Patent Application
20190096518
Drug infusion devices may be used for controlled delivery of a variety of different types of drugs to a patient. Typically, a doctor orders a prescription for a particular drug with allowable dose amounts and a dosing schedule for the patient. Then the drug infusion device is programmed or configured with various parameters that are determined in accordance with the prescription, and a container of the drug is attached to the drug infusion device. The drug infusion device then delivers, or infuses, the drug from the container to the patient according to the programmed parameters.
The parameters typically call for a continuous delivery mode for the drug and/or a repeatable as-needed patient-controlled delivery mode. The continuous delivery mode is automatic, meaning there is no need for the patient, nurse or other person to intervene during normal infusion operations after the programming of the drug infusion device until the container runs empty. The patient-controlled delivery mode is generally controlled, for example, by manually activating the release of a single-dose at a time to the patient.
Certain considerations are generally taken into account for the design of the drug infusion devices and the control features thereof. One such consideration is that it should be possible to program the drug infusion device and begin delivering the drug relatively quickly. For example, a patient who is suffering acute distress may need to begin experiencing some relief as quickly as possible, so the time needed for setting up, programming or configuring the drug infusion device must be minimized. Another consideration is that it should be fairly easy or straightforward to program or otherwise operate the drug infusion device. Otherwise, a user may be more likely to make mistakes when setting-up/programming the drug infusion device or take an unacceptably long time to get the drug infusion started. A further consideration is that the safety of the patient should be of paramount importance. Therefore, accuracy of the setting-up, programming or configuring of the drug infusion device should not be sacrificed for a quick or easy operation thereof, since any mistake could potentially be devastating for the health or well-being of the patient. Other considerations may include a high accuracy for drug delivery rate/amount and a low mean-time-between-failure for the overall device, among other potential issues.
Some embodiments involve a method comprising: determining, by a controller of a drug infusion device, whether an infusion program is stored within a memory of the drug infusion device, the drug infusion device being capable of being connected to a patient and delivering a drug to the patient in accordance with the infusion program under control of the controller after configuration of the drug infusion device according to parameters specified by the infusion program; if the infusion program is stored within the memory, prompting, by the controller with a first series of prompts, a user to confirm usage of the infusion program, to make a confirmation of a drug identifier, and to review the configuration of the drug infusion device according to the parameters specified by the infusion program; if the infusion program is not stored within the memory, enabling, by the controller, a capability for the drug infusion device to receive an auto program with which the drug infusion device can configure itself without intervention by the user according to parameters specified by the auto program as the infusion program; if the auto program is not received after the capability for the drug infusion device to receive the auto program is enabled, waiting, by the controller, for receipt of the auto program or for a selection by the user to manually enter the infusion program; and when the controller begins waiting for receipt of the auto program or for a selection by the user to manually enter the infusion program, displaying, by the controller, a menu screen indicating that the drug infusion device is waiting for the auto program; and wherein if the auto program is received i) while the capability for the drug infusion device to receive the auto program is enabled and ii) before the controller begins waiting for receipt of the auto program or for a selection by the user to manually enter the infusion program, then the menu screen indicating that the drug infusion device is waiting for the auto program is not displayed.
Some embodiments involve a method comprising: performing, by a controller, a power-on self-test of a drug infusion device, the drug infusion device being capable of being connected to a patient and delivering a drug to the patient in accordance with an infusion program under control of the controller; receiving a drug vial into a receptacle space within a housing of the drug infusion device, the controller being capable of receiving a vial-reset signal indicating that the drug vial has been removed from the receptacle space; configuring, by the controller, the drug infusion device according to infusion parameters specified by the infusion program; prompting, by the controller with a series of prompts, the user to review the infusion program; if the vial-reset signal is received by the controller after the performing of the power-on self-test, stopping, by the controller, the method during any step therein and resetting, by the controller, the method to a point after the performing of the power-on self-test; and if the vial-reset signal is not received by the controller, performing the method to a conclusion.
In order that this invention may be better understood, the following examples are set forth. These examples are for purposes of illustration only and are not to be construed as limiting the scope of the invention in any manner.
An example medication administering system 100, such as may be used within a clinical facility 101, is shown in
In accordance with various embodiments, the drug infusion device 102 is capable of being connected to a patient 105 within a clinical care area 106 of the clinical facility 101 and delivering, infusing or providing a drug or medication to the patient 105 in accordance with an infusion program 107 after configuration of the drug infusion device 102 according to parameters specified by the infusion program 107. In one embodiment, the clinician can manually enter parameters for the infusion program 107 into the device 102 through a user interface and/or keypad described below. In some other embodiments, the infusion program 107 can be electronically delivered to the drug infusion device 102 by the medication management server 103 and/or the clinical system 104 via an auto program message (auto program) 113. The auto program feature is advantageous when it is stored in the drug infusion device 102, because it can be used by the drug infusion device 102 to automatically set infusion parameters or configure itself without interference or intervention by a user or clinician, except primarily for performing appropriate safety checks. Additionally, in some embodiments, the drug infusion device 102 includes various operation and control features that render the drug infusion device 102 capable of being programmed, set up or configured relatively quickly, so that the drug infusion device 102 can begin delivering the drug with very little lead time or delay. Also, the drug infusion device 102 includes additional operation and control features that enable redundant safety checks to minimize, mitigate or eliminate the potential for some types of mistakes occurring in the setting-up, programming or configuring of the drug infusion device 102. These features also enhance the ease with which the drug infusion device 102 can be programmed, further mitigating the potential for mistakes or human error. These and other features will be described in more detail below.
The clinical facility 101 generally represents any appropriate facility or environment in which medical care may be provided, such as a hospital, a nursing home, a hospice, an emergency clinic, a doctor's office, a field or mobile clinic, a recovery center, etc. In some embodiments, the clinical facility 101 may even represent a home for a patient 105 receiving medical care at home. Any appropriate number and types of medical care providers and management and staff personnel (e.g., doctors 108, pharmacists 109, nurses 110, clinicians, technicians, device operators, etc.) may perform medical care or support duties within or in association with the clinical facility 101, including operating the drug infusion device 102 to deliver a drug to the patient 105 (e.g., through a catheter 114 and a drug administration set 115 attached to the patient 105 and the drug infusion device 102). Additionally, the clinical facility 101 generally includes one or more of the clinical care areas 106.
