US20070233520A1 - Medication administration and management system and method - Google Patents

Abstract

A system, method and computer program for programming a medical device to administer a medication to a patient includes the medical device, a scanner that may be associated with a point of care (POC) system, and a medication management unit (MMU). A computer in the POC system can directly program the medical device with the permission of the MMU after a full “five rights” check or the “right patient” check can be delayed until after the pump program is downloaded. Other workflows are disclosed for programming the medical device in manual, semi-automatic and automatic modes, with safety checks incorporated at various points.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application claims the priority of U.S. Provisional Patent Application No. 60/786,599, filed Mar. 28, 2006, which is incorporated by reference herein in its entirety.
BACKGROUND OF THE INVENTION
• The present invention relates to the field of delivering medication to patients, more particularly to an integrated system for maximizing patient safety and caregiver productivity for medication delivery.
• Modern medical care often involves the use of medical pump devices to deliver fluids and/or fluid medicine to patients. Medical pumps permit the controlled delivery of fluids to a patient, and such pumps have largely replaced gravity flow systems, primarily due to the pump's much greater accuracy in delivery rates and dosages, and due to the possibility for flexible yet controlled delivery schedules. However, modem medical devices, including medical pumps, can be complicated and time-consuming for caregivers to program. Medical facilities struggle to provide appropriate caregiver staffing levels and training while holding down the cost of medical care. Human errors in pump programming and other medication errors can have adverse or even deadly consequences for the patient. Medication errors, which are sometimes referred to as adverse drug events (ADE), can increase the length of hospital stay and the cost of medical care for the patients involved or their healthcare insurance carrier.
• Therefore, a principal objective of this invention is to provide an integrated medication management system that is flexible, reduces the risks of medication error, improves patient safety, and improves caregiver productivity.
• These and other objectives will be apparent to those skilled in the art.
A SUMMARY OF THE INVENTION
• A system, method and computer program product for administering a medication to a patient with a medical device includes a point of care (POC) system and a medication management unit (MMU) in communication with each other. A computer in the POC system can directly program the medical device with the assistance or permission of the MMU after a full “five rights” check using an input device for receiving identification information. A full five rights check ensures that the right medication in the right dose or rate through the right device channel or route at the right time is administered to the right patient. Alternatively, a “right patient” check can be delayed until after the pump program has been downloaded to the pump by the POC system or the MMU.
• The present invention is directed to a medication management system which includes various computers, including a medication management unit (MMU) associated with a medical device for performing a medication order. The medication management system is flexible and integrated to provide for enhanced patient safety and caregiver productivity with a variety of hospital information and point of care systems. The medication management system can take various forms and provides methods for administering the right medication in the right dose or rate through the right device channel or route at the right time to the right patient. By confirming the accuracy of the drug, dose, patient, time, and route, medication errors at the bedside can be prevented before an ADE occurs. The caregiver confirms and starts the infusion of the medication order at the pump only if these bits of identification information match the order.
• The MMU is able to determine the network IP address of a medical device it is in wireless communication with based on the factory-established or hospital-established logical address of the medical device. The MMU monitors the general physical location of a medical device based on the last access node used by the wireless connectivity capability in the medical device.
• The device is capable of storing two, simultaneous versions of a drug library—one in primary memory and another in cache memory. Upon occurrence of a triggering event, the device will receive an updated drug library, store it in its cache, and ultimately replace the existing drug library in primary memory with the new library in the cache. During execution of a medication order, the medical device utilizes the drug library in its primary memory.
• In other embodiments of the medication management system of this invention, the MMU receives medication order and delivery information from an information system directly through an electronic network or indirectly through a wireless handheld point of care (POC) input (scanning) device, such as a personal digital assistant (PDA). The PDA transmits the delivery information and the medication order in the form of an infusion delivery order that may include various pieces of information including but not limited to an infusion rate to the MMU.
• The MMU translates the simple infusion rate of the delivery order into delivery programming code or information suitable for automatically programming the designated pump and further checks the delivery order and delivery programming code against a variety of drug library parameters (including but not limited to hard and/or soft limits for drug delivery rates, dose, volume, duration, route and site of administration), patient-specific safety factors, and clinical decision support rules including drug compatibility and drug-drug interactions. The MMU can be configured by the user at the MMU console or client workstation to monitor the status of the pump and the infusion (including alarms, event logs, and pump user interface inputs), generate reports, and control the distribution of drug library and operating software code updates to one or more pumps. A drug library editor (DLE) deployed as a part of the MMU, its console, or on a separate computer (DLE client workstation), enables the user to import, export and edit whole drug libraries and individual drug library values to control and customize a drug library according to hospital preferences.
• The MMU and/or the POC system saves the caregiver time by automatically populating or programming data entry fields in the pump that previously had to be entered manually. The medication management system of this invention enhances patient safety by minimizing manual entries. The system also enhances patient safety by screening drug delivery orders for conformance with established hospital practices, expert or clinical decision support rules and recommendations before, or more preferably immediately before, the pump begins to execute the order. The caregiver is provided with a least one and preferably several opportunities to catch a medication error before it happens. The caregiver can confirm the order at the point of care (POC) system and/or before starting the infusion at the pump. The system is flexible enough to permit human interventions and overrides, and tracks such events for documentation, reporting, benchmarking and trouble-shooting purposes.
• In one embodiment, a method is provided for administering a medication to a patient with a medical device. The medical device can be an infusion pump, and the medication can be a medication solution for infusion into the patient. The method receives at a first computer, in communication with a second computer, caregiver specific identification information, drug container specific identification information, medical device specific identification information, with one or more identification receivers or input devices, such as a handheld wireless personal digital assistant (PDA) having barcode scanner for scanning barcoded information. The drug container specific identification information is located on a container containing the medication. The first computer can be computer in a POC system and the second computer can be a medication management computer, such as the MNI mentioned above and further described below. The caregiver specific identification information can include the identification of a specific caregiver (i.e., name, social security number, ID number, and/or some other identifier), or provide “look-up” information for retrieving the identification of a specific caregiver. The medical device specific identification information can include the identification of a specific medical device (i.e., a logical name or address, the IP address, or some other information identifying an infusion pump), or provide “look-up” information for retrieving the identification of a specific medical device. Likewise, patient specific identification information can include the identification of a specific patient (i.e., name, social security number, ID number, digital photograph and/or some other identifier) or provide “look-up” information for retrieving the identification of a specific patient. In addition, the medical device specific delivery information can be actual data required to operate the medical device or the general medical order information specific to the type of medical device (i.e., for an infusion pump, which could include start time for an infusion, rate of an infusion, and volume to infuse).
• The method also retrieves at the first computer medical device specific delivery information based on the drug container specific identification information, transmits to the second computer from the first computer the medical device specific identification information and the medical device specific delivery information, and transmits the medical device specific delivery information from the second computer to the medical device. The medical device can have a medical device memory for storing the medical device specific delivery information for use in programming the medical device to deliver the medication to the patient. After at least one of the aforesaid transmitting steps, the method receives at the first computer patient specific identification information, and compares at least one of the received drug container specific identification information and the patient specific identification information to stored medication order information within a first memory associated with the first computer. The method further transmits a first medication delivery initiation signal to the second computer if the received drug container specific identification information and/or the patient specific identification information matches the stored medication order information within the first memory associated with the first computer, and, at least in part in response to receiving the first medication delivery initiation signal at the second computer, the second computer transmits a second medication delivery initiation signal to the medical device to initiate the delivery of the medication to the patient using the medical device specific delivery information previously received by the medical device.
• In another embodiment, the first memory associated with the first computer further comprises a plurality of medical administration records (MARs), wherein at least one MAR comprises a medication order.
• In another embodiment, the above comparing step is performed without using the patient specific identification information.
• In another embodiment, the drug container specific identification information comprises at least one of patient identification information, medication identification information, universal identification information, medication order information, and/or medical device delivery information.
• In another embodiment, the method receives at the first computer patient specific identification information from the input device prior to transmitting to the second computer from the first computer the medical device specific identification information and the medical device specific delivery information, and/or prior to transmitting the medical device specific delivery information from the second computer to the medical device.
• In another embodiment, the method transmits the patient specific identification information from the first computer to the second computer prior to the above comparison step.
• In another embodiment, the method transmits the patient specific identification information from the second computer to the medical device prior to the comparison step.
• In another embodiment, the method receives from the second computer, in communication with the medical device, an availability state signal for the medical device, and, if the availability state signal for the medical device indicates that the medical device is available, then the method transmits the medical device specific delivery information to the medical device for programming the medical device to deliver the medication to the patient. The method can further compare at least one of the received drug container specific identification information and the patient specific identification information to stored medication order information stored within a first memory associated with the first computer, and transmit a first medication delivery initiation signal to the medical device if the received drug container specific identification information and/or the patient specific identification information matches the stored medication order information within the first memory. In one embodiment, these comparing and transmitting steps are only performed if the availability state signal for the medical device indicates that the medical device is available. In another embodiment, the method only transmits the medical device specific delivery information to the medical device if the received drug container specific identification information and/or the patient specific identification information matches the stored medication order information within the first memory. In a further embodiment, if the availability state signal for the medical device indicates that the medical device is not available, then the method prevents any transmission of the medical device specific delivery information to the medical device.
• In another embodiment, the method generates at the second computer first key information and second key information, transmits from the second computer the first key information to the first computer, transmits from the second computer the second key information to the medical device, transmits from the first computer the first key information to the medical device along with the medical device specific delivery information, and compares at the medical device the first key information to the second key information. In one embodiment, if a match exists between the first key information and the second key information, then the method displays the medical device specific delivery information on a display of the medical device for review by a caregiver to confirm that at least the medical device specific delivery information is correct for the patient. In another embodiment, if a match exists between the first key information and the second key information, then the method operates the medical device according to the medical device specific delivery information. The first key information and/or the second key information can be an encrypted security token. The method can further transmit from second computer to the first computer the IP address of the medical device, if the availability state signal for the medical device indicates that the medical device is available. In one embodiment, the first computer and the first memory associated with the first computer do not maintain the IP address of the medical device. Alternatively, the first memory associated with the first computer can store the IP address of the medical device within a MAR for the patient for tracking to which medical device the medical device specific delivery information is transmitted.
• In another embodiment, the first key information includes a time stamp, and the method compares at the first computer the time stamp to a first actual time. If the difference between the time stamp and the first actual time is less than a predetermined time criteria, then the method transmits from the first computer the first key information to the medical device along with the medical device specific delivery information to the medical device. The method can also transmit the time stamp to the medical device, and compare at the medical device the time stamp to an actual time. If the difference between the time stamp and a second actual time is less than the predetermined time criteria, then the method programs the medical device with the medical device specific delivery information.
• In another embodiment, the second key information comprises a second time stamp, and the method compares at the medical device the first time stamp and the second time stamp to an actual time. If the difference between the first time stamp and the actual time, and if the difference between the second time stamp and the actual time, are both less than a predetermined time criteria, then the method programs the medical device with the medical device specific delivery information.
• The present invention is also directed to a system for implementing the above and other methods, as well as a computer program product for operation within a medication management computer for implementing a least a portion of the above and other methods, for administering a medication to a patient using a medical device.
• Other features and advantages of the invention will be apparent from the following specification taken in conjunction with the following drawings.
DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a schematic diagram showing a system and method for administering a medication to a patient using a point of care computer system comprising a POC server and a thick client input device according to one embodiment of the present invention.
• FIG. 2 is a schematic diagram showing a system and method for administering a medication to a patient using a point of care computer system comprising a POC server and a thin client input device according to one embodiment of the present invention.
• FIG. 3 is a front view of a medical device with a display and user interface, wherein the medical device is stopped and not displaying programmed infusion settings.
• FIG. 4 is a front view of a medical device with a display and user interface, wherein the medical device is displaying downloaded infusion settings for confirmation or modification.
• FIG. 5 is a simplified pictorial schematic diagram of a system for administering medication to a patient according to one embodiment of the invention.
• FIG. 5A is a simplified pictorial schematic diagram of a system for administering medication to a patient similar toFIG. 5 but shows the patient with a RFID wristband for auto-associating the patient and the medical device into a patient area network according to one embodiment of the invention.
• FIG. 6 is a screen shot of one embodiment of a delivery information input device for inputting identification information and/or confirming delivery programming code data.
• FIG. 7A is a flow chart showing a method for administering a medication to a patient according to one embodiment of the present invention.
