Management of pending medication orders

ES 2 346 342 T3

DESCRIPTION

Management of pending medication orders.

Background of the invention

The present invention relates, in general, to medication management systems and procedures and, more specifically, to the management of medication backorders and controlled medications.

Doctors, and other medication personnel, apply intravenous (“IV”) infusion therapy to treat various complications of medication in patients. IV infusion therapy typically involves infusing medication fluids, such as drugs or nutrients, from a fluid supply, such as a bag, bottle, or other container, through the tubing of a fluid administration set, into a cannula inserted into a patient's blood vessel. Other medications may be ordered by a doctor for a patient, such as pills or liquids, for the patient to take by mouth. In some cases, a physician may order multiple medications for a single patient, and these must be administered at certain times of the day, or over a certain number of days, resulting in a list of "medication backorders" for the patient. patient. In some cases, the administration of multiple medications must occur sequentially and, in other cases, there is an overlap of the administration of medications. In still other cases, the administration of certain medications must occur at a certain time before or after the administration of other medications, or other medications.

In a typical location, a physician enters an order for medication for a specific patient. This order can be handled either as a prescription card, or it can be entered into an automated system, such as a medical order entry system (“IPM”). The prescription card or electronic prescription from the IPM system is routed to the pharmacy, where the order is verified and then served. For medication to be delivered IV, the prescribed medication is prepared by a pharmacist and added to a bag, bottle, or other medication container (such as a syringe) at a pharmacy. A pharmacist usually also identifies the prepared order, identifying the contents of the container and the patient for whom the container is intended, with a written paper label that is attached to the container and, in some cases, by some other means, such as such as the inclusion of a barcode or magnetic device, or through the use of an interactive radio frequency ("RF") device, such as an RFID tag, as examples. The prepared medication is then delivered to a nursing station for subsequent administration to the patient.

For safety reasons, and in order to achieve optimal results, medical fluid is often administered in precise amounts, as prescribed by the doctor, and in a controlled manner, using an IV infusion pump. Infusion pumps work by displacing fluid located in a fluid administration set, to force fluid, from the fluid supply, through the tubing, and to the patient. The infusion pump is programmed by an operator such as a nurse or other medical or clinical personnel, with operational parameters in order to achieve drug delivery as prescribed by the physician. Such operating, or pumping parameters, are specific to the drug and the patient. That is, the pumping parameters are selected based on the specific medication prescribed and the specific patient for whom they are intended. It is the nurse's responsibility to associate the prescribed medication with the correct patient, and with the pump properly programmed, at the correct time for the administration of the medication.

Hospitals and other institutions continually strive to provide quality patient care. Medication errors, such as a patient receiving the wrong medication, or receiving the correct medication at the wrong time or at the wrong dosage, are significant problems for all healthcare facilities. In administering medication, the focus is usually on the following “right”, or factors: the right patient, the right drug, the right route, the right amount, and the right time. The nurse tries to ensure that these "correct" ones are met. Systems and procedures that seek to reduce medication errors should also take these five "rights" into account.

In some cases, a single patient may be prescribed multiple simultaneous infusions for different medications, sometimes four or more, requiring multiple infusion pumps, all of which can be programmed differently. Previous attempts have been made to ensure that the correct medication is delivered to the correct patient by the correct pump. In one example, a barcode label, identifying the medication and the patient, is applied to the bag at the pharmacy. After an operator, such as a nurse, manually programs the pump, a barcode scanner, connected to the pump, is used to read the barcode label on the bag to verify that it identifies the bag. medication than programmed into the pump. In another example, US Patent No. 5,078,683 to Sancoff et al. reveals a barcode label applied to the bag, which is read with a barcode scanner to automatically program the pump, thus completely avoiding manual programming. This feature of automatic programming, or of automatically assigning infusion pump pump parameter fields, can provide significant benefit to busy clinicians, and can increase the accuracy of pump programming.

Advanced infusion pumps have revolutionized the way IV medications are delivered, providing dose limit protection, and ensuring the “right” dose. Still lacking in these pumps, in a non-networked environment, the ability to automatically select the “correct” medication from the library of

ES 2 346 342 T3 pump medications, and to ensure that the medication being administered is for the patient who is currently connected to the pump, and that the assistant administering the medication is authorized to do so.