The clinical care area 106 generally represents any appropriate designated area in which medical care may be provided within the clinical facility 101. For example, the clinical care area 106 may be an intensive care unit or ward, a common patient room, an operating room, a recovery room, an examining room, a medical testing room, a long term care ward, a patient's home, etc. Different clinical care areas 106 may be associated with different drugs or drug dosages that are allowed to be provided to the patient 105 when the patient 105 is receiving medical care within each of the different types of clinical care areas 106. Thus, the infusion program 107 may be limited to certain parameters depending on the clinical care area 106 in which it is being used.
The clinical system 104 generally represents a computerized system of any appropriate number, type and combination of computers, workstations, terminals, servers, handheld devices, computers on wheels, and wired and wireless network communication devices within or associated with the clinical facility 101. In some embodiments, for example the clinical system 104 represents components of a Hospital Information System (HIS) or Electronic Medical Records (EMR) Management System. Various medical care providers and management and staff personnel may use various terminals of the clinical system 104 to manage some of the medical care functions for the patient 105 related to the drug infusion device 102, as described below, as well as many other medical and/or business functions of the clinical facility 101. For example, in some embodiments, the doctor 108 may use a desktop, notebook, tablet, handheld computer or other terminal of the clinical system 104 to enter into the clinical system 104 a prescription for a desired drug to be provided to the patient 105. Alternatively, the doctor 108 may simply write the prescription down, and the nurse 110, pharmacist 109 or other clinician having appropriate authority may enter the prescription into the clinical system 104. The prescription may then be routed through the clinical system 104 to a terminal for an appropriate pharmacist 109 or other clinician who generates a formal order for the drug to be provided to the patient 105, based on the prescription. The formal order is processed through the clinical system 104 and the medication management server 103 to generate the infusion program 107 for eventual electronic transmission to, and programming of, the drug infusion device 102, as described below.
In other embodiments, the drug infusion device 102 may be programmed manually, e.g., by the nurse 110 or other clinician, in accordance with the prescription or order produced by the doctor 108. In this case, the infusion program 107 may be generated at the drug infusion device 102, as described below, instead of at the clinical system 104 and the medication management server 103. To do so, the drug infusion device 102 may be directly operated with built-in control features (described below). Alternatively, the drug infusion device 102 may be operated remotely, e.g., with a remote control or handheld device 111 that has a wireless connection directly to the drug infusion device 102 or indirectly through the wireless capabilities of the clinical system 104 to the drug infusion device 102. In some embodiments, however, these manual programming capabilities can be bypassed by the above mentioned technique for generating the infusion program 107 through the clinical system 104 and the medication management server 103 and electronically transmitting the infusion program 107 to the drug infusion device 102.
The medication management server 103 generally represents one or more computer servers and workstations or terminals for accessing the computer servers, either onsite at the clinical facility 101 or offsite at a remote computing center (or a combination of both onsite and offsite computing facilities). Additionally, the medication management server 103 maintains a database 112 or drug library of data used for managing the proper functioning of the drug infusion device 102, among other data. For example, the database 112 may store drug data describing the various drugs that the drug infusion device 102 may deliver to the patient 105 and allowable parameters for programming the drug infusion device 102 under various conditions or within the various clinical care areas 106. In response to orders received from the clinical system 104, the medication management server 103 may also generate the infusion programs 107 for the patients 105 and store the infusion programs 107 in the database 112. When called upon to program the drug infusion device 102 for the patient 105, the medication management server 103 transmits the desired infusion program 107 through the clinical system 104, e.g., through a wired and wireless network communication subsystem, to the drug infusion device 102.
The medication management server 103 and the clinical system 104 are connected together and their functions coordinated such that the formal order generated by the clinician through the clinical system 104, as mentioned above, is in a format with which the parameters for programming the drug infusion device 102 can be determined. With specific allowable parameters provided by the medication management server 103 and the order generated through the clinical system 104, therefore, the infusion program 107 for programming or configuring the drug infusion device 102 is generated in accordance with the original prescription provided by the doctor 108. The infusion program 107 specifies the exact parameters by which the drug may be delivered by the drug infusion device 102 to the patient 105. The infusion program 107 is electronically transmitted to the drug infusion device 102, and the drug infusion device 102 is configured accordingly, as described below.
In addition, where appropriate, and where it supplements without contradicting the disclosure herein, some of the components, features, and/or functions of the medication administering system 100 may be described with respect to similar components and features shown and described in US Pat. No. 8,768,719 82, which is assigned to the same assignee as that of the present invention. Therefore, US Pat. No. 8,768,719 82 is incorporated herein by reference for all purposes as if fully set forth herein.
In some embodiments, as shown in a simplified or idealized illustration in
In some embodiments, some of these components 200-215, or the features or functions described, may be combined into, or distributed among, a different number or combination of actual components. Additionally, in some embodiments, the drug infusion device 102 may further include other components, features or functions or combinations thereof (e.g., a battery, a power supply, a speaker, a pole clamp, etc.) not shown for simplicity of explanation. Therefore, the specific components 200-215 shown and described are simplified or idealized components that are provided for illustrative and explanatory purposes only and are not meant to limit the scope of the invention, unless otherwise specified.
The controller 200 generally represents one or more appropriate programmable microprocessors, microcontrollers or central processing units (CPU). The controller 200 controls various components, features or functions of the drug infusion device 102 in accordance with programmed instructions and data stored in and received from the memory 201. The programmed instructions and data may be replaced, updated or enhanced by electronically transmitting new or revised programmed instructions and data from the medication management server 103, e.g., through the network communications functions of the clinical system 104. For example, the controller 200 may control the various components, features and functions associated with configuring the drug infusion device 102 with the infusion program 107, whether manually entered by a clinician or automatically received from the medication management server 103, as described below. Additionally, the controller 200 may handle tasks associated with monitoring the delivery of the drug to the patient 105, logging occurrences of events/alarms during delivery of the drug or changes in the status of the drug infusion device 102, and reporting such event, alarm, and status information to the medication management server 103.
The internal communication system 214 generally represents one or more appropriate communication components through which the various other components of the drug infusion device 102 may transmit and receive commands, data or signals between each other. In some embodiments, not all of the components of the drug infusion device 102 use the same communication components or protocols for such communications. Thus, some combinations of the components of the drug infusion device 102 may have communication capabilities that are separate from other components of the drug infusion device 102.