• FIG. 7B is a continuation of the flow chart ofFIG. 7A.
• FIG. 8A is a flow chart showing a method for administering a medication to a patient according to one embodiment of the present invention.
• FIG. 8B is a continuation of the flow chart ofFIG. 8A.
• FIG. 9A is a flow chart showing a method for administering a medication to a patient according to one embodiment of the present invention.
• FIG. 9B is a continuation of the flow chart ofFIG. 9A.
• FIG. 10A is a flow chart showing a method for administering a medication to a patient according to one embodiment of the present invention.
• FIG. 10B is a continuation of the flow chart ofFIG. 10A.
• FIG. 11A is a flow chart showing a method for administering a medication to a patient according to another embodiment of the present invention.
• FIG. 11B is a continuation of the flow chart ofFIG. 11A.
• FIG. 12 is a flow chart showing a method for administering a medication to a patient according to another embodiment of the present invention.
• FIG. 13 is a flow chart showing a method for administering a medication to a patient according to another embodiment of the present invention.
• FIG. 14 is a flow chart showing a method for administering a medication to a patient according to another embodiment of the present invention.
• FIG. 15 is a flow chart showing a method for administering a medication to a patient according to another embodiment of the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS(S)
• In the figures and the description that follows, like reference numerals generally refer to like components or steps. In general, the system components described herein are described in greater detail in the commonly owned published U.S. patent application Ser. No. 20050144043, the disclosure of which is incorporated herein by reference in its entirety.
• Definitions are provided below for some terms that appear in this description.
• “Medical device” includes without limitation a pump, a monitor for monitoring patient vital signs or other parameters, or a diagnostic device. Typically a medical device is located in a particular physical location or clinical care area (CCA) within a hospital or some other environment. The medical device has a logical identifier or logical address and, when in contact with a communication network, has a network internet protocol or IP address if it is on a communication network
• “Pump” includes without limitation a device that acts upon a cassette, reservoir, vial, syringe, or tubing to convey medication or fluid to or from a patient (for example, without limitation, an enteral pump, an infusion pump, a patient controlled analgesia (PCA) or pain management medication pump, or a suction pump.
• “Medication” as used herein is something that has a physiological impact on a person or animal, including but not limited to liquid or gaseous fluids, drugs or medicines, liquid nutritional products and combinations thereof. Medications that are delivered intravenously to patients are generally in liquid form, and are thus also referred to herein as “solutions”.
• With reference toFIGS. 1 and 2, the medication management system (MMS) of the present invention includes a medication management unit (MMU)3108,3208 and amedical device3130,3230, typically operating in conjunction with one or more information systems or components of a hospital environment as further discussed below.
• IV fluids/medications3100,3200 incontainers3102,3202 can be administered to apatient3104,3204 through the system(s) shown in these FIGS. While the embodiments shown inFIGS. 1 and 2 utilize barcodes and a barcode reader as means for providing and inputting or reading machine readable information for identification or other purposes, those skilled in the art will appreciate from this description that other means for providing and reading information can be utilized. Machine readable indicia or identifying information can be provided by a radio frequency identification (RFID) tag, transmitter, or transponder and read by a radio frequency receiver or transceiver. Digital photography or imaging and scanning technology can be used. Human biometric data, including but not limited to skin/fingerprints, retina patterns, voice, etc can be recognized by an appropriate scanner or receiver. Aninput device32 or identification receiver adapted to “read” or recognize such indicia can be provided.
• The IV fluids/medications3100,3200 in barcode-identifiedcontainers3102,3202 can be given new or supplemental label(s) with a unique infusion order identifying barcode by the pharmacist according to hospital practice. In particular, the drug container specific identification information, such as barcoded information on thecontainer3102,3202, can include patient identification information, such a patient name, patient number, or medical record number for which the medication has been prescribed, medication identification information, such as a medication name of the medication or solution within the IV bag orcontainer3102,3202, universal identification information which can be created or assigned at the hospital, medical device delivery information, such as the operating parameters to use in programming an infusion pump to deliver themedication3100,3200 to thepatient3104,3204, and/or medication order information, such as one or more of the above information items and/or other medication order information specific to aparticular patient3104,3204, and which may be a part of a medication order for a particular patient. The IV fluids/medications3100,3200 in barcode-identifiedcontainers3102,3202 can be supplied to hospitals by various vendors, with preexisting unique barcode identifiers which include medication information and other information, such as National Disease Center (NDC) code, expiration information, drug interaction information, and other information.
• The universal identification information on thecontainer3102,3202 can be a unique medication order identifier that, all by itself, identifies the order associated with the container. Alternatively, the identification information on thecontainer3102,3202 can be a composite patient/order code that contains both a patient ID (usually a medical record number) and an order ID (where the order ID is unique only within the context of that patient). Alternatively, the identification information on thecontainer3102,3202 is merely a medication ID. Within a given hospital, all medications prepared or packaged for patients by the pharmacy will contain either a universally unique order ID or a composite patient/order ID, but generally not both within the same institution. The medication ID alone option is typically used only for medications that are pulled by the nurse directly from floor stock at the point of care.
• The systems identified inFIGS. 1 and 2 can have a “drug library editor” orDLE computer3106,3206 such as a desktop, notebook, or server computer, with DLE software that runs on the DLE terminal, computer orworkstation3106,3206 also shown as “DLE Client” inFIGS. 1 and 2. As described above, a medication management unit (MMU) orcomputer3108,3208, such as a server, has MMU software that is installed and runs on theMMU server3108,3208. The drug library and other databases can be stored on theMMU server3108,3208, a separate server, and/or in remote locations.
• Hospital information systems (HIS)3110,3210 typically include one or more computers hard-wired together into a network76 (FIGS. 5 and 5A) by cabling, interfaces and/or Ethernet connections. Alternatively wireless connections and communications can be used in whole or in part. Servers provide processing capability and memory for storage of data and various application programs or modules, including but not limited to a module for admissions-discharge-and-transfer (ADT)3112,3212, a computerized physician order entry (CPOE)module3114,3214, and a pharmacy information system (PhIS or PIS)module3116,3216. Hospital personnel, such asadmission clerks3118,3218,physicians3120,3220, andpharmacists3122,3222, respectively, can be authorized to access these modules through client workstations connected to the servers in order to enter data, access information, run reports and complete other tasks.
• In the embodiment shown inFIG. 1, the HIS3110 can also include a point of care (POC)system3125 including a server or POC computer3124 (sometimes referred to as a barcode point of care server or computer), or thePOC computer3124 can be separate from theHIS3110. In either case, thePOC computer3124 is typically hard-wired into the HIS network. ThePOC computer3124 acts as part of a point of care (POC) system3125 (sometimes referred to as the barcode point of care system or BPOC) and is able to wirelessly communicate through a plurality of wireless communication nodes located throughout the hospital, utilizing a wireless communications protocol, such as IEEE 801.11, IEEE 802.11, or Bluetooth. Awireless communication node84 with anantenna82 is typically included in each patient room or treatment area, as shown inFIG. 5. In the embodiment shown inFIG. 1, thePOC computer3124 wirelessly communicates with a portable “thick client” POC orinput device3126 carried by the caregiver. Referring toFIGS. 5 and 5A, thePOC client device3126 can be a personal digital assistant (PDA) that is equipped with or connected to a barcode scanner or other identification receiver/reader32 such as a radio frequency (RF) receiver for receiving “RF tag” information when an RF tag is sufficiently near the RF receiver. ThePOC client device3126 is referred to as a “thick client” because it has significant memory, display and processing capabilities of its own and can execute a variety of programs stored in its memory in some degree independently of thePOC computer3124.
• In one embodiment ofFIGS. 1 and 2, theMMU server3108,3208 is hard-wired to the DLE client desktop computer/workstation3106,3206 and to a MMU client computer/workstation3128,3228. Alternatively, the MMU and DLE client functions can be combined onto a single client computer/workstation or may reside together with theMMU server3108,3208 on a single combined MMU/DLE server. TheMMU server3108,3208 preferably resides in a location remote from the patient's room or treatment area. For instance, theMMU server3108,3208 can reside in a secure, climate controlled information technology room with other hospital servers and computer equipment and its client terminals can be located in the pharmacy, biomedical engineering area, nurse station, or ward monitoring area. OneMMU server3108,3208 can monitor, coordinate and communicate withmany infusion pumps3130,3230. For example, in one embodiment, the MMU software running on theMMU server3108,3208 can support up to one thousand infusion pumps concurrently. In the thick client embodiment shown inFIG. 1, theMMU server3108 need not be connected (hard-wired or wirelessly) to the hospital's Ethernet network backbone.
• In the thick client embodiment ofFIG. 1, thethick client PDA3126 in thePOC computer system3125 may communicate in a peer-to-peer manner with theMMU server3108. TheMMU server3108 interfaces or communicates wirelessly with theinfusion pump3130 and the PDA orPOC client3126 through thesame wireless nodes84 utilized by thePOC system3125 and a connectivity engine and antenna78 (FIG. 5) on or in theinfusion pump3130. Communication between theMMU server3108 and thePOC system3125 takes place through the PDA (POC client3126)/MMU server3108 wireless interface. Communication between theinfusion pump3130 and thePOC client3126 takes place through theMMU server3108. Eachthick POC client3126 stores in an associated memory the URL address or internet protocol (IP) address of eachMMU computer3108 and eachPOC client3126 communicates directly withsuch MMU computer3108. TheMMU computer3108 stores in an associated memory both the logical ID and the network ID or Internet Protocol (IP) address of the infusion pump(s)3130, such that only theMMU computer3108 can communicate in a direct wireless manner with theinfusion pump3130. Alternatively, as will be described later, theMMU3108 can provide the IP address and other information about thepump3130 to thePOC system3125 to facilitate direct communication between thePOC system3125 and thepump3130.
• Regardless of whether the hospital uses the system architecture ofFIG. 1 orFIG. 2, certain activities related to patient care typically take place in a hospital environment. Upon admission to the hospital, theadmission clerk3118,3218 or similar personnel enters demographic information about each patient3104,3204 into an associated memory of the ADT computer ormodule3112,3212 of an HIS database stored in an associated memory of theHIS system3110,3210. Eachpatient3104,3204 is issued a patient identification wristband, bracelet ortag112,112A (FIGS. 5 and 5A) that includes anidentifier3103,3203, such as a barcode or RFID tag for example, representing a unique set of characters, typically a patient ID or medical record number, identifying the patient, sometimes referred to as patient specific identification information. The wristband, bracelet ortag112,112A may also include other information, in machine readable or human-readable form, such as the name of the patient's doctor, blood type, allergies, etc. as part of the patient specific identification information.
• The patient'sdoctor3120,3220 prescribes medical treatment by entering an order into the CPOE computer terminal ormodule3120,3220 within theHIS system3110,3210. The order, as prescribed, may specify a start time, stop time, a range of allowable doses, physiological targets, route, and site of administration. In the case of an order for infusion of fluids or medication, the order may be written in various formats, but typically includes the patient's name, patient ID number, a unique medication order or prescription number, a medication name, medication concentration, a dose or dosage, frequency, and a time of desired delivery. This information is entered into the memory of theCPOE computer3124,3224, and is stored in a memory associated with at least the POC server orcomputer3124,3224.
• The medication order is also delivered electronically to thePIS computer3116,3216 in the pharmacy and is stored in an associated memory. Thepharmacist3122,3222 screens the prescribed order, translates it into an order for dispensing medication, and prepares the medication or fluids with the proper additives and/or necessary diluents. As best seen inFIGS. 1, 2,5 and5A, thepharmacist3122,3222 prepares and affixes alabel102,108 with drug containerspecific identifying information3101,3201 to the medication ordrug container3102,3202. In one embodiment, the label only includes in machine-readable (barcode, RFID, etc.) form a unique sequentially assigned “dispense ID number” that can be tied or associated to the particular patient ID number and medication order number in theHIS3110,3210,PIS3116,3216 and/orPOC computer3125,3225. In another embodiment, the label can include in machine readable form a composite identifier that includes an order ID and a patient ID, which is usually a medical record number. In another embodiment, the label does not include a patient ID at all in barcode or machine readable format but includes in machine readable form only a medication ID. This last embodiment may be useful for “floor stock” items that are commonly stocked in operating rooms, emergency rooms, or on a ward for administration on short notice with ad hoc or post hoc orders. In another embodiment, the label may include in machine readable and/or human-readable form medical device specific delivery information including but not limited to the dispense ID number, patient ID, drug name, drug concentration, container volume, VTBI, rate or duration, etc. Only two of the three variables VTBI, rate and duration must be defined as the third can be calculated when the other two are known. The labeled medication typically is delivered to a secure, designated staging location or mobile drug cart on the ward or floor near the patient's room or treatment area. The medication order pending dispensing or administration is posted to a task list in theHIS system3110,3210 andPOC system3125,3225 and stored in an associated memory.
• Thenurse3132,3232 uses theinput device32 or identification receiver/reader associated with thePOC client3126,3226 to scan the caregiverspecific identification information3133,3233 or barcode on his/hercaregiver identification badge116 and enters a password, which logs the caregiver into the system and authorizes them to access a nurse's task list from thePOC system3125,3225 through thePOC client3126,3226. The information within the nurse's badge is sometimes referred to as the caregiver specific identification information herein. Thenurse3132,3232 can see from the task list that IV drugs are to be administered tocertain patients3104,3204 in certain rooms. Thenurse3132,3232 obtains the necessary supplies, including medications, from the pharmacy and/or a staging area in the vicinity of the patient's room.
• The following will be described with reference toFIG. 1, but may also be applicable to the embodiment ofFIG. 2. Thenurse3132 takes the supplies to a patient's bedside, turns on theinfusion pump3130, verifies that the network connection icon on thepump3130 indicates a network connection is present, selects the appropriate clinical care area (CCA) on the pump, and may mount the IV bag, container, orvial3102 and any associated tube set as required in position relative to thepatient3104 andinfusion pump3130 for infusion. Using the identification receiver/reader32 integral to thePOC client PDA3126, thenurse3132 scans the barcode on the patient'sidentification bracelet112. A task list associated with that particular patient will appear on thePDA3126 screen. Presumably this task list, which may also include orders to give other forms of treatment or medication by other routes (oral, topical, etc.), is obtained from the HIS via thePOC server3124 and communicated wirelessly to thePOC client PDA3126. In one embodiment, the list is generated by matching the scanned patient ID with the patient ID for orders in memory within thePOC server3124. In another embodiment, as will be described below, the order information can be obtained by scanning the drug container specific identification information, for associated orders in memory within thePOC server3124, through the following step(s).
• Thenurse3132 scans themedication barcode label102 containing medication containerspecific identification information3101 on themedication container3102 with thePDA3126. ThePDA3126 highlights the IV administration task on the task list and sends the scanned medication container specific identification information, such as dispense ID information, from themedication container3102, to thePOC server3124, which uses the medication container specific identification information, such as the dispense ID, to pull together the rest of the order details and send them back to thePDA3126. ThePDA3126 then displays an IV Documentation Form on its screen, as illustrated for example inFIG. 6. One side of the IV Documentation Form screen shows the order details as “ordered” and the other side is reserved for a status report from theinfusion pump3130. The status report from theinfusion pump3130 is transmitted to thePDA3126 through theMMU server3108, as will be described below. The lower portion of the IV Documentation Form screen gives thecaregiver3132 instructions (like to scan theinfusion pump3130 barcode) or tells whether the pump is running or stopped.
