Secure transfer of medications within hospital

Abstract

A process of safe, secure storage and transfer of prescription medications for patient care in a hospital, clinic, nursing home, or similar health care facility, permits the authorized user to obtain medications for multiple patients along a patient care route, place the medications in respective locking compartments for each patient, and bring the cart to each patient in turn to administer the medications. Scanning in the user ID opens the cart, and the ward or floor medications cabinet displays a 2-D bar code containing patient identification data, the user identification, and one or more delimiter characters indicating that the medication was transferred by the authorized user directly to the cart. For each patient, a patient specific drawer or compartment is unlocked and opened, and the medications are placed into it. This is repeated for each patient on the care route. At each patient bedside, the user scans in the patient ID, which opens only the patient specific drawer. If a medication is obtained when the cart is not at the cabinet, the cabinet labels the medication with a bar code containing a different delimiter. The system maintains an audit of each person handling the medication, and when each event occurred.

Claims

1. Method of administering prescribed medications to patients on a patient care route within a care facility, wherein an authorized medications dispensing user has a machine-readable user identification and each said patient has a machine-readable patient identification; the method comprising: (a) one said authorized dispensing user bringing to a central medications cabinet or carousel in said care facility a mobile medications cart, the medications cart including a plurality of individual locking medications compartments, a viewing screen, a coded symbol reader, and a suitably programmed processor; (b) the authorized dispensing user presenting the user's user identification to an ID reader of the central medications cabinet or carousel, whereupon the cabinet or carousel displays a coded symbol, the coded symbol containing data identifying said user, data identifying one of said patients on said patient care route; and an added delimiter character selected from a plurality of delimiter characters each indicating a different dispensing condition, and a predetermined first one of said delimiting characters indicating that the authorized dispensing user is present with said medications cart at said central medications cabinet or carousel; (c) said authorized dispensing user scanning the displayed coded symbol with the coded symbol reader of said cart, whereupon the programmed controller of said cart assigns one of said locking compartments of the cart to said one patient and unlocks or opens the assigned compartment; (d) said authorized dispensing user obtaining one or more medications prescribed for said one patient, placing said one or more medications into said assigned compartment, and closing said compartment; (e) said screen of said central medications cabinet or carousel displaying a successive coded symbol that contains data identifying said authorized dispensing user, data identifying a successive one of the patients on said patient care route, and said at least one additional delimiter character; and (f) said authorized dispensing user repeating the aforesaid steps {circle around (c)} to (e) for each of the patients on said patient care route.

2. The method of administering prescribed medications according to claim 1, further comprising: (g) said authorized dispensing user bringing said mobile medications cart to a bedside of one of said patients on said patient care route; (h) the authorized dispensing user scanning with said coded symbol reader of said cart the machine-readable identification of said one patient; whereupon the programmed controller of said cart unlocks or opens the medications compartment of said cart which has been assigned to said one patient; (i) the authorized dispensing user removing each said prescribed medication from said compartment for administering of such medication to said one patient, and closing said medications compartment; (j) the authorized dispensing user bringing said mobile medications cart to a bedside of a successive one of the patients on said patient care route; and (k) said authorized dispensing user repeating the aforesaid steps (h) to (I) for each of the patients on said patient care route.

3. The method of administering prescribed medications according to claim 2, comprising scanning a coded label on each such medication with said coded symbol reader.

4. The method of administering prescribed medications according to claim 2, comprising dispensing said prescribed medications according to a protocol of an existing electronic medications administration record system.

5. The method of administering medications according to claim 1, further including transferring at least one unit of medications for a selected patient on said care route from said central medications cabinet or carousel to said cart or to a bedside cabinet or carousel when said authorized dispensing user is not present with said cart at the central medications cabinet or carousel including placing in said coded symbol a predetermined second one of said delimiter characters to identify that said at least one unit of medications was obtained when the authorized dispensing user was not present with the cart at the central medications cabinet or carousel.

6. The method of administering medications according to claim 1, comprising maintaining an audit trail record of dispensing users obtaining each medication from said dispensing cabinet or carousel, identity of any pharmacy personnel placing said medication into said cart, patient identification for each said patient for whom said medications have been removed from said cart, time each said compartment on said cart was opened.