The memory 201 generally represents one or more appropriate computer or electronic memory devices, such as SRAM or DRAM memory modules, flash memory devices, mass storage devices (e.g., magnetic, optical, etc.), registers, field programmable devices, etc. The drug infusion device 102 may use a variety of the different types of electronic memory devices, e.g., each for a different specific purpose. In general, though, the memory 201 stores the programmed instructions and data used by the controller 200 and files that have been received from or are to be transmitted to the medication management server 103 or the clinical system 104. For example, in some embodiments, the memory 201 stores a software program 216, an infusion program 217, and a drug library 218, among other programmed instructions and data not shown for simplicity, for use in cooperation with the controller 200.
The software program 216, defining the workflow aspects of the drug infusion device 102, generally represents the programmed instructions and data used by the controller 200 during a workflow to initialize the drug infusion device 102 for operation, configure the drug infusion device 102 for delivering the drug to the patient 105, and monitor the drug delivery process, among other potential functions not shown for simplicity. The infusion program 217 generally represents one or more program drug identifiers, such as the name of the drug, the concentration of the drug, and the parameters used to configure the drug infusion device 102 during the execution of the workflow for delivering the drug to the patient 105. Under the auto program feature, the auto program 113 is received through the communication engine 202 and stored as the infusion program 217. The auto program 113 generally represents a message or file containing the program drug identifiers and other parameters used to automatically configure the drug infusion device 102 for delivering the drug to the patient 105 in accordance with the infusion program 107 upon electronic transmission of the infusion program 107 (via the message of the auto program 113), thereby bypassing some manual programming steps typically performed by the nurse 110 or clinician. Thus, in some embodiments, the infusion program 217 refers generically to the parameters used for drug delivery configuration; whereas the auto program 113 refers more specifically to the message or file used in a situation where the automatic configuration capability is enabled and performed. In other words, the infusion program 107, or portions thereof, is the payload carried by the electronically transmitted message or file of the auto program 113 from the medication management server 103 to the drug infusion device 102 to form the infusion program 217.
The communication engine 202 generally represents one or more appropriate components used to transmit and receive network packets to and from the medication management server 103 or the clinical system 104. Thus, the communication engine 202 includes a network access point 219 for establishing a network connection with the network communication devices of the medication management server 103 or the clinical system 104. In some embodiments, particularly for mobile designs of the drug infusion device 102, the network connection is wireless, such as WiFi, Bluetooth, etc. However, wired network connections may also be used, such as Ethernet, IEEE 1395 FireWire, etc. Additionally, the communication engine 202 may also include a cache memory 220, typically for the temporary storage of network packets and the messages converted from, or to be converted to, a protocol for transmitting and receiving the network packets. For example, when the drug infusion device 102 receives the auto program 113 from the medication management server 103 or the clinical system 104, these components 219 and 220 (and other components, such as a processor circuitry) of the communication engine 202 handle the receipt and packet conversion and then send it through the internal communication system 214 for storage in the memory 201 as the infusion program 217. In a reverse process, log files and other messages to the medication management server 103 and/or the clinical system 104 are transmitted out.
The keypad 203 and the display 204 represent built-in control features or interfaces for operating the drug infusion device 102. For example, the display 204 generally represents one or more display screen devices (e.g., a flat panel display, an LCD, an LED, etc.) that may be used to present information and menu options (e.g., status, instructions, requests, alerts, alarms, etc.) to the user (e.g., nurse 110 or other clinician) during setup, configuration and/or operation of the drug infusion device 102. Additionally, the keypad 203 generally represents one or more appropriate input devices involving push buttons, such as an alphanumeric keyboard, an enter button, a set of selection keys, etc. With the keypad 203, the user can input instructions or make selections for configuring or operating the drug infusion device 102, e.g., in response to the information or menu options presented on the display 204, as described below. Some of the push buttons may be aligned with areas of the display 204, so that the user can select menu options presented within these areas. In some embodiments, the display 204 may be touchpad, so it can also double as an input device.
The receptacle space 209 represents a region within the housing 213 that is accessible through the door 210 and in which the drug vial 215 may be inserted or loaded, so that the drug in the drug vial 215 may be drawn out and delivered to the patient 105. Additionally, since it is desirable from a safety and security standpoint for only a properly authorized clinician to operate the drug infusion device 102, the door 210 has a lock to prevent an unauthorized person from attempting to remove the drug vial 215. Thus, the user may open the door 210, insert the drug vial 215 into the receptacle space 209 (e.g., into a cradle), and close and lock the door 210. Furthermore, a door sensor 221 is provided in order to detect whether the door 210 is properly closed, latched and/or locked, because it is desirable from a safety and security standpoint to enable some of the operational functions of the drug infusion device 102 only when the door 210 is properly closed and/or locked and the drug vial 215 cannot be removed. Thus, a signal indicating whether the door 210 is properly closed and/or locked may be sent from the door sensor 221 to the controller 200, which may then affect the workflow, as described below.
The vial presence sensor 207 represents any appropriate component that can detect whether the drug vial 215 is properly inserted, or loaded, into the receptacle space 209. In some embodiments, for example, the vial presence sensor 207 may be a set/reset trigger button disposed within the receptacle space 209 in such a manner that when the drug vial 215 is properly inserted, the trigger button is depressed. Upon depressing the trigger button, a vial detect signal is activated, which indicates that the drug vial 215 is in its proper insertion position for use with the drug infusion device 102. Notification of the signal activation is provided to the controller 200 to affect the workflow, as described below. Also, when the drug vial 215 is removed, or just slightly pulled away from its proper insertion position, the trigger button is released, thereby deactivating the vial detect signal. Notification of the signal deactivation, even if occurring only momentarily, is provided to the controller 200 to affect the workflow, as described below.
In some embodiments, the vial presence sensor 207 and the vial detect signal may be used to trigger a reset of the workflow of the controller 200 to an appropriate point at which the configuration of the drug infusion device 102 can be restarted. In this case, the notification of the deactivation of the vial detect signal may be considered to be a “vial-reset signal” that triggers a “vial-reset” condition or function. In some embodiments, the point within the workflow to which the workflow is reset is after an initial power-on self-test and optionally bypasses any other early steps of the workflow that may be unnecessary in a reset event, as described below. The vial-reset function thus enables the clinician, whenever it may become necessary, to be able to restart the configuration of the drug infusion device 102 by simply removing and reinserting the drug vial 215 and without having to completely restart the entire drug infusion device 102, as would occur if the clinician cycled the power off and on for the drug infusion device 102. The vial-reset function, therefore, may save valuable time when the clinician determines that an error has been made during the configuration process, and the best solution is simply to start over, but the patient 105 needs the drug delivery as soon as possible.