• Thenurse3132 then scans thebarcode label92,96 (FIGS. 5 and 5A) associated with the infusion pump3130 (or pump channel if the pump is a multi-channel pump). Thebarcode label92,96 contains medical devicespecific identification information3131, such as the logical name and/or logical address of the device or channel. ThePDA3126 then automatically bundles the information into a program pump request containing the “order details” and in one embodiment, without further interaction with thecaregiver3132, transmits this information wirelessly to theMMU server3108. In another embodiment thePOC server3124 can transmit the order details to theMMU server3108 via a hard-wired network connection.
• The program pump request can includes the following information (in HIS/POC system format): a Transaction ID, which can include a Logical Pump ID, a Pump Compartment, a Pump Channel ID, a Reference Device Address, a Caregiver ID, a Caregiver Name, a Patient/Person ID (HIS identifier), a Patient Name, a Patient Birth Date & Time, a Patient Gender, a Patient Weight, a Patient Height, and an Encounter ID which can include a Room, a Bed, and a Building (including Clinical Care Area or CCA). The program pump request can also include Order Information or “order details” , including an Order ID, a Start Date/Time, a Stop Date/Time, a Route of Administration, a Rate, a Duration of Infusion (Infuse Over), a Total Volume to be Infused (VTBI), an Ad Hoc Order Indicator, and Ingredients including HIS Drug Name or HIS Generic Drug Name, HIS Drug Identifier or HIS Generic Drug ID, Rx Type (Additive or Base), Strength w/units, and Volume w/units. The program pump request can further include Patient Controlled Analgesia (PCA) Orders Only information, such a PCA Mode-PCA only, Continuous only, or PCA and Continuous, a Lockout Interval (in minutes), a PCA Continuous Rate, a PCA Dose, a Loading Dose, a Dose Limit, a Dose Limit Time w/units, a Total Volume in vial, and Order Comments.
• Upon receipt of a program pump request from thePDA3126, theMMU3108 validates the request by making sure that all infuser-required information has been provided and that any information provided, whether required or optional, is complete, within expected ranges and correctly formatted. For example, if height is included but is not a valid number or does not include units, the order would not be valid or complete. If the validation is successful, theMMU3108 responds to thePDA3126 with a program pump reply message. If the validation is unsuccessful, theMMU3108 notifies thePDA3126 via a program pump reply message and does not transform or send the order to theinfusion pump3130. Likewise, if theinfusion pump3130 is currently infusing, theMMU3108 will reject the request and indicate with an error description in the program pump reply that theinfusion pump3130 is not ready to receive an order. Thenurse3132 must take some action to address the issue related to theinfusion pump3130, such as stopping the pump, retrying, or perhaps rescanning the correct pump channel on theinfusion pump3130 if the wrong channel was initially scanned. If the program pump reply message was affirmative, thePDA3126 will repeatedly poll theMMU3108 at regular intervals, for example every two seconds, with a read pump status request until theMMU3108 is able to respond with a pump status reply based on a status message theMMU3108 receives from theinfusion pump3130. ThePDA3126 also polls periodically for status updates as the infusion progresses.
• TheMMU3108 identifies what type of infusion pump3130 (standard or PCA) the program pump request is targeting, and then transforms the order into infuser specific details or settings. TheMMU3108 converts or reformats numbers received from theHIS system3110 to the particular syntax, such as fixed-decimal point format for example, required by theinfusion pump3130. Rounding, conversion, or mapping of certain data may be needed to convert the information received from thePDA3126 to settings theinfusion pump3130 can recognize, accept and utilize. Any data that is not required from the above listing can be left out of the request, then theMMU3108 will transmit the incomplete order to theinfusion pump3130 and thecaregiver3132 can complete or modify the order at theinfusion pump3130, if desired.
• TheMMU3108 maps or converts the wide range of expressions of units allowed by theHIS system3110 orPOC system3125 forPDA3126 requests into the much more limited set of units allowed in theMMU3108 andinfusion pump3130. For example, thePDA3126 request may express “g, gm, gram, or grams” whereas theMMU3108 and/orinfusion pump3130 can accept “grams” only.Infusion pump3130 delivery parameters orinfusion pump3130 settings are mapped or converted from corresponding order information or “order details” of the program pump request.
• TheMMU3108 stores in an associated memory a mapping or translation table that keeps track of the logical ID of aninfusion pump3130 and the corresponding current network (static or dynamic) address (Internet Protocol (IP) address) or ID of theinfusion pump3130 on the network, which in this example is a wireless network. TheMMU3108 is able to translate or associate a given logical ID of theinfusion pump3130 with its network address in the translation table and provide the network IP address to the requestingPOC system3125 or device. TheMMU3108 also stores in an associated memory and/or can look up the drug library applicable to the scannedinfusion pump3130 and also converts the Drug ID and Strength from the pump program request into an index number of the medication at the desired strength or concentration from the drug library. The duration of the infusion comes from thePOC system3125 in hours and minutes and must be converted to just minutes for the infuser to recognize it. Volume or VTBI will be rounded to provide a value-specific and infuser-specific number of digits to the right of the decimal point. Units (of drug) will be converted to million units where appropriate. Patient weight is converted and either rounded according to infuser-specific rules or not sent to the infuser.
• Once theMMU3108 transforms the information from the program pump request into infusion pump settings or delivery parameters and other information in a format acceptable to theinfusion pump3130, theMMU3108 wirelessly downloads a command message to theinfusion pump3130. If theinfusion pump3130 is not already equipped with the latest appropriate version of the hospital-established drug library, theMMU3108 can also automatically download a drug library to theinfusion pump3130. The hospital-established drug library is maintained in a separate process undertaken by the biomedical engineer orpharmacist3122 to place limits on the programming of theinfusion pump3130, as well as other infusion pump operating parameters such as default alarm settings for air in the line, occlusion pressure, etc. The drug library sets up acceptable ranges or hard and/or soft limits for various drug delivery parameters in theinfusion pump3130.
• TheMMU3108 can also download to the infusion pump new versions, patches, or software updates of the infusion pump's internal operating system software. The infusion settings or delivery parameters and other information from theMMU3108 is entered into the memory of theinfusion pump3130 and theinfusion pump3130 settings can automatically populate the programming screen(s) of the infuser, just as if thecaregiver3132 had entered the information and settings manually. Theinfusion pump3130 screen populates with the name of the drug and drug concentration based on the drug library index number, patient weight (if applicable), rate, VTBI, and duration (only two of the last three variable are sent by theMMU3108 because thepump3130 can calculate the third from the other two). A return message of confirmation signal is sent to theMMU3108 by theinfusion pump3130 to indicate that the command message has been received. At this point thecaregiver3104 may manually enter any additional infusion settings or optional information that was not included in the command message.
• Theinfusion pump3130 then prompts thecaregiver3132 to start theinfusion pump3130 by pressing the start button. When thecaregiver3132 presses the start button, a confirmation screen with the infusion settings programmed is presented to them for confirmation, as best seen inFIG. 4. When thecaregiver3132 presses the button to confirm, theinfusion pump3130 will begin delivering fluid according to the programmed settings. Theinfusion pump3130 sends a status message to theMMU3108 indicating that theinfusion pump3130 was successfully auto-programmed, confirmed and started by thecaregiver3132, and is now delivering fluid. TheMMU3108 continues to receive logs and status messages wirelessly from theinfusion pump3130 periodically as the infusion progresses or when alarms occur.
• TheMMU3108 reports a portion of the initial status message to the PDA3126 (in MMU format) to indicate that theinfusion pump3130 has been autoprogrammed and thecaregiver3132 has confirmed the settings. TheMMU3108 communicates to thePDA3126 the actual Rate, VTBI and Duration. As shown inFIG. 6, these values are filled into the appropriate actual (pump) fields on the opposite side of the PDA IV Documentation Form screen from the corresponding “Ordered” values. A notation at the bottom of the PDA screen indicates that theinfusion pump3130 is running. ThePDA3126 will compare and give a visual, audio or other type of affirmative signal if the pump information matches or acceptably corresponds with the ordered information. An initial determination of whether the pump information matches the order can be done in theMMU3108 and communicated to thePDA3126. Alternatively, thePOC server3124 or thePOC client PDA3126 can make the necessary comparisons. If the pump information does not match the order, thePDA3126 gives a visual, audio or other type of negative signal, which may include an error message. The nurse can also be prompted by the POC client orPDA3126 at anytime during the process to enter the site of administration, and thePDA3126 or thePOC server3124 matches that information as well. The same notification scheme or signals, as described above, can be followed for matching or mismatched conditions relating to the site of administration. In one embodiment, the site of administration is matched after the pump information is matched with the other order information.
• Thenurse3132 is prompted to review and press a save button on thePDA3126 if the order has been begun as desired or any variations are acceptable. In a separate subsequent step, the nurse electronically signs the record and presses a send button to send the information to the patient's electronic medication administration record (electronic MAR or EMAR).
• Referring toFIG. 2, a thin client medication administration and management system and method is shown. From an HIS perspective, the structure is similar to the thick client POC structure described above, and shown inFIG. 1. However, thePOC system3225 includesPOC server3224 and a thin client notebook, tablet, handheld orPDA computer workstation3226 that has little memory, computational power or ability to run its own programs. Instead, the client workstation orinput device3226 merely displays web pages it accesses from theserver3224 and relays input information to the POC server orcomputer3224. The information is input through a user interface and/or an identification receiver/reader32 integral with the POC client3226 (FIG. 5) or connected to thePOC client3226 by a USB cord as shown inFIG. 2. Although thePOC client3226 has wireless WI-FI capability, in one embodiment, thePOC client3226 only communicates with thePOC server3224. Thethin POC client3226 may be attached to a mobile drug cart, mounted on a wall, or mounted at the bedside in the patient's room. Thethin client computer3226 at least temporarily stores data in a memory associated therewith in order to relay the data to thePOC server3224 or to display the data.
• ThePOC server3224 is typically hard-wired for communication with theMMU server3208, but wireless communication is also a possibility due to the capabilities of the POC andMMU servers3224,3208.
• Thethin POC client3226 ofFIG. 2 is generally an input/pass-through/display device. In this embodiment, thePOC client3226 does not actually make any comparisons for five rights checking. The comparisons are made within thePOC server3224. ThePOC server3224, rather than thePOC client3226, communicates directly with theMMU3208.
• In operation, thenurse3232 scans his/herID badge116 and enters a password to access thesystem3225 and an electronic MAR To-Do List that is displayed on thePOC client3226 screen. Thenurse3232 gathers the necessary supplies and medication, and then proceeds to the bedside of thepatient3204. Thenurse3232 places theIV bag3202 or container and the associated tube set in position with respect topatient3204 and theinfusion pump3230. Thenurse3232 turns on theinfusion pump3230, selects the clinical care area (CCA), and verifies that a wireless connection icon or indicator is present on the pump.
• Thenurse3232 uses the identification (barcode)reader32 on or attached to thePOC client3226 to scan the patientspecific identification information3203 on the patient'swristband112. The wristband barcode includes a patient identification number in machine-readable format, and/or other information described above. ThePOC client3226 displays the various physician orders and medication orders for thepatient3204.
• Thenurse3232 scans the identifier, such as abarcode label102 on the medication container orIV bag3202 to obtain the medicationspecific identification information3201. Thebarcoded label102 on themedication container3202 includes the medicationspecific identification information3201, such as a unique number that is a combination of the patient ID and medication order number in a single block, as indicated above. The particular medication order associated with themedication container3202 can retrieved from the medication specific identification information and/or from thePOC server3224, and displayed on thePOC client3226 screen along with an instruction for the caregiver to scan the IV pump3230 (or channel if the pump is a multiple channel pump). In one embodiment, thenurse3232 scans thelabel92 or96 on theinfusion pump3230 or pump channel and hits the “next” button on thePOC client3226. The order details are then retrieved from thePOC server3224 and displayed at thePOC client3226.
• In one embodiment, nothing will happen until thenurse3232 selects and enters the site (i.e., location on the body of the patient3204) of the infusion from a dropdown menu on the order details screen. Consistent with the original order as prescribed by thephysician3220, thecaregiver3232 can modify the order and/or supply additional information such as rate, volume or other values which may be omitted in the order from the pharmacy. For example, if the physician's order is written as “titrate to affect” until blood pressure is below200/100, a particular rate may not have been supplied with the order as translated by the pharmacy. After checking the patient's blood pressure or reviewing the latest measurements, thenurse3232 may input a new or modified rate based on the specific patient condition. Recent laboratory results or values may also be relied upon to determine or adjust the order within the prescription of the physician.
• In response to the caregiver hitting “next” after entering the site information and making any desired modifications to the order information, thePOC server3224 will download the order information to theMMU server3208. A screen on thePOC client3226 indicates that thePOC server3224 is “sending settings to the IV pump”, albeit through theMMU server3208. ThePOC client3226 screen instructs thenurse3232 to go to theIV pump3230 and confirm the settings on the display of the pump when they appear. Thenurse3232 also can change the settings by reprogramming the settings at theinfusion pump3230.
• As in the “thick” client embodiment shown inFIG. 1, theMMU server3208 must transform the order information from format stored in the memory associated with thePOC server3224 into infusion pump-recognizable settings. TheMMU server3208 also provides the latest appropriate drug library information for theinfusion pump3230 and converts the drug name and concentration information from thePOC server3224 into a drug library index number that theinfusion pump3230 understands. TheMMU server3208 andinfusion pump3230 communication and workflow is substantially the same as in the thick client embodiment. Thenurse3232 reviews theinfusion pump3230 settings on thedisplay88 of theinfusion pump3230, presses a start button, then is prompted with a confirmation screen to confirms the settings again as shown inFIG. 4. Thenurse3232 presses “yes” at a confirmation screen to actually start the infusion.
• Theinfusion pump3230 wirelessly communicates the start of the infusion and its infusion parameters back to theMMU3208, which relays information such as the dose, VTBI, duration, rate and backpressure (distal pressure) to thePOC server3224 for display on thePOC client3226 display screen. Alternatively, the infusion settings or parameters can be relayed back to thePOC client3226 through theMMU3208 andPOC server3224 at the press of the start button, and then updated when the “yes” button is pressed. Thecaregiver3232 must hit “done” on thePOC client3226 screen to send this information to the patient's EMAR.
• With reference toFIGS. 1 and 2, another embodiment of the medication administration system and method will now be described. As mentioned, the POC client3126 (FIG. 1) or the POC computer3224 (FIG. 2) is in communication with theMMU computer3108,3208. ThePOC server3124,3224 is also in communication with the POCclient input device3126,3226. Thenurse3132,3232 uses thePOC client3126,3226 to scan his or herown badge116, and thePOC client3126,3226 processes and/or sends the caregiverspecific identification information3233 from thebadge116 to thePOC computer3224 for receipt by thePOC computer3224. Thenurse3132,3232 uses thePOC client3126,3226 to scan an identifier, such as abarcode label102 for example, on themedication container3102,3202 to obtain medication or drug containerspecific identification information3101,3201 on the identifier, and thePOC client3126,3226 processes and/or sends the drug container specific identification information to thePOC computer3124,3224 for receipt by thePOC computer3124,3224. Thenurse3132,3232 uses thePOC client3226 to scan an identifier, such as abarcode label92 fro example, on theinfusion pump3130,3230 or a channel of the pump to obtain medical devicespecific identification information3131,3231 on the identifier, and thePOC client3126,3226 processes and/or sends the medical device specific identification information to thePOC computer3124,3224 for receipt by thePOC computer3124,3224.
• Using the drug container specific identification information, thePOC computer3124,3224 finds or retrieves from its own memory or a memory associated with thePOC computer3124,3224, the medication order information associated with the drug containerspecific identification information3101,3201, which contains medical device specific delivery information for use in programming theinfusion pump3130,3230. ThePOC computer3224 or thePOC client3126 sends or transmits the medical device specific identification information, such as the pump ID, the caregiver specific identification information, such as the nurse's ID, the order ID obtained or retrieved from one of the drug container specific identification information or from the associated medication order stored in the memory associated with thePOC computer3224 and/or thePOC client3126, and the medical device specific delivery information, such as the pump settings for the order, to theMMU computer3108,3208.