In the setting of intensive care units, cardiac care units, operating rooms, or trauma centers, it is often necessary to infuse the patient with multiple medications simultaneously. Furthermore, some of the medications used in these settings are not directly compatible with each other and therefore must be infused into the patient at different points in the body. Recently, infusion pumps capable of delivering various medications at different rates to a patient have been developed. While some types of these pumps are designed to deliver medications through a common cannula, others are designed with multiple pumps, or channels, that pump fluid to a patient through a plurality of infusion lines. One such pump is the Medley medication safety system from ALARIS of Cardinal Health Products, San Diego, California, USA, which provides this level of protection in both a networked and a non-networked environment.

As the name suggests, multichannel infusion pumps have more than one pump channel, and an infusion line, or administration set, is installed separately on each channel. This arrangement allows each pump to be programmed to deliver the specific medication that flows through the infusion line or set installed in the channel, so that each line can deliver medication at different rates or in different volumes. One problem with infusing a patient with multiple infusion medications delivered through different infusion lines is that it is necessary to ensure that each channel of the infusion pump is properly programmed to deliver each medication. There is a notable advantage in using a single controller to program multiple infusion pumps, or channels, to deliver various medications to the patient. The interface is the same for all channels and the controller is in the same location for all channels. Where four or more channels are present, and all must be operated simultaneously, a considerable volume of programming may be involved. There is a need to make such scheduling an easier task, while preserving security in the supply of medication.

Medication errors, that is, errors that occur in the ordering, dispensing and administration of medications, regardless of whether those errors caused harm or not, have a significant consideration in the provision of healthcare in the institutional setting. In addition, adverse medication events (“SMAs”), which are a subset of medication errors, defined as harm involving a medication and requiring medical intervention, and representing some of the most serious medication errors, are responsible for a good number of injuries and patient deaths. Healthcare facilities continually seek ways to reduce the occurrence of medication errors. Various systems and procedures are currently being developed to reduce the frequency of occurrence and severity of preventable adverse medication events (“EMS”) and other medication errors.

Most hospitals today have a pharmacy equipped with a computerized system to enter, prepare, and track prescriptions, manage drug inventory, verify drug incompatibilities, and print prescription orders and labels. Various solutions have been proposed to increase the security of the medication supply, such as systems that use barcodes to identify patients and medications, or systems that allow the entry of patient data at the bedside. While these systems have significantly advanced technology, even more comprehensive systems could prove to be of greater value.

Typically, medications are delivered to a nursing station in a medication cart, or other carrier that supports a certain degree of security, to prevent theft or other loss of medications. In one example, the drug cart or carrier is divided into a series of drawers or containers, each container holding the prescribed medication for an individual patient. To access medication, the nurse must enter the proper identification to unlock a drawer, door, or container. In other situations, commonly used drug inventories can be kept in a secure cabinet located in an area at or near a nursing station. This inventory may contain not only topical medications but also oral, intramuscular, and intravenous medications. The nurse's ID, and a medication order number, are typically required to gain access to the cabinet. The nursing station receives a list of medications to be dispensed to patients at certain intervals throughout the day. A nurse, or other clinician, reads the list of medications to be given, and gathers those medications from the inventory at the nursing station. Once all the medications for the patients have been gathered in the unit for which the nursing station is responsible, one or more nurses then deliver the medications to the individual patients and administer the dosages.

Such a system, however, may not be able to comprehensively verify that the proper regimen is being delivered to a patient in the case where IV medications are being delivered. For example, a nurse can bring an IV bag to a specific patient area, hang up the bag, program an infusion pump with the appropriate treatment parameters, and begin the infusion of the medication. The applicable hospital control system, such as the pharmacy information system, may not know that the patient has received the medication and, if the information has been lost somewhere, there is a possibility to medicate the patient twice. Thus, there may be a break in the verification link that the medication is being properly delivered to the patient if an event occurs that results in a deviation from the desired treatment parameters.

Furthermore, even where the correct medication reaches the correct patient for administration, incorrect administration of the medication can occur where the medication is to be administered using a delivery device.

ES 2 346 342 T3 automated or semi-automated delivery, such as an infusion pump, if the automated device is programmed with incorrect medication delivery parameters. For example, even where the medication order includes the correct infusion parameters, those parameters can be incorrectly entered into the infusion pump, causing the infusion pump to deliver the medication in a way that does not result in the prescribed treatment. The nurse may also start an infusion at the wrong time, or forget to administer an infusion, resulting in incorrect treatment that can interfere with other scheduled medications prescribed by the doctor.

An attempt to provide a system with built-in safeguards to prevent incorrect entry of treatment parameters uses a customizable drug library, which is capable of monitoring the parameter entry process and interacting with the clinician if incorrect entry is attempted. or an income out of range. In this case, an alert is communicated to the clinician that the parameter entered is incorrect or is outside the appropriate range for that medication, as established by the institution where the assistance is being provided. Such a system contributes to a great increase in patient safety. However, further increases in security and in data communication and availability are desired so that busy clinicians have the necessary data immediately at hand.