In some embodiments, the reset function may be enabled by some means other than using the vial detect signal. For example, a separate reset button may be provided on the keypad 203. However, for safety and security purposes, it is not desirable to have such a reset button be easily accessible. Otherwise, an unauthorized person might accidentally or maliciously reset the drug infusion device 102, thereby causing severe problems for the patient 105. By using the vial presence sensor 207 as a reset button, i.e., hiding the reset button inside the receptacle space 209 behind both the lockable door 210 and the drug vial 215, it is possible to ensure that only a properly authorized clinician will trigger a reset.
The vial scanner 206 generally represents any appropriate component that can read or scan information from the drug vial 215. For example, the drug vial 215 may be provided with an external barcode or an RF 10 tag that encodes “one or more vial drug identifiers” that identify the name of the drug contained in the drug vial 215 and one or more parameters, such as the amount and/or concentration of the drug. The vial scanner 206 is disposed in the receptacle space 209, so the vial scanner 206 reads the vial drug identifiers when the drug vial 215 is inserted into its proper insertion position in the receptacle space 209. In some embodiments, the reading or scanning is triggered by the vial detect signal generated by the vial presence sensor 207 upon insertion of the drug vial 215. The vial drug identifiers are provided to the controller 200 for use in the workflow. The read or scanned vial drug identifiers are used by the controller 200 to select drug-related operational limits from the drug library 218, which has also been transmitted to the memory 201 by the medication management server 103 or clinical system 104.
It may be assumed that the clinician operating the drug infusion device 102 will check the drug vial 215 against the order or doctor's prescription before inserting the drug vial 215 into the receptacle space 209. However, it is still possible, for example, for the clinician to set the drug vial 215 down and subsequently pick up a wrong drug vial 215 or otherwise make some kind of mistake that results in the wrong drug vial 215 being inserted into the receptacle space 209. With the vial scanning feature enabled by the vial scanner 206 disposed within the receptacle space 209 and triggered by the vial detect signal, on the other hand, it can be considered fairly certain that the drug identified by the scanned vial drug parameters/identifiers has in fact been loaded into the drug infusion device 102. In this manner, a redundant safety and security check is provided by this vial scanning feature to ensure that the correct drug is being delivered to the patient 105 at the correct concentration and dosage.
The pump unit 208 generally represents any appropriate combination of one or more components that can cause the drug to be drawn out of the drug vial 215 and delivered to the patient 105, e.g., through the catheter 114 and the drug administration set 115, e.g., a series of tubes, connectors and needles. For example, the pump unit 208 may represent an actuator and piston, wherein the actuator plunges the piston into the drug vial 215 to generate a pressure differential that causes the drug to flow through the drug administration set 115. Thus, when the drug vial 215 has been properly inserted into the receptacle space 209 and the door 210 has been closed and locked, the pump unit 208 has access to the drug in the drug vial 215, so when the drug infusion device 102 has been programmed, the pump unit 208 can draw out the drug and deliver it to the patient 105 through the catheter 114 and the drug administration set 115.
The pump control logic 205 generally represents any appropriate components that can directly control the pump unit 208 in accordance with the infusion parameters of the infusion program 217, such as a motor control unit, registers, state machines, motor driver, etc. In some embodiments, the infusion parameters are entered into the pump control logic 205. With these parameters, the pump control logic 205 is configured to control the pump unit 208 to deliver the drug at the desired flow rate, volume, time interval, etc. In some embodiments, the pump control logic 205 may be the same micro control unit that comprises the controller 200.
The PCA control unit 211 generally represents any appropriate components that enable the patient 105 to select when to receive a single PCA dose of the drug, such as an as-needed dose of pain medication. In some embodiments, the PCA control unit 211 includes the PCA patient pendant cord 211A with the button 211 B that the patient 105 may press to receive the PCA dose. The PCA control unit 211, thus, provides a signal to the controller 200 or the pump control logic 205 to activate the PCA dose. The parameters of the infusion program 217 describe the amount of the PCA dose, a lockout time interval that the patient 105 must wait before being able 10 to repeat the PCA dose, and/or a time period during which the patient 105 may receive the PCA dose.
The external scanner 212 generally represents any appropriate one or more components for scanning a patient wristband for a patient ID and/or an identifier such as a barcode or RF ID tag on the drug vial 215 for a vial ID before inserting the drug vial 215 into the receptacle space 209. With this scan, both the patient 105 and the drug vial 215 can be matched with the infusion program 217. In this manner, the clinician has another redundant check with which to be sure that the correct patient is about to receive the correct medication. Additionally, the patient ID can be sent to the medication management server 103 and/or the clinical system 104, so that the medication management server 103 and/or the clinical system 104 has data indicating which drug infusion device 102 is associated with the patient 105. Once the medication management server 103 has the data associating the drug infusion device 102 with the patient 105, the medication management server 103 can electronically transmit the infusion program 107 for the patient 105 to the correct drug infusion device 102.
If the determination at 401 is negative, then it may be possible to use the previous infusion program 217 (if present) if the patient 105 has not changed. Therefore, a menu screen 402 is presented to prompt the user to indicate whether the patient 105 is new. If so, then the infusion program 217 is cleared at 403.