• In addition to or separate from other actions or functions which theMMU computer3108,3208 may perform at this stage, the MMU computer transmits the medical device specific delivery information, such as the pump settings, to theinfusion pump3130,3230. Theinfusion pump3130,3230 includes a medical device memory for storing the medical device specific delivery information for use in programming theinfusion pump3130,3230 to deliver themedication3100,3200 to thepatient3104,3204. Theinfusion pump3130,3230 stores the settings in the pump memory, but in one embodiment does not display the settings on thedisplay88 of theinfusion pump3130,3230, and therefore the settings cannot be seen by thenurse3132,3232 when the settings are initially stored in the pump memory. Alternatively, the programmed settings may be displayed on thedisplay88 of thepump3130,3230, but with a large cautionary warning that the settings are merely preliminary. Theinfusion pump3130,3230 then transmits a confirmation signal to theMMU computer3108,3208 that theinfusion pump3130,3230 received the medical device specific delivery information, such as the pump settings for performing the infusion for thepatient3104,3204 with themedication3100,3200. Once theMMU computer3108,3208 receives this confirmation signal, theMMU computer3108,3208 transmits a confirmation signal to thePOC computer3124,3224 and/or thePOC client3126,3226 that the medical device specific delivery information was received by theinfusion pump3130,3230.
• Once thePOC computer3124,3224 and/or thePOC client3126 receives this confirmation signal, the software running on one or more of thePOC system3125,3225 computers is structured to transmit a request to thePOC client3126,3226 to prompt thenurse3132,3232 to read or scan the identifier, such as a barcode, on the patient'sidentification wristband112. Thus, at this point, thenurse3132,3232 uses thePOC client3126,3226 to scan the identifier, such as a barcode on thepatient wristband112 to obtain patientspecific identification information3103,3203 on the identifier, and thePOC client3126,3226 processes and/or sends or transmits the patientspecific identification information3103,3203 to thePOC computer3124,3224 for receipt by thePOC computer3124,3224.
• After receipt of patient specific identification information, thePOC computer3124,3224 and/or thePOC client3126 does a “right patient” check. Specifically, thePOC computer3124,3224 and/or thePOC client3126 compares at least one of the received drug container specific identification information and the patient specific identification information to the stored medication order information within the memory associated with thePOC computer3124,3224 and/or thePOC client3126. If the received drug container specific identification information and/or the patient specific identification information matches the stored medication order information within the memory, then thePOC computer3124,3224 and/or thePOC client3126 transmits a medication delivery initiation signal to theMMU computer3108,3208, which tells theMMU computer3108,3208 to “start the infusion.” If all other applicable checks occurring at theMMU computer3108,3208, as described within the present specification, are satisfied then theMMU computer3108,3208 transmits a second medication delivery initiation signal to theinfusion pump3130,3230 to communicate to theinfusion pump3130,3230 that it is “safe” to initiate the delivery of the medication to thepatient3104,3204 using the medical device specific delivery information, such as infusion parameters, previously transmitted to and received by theinfusion pump3130,3230.
• Software running on theinfusion pump3130,3230 will then consider it safe to display the medical device specific delivery information, such as the infusion parameters for the medication order for the patient, on thedisplay88 of theinfusion pump3130,3230 (without any warning that the settings are merely preliminary), and will do so. Theinfusion pump3130,3230 can be programmed to force thecaregiver3132,3232 to manually press one or more buttons or receive some affirmative indication from thecaregiver3132,3232 that the medical device specific delivery information on thedisplay88 is confirmed as correct for thatparticular patient3104,3204 and thatparticular medication3100,3200, etc. As described in prior embodiments, theMMU computer3108,3208 receivesinfusion pump3130,3230 status information from theinfusion pump3130,3230. TheMMU computer3108,3208 transmits thisinfusion pump3130,3230 status information along to thePOC computer3124,3224 and/orPOC client3126 for display on thePOC client3126,3226. TheMMU computer3108,3208 stores this information in a memory associated with theMMU computer3108,3208 before forwarding along to thePOC computer3124,3224 and/or thePOC client3126,3226. Alternatively, theMMU computer3108,3208 can store theinfusion pump3130,3230 status information in an associated memory and wait until thePOC system3125,3225 requests or polls theMMU computer3108,3208 to request theMMU computer3108,3208 to send the pump status information to thePOC system3225 for display on thePOC client3126,3226, for viewing by thecaregiver3132,3232.
• With continued reference toFIGS. 1 and 2, another embodiment of the medication administration system and method will now be described. This further embodiment is similar to the previous described embodiment. However, instead of waiting to read the identifier on thewristband112 of thepatient3104,3204 until after the medical device specific delivery information is transmitted to theinfusion pump3130,3230, thecaregiver3132,3232 scans the patient wristband identifier just after scanning the identifier on his or herown caregiver badge116. Thenurse3132,3232 can scan thepatient wristband112 before scanning the nurse'sbadge116 or even after scanning theidentifier102 on themedication container3102,3202. The order is not significant, except that the system and method can be arranged to comply with a set of tasks and steps which are comfortable for thecaregiver3132,3232 to follow. Thus, after the nurse scans the identifiers on thecaregiver badge116, thepatient wristband112, themedication container3102,3202, and theinfusion pump3130,3230, but not necessarily in any particular order except for ease of use by acaregiver3132,3232, using the drug containerspecific identification information3101,3201 from thedrug container3102,3202, thePOC computer3124,3224 and/orPOC client3126,3226 finds or retrieves from the memory associated with thePOC computer3124,3224 and/or thePOC client3126,3226, the medication order associated with the drug container specific identification information, which contains medical device specific delivery information for use in programming theinfusion pump3130,3230. ThePOC computer3124,3224 and/or thePOC client3126 then sends or transmits the medical device specific identification information, such as the pump ID, the caregiver specific identification information, such as the nurse's ID, the patient specific identification information, such as the patient ID, the order ID obtained or retrieved from one of the drug container specific identification information or from the associated medication order stored in the memory associated with thePOC computer3124,3224 and/orPOC client3126, and the medical device specific delivery information, such as the pump settings for the order, to theMMU computer3108,3208.
• In addition to or separate from other actions or functions which theMMU computer3108,3208 may perform at this stage, software running on the MMU computer transmits the medical device specific delivery information, such as the pump settings, and the patient specific identification information, such as the patient ID to theinfusion pump3108,3230. Theinfusion pump3130,3230 stores this information in the pump memory, but does not display this information on the display of theinfusion pump3130,3230, and therefore this information cannot be seen by thenurse3132,3232. Theinfusion pump3130,3230 then transmits a confirmation signal to theMMU computer3108,3208 that theinfusion pump3130,3230 received the medical device specific delivery information and the patient specific identification information. Once theMMU computer3108,3208 receives this confirmation signal, theMMU computer3108,3208 transmits a confirmation signal to thePOC system3125,3225, more specifically thecomputer3124,3224 and/or thePOC client3126,3226 that the medical device specific delivery information and the patient specific identification information was received by theinfusion pump3130,3230.
• Once thePOC computer3124,3224 and/or thePOC client3126 receives this confirmation signal, the software running on thePOC computer3124,3224 and/or thePOC client3126 does a “right patient” check. Specifically, thePOC computer3124,3224 and/or thePOC client3126 compares at least one of the received drug container specific identification information and the patient specific identification information to the stored medication order information within the memory associated with thePOC computer3224 and/or thePOC client3126,3226. If the received drug container specific identification information and/or the patient specific identification information matches the stored medication order information within the memory associated with thePOC computer3124,3224 and/or thePOC client3126,3226, then thePOC computer3124,3224 and/or thePOC client3126 transmits a medication delivery initiation signal to theMMU computer3108,3208, which tells theMMU computer3108,3208 to “start the infusion.” If all other applicable checks occurring at theMMU computer3108,3208, as described within the present specification, are satisfied, then theMMU computer3108,3208 transmits a second medication delivery initiation signal to theinfusion pump3130.3230 to communicate to theinfusion pump3130,3230 that it is “safe” to initiate the delivery of the medication to thepatient3104,3204 using the medical device specific delivery information, such as infusion parameters, previously transmitted to and received by theinfusion pump3130,3230.
• Software running on theinfusion pump3130,3230 will then consider it safe to display the medical device specific delivery information, such as the infusion parameters for the medication order for the patient, on the display of theinfusion pump3130,3230, and will do so. Theinfusion pump3130,3230 can be programmed to force thecaregiver3132,3232 to manually press a button or receive some indication from thecaregiver3132,3232 that the medical device specific delivery information on the display is correct for thatparticular patient3104,3204 and thatparticular medication3100,3200, etc. As described in prior embodiments, theMMU computer3108,3208 receivesinfusion pump3130,3230 status information from theinfusion pump3130,3230. TheMMU computer3108,3208 transmits thisinfusion pump3130,3230 status information along to thePOC computer3124,3224 and/or thePOC client3126 for display on thePOC client3126,3226. TheMMU computer3108,3208 stores this information in a memory associated with theMMU computer3108,3208 before forwarding along to thePOC system3125,3225. Alternatively, theMMU computer3108,3208 can store theinfusion pump3130,3230 status information in an associated memory and wait until thePOC computer3124,3224 and/or thePOC client3126,3226 requests theMMU computer3108,3208 to request theMMU computer3108,3208 to send the pump status information to thePOC computer3124,3224 and/or thePOC client3126 for display on thePOC client3126,3226, for viewing by thecaregiver3132,3232.
• With continued reference toFIGS. 1 and 2, another embodiment of the medication administration system and method will now be described. However, for the purposes of this embodiment, in addition to theinfusion pump3130,3230 communicating directly with theMMU computer3108,3208, theinfusion pump3130,3230 also communicates directly with thePOC computer3124,3224 and or thePOC client3126,3226, which can be referred to as a peer to peer arrangement. In this embodiment, theMMU computer3108,3208 can be considered as a “marriage” broker, supplying an availability state signal or marrying a computer of thePOC system3125,3225 to aninfusion pump3130,3230 when the infusion pump is “available” for performing an infusion function with apatient3104,3204. The status and availability of the infusion pumps3130,3230 is tracked by theMMU computer3108,3208. Communication from thepump3130,3230 to thePOC system3125,3225 is routed through theMMU server3108,3208 to allow for centralized monitoring of infusions by theMMU server3130,3230 while freeing up thePOC system3125,3225 for other processing tasks.
• In this embodiment, the caregiver uses thePOC client3126,3226 to scan the identifiers on thecaregiver badge116, thepatient wristband112, themedication container3102,3202, and theinfusion pump3130,3230 or channel thereof, but not necessarily in any particular order except for ease of use by acaregiver3132,3232. At this point thePOC computer3124,3224, or even the POCthick client3126, can perform one or more of the “five rights” checks, including comparing the received drug containerspecific identification information3101,3201and/or the patientspecific identification information3103,3203 to stored medication order information stored within the memory associated with thePOC computer3124,3224 and/orPOC client3126. At this point, thenurse3132,3232 can review the medical device specific delivery information through thePOC client3126,3226 and make any changes deemed necessary by thenurse3132,3232. The medical devicespecific delivery information3131,3231 can also be checked by, or against information which is stored in, theMMU computer3108,3208, in a manner similar to prior embodiments, such as for drug-drug interaction, dosing limits, and/or other checks. Alternatively, these comparisons and checks can be performed later in the process of the present embodiment.
• ThePOC computer3124,3224 and/or thePOC client3126 then transmits a request to theMMU computer3108,3208 for permission to communicate with theinfusion pump3130,3230 which has been scanned by thenurse3132,3232. This request is performed at least because theinfusion pump3130,3230 may already be in communication in another server-client relationship with thePOC server3124,3224 and/or thePOC client3126, or turned off, out of communication, or theinfusion pump3130,3230 may be communicating with a separate POC sever or other system, or may be operating an infusion to the same patient or another patient. Thus, for preventing interruption of other communications and operations, and for other understandable safety reasons, theMMU computer3108,3208 determines if theinfusion pump3130,3230 is available to communicate with thePOC computer3124,3224 and/or thePOC client3126 and receive the medical device specific delivery information. If theMMU computer3108,3208 determines that theinfusion pump3130,3230 is not available, theMMU computer3108,3208 transmits a non-available state signal to thePOC computer3124,3224 and/or thePOC client3126,3226, and thenurse3132,3232 is prevented from proceeding further with the infusion procedure or workflow. If theMMU computer3108,3208 determines that theinfusion pump3130,3230 is available, then theMMU computer3108,3208 generates and transmits an available state signal for themedical device3130,3230. In one embodiment, the available state signal can include key information such as an encrypted security token which is generated by theMMU computer3108,3208. The key information can alternatively be separate from the available state signal. TheMMU computer3108,3208 then transmits the key information, such as an encrypted security token, along with the IP address ofinfusion pump3130,3230 to thePOC computer3124,3224 and/or thePOC client3126,3226. TheMMU computer3108,3208 also transmits the key information, such as an encrypted security token to theinfusion pump3130,3230. Each key information, such as an encrypted security token can include an age or have an age associated therewith, which after a predetermined amount of time, such as two minutes, will time out or expire and prevent the key information, such as an encrypted security token from being useable. In one embodiment, each time the key information, such as an encrypted security token is used within a communication, the age can be reset or renewed. Alternatively, the key information, such as an encrypted security token can have a time stamp created at the time of generation by theMMU computer3108,3208, which can be used compared against an actual time of day when the key information, such as an encrypted security token is attempted to be used. The comparison of the time stamps to the time of day can be performed at thePOC computer3124,3224, thePOC client3126,3226 and/or at theinfusion pump3230, based on time of day tracking at these devices. Theinfusion pump3130,3230 can have a real-time clock for this purpose.
• If an available state signal, which can include key information for theinfusion pump3130,3230 is received by thePOC computer3124,3224 and or thePOC client3126,3226, thePOC computer3124,3224 and/or thePOC client3126,3226 can then retrieve the medical device specific delivery information and any other information that may be needed by theinfusion pump3130,3230, and transmit this information along with the key information, such as an encrypted security token to theinfusion pump3130,3230, using the IP address of theinfusion pump3130,3230 received from theMMU computer3108,3208, for use in programming theinfusion pump3130,3230 to infuse themedication3100,3200 to thepatient3104,3204. If thePOC computer3124,3224 has not performed any or completed “five rights” checking, thePOC computer3124,3224 and/or thePOC client3126,3226 will compare the received drug container specific identification information and/or the patient specific identification information to the stored medication order information within the memory associated with thePOC computer3124,3224 and/orPOC client3126, before retrieving and transmitting the medical device specific delivery information to theinfusion pump3130,3230 along with the key information, such as an encrypted security token, for use in programming themedical device3130,3230 to deliver themedication3100,3200 to thepatient3104,3204. Alternatively, thePOC computer3124,3224 and/or thePOC client3126,3226 can transmit the medical device specific delivery information to theinfusion pump3130,3230 without the key information, such as an encrypted security token and wait until after “five rights” checking is completed by thePOC computer3124,3224 and/or thePOC client3126,3226 before transmitting the key information to theinfusion pump3130,3230.
• In one embodiment, if the medical device specific delivery information is transmitted to theinfusion pump3130,3230 without the security token, theinfusion pump3130,3230 will automatically reject the medical device specific delivery information, and will prevent theinfusion pump3130,3230 from being programmed utilizing the medical device specific delivery information retrieved by thePOC computer3124,3224 and/or thePOC client3126,3226. In one embodiment, theinfusion pump3130,3230 compares encrypted security tokens received from thePOC computer3124,3224 (and/or thePOC client3126,3226) and from theMMU computer3108,3208 to determine if theinfusion pump3130,3230 should be programmed according to the received medical device specific delivery information. If the key information, such as the encrypted security tokens do not match or correspond in a predetermined way, theinfusion pump3130,3230 will automatically reject the medical device specific delivery information, and will prevent theinfusion pump3130,3230 from being programmed utilizing the medical device specific delivery information sent by thePOC system3125,3225 (retrieved by thePOC computer3124,3224 and/or thePOC client3126,3226). In one embodiment, until the above checks occur at theinfusion pump3130,3230, the medical device specific delivery information will be stored in the infusion pump memory and will not be displayed until after such checks occur and are affirmative.