Thus, those skilled in the art have recognized that there is a need to more precisely ensure that the correct medications are provided to a patient. There is a further need to more precisely ensure that the correct infusions are delivered to a patient with the correct pump parameters. Additionally, those skilled in the art have recognized a need to provide more patient medication data to clinicians at the point of patient care. A further need to provide data regarding the administration of a medication has been recognized. The present invention meets these needs, and others.

Summary of the invention

Briefly, and in general terms, the present invention is directed to the display of pending orders of medication for a patient in a controller of an infusion pump, once a patient has been identified by that controller. In another aspect, the invention is aimed at submitting pending orders for medication for a patient at an infusion controller at the point of care of the patient and, in another detailed aspect, the invention is aimed at submitting all orders for medication, infusion and others, including oral medications, in an infusion controller at the patient's point of care.

According to the invention, there is provided a system for managing pending orders for medication, as defined in claim 1, the preamble of which corresponds to document US 2002/038 392.

In more detailed aspects, the identification device is also configured to acquire clinician identification data from a clinician, and to provide that clinician identification data to the controller, and the controller processor is configured to provide a receive signal from patient identification only after you have received the clinician identification data. The identification device is also configured to acquire clinician identification data from a clinician, and to provide that clinician identification data to the controller; The controller includes a selection device configured to allow selection of a pending medication order displayed on the display, and the controller processor is further configured to receive clinician identification data and to allow use of the selection device only after that you have received the clinician identification data. The identification device is also configured to acquire clinician identification data from a clinician, and to provide that clinician identification data to the controller, and the controller processor is configured to receive the clinician identification data and to display the clinician identification data. Pending medication orders for the identified patient only if the identified clinician is authorized to assist the identified patient. The identification device is also configured to acquire clinician identification data from a clinician, and to provide that clinician identification data to the controller, and wherein the controller processor is configured to receive the clinician identification data and to allow a clinician to select a pending order from the displayed medication backorders only if the identified clinician is authorized to carry out the selected backorder.

In further more detailed aspects, the controller processor is configured to provide a backorder execution signal to a second processor at the healthcare facility, upon selection of a displayed backorder. The controller processor is configured to provide the backorder execution signal to the second processor at the healthcare facility upon manual selection of a displayed backorder. The identification device is also configured to acquire medication identification data from a medication, and to provide that medication identification data to the controller; and the controller processor is configured to automatically select a displayed backorder upon receipt of the medication identification data that corresponds to the displayed backorder data.

In other aspects, the controller processor is configured to monitor the infusion pump and provide a backorder signal to a second processor at the healthcare facility, at the

ES 2 346 342 T3 determine the existence of the infusion by the infusion pump, according to a pending order displayed. The controller processor is configured to receive a manual indication that a medication has been administered to the patient according to a selected pending medication order, and to provide a pending order execution signal to a second processor at the healthcare facility, upon receipt of the manual dispensing indication.

Other aspects correspond to the management of controlled elements. Upon a selection of a displayed backorder comprising a controlled item, the controller processor provides a controlled item delivery signal to a second processor at the healthcare facility. The second processor is configured to point the controlled item management signal to a log, thereby resolving a checked out transaction. A dispensing processor of a medication dispensing site is configured to provide a controlled item withdrawal signal to a second processor at the healthcare facility when a controlled item has been dispensed, wherein the second processor monitors the time elapsed since the provision of the controlled element withdrawal signal and, If the second processor does not receive a controlled item management signal within a predetermined period of time, the second processor generates an alert signal. The dispensing processor is also configured to send a backorder ID that is associated with the controlled item that was picked up, and a patient ID for the backorder, to the second processor; the second processor determines if a patient identification reception signal has been received for the pending order patient identified by the dispensing processor and, if the patient identification has been received from a controller, the second processor communicates the alert to the controller that provided the patient ID receive signal. The controller processor is configured to provide the controlled item management signal to the second processor upon manual selection of a displayed backorder. The identification device is also configured to acquire medication identification data from a medication, and to provide that medication identification data to the controller; and the controller processor is configured to provide the controlled item delivery signal to the second processor automatically upon receipt of the medication identification data, from the identification device that matches a displayed backorder.