Even if the patient 105 is the same as the previous one, it is generally hospital good practice to clear the previous infusion program 217 if the clinical care area 106 is different from the previous use. If there is more than one clinical care area 106, as determined at 404, then it is possible for it to change. If there is only one clinical care area 106, then it is selected automatically at 404, and an ID for the clinical care area 106 is stored in the memory 201. On the other hand, if there is more than one clinical care area 106, as determined at 404, a menu screen 405 is presented to prompt the user to indicate the clinical care area 106 in which the drug infusion device 102 is to be used. When the user selects (at 405) the clinical care area 106, the ID for the clinical care area 106 is stored in the memory 201. If the selected clinical care area 106 is different from the previous one, as determined at 406, then a menu screen 407 is presented to warn or remind the user that changing the clinical care area 106 will result in clearing the infusion program 217 (“Rx in memory” or program settings in
If the determination at 401 is positive (i.e., that the drug infusion device 102 should be automatically reset) or the patient 105 is new (as indicated at 402), then it is still necessary to select the clinical care area 106, as described previously. In some embodiments, there is no preexisting ID for the clinical care area 106 stored in the memory 201, if any such data was cleared along with deletion of the previous infusion program 217. In other embodiments, the ID for the clinical care area 106 is not cleared, but it is still necessary to either confirm or change it through 404-407. Additionally, if the vial-reset (“VR”) condition has occurred, as mentioned above, then a point between 401 and 404 is one possible point within the process flow of the software program 216 to which the workflow may be reset, thereby avoiding the start-up and power-on self-test portion 300 and bypassing at least the receiving of the indication at 402 of whether the patient to be served by the drug infusion device is a new patient. (For the vial-reset condition, returning the process to this point results in restarting the program review aspects of the process, e.g., with subsequent options being generally to retain, clear or modify the existing infusion program 15217.) In any of these cases, if there is only one clinical care area 106, as determined at 404, then it is selected automatically, and the ID for the clinical care area 106 is stored in the memory 201. On the other hand, if there is more than one clinical care area 106, as determined at 404, the menu screen 405 is presented to prompt the user to indicate the clinical care area 106 in which the drug infusion device 102 is located or to be used. When the user selects (at 405) the clinical care area 106, the ID for the clinical care area 106 is stored in the memory 201. However, since there was no ID for a previous clinical care area 106 stored in the memory 201 in any of these situations, the determination at 406 is necessarily negative, and so the menu screen 407 is skipped.
It is generally preferable in some embodiments for the medication management server 103 to be able to send the auto program 113 to the drug infusion device 102 as early as possible in the process flow, even if the process flow has not yet reached a point at which it can use the infusion program 107. In this manner, it can be assured that the drug infusion device 102 is not often left waiting for the auto program 113 to arrive, but can instead begin to benefit as soon as possible from the expedited process flow. On the other hand, it is generally not preferable in some embodiments for the drug infusion device 102 to receive the auto program 113 from the medication management server 103 before the clinical care area 106 has been identified. Otherwise, the drug infusion device 102 may have stored an auto program 113 that it is not valid for the clinical care area 106. In some embodiments, therefore, after the clinical care area 106 has been identified, the drug infusion device 102 may simply be enabled with a capability to receive the auto program 113. This capability may be further dependent on whether the preexisting infusion program 217 is still stored, or programmed into, the drug infusion device 102. Confusion between conflicting infusion programs can be avoided, therefore, if the drug infusion device 102 is disabled from the capability of storing the received auto program 113 as long as the previous infusion program 217 is still present in memory.
At the point after 401-407, the clinical care area 106 has been identified within the drug infusion device 102 and, in some of the above described situations, the infusion program 217 is not present. For the medication management server 103 to properly transmit the auto program 113, however, the drug infusion device 102 needs to be associated with the patient 105. Furthermore, a clinical care area 106 needs to be selected on the drug infusion device 102 and an identifier for the clinical care area 106 transmitted to the server 103 at 408 to identify the area the device 102 is located in or being prepared for use in. It is typical in some embodiments to have also identified the patient 105 within the clinical system 104 by this point, e.g., by scanning the wristband for the patient 10, as mentioned above. The patient 10, the drug 10 on the drug container, and an 10 for the drug infusion device 102 are collected by a scanner such as in the handheld device 111, vial scanner 206, or the external scanner 212, and then may be sent to the medication management server 103 along with an infusion program 107. With this 10 information properly associating the drug or drug container, the patient 105, and the drug infusion device 102 together, the medication management server 103 can determine whether it has an infusion program 107 for the identified patient 105 that can be used in the identified device 102. For accuracy of drug delivery reports, it also helps the medication management server 103 to know the clinical care area 106 of the drug infusion device. At any rate, the medication management server 103 can send the proper infusion program 107 via an auto program message 113 to the identified drug infusion device 102.
However, the infusion program 107 might not be sent immediately upon the medication management server 103 receiving the various ID information. The delay may be caused by a variety of reasons. For example, the infusion program 107 may simply not be ready yet, or high network traffic may slow network communications through the clinical system 104. Therefore, if the infusion program 217 (Rx) is not in the memory 201, as determined at 409, the controller 200 may simply enable (at 410) the ID capability for the drug infusion device 102 to receive and store the auto program 113 (AP). This capability may be enabled in any appropriate manner, such as setting a flag indicating that the auto program receiving capability is enabled, running a subroutine specifically for handling the auto program 113 when it is received, ending a subroutine specifically designed to 15 reject the auto program 113 when it is received, etc. In general, the enabling at 410 may be considered as opening a window of time (a “receive auto program window of opportunity”) during which the auto program 113 may be received and stored in the memory 201. This period of time may be made as long as possible or practical by enabling the receive auto program window as early in the process flow as possible. In some embodiments, the window of opportunity is opened immediately following any point at which the infusion program 217 has been deleted from the memory 201, so that a new infusion program 217 can be received at the earliest possible time, and the process flow can be optimized. In some embodiments, the window of opportunity is opened before or after the clinical care area 106 has been selected or the identifier thereof has been transmitted to the server 103. In some embodiments, the window of opportunity is opened prior to receiving confirmation that the drug and concentration in the drug vial 215 is correct. In some embodiments the window of opportunity is opened prior to the vial 215 being inserted into the receptacle space 209. At any point after enabling the capability for the drug infusion device 102 to receive and store the auto program 113, when the auto program 113 is received through the communication engine 202, it is stored in the memory 201.
In some embodiments, it is desirable to have inserted the drug vial 215 into its proper insertion position in the receptacle space 209 by this point. Therefore, the controller 200 may check (at 411) for an error associated with the drug vial 215, which may be determined, for example, based on signals or data from the vial scanner 206 or the vial presence sensor 207. For example, the scanned vial drug identifiers (e.g., drug name and drug concentration) can be compared with the drug library 218. In another embodiment, if the infusion program 217 is present in the memory 201, then scanned vial drug identifiers (e.g., drug name and drug concentration) can be compared with the corresponding program drug identifiers in the infusion program 217 to determine whether the correct drug vial 215 has been inserted. The presence of an incorrect drug vial 215 may thus be a vial error in this situation. In some embodiments, the lack of the drug vial 215, as indicated by the signal from the vial presence sensor 207, may also indicate a vial error.