• Theinfusion pump3130,3230 status information functionality can be performed according to embodiments described above, through theMMU computer3108,3208 and to thePOC computer3124,3224 and/or thePOC client3126,3226. Alternatively, theinfusion pump3130,3230 status information can be sent directly to thePOC computer3124,3224 and/or thePOC client3126,3226 for display on the display of thePOC client3126,3226, or when the POC system3225 (computer3124,3224 and/orPOC client3126,3226) requests status from theinfusion pump3130,3230. Even if theinfusion pump3130,3230 status information is to be sent directly to thePOC system3125,3225, theinfusion pump3130,3230 status information can also be sent directly to theMMU computer3108,3208 according to prior embodiments described herein.
• The present embodiment prevents theMMU computer3108,3208 from having to process as much information, as compared to prior embodiments. The present embodiment also improves the liveliness of the auto-programming workflow by using peer-to-peer communications betweenPOC system3125,3225 and theinfusion pump3130,3230, circumventing MMU message queuing and any inherent disadvantages associated therewith.
• Referring to flowcharts ofFIGS. 7A and 7B in addition toFIGS. 1 and 2, another embodiment of the system and method of administering amedication3100,3200 to apatient3104,3204 using aninfusion pump3130,3230 is shown. Specifically, similar to the previous embodiment, when thePOC system3125,3225 is auto-programming theinfusion pump3130,3230, thePOC system3125,3225, including thePOC computer3124,3224 and/or thePOC client3126,3226 requests theMMU3108,3208 for permission to program theinfusion pump3130,3230. Once this permission is granted by theMMU computer3108,3208, thePOC system3125,3225 communicates directly with theinfusion pump3130,3230 withoutMMU computer3108,3208 intervention. In this embodiment, afirst process step3302 provides that theMMU computer3108,3208 continually receives asynchronous (i.e. unsolicited, un-polled) status messages and event logs from theinfusion pump3130,3230 and stores this information in an associated memory for purposes of at least displayinginfusion pump3130,3230 status and generating reports.
• In asecond process step3304, as in prior embodiments, thenurse3132,3232 can start the workflow for automatically programming theinfusion pump3130,3230 by using thePOC system3125,3225 to scan the identifier on the nurse'sID badge116. In athird process step3306, thePOC system3125,3225 determines if thenurse3132,3232 is avalid POC system3125,3225 user. ThePOC system3125,3225 may also require thenurse3132,3232 to enter a password, and/or other information.
• In afourth process step3308, thenurse3132,3232 at thePOC system3125,3225 then scans the identifier on the patient'swristband112. In afifth process step3310, thePOC system3125,3225 then looks up thepatient3104,3204, at which time thePOC computer3124,3224 and/or thePOC client3126,3226 can retrieve the patient status, such as their recorded condition, present medications being taken, and/or any other information which may exist in that patient's EMAR, as well as retrieve the patient's medication orders, for administration.
• In asixth process step3312, thenurse3132,3232 obtains the bag orcontainer3102,3202 ofmedication3100,3200, and scans the identifier on theidentification label102 on thecontainer3102,3202. In aseventh process step3314, thePOC system3125,3225 performs various checks on the order or medication typically ensuring that the medication was, in fact, ordered, that it is the correct time to deliver the medication, that the patient has no known allergies or intolerances toward the medication, that the medication will not interact adversely with another medication the patient is receiving, and/or other “five rights” and safety checks.
• In aneighth process step3316, thePOC system3125,3225 determines that the medication is potentially “pump-able” and transmits a query to thePOC client3126,3226 asking thenurse3132,3232 if the nurse wants to deliver themedication3100,3200 using aninfusion pump3130,3230. ThePOC system3225 can accept a yes/no response to the query, or thePOC computer3124,3224 and/or thePOC client3126,3226 can accept a response of thenurse3132,3232 actually scanning an identifier for aninfusion pump3130,3230 channel. If thenurse3132,3232 scans the identifier of theinfusion pump3230 channel as the response, thePOC system3125,3225 receives a pump channel logical ID from the scannedbarcode identifier92.
• In aninth process step3318, thePOC system3125,3225 transmits a request to theMMU computer3108,3208 for the type ofinfusion pump3130,3230 and the software revision for theinfusion pump3130,3230 based upon the given logical ID of the pump/pump channel. At this point, thePOC system3125,3225 can then utilize the information concerning the type ofinfusion pump3130,3230 and the software revision for theinfusion pump3130,3230 to adjust or tailor the workflow, communications, and the user interface itself (on thePOC client3126,3226 and elsewhere) so as to be appropriate for the type ofinfusion pump3130,3230 and the software revision for theinfusion pump3130,3230 being used.
• In anothervariant3318A of the ninth step, thePOC system3125,3225 may further include or transmit, concurrently with or separately from the pump type and software revision request, a request to theMMU3108,3208 to provide the pump's program schema (i.e., the syntax of the program messages it accepts) from theMMU3108,3208 for theinfusion pump3130,3230 based on the given pump/pump channel logical ID and/or the pump type and/or software revision. The program pump schema is an XML schema that precisely defines the syntax for programs aparticular pump3130,3230 will accept. In addition to defining the specific optional and required information, the schema can define the required characteristics of such information, including but not limited to format, maximum values, minimum values, decimal point placement, and number of digits or characters. ThePOC system3125,3225 can then use this information to ensure that the program it sends to thepump3130,3230 has the correct syntax. In other words, the pump program schema is basically a template that thePOC system3125,3225 can use as a guide to transform its medical device specific delivery information or medication order information into information that is usable to program aparticular pump3130,3230 of a given type and software revision.
• In anothervariant3318B of the ninth step, thePOC system3125,3225 may further include or transmit, concurrently with or separately from the pump type and software revision request, a request to theMMU computer3108,3208 to provide an actual software module or program (i.e., an executable software package) which thePOC system3125,3225 can run in its process space (POC computer3124,3224 or POC client3226) that will automatically translate the infusion pump program from a device-neutral to a device-specific format. The program is translator script or executable code written in Java or another suitable programming language, which when executed by thePOC system3125,3225 will automatically convert, translate, or transform the medical device specific delivery information or medication order information from thePOC system3125,3225 into information that is usable to program thepump3130,3230. The translator program can be tailored for theparticular POC system3125,3225 in question by utilizing a POC system ID such as described below and is, of course, tailored to the specifictarget infusion pump3130,3230.
• In an optionaltenth process step3320, thePOC system3125,3225 displays medication order and/ormedication3100,3200 information on the display of thePOC client3126,3226, which can be tailored for theparticular pump3130,3230 type. The pump type or other information about the pump, such as software revision, schema, or translation identifiers can also be displayed on thePOC client3126,3226. The medication and medication order information can be in POC system format or in infuser setting format.
• In an optionaleleventh process step3322, thenurse3132,3232 at thePOC system3125,3225 can then adjust the infusion pump settings through thePOC client3126,3226. In one embodiment, if a medication ID was scanned from the identifier on thelabel102 on themedication container3102,3202, and the identifier does not include an order ID, then thenurse3232 may have to enter theinfusion pump3230 settings from scratch on thePOC client3126,3226. Thenurse3232 then confirms the settings indicating that the infusion should proceed to be programmed into thepump3130,3230.
• In atwelfth process step3324, thePOC system3125,3225 transmits a requests to theMMU computer3108,3208 requesting permission to program theinfusion pump3130,3230. With the request, thePOC system3125,3225 transmits the pump channel's logical ID, the POC system's ID, at least some patient information (e.g. name, number, room, bed, etc.) at least some order information (e.g., order ID, parameters for infusion, etc.) and some medication information (e.g., medication ID, medication name, etc.). TheMMU computer3108,3208 first ensures that thePOC system3125,3225 is known based on the POC system ID provided.
• In a thirteenth process step3326, theMMU computer3108,3208 attempts to translate the pump channel's logical ID into a physical IP address, using medical device information stored in a memory associated with theMMU computer3108,3208. TheMMU computer3108,3208 has in its memory (as part of the status information it receives on a periodic or looping basis instep3302 from various infusion pumps it is in communication with) an up-to-date look up or translation table of static pump logical IDs and network pump IDs or IP addresses. In afourteenth process step3328, theMMU computer3108,3208 then transmits a signal which “pings” theinfusion pump3130,3230 to make sure theinfusion pump3130,3230 is online and available for an infusion. It is possible that theinfusion pump3130,3230 may not be available because it may be currently infusing a different patient, the pump channel may already be in use, etc. This transmission can also request theinfusion pump3130,3230 to retrieve the very latest status information from theinfusion pump3130,3230 and transmit this status information back to theMMU computer3108,3208 as a part of its ping response.
• In afifteenth process step3330, assuming the pump channel is available for programming an infusion, theMMU computer3108,3208 generates a security key that thePOC system3125,3225 will use to identify itself (thePOC system3125,3225) to theinfusion pump3130,3230. In one embodiment, the POC system ID is included in the security key or token, which can be encrypted. In asixteenth process step3232, theMMU computer3108,3208 transmits the security key to theinfusion pump3130,3230. Theinfusion pump3130,3230 maintains list of security keys within theinfusion pump3130,3230 memory. Every security key can have a finite predetermined lifetime, such as five minutes for example. If theinfusion pump3130,3230 does not receive any communication from theappropriate POC system3125,3225 for which the respective security key was assigned and stored within the memory of theinfusion pump3130,3230, within lifetime of the stored security key, the security key automatically expires. Conversely, every time the infusion pump does receive a communication relating to aparticular POC system3125,3225 and thus to a particular security key stored in the infusion pump memory, the security key is renewed, and the finite lifetime is reset to its original time or some other increased finite time. Theinfusion pump3130,3230 then transmits to theMMU computer3108,3208 an acknowledgement or confirmation signal, and theMMU computer3108,3208, in turn, transmits the security key and IP address to thePOC system3125,3225.
• In a seventeenth process step3334, thePOC system3125,3225 then transmits the medical device specific delivery information, such as the program settings, directly to theinfusion pump3130,3230 using the IP address of theinfusion pump3130,3230, including transmission of the security key to theinfusion pump3130,3230. In one embodiment, thePOC system3125,3225 prompts thenurse3132,3232 through thePOC client3126,3226 to step over to theinfusion pump3130,3230 to confirm the program settings on thedisplay88 of the pump. The program settings can be transmitted to theinfusion pump3130,3230 in the pump's device-specific format.
• In aneighteenth process step3336, theinfusion pump3130,3230 receives the program settings and displays the program settings on thedisplay88 of theinfusion pump3130,3230. As mentioned, thenurse3132,3232 can confirm the program settings on thepump3130,3230. Once confirmation occurs, and theinfusion pump3130,3230 is programmed, theinfusion pump3130,3230 then expires the security key since theinfusion pump3130,3230 has been successfully programmed. Alternatively, theinfusion pump3130,3230 could be designed so as not to immediately expire the security key. In this alternative, it would be possibly to resend program settings in the event of communication failure or other error conditions. Theinfusion pump3130,3230 could always use the security key to ensure that it receives a complete program at most once. In either case, theinfusion pump3130,3230 transmits a confirmation or disposition signal to thePOC system3125,3225, including information indicating that the program settings were accepted as-is, accepted with edits, or rejected—along with, if accepted, the final program settings.
• In anineteenth process step3338, thePOC system3125,3225 may then poll theMMU computer3108,3208 for status information about an infusion pump channel using the channel's logical ID. In atwentieth process step3340, which can be a part of other steps, aninfusion pump3130,3230 will automatically expire a security key when the key's lifetime elapses without any communication from a POC system using the key.
• Referring to flowcharts ofFIGS. 8A and 8B in addition toFIGS. 1 and 2, another embodiment of the system and method of administering amedication3100,3200 to apatient3104,3204 using aninfusion pump3130,3230 is shown. Specifically, this MMU server mediated embodiment is substantially similar to the previous embodiments where the medical device specific delivery information, including a program, is transmitted to theinfusion pump3130,3230 from thePOC system3125,3225 through theMMU computer3108,3208 before thepatient3104,3204 is positively identified. In the present embodiment, as described below a subsequent updated program can be transmitted to theinfusion pump3130,3230, if necessary.
• In this embodiment, a first process step3502 provides that theMMU computer3108,3208 continually receives asynchronous (i.e. unsolicited, un-polled) status messages and event logs from theinfusion pump3130,3230 and stores this information in an associated memory for purposes of at least displayinginfusion pump3130,3230 status and generating reports.
• In asecond process step3504, as in prior embodiments, thenurse3132,3232 can start the workflow for auto-programming of theinfusion pump3130,3230 by using thePOC system3125,3225 to scan the identifier on the nurse'sID badge116. In athird process step3506, thePOC system3125,3225 determines if thenurse3132,3232 is a valid user of thePOC system3125,3225. ThePOC system3125,3225 may also require thenurse3132,3232 to enter a password, and/or other information. In afourth process step3508, thenurse3132,3232 at thePOC system3125,3225 then scans the identifier on the patient'swristband112. As will be understood based on the description below, the scanning of the identifier on the patient'swristband112 alternatively can be delayed until after programming the pump when the identifier is actually needed for a “right patient” comparison.
• In afifth process step3510, thenurse3132,3232 obtains thecontainer3102,3202 ofmedication3100,3200 and then scans the identifier on theidentification label102 on thecontainer3102,3202. The container ID can be a universally unique order ID so that thePOC system3125,3225 can retrieve information about the associated medication order without having to scan the patient ID on thepatient wristband112 or rely on such patient ID information for comparison purposes. In asixth process step3512, thePOC system3125,3225 performs various checks on the order including checking the order ID, as in prior embodiments, but does not make any checks relative to the patient, as the patient wristband may not yet have been scanned to determine the identify of the patient. Alternatively, these order related checks can be deferred until after thetenth process step3520, described below.
• In aseventh process step3514, thePOC system3125,3225 determines that the medication is potentially “pump-able” and either transmits a query to thePOC client3126,3226 asking thenurse3132,3232 if the nurse wants to deliver the medication using aninfusion pump3130,3230. ThePOC computer3124,3224 and/or thePOC client3126,3226 can accept a yes/no response to the query or thePOC system3125,3225 can accept a response of thenurse3132,3232 actually scanning anidentifier92 for aninfusion pump3130,3230 or pump channel thereof If thenurse3132,3232 scans theidentifier92 of theinfusion pump3130,3230 channel as the response, thePOC system3125,3225 receives a pump channel logical ID from the scanned barcode.
• In aneighth process step3516, thePOC system3125,3225 transmits the pump channel's logical ID, the order ID, and the medical device specific delivery information, such as the program (i.e. order) settings to theMMU computer3108,3208, and communicates to theMMU computer3108,3208 that theMMU computer3108,3208 should send the medical device specific delivery information to theinfusion pump3130,3230. In aninth process step3518, theMMU computer3108,3208 translates the pump channel's logical ID into an IP address, as in prior embodiments.
• In atenth process step3220, theMMU computer3108,3208 transmits the medical device specific delivery information, including the program to theinfusion pump3130,3230. Theinfusion pump3130,3230 stores this information in the pump memory for use in programming the pump to infuse the medication into the patient. Theinfusion pump3130,3230 can send a confirmation to theMMU computer3108,3208 that it received this information. TheMMU computer3108,3208 then transmits to thePOC system3125,3225 that the medical device specific delivery information has been sent to theinfusion pump3130,3230.
• In aneleventh process step3522, thenurse3132,3232 checks the order information and in atwelfth step3524 can adjust and confirm the medical device specific delivery information, such as the program settings through thePOC system3125,3225, such as through thePOC client3126,3226.