In still other detailed aspects, the identification device is also configured to acquire medication identification data from a medication, and to provide that medication identification data to the controller, the medication identification data including a medication identifier and information. medication administration; and the controller processor compares the drug identifier and drug delivery information with the pending medication orders and, if a match to a pending order is determined, the controller processor allows selection of the matching pending order. The controller processor automatically programs the infusion pump with pump parameters for the matching backorder when the matching order is selected. The identification device is also configured to acquire medication identification data from a medication, and to provide that identification data to the controller, the medication identification data including a medication identifier and drug delivery information; and the controller processor is additionally configured to access a drug library, compare the medication identification data with the drug library data and provide an alert if the medication identification data is not compliant with the drug library . Upon selection of a pending medication order, the controller processor communicates with a second processor at the healthcare facility to obtain any updated information about the selected pending medication order.

According to the invention, there is provided a method for the provision of pending medication orders, as defined in claim 20, the preamble of which corresponds to document US 2002/038 392.

These and other features and advantages of the present invention will become apparent from the following detailed description of the preferred embodiments, which, taken in conjunction with the accompanying drawings, illustrate by way of example the principles of the invention.

Brief description of the drawings

Figure 1 is a partial block diagram of a system according to aspects of the invention, in which an infusion device and the associated controller are connected to a server of the healthcare facility that communicates pending medication orders belonging to a patient, upon identification of the patient by the infusion pump or controller, and also shows the interaction of an automated dispensing machine with the server;

Fig. 2 is a diagram showing a means of identifying a patient, a clinician and a medication, using a self-identification module connected to a controller associated with the infusion pump of Fig. 1;

FIG. 3 is an exemplary display of pending medication orders pertaining to an identified patient displayed on the display of an infusion pump or associated controller, both located at the patient's point of care;

ES 2 346 342 T3 Fig. 4 is a diagram showing a means of identifying a medication by using a built-in scanner mounted on a self-identification module connected to a controller associated with the infusion pump of Fig. 1;

Fig. 5 is a block diagram showing the interaction of the controller with the viewer, a drug library, a patient identification device, a medication identification device, a clinician identification device and a server, where the server interacts with a device, or devices, for entering medication orders, with the patient's medical administration record (“RAM”), in this case, an eRAM (electronic rAm), and with an automated dispensing machine ("MDA"), and that also shows the processors of the various devices;

FIG. 6 is a flowchart of a procedure implementing the patient identification and backorder management system and procedure, described above, showing the administration of infusion and non-infusion medication, and reporting the status of administration to the server; and Fig. 7 is a flowchart of a procedure implementing the patient identification and pending medication order management system, described above, showing closed-loop tracking of medications and medication orders.

Detailed description of the preferred embodiments

Referring now, in more detail, to the drawings for purposes of illustration of embodiments of the invention, in which like reference numerals designate corresponding or equal elements among the various views, a diagram is shown in FIG. partial blocks of a system according to certain aspects of the invention. An infusion pump system 20 is shown connected to a patient 22 to infuse medication fluid from an IV fluid container 24, such as a bag, to the patient, through a fluid delivery set 26. The pump system includes an infusion pump 28 located on the left side of a controller 30 and a self-identification module 31 or "auto ID module" located on the right side of the controller. The identification module, in this case, includes a barcode reader 34 attached 33.

Controller 30 is connected to a server 35, which can take the form of any server, or servers, in a healthcare facility. Frame 35, identified as "server", may be a single server or it may comprise multiple servers or computers and memory for data storage. The data includes patient identification data as well as pending medication orders for patients admitted to the healthcare facility. You can also store clinician identification data and other data. The "server" identified by the numeral 35 may also include, for convenience of display and illustration, a company server that provides the infusion pump system 20 and establishes communication protocols between that infusion pump system and the local health care servers. Server 35 electronically receives physician medication orders from one or more sources 36, such as the pharmacy information system (SIF), laptop computers, physician order entry devices, electronic agendas ("PDAs"), and other devices. . Medication orders can also be entered on the server by the pharmacy. Controller 30 can be in communication with server 35 by any wired or wireless means, and the server can be in communication with other devices by wired or wireless means.

As is well known, the local health care pharmacy, or other pharmacy, or other department, can print physical labels for medications to be administered to patients. These labels can include various information, such as the patient's name, medication name, and concentration, and can include effective pump parameters, such as a rate and volume to be infused (“VAI”) as well as the time of delivery. administration and other information. The tag may also include a barcode tag, either two-dimensional or linear, or an RFID tag, or other machine-readable data source. The labeled medications are transported to the patient's location, or near the patient, for administration.