If there is a vial error, as determined at 411, then an appropriate vial error handling subroutine (at 412) may handle it. For example, the clinician may be prompted to insert the correct drug vial 215 or simply check to make sure the drug vial 215 is seated within the receptacle space 209 correctly. Alternatively, the clinician may be able to cancel out of the vial error handling subroutine in order to proceed to the portion of the process flow in which the infusion program 217, if present, may be cleared. In other embodiments, e.g., when the clinician plans to insert a different drug vial 215 with a different infusion program 217, the lack of the drug vial 215 at this point might not be a vial error, thereby allowing the clinician an opportunity to clear the preexisting infusion program 217 without having to insert the drug vial 215, be told that it does not match the preexisting infusion program 217, and cancel out of the vial error handling subroutine in order to proceed. Upon returning from the vial error handling subroutine (at 412) or if there was no vial error (at 411), the process flow proceeds to the next portion (designated herein as “Cl.,”
If the infusion program 217 was cleared by the selections at 502 and 503, then it is possible at this point to open or enable the receive auto program (AP) window, described above. Therefore, query 504 checks whether the infusion program 217 (“Rx”) is in the memory 201, and if not, the capability for the drug infusion device 102 to receive and store the auto program (AP) 113 is enabled at 505. In either case, a display screen 506 is presented to confirm to the user which data has been cleared. The display screen 506 may timeout after a period of time, or the user may make a selection on the keypad 203, to cause the process flow to continue to the next portion (“CR”).
If the infusion program 217 has been cleared from the memory 201, then the receive auto program (AP) window will have been enabled, and the auto program 113 may have already been received. Therefore, query 601 determines whether an infusion program 217 (“Rx”) is in the memory 201. If not, then query 602 determines whether the auto program (AP) 113 has been received. If so, and if the drug vial 215 is present, then query 603 determines whether the vial drug identifiers as determined by the vial scanner 206, external scanner 212 or a scanner in the handheld device 111 match corresponding program drug identifiers in the auto program 113. If not, then a display screen 604 is presented to the user to inform the user that the medication in the vial 215 does not match the order (i.e., the auto program 113) and to prompt the user to remove the drug vial 215 and insert a correct drug vial 215. When the vial scanner 206 makes the determination, the user can be assured that the correct drug vial 215 was actually inserted in the drug infusion device 102. When the user removes the drug vial 215, the vial reset function (“VR”) is triggered, thereby resetting the process flow to the point described above. All alternative determinations at queries 601,602 and 603 (i.e., the infusion program 217 is in the memory 201, the auto program 113 has not been received, or the vial drug identifiers match the auto program 113) result in proceeding to the next portion (designated herein as “VC”
If the user selects to “confirm” that the drug vial 215 is correct, then additional checks are performed based on the vial drug identifiers determined from the vial scanner 206. For example, if the barcode on the drug vial 215 has not changed (assuming a barcode for the previous drug vial or the infusion program 217 is present in the memory 201), as determined at 702, and the barcode is a standard one (rather than a custom barcode for a vial custom filled and labeled by the customer), as determined at 703, then the process flow may proceed back to the process flow portion 600 (
On the other hand, if the barcode has changed, as determined at 702, then a display screen 704 is presented to the user with an extra warning that the drug or the concentration or both has been detected to have changed. The user is instructed again to remove the drug vial 215 if it is incorrect, thereby triggering the vial reset function, described above. However, if the user determines that the drug vial 215 is in fact correct, then the user may select “continue,” and the process flow may proceed back to the process flow portion 600 (
Alternatively, if the barcode on the drug vial 215 is not a standard one, but a custom vial/barcode, as determined at 703, then a display screen 705 is presented to the user to warn that the drug or the concentration or both may have changed, since the same custom barcode could potentially be used in different situations. The user is instructed again to remove the drug vial 215 if it is incorrect, thereby triggering the vial reset function, described above.
However, if the user determines that the drug vial 215 is in fact correct, then the user may select “continue,” in which case a display screen 706 is presented to the user to once again check to be sure that the concentration does in fact match the order or the doctor's prescription (“physician Rx”). If the vial drug concentration is correct, but the program drug concentration parameter in the infusion program 217 is wrong, then the user may select “change concentration” to receive a menu screen (not shown) to correct the infusion program 217. On the other hand, if the user once again determines that the drug vial 215 is in fact correct, then the user may select “confirm,” and the process flow may proceed back to the process flow portion 600 (
Referring back to
If the auto program 113 has been received, as determined at 607, and the vial drug identifiers, for example drug name and drug concentration from the drug library 218, match the corresponding program drug identifiers in the auto program 113, as determined at 608, then the process flow may proceed to the “program review” (
If the user decides not to wait for the auto program 113, then the user can select the “manual program” menu option. In this case, the receive auto program (AP) window is disabled (at 802), since it has been decided or assumed that the auto program 113 is not going to be used at this time, and it could potentially cause confusion between conflicting programs if the auto program 113 were to be received during the manual programming portion. Then a menu screen 803 is presented to the user to prompt the user either to “confirm” the selection to enter into the manual programming portion or to return to the “previous” display screen 801 to continue waiting for the auto program 113. If the user selects to “confirm” entering the manual programming portion, then the process flow may proceed to the portion (designated herein as “MP”) wherein the user can manually program the drug infusion device 102 (
In some embodiments, after the “manual program” is selected at display screen 801, the receive auto program (AP) window is not disabled until after the user selects to “confirm” entering the manual programming portion at the menu screen 803. In this case, if the auto program 113 is received while the menu screen 803 is presented, then the process flow may quit the menu screen 803 and either automatically proceed back to the process flow portion 600 (
After proceeding from menu screen 902 or selecting “no” at menu screen 901, a menu screen 903 is presented to prompt the user to select the delivery mode. Alternatively, this menu screen 903 may be the first menu screen for the manual programming portion if a loading dose is not an option. The delivery modes are typically a PCA mode in which the patient 105 can receive an as-needed single on-demand PCA dose of the drug (as described above), a basal or continuous mode in which the patient 105 receives a steady volume over a period of time at a given rate, or a combination PCA and continuous mode in which both options are enabled. Additionally, other modes may be variations on these modes. The user may also select certain predefined “protocols” associated with one or more of the various delivery modes. Alternatively, the user may select to return to the “previous” menu screen 901 or 902.