• In athirteenth process step3526, thePOC system3125,3225 transmits an updated medical device specific delivery information, such as an updated pump program including the pump channel's logical ID, the order ID, and a program update to theMMU computer3108,3208. If thenurse3132,3232 made no changes to the medical device specific delivery information, then this transmission is an “empty trigger” to theMMU computer3108,3208, which merely instructs theMMU computer3108,3208 to transmit to theinfusion pump3130,3230 to continue with the previously sent medical device specific delivery information/program. ThePOC system3125,3225 might display a message, such as through thePOC client3126,3226, instructing thenurse3132,3232 to review and confirm the medical device specific delivery information on thedisplay88 of theinfusion pump3130,3230.
• In afourteenth process step3528, theMMU computer3108,3208 again translates the logical ID into an IP address. In afifteenth process step3530, theMMU computer3108,3208 transmits the updated medical device specific delivery information, such as the updated program to theinfusion pump3130,3230, instructing theinfusion pump3130,3230 to actually implement the medical device specific delivery information. In asixteenth process step3532, theinfusion pump3130,3230 receives the medical device specific delivery information and displays the medical device specific delivery information on thedisplay88 of theinfusion pump3130,3230. Thenurse3132,3232 confirms the medical device specific delivery information at theinfusion pump3130,3230 by performing some affirmative act at theinfusion pump3130,3230. Theinfusion pump3130,3230 transmits to theMMU computer3108,3208 a disposition or acknowledgment including how the medical device specific delivery information was disposed of (accepted as is, accepted with edits, or canceled), and theMMU computer3108,3208 transmits this information to thePOC system3125,3225 along with the final medical device specific delivery information settings.
• In aseventeenth process step3534, thePOC system3125,3225 performs a “right patient” check as a part of the “five rights” checking. At this time any other checking on the order (e.g. right time, allergies, drug-drug interactions, etc.) can also be performed.
• In aneighteenth process step3536, thePOC system3125,3225 may then poll theMMU computer3108,3208 for status information about an infusion pump channel using the channel's logical ID.
• Referring to flowcharts ofFIGS. 9A and 9B in addition toFIGS. 1, 2 and5, another embodiment of the system and method of administering amedication3100,3200 to apatient3104,3204 using aninfusion pump3130,3230 is shown. Specifically, this MMU server mediated embodiment is substantially similar to the previous embodiments where the medical device specific delivery information, including a program, is transmitted to theinfusion pump3130,3230 from thePOC system3125,3225 through theMMU computer3108,3208 before thepatient3104,3204 is positively identified. This embodiment is similar to the embodiment ofFIGS. 8A and 8B in the first through the twelfth process steps3602-3624. However, instead of thenurse3132,3232 making program adjustments at thePOC system3125,3225, in athirteenth process step3626, adjustments are made by thenurse3132,3232 using theuser interface86 and thedisplay88 of the pump. In anfourteenth process step3628, thePOC system3125,3225 may then poll theMMU computer3108,3208 for status information about an infusion pump channel using the channel's logical ID. Thus, the POC system learns of any program adjustments made at thepump3130,3230. This embodiment advantageously has fewer steps yet allows for program adjustments. Any adjustments made will also be subject to the safety limits of the drug library of the pump and will give the caregiver immediate alarm feedback if the adjusted pump program settings are not within such limits.
• With reference toFIGS. 10A and 10B andFIGS. 1 and 2, another server mediated embodiment is shown. This embodiment, which is called a server mediated “unopened letter” programming model, is similar to the previously described server mediated embodiments through the first seven process steps3702-3714. In a eighth process step3716, thePOC system3125,3225 transmits a request to theMMU computer3108,3208 for the type ofinfusion pump3130,3230 based upon the given logical ID of the pump/pump channel. At this point, thePOC system3125,3225 can then utilize the information concerning the type ofinfusion pump3130,3230 to adjust or tailor the workflow, communications, and the user interface itself (on thePOC client3126,3226 and elsewhere) so as to be appropriate for the type ofinfusion pump3130,3230 being used. In aninth process step3718, thePOC system3125,3225 checks the patient ID or performs a “right patient” check as a part of the “five rights” checking. The right patient check and other checks alternatively can be postponed until just prior to the final confirmation of order settings in step fifteen described below. In atenth process step3720, thePOC system3125,3225 performs any additional “five rights” checking and/or other checking on the order (e.g. right time, allergies, drug-drug interactions, etc.). In aneleventh process step3722, thenurse3132,3232 can adjust and confirm the medical device specific delivery information, such as the program settings through thePOC system3125,3225, such as through thePOC client3126,3226.
• In atwelfth process step3724, thePOC system3125,3225 sends or transmits the medical device specific identification information, such as the pump or pump channel ID, the caregiver specific identification information, such as the nurse's ID, the patient specific identification information, such as the patient ID, the order ID and the medical device specific delivery information, such as the pump settings for the order, to theMMU computer3108,3208.
• In athirteenth process step3726, theMMU3108,3208 bundles at least the pump settings for the order and optionally any of the other information received from thePOC system3125,3225 into a sealed program information letter and assigns it a unique letter ID. In afourteenth process step3728, theMMU3108,3208 transmits the sealed program information letter and letter ID to thepump3130,3230. Thepump3130,3230 receives the letter and acknowledges to theMMU3108,3208 that the letter was received, but cannot open the letter except in response to a unseal letter message from theMMU3108,3208. TheMMU3108,3208 sends the letter ID to thePOC system3125,3225.
• In afifteenth process step3730, thenurse3132,3232 confirms the order settings at thePOC client3126,3226. In asixteenth process step3732, thenurse3132,3232 presses a button on thePOC client3126,3226 to transmit a signal from thePOC system3125,3225 to theMMU3108,3208 to proceed with the program for the given letter ID. In aseventeenth process step3734, theMMU3108,3208 transmits a command to thepump3130,3230 to unseal the program pump information letter associated with the given letter ID. In aneighteenth step3736, thepump3130,3230 unseals the program pump letter, sets the infusion settings in its memory and displays them, then sends an acknowledgement to theMMU3108,3208, which in turn transmits an acknowledgement to thePOC system3125,3225. As in previously described embodiments, thePOC system3125,3325 polls theMMU3108,3208 to get pump status information in anineteenth step3738.
• Referring toFIGS. 1, 2,11A and11B, another embodiment of the system and method of administering amedication3100,3200 to apatient3104,3204 using aninfusion pump3130,3230 is shown. In this embodiment, theinfusion pump3130,3230 pulls its program information from a remote computer within the system in response to a request from thenurse3132,3232 at theinfusion pump3130,3230.
• In this embodiment, afirst process step3802 provides that theMMU computer3108,3208 continually receives asynchronous (i.e. unsolicited, un-polled) status messages and event logs from theinfusion pump3130,3230 and stores this information in an associated memory for purposes of at least displayinginfusion pump3130,3230 status and generating reports. Alternatively, theMMU computer3108,3208 can poll theinfusion pump3130,3230 and synchronously receive information from theinfusion pump3130,3230.
• In asecond process step3804, as in prior embodiments, thenurse3132,3232 can optionally start the workflow for auto-programming of theinfusion pump3130,3230 by using thePOC system3125,3225 to scan the identifier on the nurse'sID badge116. In a substep3805, thePOC system3125,3225 determines if thenurse3132,3232 is a valid authorized user of thePOC system3125,3225. This enhances patient safety by preventing unauthorized infusions and facilitates electronic documentation of infusion orders administered. ThePOC system3125,3225 may also require thenurse3132,3232 to enter a password, and/or other information at thePOC system3125,3225 or at theinfusion pump3130,3230.
• In athird process step3806, thenurse3132,3232 at thePOC system3125,3225 scans the identifier on the patient'swristband112. The resultant patient ID, which may be a medical record number, an account number or some other identifier that the care facility uses to positively identify the patient, is retained in a memory in thePOC system3125,3225.
• In afourth process step3808, thenurse3132,3232 obtains thecontainer3102,3202 ofmedication3100,3200 and scans theidentifier3101,3201 on theidentification label102 on thecontainer3102,3202. Thecontainer ID3101,3201, which may comprise machine-readable indicia such as a bar code, RFID tag, or the like, can be a universally unique order ID so that thePOC system3125,3225 can retrieve information about the associated medication order without having to scan the patient ID on thepatient wristband112 or rely on such patient ID information for comparison purposes. Alternatively, the container ID can be a composite ID that includes patient ID or some portion thereof and an order ID related to that particular patient. Alternatively, the container ID can be an absolute or unique pharmacy order identifier that can be generated by the order entry or pharmacy information systems. Alternatively, for commonly used containers that are stocked on the ward or patient care floor, like dextrose, saline or other solutions, the container ID may be a medication ID that includes only medication-specific information, including but not limited to medication name, concentration (if applicable) and volume.
• In afifth process step3810, thePOC system3125,3225 determines that the medication is potentially “pump-able” and either transmits a query to thePOC client3126,3226 asking thenurse3132,3232 if the nurse wants to deliver the medication using aninfusion pump3130,3230. ThePOC computer3124,3224 and/or thePOC client3126,3226 can accept a yes/no response to the query or thePOC system3125,3225 can accept a response of thenurse3132,3232 actually scanning anidentifier92 for aninfusion pump3130,3230 or pump channel thereof If thenurse3132,3232 scans theidentifier92 of theinfusion pump3130,3230 channel as the response, thePOC system3125,3225 receives a pump channel logical ID from the scanned barcode and stores it in memory.
• In an optional alternativesixth process step3812, thePOC system3125,3225 transmits a request to theMMU computer3108,3208 requesting the pump type ofinfusion pump3130,3230 based upon the given logical ID of the pump/pump channel. In response, theMMU computer3108,3208 transmits or provides to thePOC system3125,3225 the pump type corresponding to the logical ID of the scanned infusion pump or pump channel. ThePOC system3125,3225 can then tailor its subsequent workflow to the particular type ofpump3130,3230. For example, different prompts, checks, screens, and warnings may be provided by thePOC system3125,3225 for syringe, peristaltic, cassette, general infusion, elastomeric and patient controlled analgesia pumps.
• In aseventh process step3814, thePOC system3125,3225 checks the patient ID or performs a “right patient” check as a part of the “five rights” checking. The right patient check and other checks alternatively can be postponed until just prior to adjustment or the final confirmation of order settings at thepump3130,3230 instep3830 described below (the program settings will have been received at the pump). ThePOC system3125,3225 can also perform additional checking based on the patient ID, order ID and/or the container ID (e.g. right time, allergies, drug-drug interactions, etc.).
• In an optionaleighth process step3816, thenurse3132,3232 can adjust and confirm the medical device specific delivery information, such as the program settings through thePOC system3125,3225, for example through thePOC client3126,3226. In aninth process step3818, thePOC system3125,3225 submits pump program information including a generically formatted (non-pump specific) pump program and the pump channel logical ID to theMMU server3108,3208. It is important to note that the generic pump program is incapable of operating the pump.
• In atenth process step3820, theMMU server3108,3208 gets from its memory the pump type corresponding to the logical ID of the scanned infusion pump or pump channel, ifstep3812 was previously omitted. Of course, ifstep3812 was previously executed, the pump type information could be included in the pump program information provided to theMMU3108,3208 by thePOC system3125,3225 instead of or in addition to the pump channel logical ID. TheMMU3108,3208 uses the pump type information and the generic pump program to generate a specific pump program that is acceptable to the particular type of pump. In other words, theMMU3108,3208 translates the generic program into one specific to the particular type ofpump3130,3230. TheMMU3108,3208 converts the logical ID of the scannedpump3130,3230 to a pump IP address by consulting a dynamic IP address lookup table in the memory of theMMU3108,3208. TheMMU3108,3208 does not download the program to thepump3130,3230 in response to the above steps. Instead, theMMU3108,3208 holds onto the pump program and acts like a post office holding a letter addressed to thepump3130,3230.
• TheMMU3108,3208 can also perform additional functions of establishing and monitoring time stamps on pump programs, as well as managing multiple infusion programs destined for thesame pump3130,3230. Programs can be made available to thesame pump3130,3230 on a first-in-first-out (FIFO) basis, last-in-first-out (LIFO) or other priority basis. For example, boluses might be prioritized for delivery before maintenance doses and “crash cart” or “code blue” response drugs might be given top priority. LIFO can be used to insure that only the most recent or most recently modified order is available to thepump3130,3230. TheMMU3108,3208 can automatically expire unutilized pump programs or send alarms or error messages to thepump3130,3230 and/orPOC system3125,3225 when a time stamp from the MMU or POC system indicates a program age greater than a predetermined program age. Thus, stale, superseded, or out-of-date orders can be removed from the queue.
• In aneleventh process step3822, theMMU3108,3208 sends a message to thepump3130,3230 stating that a pump program is available for the pump to pull. Returning to the post office analogy, theMMU3108,3208 tells thepump3130,3230, “You have mail.” Thepump3130,3230 displays a message on itsdisplay88 that tells thenurse3132,3232 to load the program when ready. TheMMU3108,3208 sends a message toPOC system3125,3225 indicating that it successfully received the generic pump program, translated the generic pump program into a pump-specific program, and advised thepump3130,3230 of the availability of the specific pump program. The last-mentioned message from theMMU3108,3208 signals the conclusion of the programming-related transactions between theMMU3108,3208 and thePOC system3125,3225. In an optionaltwelfth process step3824, receipt of the message from theMMU3108,3208 triggers thePOC system3125,3225 to display a prompt on thePOC client3126,3226 instructing thenurse3132,3232 to go to thepump3130,3230 to load the program on thepump3130,3230. This is especially useful if thenurse3132,3232 is not presently looking at thepump display88 or proximate to it.
• In athirteenth process step3826, thenurse3132,3232 uses thekeypad86 ordisplay88 to instruct thepump3130,3230 to retrieve or pull the pump specific program from theMMU3108,3208. In a fourteenth process step, thepump3130,3230 retrieves or pull the pump specific program from theMMU3108,3208. In afifteenth process step3830, thenurse3132,3232 can adjust (modify) the program settings on thepump3130,3230, if desired. Then, as illustrated inFIG. 4, thenurse3132,3232 must confirm or cancel the settings by pressing an appropriate button on thekeypad86 or touching a designated area of thedisplay88 when the display is a touch screen. Upon confirmation, thepump3130,3230 prompts thenurse3132,3232 with a second screen asking if they are ready to start the infusion. Upon receipt of an affirmative response from thenurse3132,3232, thepump3130,3230 runs the programmed infusion.
• In asixteenth process step3832, thePOC system3125,3225 periodically requests pump status information from theMMU3108,3208. The pump status supplied by theMMU3108,3208 will either provide a positive confirmation that the program is running on thepump3130,3230 or a negative indication that the program has been rejected. Based upon the pump status or after a predetermined period of time has elapsed or by direct intervention by thenurse3132,3232, thePOC system3125,3225 removes its prompt to load the program on the pump, ifstep3824 was executed. Alternatively, pump status messages can be supplied when thepump3130,3230 is on but not in an active pumping state, such as when the program settings have been received or when the program settings have been confirmed but thepump3130,3230 has not been started by thenurse3132,3232.
• The embodiment ofFIGS. 11A and 11B is advantageous in that it is flexible enough to fit with the workflows of most clinical POC systems. This embodiment decouples the three major processors in the system (the pump, the MMU and the POC system), which allows for more efficient asynchronous communication, scales well if many pumps need to be communicated with, and provides greater security by preventing thePOC system3125,3225 from programming thepump3130,3230 directly without permission from theMMU3108,3208. This embodiment is also flexible enough to allow additional checks to be done by theMMU3108,3208, if desired. Advantageously program settings can be ready, waiting and perhaps even scheduled for aparticular pump3130,3230 before the pump is available.
• Referring toFIGS. 1, 2 and12, another embodiment of the system and method of administering amedication3100,3200 to apatient3104,3204 using aninfusion pump3130,3230 is shown. This embodiment is called the “medication selection” workflow and works with a stand alone scanner or one associated with aPOC system3125,3225,MMU3108,3208, or apump3130,3230. In this embodiment, afirst process step3902 provides that theMMU computer3108,3208 continually receives asynchronous (i.e. unsolicited, un-polled) status messages and event logs from theinfusion pump3130,3230 and stores this information in an associated memory for purposes of at least displayinginfusion pump3130,3230 status and generating reports. Alternatively, theMMU computer3108,3208 can poll theinfusion pump3130,3230 and synchronously receive information from theinfusion pump3130,3230.
• In a second process step3904, similar to the previously described embodiments, thenurse3132,3232 can optionally start the workflow for auto-programming of theinfusion pump3130,3230 by using the scanner to scan the identifier on the nurse'sID badge116. The scanner is in communication with theMMU server3108,3208 via a wireless connection, although a wired connection is also possible. The scanner can be disposed on or in thepump3130,3230, tethered or wired thereto, or in wireless communication therewith directly or through theMMU3108,3208.
