein the other drawers of cart 50 remain
locked and
in the closed position. The patient's name is also displayed on screen 54
together with the list
of medications contained within the respective patient specific drawer 51, the
total number of
medications in drawer 51, and the list of vital signs to be obtained by the
attendant, for
example, other patient specific information, e.g., age, weight, allergies,
etc. If a prescribed
medication was not been available from medicine cabinet 30, and therefore, had
been ordered
directly from, the central pharmacy as described above, cart display 54 would
include a
reminder of this fact to the attendant.
The attendant then counts the total number of medications in the open patient
specific drawer 51, and matches the total number counted with the total number
of
medications shown on display 54. Assuming a match occurs in all respects, the
attendant then
administers the medication to the patient. Alternatively, the attendant may
scan each
medication in the patient drawers to verify that the patient is receiving the
correct medication.
For those medications taken from the common drawer 52, the medications must be
scanned
for verification.
In an alternative embodiment, cart display 54 displays a list of patients that
are
to receive medications during the current round. When the attendant arnves at
a patient's
bedside, the attendant would verify the identification of the patient and
select the patient's
name from the list of patients displayed on display 54. Once the patient is
selected, cart
processor 52 operates in the manner set forth above in the preferred
embodiment.
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During the administration of the medications, the attendant is instructed by
cart 50. For each medication to be administered, cart 50 preferably provides
step by step
instructions. When an IV is administered, the attendant is preferably
instructed to check and
confirm the flow rate. The attendant is also instructed on which hand or arm
the IV or
injection should be used, depending on the previous place of administration.
Preferably, each
time a medication is taken by the patient, the attendant is required by cart
50 to confirm and
log this event. If a medication is not taken by a patient, cart 50 preferably
requires the
attendant to log the reason the medication was not administered. This is also
required of the
attendant if during the round a patient is not in his/her bed. In this case,
the attendant would
log that the patient was skipped and the reason therefor. As disclosed above,
the logging of
these events are transmitted to server 20.
If certain vital signs are to be taken of the patient (e.g., temperature,
blood
pressure, pulse rate, etc.), as instructed via cart display screen 54, the
attendant attends to the
gathering of this information and inputs the information via cart connector 58
or manually via
keyboard 56. The gathering of this information is also logged and stored in
cart 50 until cart
50 is coupled to cabinet 30 for transmitting said information to server 20.
For those cases where the medication administration is conditioned by certain
data (i.e., vital sign result or lab result), then the attendant is instructed
to check the condition
and enter the value for confirmation. If the value allows for the
administration of the
medication, the attendant will be advised to do so.
Replenishing the Medicine cabinet
As disclosed above, the workflow program maintains the inventory of
medicine cabinet 30 associated therewith. Accordingly, whenever the workflow
program'
detects a "low level" of medication in one of drawers 31, this fact is
displayed for the
responsible healthcare attendant on display 74 and automatically ordered from
the pharmacy
via forms, or via a communication channel between the pharmacy computer and
the
workflow program. Alternatively, the workflow program may request the
authorized
attendant to reorder the identified medication from the pharmacy.
Work station 70 may be requested at any time to authorize a replenishment
from the central pharmacy. If the ordering is done with forms (i.e., without
direct
communication), the workflow program is preferably supplied with a list of
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CA 02509787 2005-06-13
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received from the pharmacy, including the exact amount of every new
medication. The
workflow program updates the inventory and transmits this information to
medicine cabinet
30. For each such medication, the cabinet program instructs the attendant to
perform the
following operations:
The attendant opens the packaging of the medication, counts the units, records
the count and places the medication in the open drawer. At this time, the
attendant again
must match the name on the package with the name on the front of the open
drawer. For
fiuther safety, the attendant may be required to scan the bar code on the
medication
packaging using cabinet bar code reader 131 to match it with the name of the
medication
displayed on cabinet screen 34.
The attendant then closes the medication specific drawer. When the closed
drawer is sensed by medicine cabinet 30, cabinet processor 38 repeats the
foregoing cycle for
all the remaining medications on the list for replenishment until all
medications are
replenished. If during such a replenishing operation the attendant notes that
one of the
drawers is full, the attendant may press a "full" button on cabinet keyboard
33 (or on display
34, if a touch screen is used), whereupon cabinet processor 33 will open an
empty drawer,
print a label with the name of the medication, and instruct the attendant to
place the label on
the new open drawer. Thus, a second medication specific drawer is created for
the patient.
It should be noted that a cabinet patient specific drawer is filled and
replenished in the same manner as disclosed hereinabove. When cabinet
processor 38
determines that a patient specific drawer should be utilized for the received
medication, a
cabinet drawer assigned to the patient associated with the received medication
is opened and
the medication placed therein. If no cabinet drawer has been assigned to the
patient,
processor 38 opens an empty drawer not currently in use, and displays the
patient's name on
the cabinet drawer LCD display. The attendant is the instructed to place the
received
medication in the patient specific drawer.
Once all of the medications have been placed in their respective medication or
patient specific drawers, the workflow program compares the count values and
information
regarding each medication as input by the attendant to the count and
information received by
the pharmacy and identifies any discrepancies.
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It is appreciated that certain features of the invention, which are, for
clarity,
described in the context of separate embodiments, may also be provided in
combination in a
single embodiment. Conversely, various features of the invention, which are,
for brevity,
described in the context of a single embodiment, may also be provided
separately or in any
suitable subcombination.
Although the invention has been described in conjunction with specific
embodiments thereof, it is evident that many alternatives, modifications and
variations will be
apparent to those skilled in the art. Accordingly, it is intended to embrace
all such
alternatives, modifications and variations that fall within the spirit and
broad scope of the
appended claims. All publications, patents and patent applications mentioned
in this
specification are herein incorporated in their entirety by reference into the
specification, to
the same extent as if each individual publication, patent or patent
application was specifically
and individually indicated to be incorporated herein by reference. In
addition, citation or
identification of any reference in this application shall not be construed as
an admission that
such reference is available as prior art to the present invention.
32

Representative Drawing