Also shown is an automated dispensing machine ("MDA") 37, which typically includes medications for surrounding patients. The MDA has a processor, referred to as a dispensing processor 50 (shown in Fig. 5), and may require the identification of the clinician before allowing any medication to be withdrawn. The dispensing processor may allow only certain clinicians to withdraw certain items from the MDA. The MDA may also contain "controlled items" which, for the purposes of this document, can be any item that is desired to be tracked by the healthcare facility in which the MDA is located. This can include narcotics, but it can also include much less sensitive items. When a controlled item is withdrawn from the MDA, the MDA's dispensing processor may send a controlled item withdrawal signal to the server 35 which opens a controlled item transaction. MDA may also provide the server with the backorder that includes a patient ID. The server can also start monitoring the elapsed time since the controlled item removal signal and, if the elapsed time exceeds a predetermined time, send an alert signal. This alert signal can be provided to various locations, as determined by the local healthcare facility. Such locations may include the pharmacy and administrative offices if a narcotic is involved. Additionally, in the case where a patient 22 has been identified to a controller 30, and the patient identification reception signal has been provided to the server, the server can compare the patient's identification from the controller with the patient associated with the signal of

ES 2 346 342 T3 controlled item withdrawal, and correlate the controller with the controlled item transaction. The server can then notify the controller about the alert.

Upon initial startup of the controller 30 in this embodiment, the controller requests the clinician to associate the controller with a patient 22, through the use of a patient identification number, or by other means. In the case of Fig. 2, a patient 22 has a bracelet 38 with a linear bar code indicating the patient's identification number and / or name, or other information specific to this patient. Using either a built-in barcode reader 40 or an attached barcode scanner 34 33, which is part of an Auto Identification module 32, as shown in Fig. 2, the clinician would scan the patient's identification bracelet. patient. The scanned patient identifier would be sent from the Auto Identification module 32 to the controller, thereby informing the controller that it is now associated with a specific patient. The self-identification module can communicate by wired or wireless means with the controller. In one case, the controller includes a communications interface ("IC Board") that contains a processor, programming, and considerable memory. The IC Board is in contact with the self-identification module and upon receipt of a patient ID, the IC Board then sends a message to the controller, telling it that it is now associated with the Scanned Patient ID. In another embodiment, all functions of the IC Board are carried out by the controller processor 46 (shown in Fig. 5) and other components within the same controller.

In another embodiment, the clinician would need to scan his identification 39 with the procedure described above, in order to even receive a screen of pending medication orders for the patient. In order to do this, the clinician must have been authorized to care for this specific patient. If such authorization has been granted, then the pending medication orders for the patient will be displayed on the display 42 in the controller. In another embodiment, the scanned clinician will not be able to select any pending orders for the patient, unless the clinician has been authorized to assist the identified patient for that specific medication order. For example, some clinicians may be authorized to administer oral medications, but not to administer infusions. If the clinician is authorized to administer infusions, then, in one embodiment, the controller 30 would then make the drug programming features available to the clinician to program the infusion pump 28.

As used herein, the term "medication" is intended to be construed, in a broad sense, as corresponding to medical care. "Medication" would include oral medications and infusions of medications, but is also intended to include physical therapy, taking vital signs, preparation for surgery, and other medical assistance. Furthermore, "administer" is intended to be interpreted, in a broad sense, as providing medical care. "Administer" is intended to encompass the dispensing of medications, such as oral medications, as well as the making of infusions on a patient and other medical care supplies. The illustrative controller 30 set forth herein, and shown in the drawings as a separate unit, may effectively be a part of an infusion pump or other medical instrument, such as viewer 42. The request for identification of individuals or medications, or of carrying out the steps, is provided as embodiments. Identifications can be carried out on different orders at certain healthcare facilities; the orders presented here are realizations.

If authorized, the clinician can then scan a medication container 24 label 46 (Fig. 1) containing the patient identifier, drug name, drug concentration, and drug dose. This information would then be passed to the controller, where processor 46 from controller 30:

1) it would check if the scanned label contains the same patient identifier that is associated with the controller, to guarantee the “correct” patient;

2) it would automatically select the drug library entry for the scanned medication, to ensure the “correct” drug and concentration; Y

3) it would automatically assign the drug dosage parameters in an associated infusion pump, to administer the medication to the patient, ensuring the "correct" dosage.

At this point, error messages would be displayed to the clinician on the display 42 of the controller 30, if the patient identifier on the controller and on the medication label do not match, and if the scanned medication is not in the drug library profile. to which the controller is associated. As used herein, the medication "label" is intended to be interpreted in a broad sense. Medications can be in labeled containers, but medications can also be provided individually, and can be scanned for identification.