• In athird process step3906, thenurse3132,3232 uses the scanner to scan the identifier on the patient'swristband112. The patient ID, which may be a medical record number, an account number or some other identifier that the care facility uses to positively identify the patient, is retained in a memory in the scanner.
• In afourth process step3908, thenurse3132,3232 obtains thecontainer3102,3202 ofmedication3100,3200 and uses the scanner to scan theidentifier3101,3201 on theidentification label102 on thecontainer3102,3202. Thecontainer ID3101,3201, which may comprise machine-readable indicia such as a bar code, RFID tag, or the like, can be a universally unique order ID so that theHIS3110,3210 orPOC system3125,3225 can retrieve information about the associated medication order without having to scan the patient ID on thepatient wristband112 or rely on such patient ID information for comparison purposes. Alternatively, the container ID can be a composite ID that includes patient ID or some portion thereof and an order ID related to that particular patient. Alternatively, the container ID can be an absolute or unique pharmacy order identifier that can be generated by the order entry or pharmacy information systems. Alternatively, the container ID may be a medication ID that includes only medication-specific information, including but not limited to medication name, concentration (if applicable) and volume. For this example, the medication ID includes a generic, brand or package level identification of the medication and its concentration as well. The container ID can include the order ID or the medication ID or both.
• In afifth process step3910, if the nurse wants to deliver the medication using aninfusion pump3130,3230, thenurse3132,3232 scans theidentifier92 of theinfusion pump3130,3230 channel and the scanner receives a pump channel logical ID or pump ID from the scanned barcode and stores it in memory.
• In asixth process step3912, the scanner sends a select medication on pump message to thepump3130,3230. The message may be routed indirectly through theMMU server3108,3208 or sent directly to thepump3130,3230. The message preferably includes the medication ID and may include additional scanned information including the order ID, pump or channel ID, and clinician ID. If the message was sent to theMMU3108,3208 and only an order ID was provided, the MMU can assist in an optionalseventh process step3914 wherein the medication (and concentration) contained in the order are determined by requesting this information or translation from thepharmacy information system3116,3216 ororder entry system3114,3214 of theHIS3110,3210 or accessing information already cached on theMMU3108,3208 by virtue of a separate MMU/HIS interface. Of course, this supplemental information or translation can be provided to thepump3130,3230 before, during or after the rest of the selected medication information is sent to the pump, if it is needed. In aneighth process step3916, thepump3130,3230 receives the “select medication” message information and sends an acknowledgement to theMMU3108,3208. Once the medication and its concentration are known by thepump3130,3230, thepump3130,3230 can use this information to automatically populate or fill in certain fields of programming screens, like medication and concentration, and set or identify appropriate drug library rule sets based on the selected CCA. This provides considerable time-savings and adds a layer of safety with the drug library rule sets.
• In aninth process step3918, thenurse3118,3218 enters into thepump3130,3230 the remaining pump program settings that have not been automatically populated. Advantageously in atenth process step3920, thepump3130,3230 checks the entered program settings against the permissible settings specified in the drug library of thepump3130,3230 and alerts the nurse of any impermissible settings. Thenurse3132,3232 can then adjust the pump program settings in anoptional step3922 or override the alert in the case of soft limit violations. Any adjusted pump program settings are also checked against the drug library, and eventually the final program settings are viewed on thepump display screen88 and confirmed by thenurse3132,3232 inprocess step3924. Then thenurse3132,3232 is presented with a start button on thescreen88 to start the infusion in accordance with the final confirmed programmed pump settings. Thepump3130,3230 continuously sends status information (i.e., current settings and state) and event logs (i.e., historical activity, alarms, alerts, overrides, etc.) to theMMU3108,3208 pursuant to step3902.
• The embodiment ofFIG. 12 is advantageous in that it saves the clinician time by automatically populating medication data on the pump, and in so doing enhances the safety of drug administration by invoking or allowing the nurse to quickly select drug library limits already provided on the pump. Many hospitals are non-profit institutions and cannot afford expensive POC systems. However, scanners are far more affordable, ubiquitous and adaptable. The software requirements for this embodiment are more straightforward than many of the other more complex embodiments previously described. The medication is identified only once by all the systems, which saves time and insures that all systems refer to the same medication. This approach is also flexible enough to accommodate medication which are bar coded with order ID or medication ID. The latter case would occur for emergency, “stat”, ad hoc, verbal orders, or other situations where the pharmacy information system has not had sufficient time to process the order and label the medication with an order ID barcode. Finally, this approach makes virtually no demands on the POC system, making it easy for hospitals to implement or add on to existing systems and workflows.
• Referring to flowchart ofFIG. 13 in addition toFIGS. 1 and 2, another embodiment of the system and method of administering amedication3100,3200 to apatient3104,3204 using aninfusion pump3130,3230 is shown. This embodiment is called the “medication selection with POC checking” workflow and includessteps4002,4004,4006,4008,4010,4012,4014 (optional),4016 and4018, which are the same assteps3902,3904,3906,3908,3910,3912,3914,3916 and3918 described above relative toFIG. 12. In atenth process step4020, thepump3130,3230 automatically or upon direction of thenurse3132,3232 seeks to check the program information it has been provided. The medication ID, order ID, pump ID and program settings are communicated to theMMU3108,3208 by thepump3130,3230. TheMMU3108,3208 in turn communicates the check program message to thePOC system3125,3225. ThePOC system3125,3225 checks the program information for right patient, right drug, right time, right route, right dose, and other concerns such as right caregiver, allergies, drug-drug interactions, etc. as desired. Results are returned to theMMU3108,3208 and thepump3130,3230 where they can be reported to the user or displayed to thenurse3132,3232. ThePOC system3125,3225 can also provide an alert directly to the nurse.
• In aneleventh process step4022, thenurse3132,3232 adjusts program settings (for example, dose, rate, VTBI, duration, etc.) on thepump3130,3230 to correct or override the alert condition. In atwelfth process step4024, thepump3130,3230 checks the entered program settings against the permissible settings specified in the drug library of thepump3130,3230 and alerts the nurse of any impermissible settings. Thenurse3132,3232 can then adjust the pump program settings in anoptional step4026 or override the alert in the case of soft limit violations. Any adjusted pump program settings are also rechecked against the POC system requirements and the pump drug library in a repetitive loop, and eventually the final program settings are viewed on thepump display screen88 and confirmed by thenurse3132,3232 inprocess step4028. Then thenurse3132,3232 is presented with a start button on thescreen88 to start the infusion in accordance with the final check and confirmed programmed pump settings. Thepump3130,3230 continuously sends status information (i.e., current settings and state) and event logs (i.e., historical activity, alarms, alerts, overrides, etc.) to theMMU3108,3208 pursuant to step4002.
• The embodiment ofFIG. 13 has all the advantages of the basic medication selection approach ofFIG. 12, plus adds POC-based order and medication, as well as POC based checking of the actual infusion parameters programmed into the pump very close in time to the final confirmation and start of delivery.
• FIGS. 1, 2, and14 illustrate another embodiment of the present invention, which is called the “order lookup” workflow. In astep4102 of this embodiment, theMMU3108,3208 receives a “receive order” message from theHIS3110,3210 that includes the patient ID, the order ID, and order settings. Such messages could be received on a synchronous (i.e., polled) or asynchronous (i.e., event driven) basis directly from the HIS or indirectly via an interface engine (not shown). The order ID may be universally unique across all patients or it may be unique only with respect to a given patient. In the latter case, theMMU3108,3208 generates a universally unique or universal order ID from the patient ID and the order ID, then forms an orders table wherein the order information is stored according to its universal order ID. For example, the patient ID can be a unique number assigned to the patient by the hospitals admission-discharge-and-transfer system3112,3212 and the order ID can be a sequential number representing each medication order written for that particular patient. The sequential number may include the date and time the order is written, the date and time the order is to be administered, or both. TheMMU3108,3208 generates an absolutely unique or universal order ID and stores the order settings in a lookup table at a cell or location associated with the assigned universal order ID.
• The scanner in this embodiment can be associated with thePOC system3125,3225 as aPOC client3126,3226. In asecond process step4104, thenurse3132,3232 scans his or hercaregiver identification badge116 to input the clinician ID. In athird process step4106, thenurse3132,3232 scans the patient identification bracelet orbadge112 associated with thepatient3104,3204 to input the patient ID. In afourth process step4108, thenurse3132,3232 scans thelabel102 on themedication container3100 to obtain either a medication ID or order ID. The second through fourth steps can be performed in any order that is convenient for thecaregiver3132,3232.
• In a fifth process step4110, thePOC system3125,3225 checks those “rights” of medication management that it has sufficient information for, such as right/authorized clinician, right patient, right medication, right dose, right route/site, allergies, drug-drug interactions, etc. If anything is not right, thePOC system3125,3225 generates an alert to thenurse3132,3232, typically through thePOC client3126,3226 and gives the nurse an opportunity to correct the problem or override the alert. Of course, as discussed above, some of the scanning and rights checking can be delayed until after the pump program settings have been sent to thepump3130,3230. ThePOC system3125,3225 determines that the medication should be delivered by anIV pump3130,3230. In asixth process step4112, thenurse3132,3232 scans the pump/pump channel bar code label orID92 on thepump3130,3230.
• In aseventh process step4114, thePOC system3125,3225 sends a message to theMMU3108,3208 telling it to program thepump3130,3230. This message must include the pump ID for thepump3130,3230 to be programmed and either the patient ID plus order ID, or the universal order ID, and optionally includes the medication ID (including medication name and concentration). The universal order ID or the patient ID plus order ID information allows theMMU3108,3208 to look up the order information it previously stored in its orders table and download the order settings to thepump3130,3230 in aneighth process step4116. Because the medication ID also was included with the information sent to theMMU3108,3208 by thePOC system3125,3225, such information can be included with the order settings downloaded to thepump3130,3230.
• In an optionalninth process step4118, the nurse can adjust or change the program settings on thepump display88 or user interface, if desired. Because the medication ID was included with the information sent to thepump3130,3230 byMMU3108,3208, thepump3130,3230 can check the pump settings (whether original, adjusted or changed) in atenth process step4120 and provide an alert to thenurse3132,3232 on thepump display88 or as part of pump status at other displays within the hospital. The nurse is prompted to change the program settings on thepump3130,3230 or, if permissible, override the alert. Thesteps4118 and4120 continue in a repetitive loop manner until the pump settings meet all the drug library constraints or the associated alerts have been overridden. In aneleventh process step4122, thenurse3132,3232 reviews the final pump settings on thepump display88 and confirms them with an appropriate affirmative action, response or acknowledgement on the user interface of thepump3130,3230. Upon confirmation, thepump3130,3230 prompts thenurse3132,3232 with a second screen asking if they are ready to start the infusion. Upon receipt of an affirmative response from thenurse3132,3232, thepump3130,3230 runs the programmed infusion.
• As with the other embodiments discussed above, theMMU computer3108,3208 can continually receive asynchronous (i.e. unsolicited, un-polled) status messages and event logs from theinfusion pump3130,3230 and store this information in an associated memory for purposes of at least displayinginfusion pump3130,3230 status and generating reports. This step has been omitted fromFIG. 14 for the sake of brevity. It will also be understood by one of ordinary skill in the art based upon the present description that the MMU can poll thepump3130,3230 and receive synchronous communication regarding status and event logs.
• FIGS. 1, 2 and15 illustrate another embodiment of the present invention. This embodiment is called a “pump-centric order settings acquisition” workflow. Like the embodiments ofFIGS. 12 and 13, a scanner for machine readable indicia is provided. The scanner can be associated with thepump3130,3230, theMMU3108,3208, or thePOC system3125,3225. The scanner can be a stand alone device communicating in a wired or wireless manner with thepump3130,3230, with thePOC system3125,3225 as aPOC client3126,3226, or even with theMMU3108,3208 as a client. The scanner can be mounted on or in thepump3130,3230.
• In afirst process step4202, thenurse3132,3232 scans his or hercaregiver identification badge116 to capture the clinician ID. In asecond process step4204, thenurse3132,3232 scans the patient identification bracelet orbadge112 associated with thepatient3104,3204 to capture the patient ID. In athird process step4206, thenurse3132,3232 scans thelabel102 on themedication container3100 to capture either a medication ID or order ID. In afourth process step4208, thenurse3132,3232 scans the pump or pump channel label orID92 on thepump3130,3230 to capture the pump ID. The first through fourth steps can be performed in any order that is convenient for thecaregiver3132,3232. In afifth process step4210, a program pump message is sent from the scanner to thepump3130,3230. The message can be sent directly to thepump3130,3230 from the scanner or it can be sent through theMMU3108,3208. The message can include the pump ID, clinician ID, patient ID and either the order ID or the medication ID.
• In asixth process step4212, thepump3130,3230 queries theMMU3108,3208 for the IP address of thePOC system3125,3225. TheMMU3108,3208 provides thepump3130,3230 with the IP address of thePOC system3125,3225. In aseventh process step4214, thepump3130,3230 sends a “getOrderSettings” message to thePOC system3125. The message includes the order ID or the medication ID and can include further information such as the patient ID. ThePOC system3125,3225 responds by providing or sending the order settings to the pump. This communication preferably occurs directly, but can take place indirectly through theMMU3108,3208 without detracting from the invention. In aneighth process step4216, thepump3130,3230 automatically populates the program setting fields on the pump with the order settings it received from thePOC system3125,3225 or the scanner earlier and any other values that can be calculated from those settings.
• In an optionalninth process step4218, thenurse3132,3232 can adjust the program settings on thepump3130,3230, typically on the user interface anddisplay88 of the pump. In atenth process step4220, the pump checks the program settings against the limits of its drug library, thanks to the medication ID it received from the scanner. Ideally, the medication ID includes medication-specific information, including but not limited to medication name, concentration (if applicable) and perhaps volume. For this example, the medication ID includes a generic, brand or package level identification of the medication and its concentration as well. If the user customizable drug library limits are violated by the original or adjusted program settings, thepump3130,3230 generates an alert on itsdisplay88 or other displays within the hospital. The adjust settings, check settings against drug library, and alert steps may be performed repeatedly in a loop until the nurse has corrected or overridden any alerts. In aneleventh process step4222, the nurse reviews and confirms the program on thepump3130,3230 as described previously and is presented with another screen to actually start the programmed infusion.
• As with the other embodiments discussed above, theMMU computer3108,3208 can continually receive asynchronous (i.e. unsolicited, un-polled) status messages and event logs from theinfusion pump3130,3230 and store this information in an associated memory for purposes of at least displayinginfusion pump3130,3230 status and generating reports. This step has been omitted fromFIG. 15 for the sake of brevity. It will also be understood by one of ordinary skill in the art based upon the present description that the MMU can poll thepump3130,3230 and receive synchronous communication regarding status and event logs.
• Any process descriptions or blocks in the figures may be understood as representing modules, segments, or portions of code which include one or more executable instructions for implementing specific logical functions or steps in the process, and alternate implementations are included within the scope of the embodiments of the present invention in which functions may be executed out of order from that shown or discussed, including substantially concurrently or in reverse order, depending on the functionality involved, as would be understood by those having ordinary skill in the art. One skilled in the art will appreciate the order of the many of the steps in the above embodiments can be changed, as necessary to conform to hospital practices and desired workflow.
• One skilled in the art will also appreciate that the present invention could be applied to a remote clinic or ambulatory home care environment and that the patient may serve as his or her own caregiver such that scanning the patient may determine both the authorized user or clinician ID and the patient ID.
• It will be understood that the invention may be embodied in other specific forms without departing from the central characteristics thereof. The present embodiments, therefore, are to be considered in all respects illustrative and not restrictive, and the invention is not to be limited to the details given herein.