If the user selected one of the delivery modes that includes a PCA dose at menu screen 903, a menu screen 904 is presented to prompt the user to enter the quantity of the PCA dose as a mass quantity, e.g., in milligrams or some other appropriate units of measure. The controller 200 can convert this quantity into a volume or flow rate value based on the vial drug concentration parameter of the drug in the drug vial 215. After entering the quantity for the PCA dose, the user may select to proceed, e.g., by pressing the “enter button.” Alternatively, the user may select to return to the “previous” menu screen 903.
After selecting the PCA dose at menu screen 904, a menu screen 905 is presented to prompt the user to enter a “lockout interval” time period. The lockout interval time period is a minimum time period that must pass after the patient 105 triggers a PCA dose and before the patient 105 can trigger another PCA dose. After entering the time for the lockout interval, the user may select to proceed, e.g., by pressing the “enter button.” Alternatively, the user may select to return to the “previous” menu screen 904.
If the user selected at menu screen 903 one of the delivery modes that includes a continuous drug delivery, a menu screen 906 is presented to prompt the user to enter a quantity for the rate at which the drug is to be continuously delivered. This quantity is typically a mass per time quantity (e.g., in milligrams per hour) or simply a mass quantity (e.g., with the time period assumed or predefined). After entering the quantity for the continuous rate, the user may select to proceed, e.g., by pressing the “enter button.” Alternatively, the user may select to return to the “previous” menu screen 905.
Additionally, a menu screen 907 is presented to prompt the user to enter a maximum “dose limit” quantity of the drug that the patient 105 is permitted to receive over a designated time period, for example but not limited to one, four, eight, twelve or twenty-four hours. This maximum quantity value may further limit the amount of the PCA dose that the patient 105 can self-administer. After entering the quantity for the maximum dose limit, the user may select to proceed to the “program review” (
If the user confirms the loading dose quantity, or if no loading dose was set (as determined at 1001), a display screen 1003 is presented to the user to show the general parameters of the infusion program 217 (e.g., type of drug, concentration of drug in the drug vial 215, and delivery mode), as well as the specific quantities for the PCA dose quantity, the lockout interval time period, the continuous delivery rate quantity, and the dose limit quantity as appropriate. The user is also prompted to “confirm” the quantities or to change one or more of the settings. (In some embodiments, the menu screens 1002 and 1003 may be combined into one menu screen.) If the user selects “confirm” at menu screen 1003, then the parameters of the infusion program 217 or the auto program 113 have been confirmed, and the process flow can proceed to a “prime sequence” (
If the user selects to change one or more of the settings (i.e., program parameters) at the menu screen 1002 or 1003, then a menu screen 1004 or 1005 is presented to prompt the user to select a setting to change. Not all of the settings may fit on a single menu screen, so the two menu screens 1004 and 1005 are used, and the user may switch between them by selecting “next.” Each of the various programmed settings is presented on one of the menu screens 1004 or 1005. When the user selects one of the settings (e.g., loading dose, delivery mode, PCA dose, lockout interval, continuous delivery rate, or maximum dose limit), another menu screen (e.g., similar to menu screen 902,903,904,905, 906, or 907, respectively) is presented with which the user can change the quantity or value for that setting.
One example for these menu screens (menu screen 1006) is shown in
In this manner, the user can continue to cycle or step through the menu screens 1004 and 1005 and the menu screens similar to 902, 903, 904, 905, 906, and 907 to make any necessary changes. When all necessary changes have been made, the user may select “save & exit” to return to query 1001 and menu screens 1002 and 1003 to review the current state of the various parameters or settings. The user may repeat this review process (1001-1005) until satisfied that the parameters are correct and then select “confirm” at both menu screens 1002 and 1003 to exit out of the program review and proceed to the prime sequence (
In some embodiments, some variations of the program review may be different when doing an initial manual programming compared to when the auto program 113 is already in the memory 201 as the infusion program 217. For example, the “change settings” option may be available only when the auto program 113 or the infusion program 217 is already in the memory 201. Alternatively, the “previous” option may be available only when doing an initial manual programming.
The controller 200 can determine whether the door is properly closed and/or locked by the signal from the door sensor 221 and can refuse to proceed if the door 210 is not properly closed and/or locked. However, the controller 200 cannot independently determine whether the drug infusion device 102 is disconnected from the patient 105, so when the user selects “continue” in order to proceed, a display screen 1102 is presented as a safety and security check to prompt the user to confirm that the drug infusion device 102 is indeed disconnected from the patient. In other words, the controller 200 prompts the clinician to confirm that the drug administration set 115 is not connected to the patient 105, or to the catheter 114. Selecting “no” causes the process flow to return to the menu screen 1101.
When the user selects “yes” at 1102, a menu screen 1103 is presented to prompt the user to “press and hold the prime key” on the keypad 203. When the user presses the prime key, a menu screen 1104 may be presented, which is similar to the menu screen 1103, but indicates that the drug infusion device 102 is performing the “priming.” If the prime key is released before the prime sequence is complete, e.g., before a sufficient amount of the drug has been passed through the pump unit 208 to completely prime the drug administration set 115, a menu screen 1105 may be presented to prompt the user to confirm whether the prime is complete. If the user selects “no,” then the process flow returns to the menu screen 1103 to prompt the user to continue to press and hold the prime key.
However, if the user selects “yes” at 1105, or if the controller 200 detects that the prime has completed, then a menu screen 1106 is presented to prompt the user to connect the drug infusion device 102 via the drug administration set 115 to the patient 105. When the user selects “continue” in order to proceed, a menu screen 1107 is presented to prompt the user to confirm whether the drug infusion device 102 has been connected to the patient 105. If the user selects “no,” then the process flow returns to menu screen 1106 to again prompt the user to connect the drug administration set 115 to the patient 105. If the user selects “yes” at 1106, then the process flow proceeds to an “LD sequence” where, if an optional Loading Dose was specified, the device 102 can begin infusing, or delivering, the drug (
When the user presses (and releases) the start button at 1201, a menu screen 1203 is presented to the user to indicate that the drug infusion device 102 is infusing the loading dose. The menu screen 1203 may also indicate the loading dose quantity. Additionally, the menu screen 1203 may indicate that the loading dose infusion can be paused or stopped by pressing a “pause button” on the keypad 203.