7. Method of administering prescribed medications to patients on a patient care route within a care facility, wherein an authorized medications dispensing user has a machine-readable user identification and each said patient has a machine-readable patient identification; the method comprising: (a) one said authorized dispensing user bringing to a central medications cabinet or carousel in said care facility a mobile medications cart, the medications cart including a plurality of individual locking medications compartments, a viewing screen, a coded symbol reader, and a suitably programmed processor; (b) the authorized dispensing user presenting the user's user identification to an ID reader of the central medications cabinet or carousel, whereupon the cabinet or carousel displays a coded symbol, the coded symbol containing data identifying said user, data identifying one of said patients on said patient care route; and an added delimiting character indicating that the authorized dispensing user is present with said medications cart at said central medications cabinet or carousel; (c) said authorized dispensing user scanning the displayed coded symbol with the coded symbol reader of said cart, whereupon the programmed controller of said cart assigns one of said locking compartments of the cart to said one patient and unlocks or opens the assigned compartment; (d) said authorized dispensing user obtaining one or more medications prescribed for said one patient, placing said one or more medications into said assigned compartment, and closing said compartment; (e) said screen of said central medications cabinet or carousel displaying a successive coded symbol that contains data identifying said authorized dispensing user, data identifying a successive one of the patients on said patient care route, and said at least one additional character; and (f) said authorized dispensing user repeating the aforesaid steps (c) to (e) for each of the patients on said patient care route; and further including (g) transferring at least one unit of medications for a selected patient on said care route from said central medications cabinet or carousel to said cart or to a bedside cabinet or carousel when said authorized dispensing user is not present with said cart at the central medications cabinet or carousel; wherein an authorized dispensing user presents the user's user identification to the ID reader of the central medications cabinet or carousel; the authorized dispensing user obtaining from said cabinet or carousel the at least one unit of medication for the patient on said patient care route; the cabinet or carousel printing out for each such unit of medication a label containing a coded symbol, the coded symbol containing data identifying said user, data identifying the selected one of said patients on said patient care route; and an added delimiting character different from the first-mentioned added delimiting character and indicating that the authorized dispensing user is not present with said medications cart at said central medications cabinet or carousel; and (h) the authorized dispensing user then bringing said one or more units of medication to said cart or to said bedside cabinet, and the authorized dispensing user scanning with said coded symbol reader on said cart or said bedside cabinet the machine-readable identification of said authorized dispensing user followed by the machine-readable identification of said one selected patient; whereupon the programmed controller of said cart unlocks or opens the medications compartment of said cart which has been assigned to said one selected patient; the authorized dispensing user scanning the coded symbol of each label or labels for said at least one additional medication with said coded symbol reader and placing said additional medication in said medications compartment.

8. The method of administering medications according to claim 7, further comprising said central medications cabinet or carousel producing said coded symbol with data identifying the dispensing act carried out at said cabinet or carousel when said cart is not present.

9. The method of administering medications according to claim 7, further comprising said cart or bedside cabinet assigning an unassigned compartment therein to said selected patient.

10. The method of administering medications according to claim 7, comprising maintaining an audit trail record of dispensing users obtaining each medication from said dispensing cabinet or carousel, identity of any pharmacy personnel placing said medication into said cart, patient identification for each said patient for whom said medications have been removed from said cart, time each said compartment on said cart was opened, and whether such medication was obtained from said dispensing cabinet or carousel without the medication cart present.

Description

BRIEF DESCRIPTION OF THE DRAWING

(1) The Sole Drawing FIGURE is a perspective schematic view of a patient ward in a hospital or other patient care facility, for explaining the methodology involved in embodiments of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

(2) Mobile medication workstations, i.e., wheeled carts with network-connected computer device and medications drawers or compartments, have become commonplace in hospitals and other patient care centers, as these improve nurse efficiency and enable the nurses to spend more time with patients and less time in administrative chores. In particular, these allow the nurse or other authorized patient-care professional to obtain the ordered prescription medications for a number of patients on the nurse's care route, so they can be administered to the patients without having to return time and again to the ward medications cabinet or floor medications cabinet. Frequently, there is a waiting time for the nurse to fill a patient's prescription order at the medications cabinet, which again reduces the amount of time the nurse can spend actually caring for the patient. Moreover, when the nurse needs to walk from the patient room to the pharmacy or the ward cabinet for each patient, the nurse may have to walk up to five miles per shift, causing fatigue and that may lead to medication errors. Accordingly, the use of these medication carts serve as a tool for the nurses to manage patient medications more efficiently and in a way where they can also avoid distractions and interruptions.

(3) Hospitals, clinics, and patient care centers now routinely employ an electronic medication administration record, or eMAR, to ensure that the correct medication is given to each patient, at the correct time and correct dose, i.e., ensuring the Five Rightsright patient, right medicine, right dose, right time, right routeare observed. The eMAR system is used to document medications given or to provide reasons they are not given, and this record is maintained hospital-wide. There are a number of software providers now that provide eMAR systems.