If all the scanned parameters are valid, the programming parameters are automatically sent to the pump channel that the clinician selects; that is, the pump channel is automatically programmed for the infusion operation. The clinician must manually confirm that these parameters are correct before pumping can begin. In a networked environment, these parameters could be verified with an order entry system, to verify that the correct order is being administered to the correct patient. In another embodiment, the clinician can manually program the pump with the pump parameters contained in a pending medication order. In one embodiment, selecting a backorder in the viewer will result in the controller providing

ES 2 346 342 T3 Give additional details of the pending order. Such additional details may contain pumping parameters that can be manually programmed into the pump.

A medication order is entered into the pharmacy and sent via an electronic interface to a server capable of communicating with the controller 30, such as the Pyxis® Profile Application or an ALARIS server. Such capabilities are provided by Pyxis Products and ALARIS Products, respectively, of Cardinal Health, San Diego, California. At the same time, an IV barcode label is generated at the pharmacy. The barcode contains a patient identification (Patient ID) and a backorder identification (Order ID). Optional information in the barcode is the Identifier and the Drug concentration. Once a clinician identifies a patient 22 with an infusion pump 28, the Order Identifier and the Medication Identifier and concentration are sent to the infusion pump or associated controller 30.

The clinician turns on the controller 30, identifies himself as required, and uses the self-identification module 32 to associate the controller with a patient 22, as previously shown and discussed. The controller notifies the server 35 that it has a Patient Identifier, and the server then uploads the pending orders to the controller. The backorder list may appear on the controller display 42, as shown in Fig. 3. The clinician can select any of the orders by pressing a soft key 44 adjacent to the order list. The clinician scans the barcode 46 on the IV container 24, as shown in FIG. 4, and can then manually program the infusion. In this embodiment, the scanning was done with a built-in barcode reader 40, located on the front panel of the Auto Identification module 32, which is connected to the controller 30. Once the infusion has been manually scheduled and started, the infusion data, along with the Patient Identifier, Clinician Identifier, and Order Identifier are returned, by wired or wireless means, to the server 35, which passes this data , through the hospital information system (“SIH”) 47, to the electronic Registry 48 of Medical Administration, as shown in Fig. 5.

In another embodiment, the clinician does not need to manually select a pending medication order from the display 42, but can simply scan the medication ID 46 into the controller 30. The controller will then correlate the information from the scanned medication with the list of pending medication orders and, when it finds one that corresponds, it will automatically select that pending order.

There is also a dynamic update feature. When the clinician scans the Patient Identifier 38 into the controller 30, the controller processor communicates the Patient Identifier to the server processor 35. The server processor then communicates all pending medication orders for that identified patient to the controller. These communicated orders may have exactly the same information on them that is on the barcode label 46 on the patient medication container 24, or the order may have been updated since the barcode label was printed. This allows the physician to update the order to reflect changing patient needs, even though the barcode label has already been printed and affixed to the medication. The barcode on the bag, therefore, serves primarily to identify the medication to be dispensed, while the information provided by the server takes precedence over the barcode label, as to how the medication is administered to the patient. Physician-initiated changes may also include canceling the order so that medication is never delivered to the patient.

The invention of managing pending medication orders allows the same data that was printed on the barcode label 46 of the medication container 24 to be transmitted to the controller 30 once it has been associated with a patient 22. When a set of pending medication orders, with the Backorder Identifiers, Patient Identifiers and Medication Identifiers, has been sent to the controller using the pending medication order management invention, then when an IV container is scanned with that Medication or order identifier, the controller can correlate that to the pending order. This is an advantage in the nursing work sequence and facilitates the updating of the electronic Medical Administration Record.

In an additional feature, scanning the data tag 46 on the medication container 24 to obtain the name of the medication can automatically program the infusion pump 28. If the scanned medication matches a pending order already in the controller, the controller will automatically program the infusion pump for operation according to the physician's order. The clinician only needs to verify that the programming is in place and acceptable, verify any drug library exceedance alerts, and if there are none, the clinician can press START on the infusion pump to begin the infusion. of the patient's medication.

Regardless of how the infusion pump 28 is programmed, the controller 30 can also compare the programmed information with an internal or external drug library 44 that has institution-determined safe supply limits for authorized medications. If the schedule is beyond a limit, an alert or warning is provided to the clinician. Other action can also be taken. For additional details on such drug libraries, see US Patent Nos. 5,681,285 and 6,269,340 issued to Ford.