If the pause button is pressed or the door 210 is opened at 1203 before the loading dose delivery is completed, a menu screen 1204 is presented to indicate to the user that the loading dose has been stopped and either the remaining quantity of the loading dose to be delivered or the quantity that has been delivered. The menu screen 1204 also prompts the user to select whether to resume the loading dose. If the user selects “no” at 1204, then delivery of the remainder of the loading dose is cancelled and then the process flow proceeds to query 1205 to continue with the remainder of the program. If the user selects “yes” at 1204, the process flow proceeds to a query 1206 to check whether the door 210 is properly closed and locked. If not, then a menu screen 1207 (similar to 1202) is presented to indicate to the user that the door is open and to prompt the user to close and lock the door 210 and to check the “PCA set” (the drug administration set 115) as above. If the door is closed and locked (as determined at 1206 or as instructed at 1207), the process flow returns to the menu screen 1203 to indicate that the drug infusion device 102 is infusing the loading dose, as above. When the loading dose infusion at 1203 completes, the process flow proceeds to the query 1206 to check whether the door 210 is properly closed and locked, as above.
At the query 1205, i.e., after the loading dose infusion has completed (at 1203) or been canceled (by selecting “no” at 1204), the controller 200 determines whether the door 210 is closed and locked. If not, a menu screen 1208 is presented to indicate that the infusion program 217 has been paused. 15 The menu screen 1208 also instructs the user to close and lock the door 210 to begin the continuous and/or PCA portion of the infusion program 217. Additionally, at the menu screen 1208, the user is presented with another opportunity to change various parameters before beginning the continuous and/or PCA portion. To change the loading dose, the user may select “loading dose,” and a menu screen 1209 (similar to 902) will be presented. If the user selects “previous” at 1209, the process flow may return to the menu screen 1208. If the user presses the “enter button” at 1209, a menu screen 1210 is presented to prompt the user to close and lock the door 210 and to press the “start button” again to begin infusing the loading dose at the menu screen 1203, as described above. However, if the user selects to change any of the settings at 1210, then the process flow may return to the menu screen 1208.
At the menu screen 1208, to change the prescription, i.e., the delivery mode and/or the mode parameters of the infusion program 207, the user may 30 select “change Rx,” and menu screens similar to 903-907 will be presented in order. To clear shift totals of the amount infused, PCA demands attempted, loading dose, 4 hour dose, etc., the clinician may push the button associated with “clear shift”. This may cause the totals to be reset to zero. To change the clinical care area 106 in the context of the work flow of
At the menu screen 1208, when the user closes and locks the door 210, a menu screen 1211 is presented to indicate to the user that the door 210 has been properly closed and locked. The menu screen 1211 also instructs the user to press the “start button” to begin the part of the infusion program 217 after the loading dose part, described above.
At the menu screen 1211, when the user presses the “start button,” a menu screen 1212 is presented to indicate to the user that the drug is being delivered, the delivery mode, whether a PCA dose is currently available, the total quantity of the drug that has been delivered so far, and the continuous delivery rate.
Additionally, if the door 210 is determined to be closed and locked at 1205, then a query 1213 determines whether the infusion program 217 includes only a PCA mode. If so, then the process flow proceeds to the menu screen 1212, as above. However, if the infusion program 217 does not include only a PCA mode, as determined at 1213, the process flow proceeds to the menu screen 1211, as above.
Furthermore, if the loading dose was not included in the infusion program 217, then instead of starting at the menu screen 1201, as described above, the process flow portion 1200 proceeds to query 1214 to determine whether the infusion program 217 includes only a PCA mode. If so, then the process flow proceeds to the menu screen 1212, as above. However, if the infusion program 217 does not include only a PCA mode, as determined at 1214, the process flow proceeds to the menu screen 1211, as above.
In some embodiments, as explained above, the improved process for configuring and controlling the drug infusion device 102 includes various operation and control features that render the drug infusion device 102 capable of being programmed, set up or configured relatively quickly, so that the drug infusion device 102 can begin delivering the drug with very little setup time or with a minimum of human operator intervention. In different situations (e.g., depending on whether the patient is new, the clinical care area 106 has changed, the infusion program 217 is in the memory 201, the loading dose is included, etc.), the overall process takes a different path through the various portions of the process shown in
For example, a common situation occurs when the drug infusion device 102 has been allocated for use with a new patient (and a standard drug) after having been left idle for a few hours, and the correct auto program 113 is received relatively early during the window of opportunity. In this case, after the start-up and power-on self-test portion 300 (
In the process flow portion 500 (
At the display screens 1002 and 1003, the operator confirms the loading dose (if set) and the rest of the parameters of the infusion program 217, respectively, are correct. The prime sequence process flow portion 1100 (
Although embodiments of the present invention have been discussed primarily with respect to specific embodiments thereof, other variations are possible. Various configurations of the described system may be used in place of, or in addition to, the configurations presented herein. For example, additional components may be included in circuits where appropriate. As another example, configurations were described with general reference to certain types and combinations of circuit or system components, but other types and/or combinations of circuit components could be used in addition to or in the place of those described.
Those skilled in the art will appreciate that the foregoing description is by way of example only, and is not intended to limit the present invention. Nothing in the disclosure should indicate that the present invention is limited to systems that have the specific type of devices shown and described. Nothing in the disclosure should indicate that the present invention is limited to systems that require a particular form of integrated circuits or hardware components, except where specified. In general, any diagrams presented are only intended to indicate one possible configuration, and many variations are possible. Those skilled in the art will also appreciate that methods and systems consistent with the present invention are suitable for use in a wide range of applications.
While the specification has been described in detail with respect to specific embodiments of the present invention, it will be appreciated that those skilled in the art, upon attaining an understanding of the foregoing, may readily conceive of alterations to, variations of, and equivalents to these embodiments. These and other modifications and variations to the present invention may be practiced by those skilled in the art, without departing from the scope of the present invention, which is more particularly set forth in the appended claims.
This application claims the benefit of U.S. Provisional Application No. 62/319,849, filed Apr. 8, 2016, entitled CONTROL OF A DRUG INFUSION DEVICE. The contents of the aforementioned application are hereby incorporated by reference in its entirety as if fully set forth herein. The benefit of priority to the foregoing application is claimed under the appropriate legal basis, including, without limitation, under 35 U.S.C. § 119(e).
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2017/026216 | 4/5/2017 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62319849 | Apr 2016 | US |