Claims (2)

1. A method for programming a medical device, comprising the steps of:

receiving at a first computer, in communication with a second computer that is in communication with the medical device, at least a medical device identifier associated with the medical device and additional identification information selected from a group of identification information consisting of a caregiver identifier, a medication container identifier, and a patient identifier;

transmitting programming information for the medical device associated with the medical device identifier from the first computer to the second computer;

sending via at least one of the first computer, the second computer, and the medical device a prompt to download the program information from the second computer to the medical device;

in response to the prompt, initiating on the medical device a request to download the programming from the second computer to the medical device to operate the medical device; and

downloading the programming information from the second computer to the medical device in response to the request.

2. A system for programming a medical device, comprising:

a first computer including an associated memory for storing programming information for administering a medication to a patient;

a second computer in communication with the first computer and the medical device;

input means for inputting identification information, the input means being associated with one of the first computer, the second computer and the medical device;

wherein the input means captures and supplies to the first computer at least a medical device identifier associated with the medical device and additional identification information selected from a group of identification information consisting of a caregiver identifier, a medication container identifier, and a patient identifier;

wherein the first computer transmits to the second computer programming information for programming the medical device associated with the medical device identifier;

wherein at least one of the first computer, the second computer and the medical device prompts a user to initiate a request on the medical device to download the programming information from the second computer to the medical device; and

wherein the second computer downloads the programming information to the medical device in response to the request.

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