ES 2 346 342 T3

With reference to Fig. 6, a flow chart is presented, describing an embodiment of a method according to aspects of the invention of managing pending medication orders. A patient is identified 60, and the pending orders for that patient are communicated to the infusion pump, or the controller of that pump 62. The pending orders are displayed on the pump or controller for review by the clinician 64. The clinician can then scan a medication label from a container and, if the controller is able to automatically select a backorder based on that medication scan 66, a determination is made as to whether the medication is an infusion, a medication oral, or other 68. If the controller is unable to automatically select a backorder based on a scan of the medication container, a backorder may be manually selected 70. If the medication is a non-infusion medication, 72 is administered and a report is sent to the healthcare server 74.

If the medication is administered through an infusion, the controller can automatically program the pump for infusion parameters 76. If this is not possible, the infusion pump must be programmed 78 manually. The infusion now begins 80 by pressing the START button on the pump. A report is sent to server 74.

In a still further feature, the labeled medications are transported to, and stored in, computer controlled storage cabinets, referred to herein as automated dispensing machines (MDA) 37, in the vicinity of the patients for whom they are to be administered. (see Fig. 1). When the prescribed time for a medication to be administered arrives, a clinician logs on to MDA processor 50 and, if the clinician is recognized by MDA as having the proper authority, the clinician is allowed to enter the necessary information, such as a patient and medication identifier, in order to withdraw a selected medication for administration to a selected patient. At that time, the selected medication is indicated to the clinician by the server 35 as checked. As shown in Figs. 1 and 5, the MDA is in electronic communication with the server, so activity or transactions in the MDA, such as storage and withdrawal of medication, can be reported to the server. For example, when a medication is withdrawn, the server obtains information regarding the Medication Identifier of the withdrawn medication, the identity of the clinician who withdrew it (Clinician Identifier), the time it was withdrawn, and the Identifier of the selected Patient. for which it is prescribed.

Another feature in accordance with aspects of the invention is that the list of pending medication orders displayed on the display 42 of the controller 30 also includes oral medications and other types of non-infusion medications, in addition to infusion medications. In this way, after a clinician has withdrawn a non-infusion medication, such as an analgesic tablet, from MDA 37 for administration to associated patient 22 to controller 30, the clinician can select a pending medication order to report that non-infusion medication has been administered. This selection of the pending medication order can be made manually from a selection device, such as a software key 44 on the controller display 42, immediately after the non-infusion medication is administered to the patient. In doing so, a controller communication device, such as the controller communication interface (IC) board, transmits a signal representative of the administration of the non-infusion medication to the server 35. At that time, the MDA non-infusion medication withdrawal transaction is resolved by the server. If, after a preselected period of time, the server does not receive any such signal, representative of the administration, the server sends an alert or warning to a preselected individual, or individuals, such as another clinician, a supervisor, or manager, to resolve the transaction or to investigate the delay in management.

In other cases, a medication 24, infusion or non-infusion, withdrawn from the MDA 37, may have a bar code 46, a radio frequency identification (RFID) tag, or other means of identification on itself, or associated to the same. In these cases, the transaction associated with the withdrawal of the ADM medication is resolved after an indication that the withdrawn medication was administered to the correct patient 22. The infusion pump system 20 can provide this indication, of medication delivery to the correct patient, to the server 35 in many ways, such as, for example, when the clinician (1) scans the barcode or RFID tag of the patient. the medication with a data reader 34, such as the Self Identification module 32, (2) manually selects 44 a corresponding medication order from the list of pending medication orders displayed 42 on the controller 30 and (3) manually enters the Medication Identifier of the medication in the controller user interface.

In a still further feature, as discussed shortly above, the server 35 stores data regarding the movement and use of the controlled items. This allows an institution to track the movement and use of controlled items, which, for example, can be done to satisfy regulatory requirements or to facilitate internal workflow or audit studies. Controlled items typically include certain narcotics and others called “controlled substances,” but can also include anything that an institution wishes to track. It is to be understood that a controlled item need not necessarily be a medication, and may be a device, such as an empty syringe, for example. With this feature, the server 35 maintains a log of medication transactions that may include the time, the Clinician Identifier, the Patient Identifier, the Medication Identifier, and other information associated with the movement and use of a controlled item. With such information, institutions can, for example, check if the withdrawal of certain controlled elements tends to have a longer than average resolution time, or if it tends to be lost, or if certain clinicians have a tendency to lose or delay administration. of specific controlled elements.