(4) This invention is directed to a drug security technique that keeps an audit trail or record of the dispensing user, i.e., nurse, as well as the pharmacy personnel or nurse who may have packaged the medication in the pharmacy or at a remote pharmacy, the patient ID, and the time the patient-labeled compartment or drawer was opened and time it was closed, and, if desired, the sequence number of the original dispensing or packaging done in the pharmacy. This information is tracked in addition to the hospital's eMAR system and does not interfere with that. In order to satisfy patient privacy laws and regulations, the information linking the prescription medications to patients is not stored on the cart.

(5) In the secure transfer arrangement of this invention, each patient on the care route for a given provider is assigned a patient-specific bin, drawer, or compartment for the patient's medications. The bin or drawer or compartment is labeled electronically for that patient, and the cart only permits access to that bin, drawer, or compartment when the cart is in the vicinity of the patient. The cart does not store patient-specific information, and thus avoids any conflict with HIPPA or other privacy rules. The cart works in cooperation with existing electronic medication administration record systems, and does not replace the eMAR system. The objective of this invention is to limit access to a cart, and to provide a more secure and safer means for transport of the medications between the pharmacy or medications cabinet (or carousel) and the patient.

(6) The sole drawing FIGURE schematically illustrates a hospital ward in which there is a central hallway or atrium 10 with a nursing station 12, and this is surrounded by a number of patient rooms 14, each with a patient bed 16. At one end of the ward, a ward medications dispensing cabinet 18, which can be a free-standing cabinet, wall-mounted cabinet, or carousel, is situated in a pharmacy room, and is configured to dispense medications according to prescription orders for the patients in the rooms 14 in the ward. One or more medications carts or mobile work stations 20 may be present, as shown in the hallway next to the nursing station 12. These can take on any of a number of configurations, but typically will have a wheeled base or pedestal 22, a number of drawers or compartments 24, an associated PC or similar computer with a monitor or viewing screen 26, and an optical scanner 28 capable of reading 2-D bar coded labels. The drawers or compartments 24 each have a latch mechanism which is controlled to lock or release under control of the computer. Each of the drawers can be labeled, i.e., identified on the computer, as being assigned for a specific patient in one of the rooms on the route at the time the nurse picks up the medications for the patient. The nurse brings the cart 20 to the central dispensing cabinet 18 and picks up the medications, in turn, for each patient on an assigned patient care route. In this example, the route may be the patients in rooms on the right-hand side of the ward, and another route may be the patients in rooms on the left-hand side of the ward. The ward or central cabinet 18 includes a computer processor for controlling the dispensing of its contents, and here has a display monitor 30, and may also have a label printer to obtain labels identifying the prescription medications to place on containers for the medications. In some configurations, the labeling of the given drawers or compartments on the cart may be only in the computer memory, without any visible identification of the patient to which it is assigned, but in some cases the cart may display the patient's name in a way that becomes visible when the nurse brings the cart to that patient's bed side and scans the patient ID bracelet or wristband to open the cart 20. In other cases, visible devices, e.g., flashing LEDs, may become visible on the assigned drawer when the patient's ID is scanned in.

(7) The nurse (or other authorized user) scans in his or her identity, i.e., an identification tag or badge, using the scanner 28 on the cart, then brings the cart 20 to the central medications cabinet 18 to obtain the prescribed medications for each of the patients on his or her care route. Alternatively, the user can log in using biometric identification, e.g., thumb print, retinal, or face recognition, or may log in manually by entering a password or PIN. For each patient, the patient identity is displayed on the monitor 30, and this can be scanned in using the cart scanner 28. Once this scan is done, the computer processor on the cart identifies a drawer or compartment 24 on the cart and opens it, if one has been already assigned to that patient. If no drawer or compartment is already labeled for that patient, then the cart on-board computer looks for an unassigned drawer or compartment, and assigns one of those to that patient, labels that drawer or compartment, and opens it. The nurse or authorized user obtains the prescribed medications that are delivered to her or him from the cabinet 18, and places them in that drawer, and when this has been done, he or she pushes the drawer or compartment shut. Then the next patient is identified and a coded symbol for that patient is displayed on the cabinet monitor 30. The nurse scans this in on the cart scanner 28, and the cart opens the drawer labeled for that patient (or assigns an empty, unlabeled drawer), and the nurse obtains the medications for that patient and places them in the drawer or compartment for this second patient. This procedure is repeated for each patient on the patient care route that the nurse has been assigned to. Then the nurse can wheel the cart from the vicinity of the central cabinet 18 to the patient rooms 14 on her or his route.