ES 2 346 342 T3

Another feature is that the controller 30 maintains a Continuous Quality Improvement (MCC) log of the activity in the infusion pump system 20. The log includes, but is not limited to, data involving errors and corrections made in programming the infusion pumps 28. As mentioned above, the controller processor 46 always compares programmed information, either obtained from scanning a label on a medication or obtained from manual entry by a clinician, with an external library 44 of medications that has limits of safe supply, determined by the institution, for the medication. If the schedule is beyond a limit, an alert or warning is generated. Such alerts and warnings, the keys pressed or other actions taken by the clinician, leading to the alert or warning, and the keys pressed or other actions taken by the clinician in response to the alert or warning, are stored in the MCC log. controller. Such data can be used by the institution to support workflow study, auditing, training, and other efforts to improve the delivery of health care services.

Referring now to FIG. 7, a flow chart describing one embodiment of a method according to aspects of the invention of managing pending medication orders is presented. A new medication order is generated 100 by a physician for a selected medication to be administered to a selected patient. The order for medication need not necessarily involve a medication medication, such as, for example, an order to provide a certain type of food, or to take, and report on, the vital signs of a patient. When the medication order involves a medication medication, the new medication order is communicated to a pharmacy, which enters 102 the new medication order into the server. At that time, the server updates 104 a list of pending medication orders for the selected patient to include the new medication order with an assigned Order Identifier. The pharmacy also instructs a technician to transport the selected medication, now associated with the Order Identifier, from the pharmacy, and to store it 106 in an MDA 37 (Fig. 1) located in the general surroundings of the selected patient.

A clinician accesses a controller 30 of an infusion pump system 20, scanning the clinician's ID 39 on his identification device, such as a card or badge 37 (Fig. 2), and associates 108 the controller with the selected patient 22 scanning the patient identification device 38, such as the patient bracelet (Fig. 2), for example. The controller then provides a patient identification receive signal to server 35, which responds by sending pending medication orders for the identified patient. At that time, the infusion pump system controller display screen 42 (FIG. 3) displays 110 the list of pending medication orders for the selected patient. Displayed pending medication orders can be dynamically updated whenever another medication order is generated, or an existing medication order is canceled or modified for the selected patient, depending on certain aspects.

By viewing the new medication order among pending medication orders on the controller's display, the clinician obtains the selected medication from a medication dispensing site, such as a pharmacy or automated dispensing machine ("MDA"). In cases where the selected medication is stored in an MDA, the clinician logs into the MDA and removes 112 the selected medication from the MDA. At that time, the MDA communicates with the server 35, which updates 114 a medication tracking log to reflect that the selected medication was removed from the MDA, and may include other information, as desired. As mentioned above, the medication transaction log is useful in tracking the movement and use of controlled items, such as narcotic medications that may be regulated by government agencies.

Upon a positive indication 116 from the infusion pump system regarding the administration of the medication, the server updates 104 the medication transaction log to reflect that the selected medication was administered to the selected patient. When the selected medication infusion starts 118, the delivery status is dynamically reported to the server by the infusion pump system controller, ultimately resolving the selected medication withdrawal transaction from the MDA. . In cases where the selected medication is a non-infusion medication, the resolution of its withdrawal from the MDA occurs automatically when its barcode, RFID, or other machine-readable label is scanned 120 with the Auto Identification module 31. of the infusion pump system, or when a medication order is manually selected 122 in the controller 30 of the infusion pump system 20.

When no positive indication from the infusion pump system 20 is received by the server 35, after a predetermined period of time after the selected medication was withdrawn from the MDA 37, the server may generate 124 an alert or warning in order requesting the clinician, or someone else, to investigate the delay in administration. This can be done in all cases where the medication or medical device is deemed of significant importance to be tracked as a controlled item. The server updates 114 the medication transaction log to reflect the resolution of the alert or warning, which may take place by returning the medication to the MDA, reporting that the medication was wasted, or by other means. In this manner, the pending medication order management of the present invention enables efficient closed-loop tracking of medications to ensure that they are administered to the correct patient at the correct time and in the correct manner.

As mentioned above, when a tag 46 or label on a medication or medication container 24 is scanned by the Auto Identification module 32, the processor 46 of the controller 30 can automatically correlate the medication with a specific pending medication order, between pending medication orders obtained from server 35. After this selection of a medication order is communicated to the

ES 2 346 342 T3 server, the server records 126 that the selected medication order has been carried out and updates 104 the list of pending medication orders in order to prevent it from being carried out again inadvertently. Thus, it will be appreciated that the pending medication order management system and method of the present invention allows for efficient closed-loop tracking of medication orders, whether or not they involve medications, to ensure that they are carried out properly.

While specific forms of the invention have been illustrated and described, it will also be apparent to those skilled in the art that various modifications can be made without departing from the scope of the invention. Accordingly, the invention is not intended to be limited except by the appended claims.