(8) At the patient bedside, when the nurse and cart are in the vicinity of the patient, the nurse can scan in the patient's ID bracelet (or other identity mechanism) using the scanner 28. The patient's identity will then be displayed on the cart monitor, and the cart opens the patient-specific drawer or compartment 24 for that patient. In some cases, especially if there are bulky materials ordered for the patient, such as an intravenous solution bag, for example, a second drawer or bin may also be labeled for that patient, in which case both drawers or compartments would open. The medications are removed from the drawer and can be administered to the patient. The drawers or bins that are labeled for other patients in that care route remain closed and locked. A sensor in each drawer or cabinet may signal that a given drawer has been emptied, but this information may also be entered by the nurse pushing a drawer empty button or similar technique, or from inventory data. Once a drawer or bin is empty, it is available for reassignment and can be re-labeled for another patient. During administration of the medications the nurse or user employs the hospital eMAR system to ensure the medication is being properly and safely given to the patient. Bin or drawer inventory will be reduced by the number of medications administered using the eMAR for that patient.

(9) Rejected or improper medications, i.e., rejected by eMAR, can be returned to the patient bin. When the nurse later returns to the central cabinet 18, he or she scans in the user ID and the patient ID to open that patient specific drawer or compartment, and then these medications can be removed and placed into the cabinet return compartment, according to the hospital protocol for wrong, unused, or waste medications.

(10) After the nurse or authorized user has completed his or her interaction with the patient, he or she can then proceed to another patient room on the route, and repeat this procedure at that patient's bedside. This is repeated until all the patients have been visited. In some cases, the medications are placed into locking drawers or compartments in a bedside cabinet, e.g., cabinet 32. These cabinets may be pre-filled by pharmacy personnel, and would be accessed by the authorized user (nurse) using the same technique of scanning in the user ID and the patient ID

(11) On occasion, a medication may not be available in the ward central medications cabinet 18, and has to be obtained directly from pharmacy, and hand-carried to the patient's ward. The safe, secure transfer procedure employed in this invention accommodates the transfer of medications from the pharmacy (or from the central cabinet) to a cart or to a bedside cabinet when the cart is not in the pharmacy or next to the cabinet.

(12) In this case, when the authorized user accesses the medications for a given patient, a printer at the cabinet 18 prints out a bar-coded label with data corresponding to the user's ID and the patient's ID, and with an additional character (or characters) to serve as a delimiter. In an example, the delimiter can be an octothorpe (#) rather than the hyphen or dash (-) employed in the example described before. Then the label is attached onto the container for this patient's medication. The medication is then carried, e.g., by hand, to the cart 20 or to the bedside cabinet 32 where the label is scanned. The cart software (or software in the bedside cabinet) asks the user to log in to learn who is bringing the medications, as this may be different person from the authorized user that packaged the medication. This may alternatively be accomplished by a biometric scan rather than from the ID card. In the same manner as described earlier, this action either opens a pre-labeled bin or drawer, or else if no drawer is specified for that patient, the cart can assign one of the empty drawers or bins, as discussed earlier. The audit trail preserves a record of the identity of the person who packaged the medication, the person who opened the cart and placed the medication into the cart, and the person who opened the patient-specific bin or drawer, as well as the patient ID and time the bin or drawer was opened, what medication was present in the bin or drawer, when the bin or drawer was opened, and when it was locked, and when the medication was administered, (using the eMAR). This information is vital when investigating drug diversion, and can be difficult to piece together using current methods.

(13) In addition, pharmacy personnel may have supervisory authority to access all the bins on the cart, each time with the cart monitor presenting a drawer or bin ID corresponding to the patient ID. This process achieves improved security and control over pharmaceuticals that must travel between the central cabinet and the bedside, and back in some cases. This requires only a few additional actions for the nurse or authorized user, namely, scanning bar codes off a cabinet monitor, scanning patient ID's to open a patient-specific bin or drawer; wheeling the cart to the cabinet; and identifying which bins or drawers are empty (although this may be done automatically by the cart). The process results in reduces nurse actions, namely, no need to place medications into a bag and seal the bag; no need to label a bag with the patient ID and initials; and fewer trips to the central cabinet for a given round. More importantly, there is no need to log into the cart separatelyonce the user is verified and logged in to the cabinet and the displayed 2-D bar code is scanned, the user has access to the cart without an additional log-in step.

(14) While the invention has been described hereinabove with reference to selected preferred embodiments, it should be recognized that the invention is not limited to those precise embodiments. Rather, many modification and variations would present themselves to persons skilled in the art without departing from the scope and spirit of this invention, as defined in the appended claims.