NZ746415A - Matching delayed infusion auto-programs with manually entered infusion programs - Google Patents
Matching delayed infusion auto-programs with manually entered infusion programsInfo
- Publication number
- NZ746415A NZ746415A NZ746415A NZ74641518A NZ746415A NZ 746415 A NZ746415 A NZ 746415A NZ 746415 A NZ746415 A NZ 746415A NZ 74641518 A NZ74641518 A NZ 74641518A NZ 746415 A NZ746415 A NZ 746415A
- Authority
- NZ
- New Zealand
- Prior art keywords
- infusion
- program
- auto
- manual
- pump
- Prior art date
Links
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Abstract
Infusion pumps serve as a useful tool for delivering medication to patients, and are particularly beneficial for their great accuracy in delivering medication at a specific rate and dose. Moreover, medical facilities have enabled hospital caregivers, such as nurses, to deliver medication to patients using auto-programming features available for the infusion pump. Although auto-programming features may reduce errors made manually by hospital caregivers, medical facilities still struggle with identifying and responding to errors made when using an infusion pump. Accordingly, one aspect of the invention relates to a system configured to identify an acceptable manual program, the system comprising: a first computer comprising a computer network interface; and an infusion pump configured to communicated with said first computer using said computer network interface; wherein said first computer is configured to: receive an infusion auto-program from a remote source, wherein said infusion auto-program comprises IV drug container information, infusion pump information, and infusion program settings, determine that said first computer is unable to transmit said infusion auto-program to said infusion pump, queue said infusion auto-program, wherein the queued infusion auto-program becomes a stale auto-program, and send said stale auto-program to said infusion pump when said infusion pump communicates with said first computer; and wherein said infusion pump is configured to: receive a manual infusion program, wherein said manual infusion program comprises one or more of a completed manual infusion program or a running manual infusion program, save and execute said manual infusion program, compare said stale auto-program to said manual infusion program, wherein said comparison is based on one or more factors comprising an approximate time of infusion administration or parameter matching logic comprising infusion parameters, identify potential matches between said stale auto-program and said manual infusion program using the infusion parameters, determine that said potential matches are within a predefined tolerance using one or more configurable rules, continue to execute said manual infusion program on said infusion pump, save differences between said manual infusion program and said stale auto-program, save a first event alert indicating the manual infusion program as an acceptable potential match of said potential matches, and save a second event alert indicating the auto-program as an un-executed program. using auto-programming features available for the infusion pump. Although auto-programming features may reduce errors made manually by hospital caregivers, medical facilities still struggle with identifying and responding to errors made when using an infusion pump. Accordingly, one aspect of the invention relates to a system configured to identify an acceptable manual program, the system comprising: a first computer comprising a computer network interface; and an infusion pump configured to communicated with said first computer using said computer network interface; wherein said first computer is configured to: receive an infusion auto-program from a remote source, wherein said infusion auto-program comprises IV drug container information, infusion pump information, and infusion program settings, determine that said first computer is unable to transmit said infusion auto-program to said infusion pump, queue said infusion auto-program, wherein the queued infusion auto-program becomes a stale auto-program, and send said stale auto-program to said infusion pump when said infusion pump communicates with said first computer; and wherein said infusion pump is configured to: receive a manual infusion program, wherein said manual infusion program comprises one or more of a completed manual infusion program or a running manual infusion program, save and execute said manual infusion program, compare said stale auto-program to said manual infusion program, wherein said comparison is based on one or more factors comprising an approximate time of infusion administration or parameter matching logic comprising infusion parameters, identify potential matches between said stale auto-program and said manual infusion program using the infusion parameters, determine that said potential matches are within a predefined tolerance using one or more configurable rules, continue to execute said manual infusion program on said infusion pump, save differences between said manual infusion program and said stale auto-program, save a first event alert indicating the manual infusion program as an acceptable potential match of said potential matches, and save a second event alert indicating the auto-program as an un-executed program.
Description
WO 2016/044232 PCT/US2015/050128
MATCHING DELAYED INFUSION AUTO-PROGRAMS WITH MANUALLY
ENTERED INFUSION PROGRAMS
BACKGROUND OF THE INVENTION
FIELD OF THE INVENTION
[0001] The present disclosure relates to infusion pump programming analysis. Specifically,
disclosed is a system and method that matches delayed infusion auto—programs with manually
entered infusion programs and analyzes differences therein. At least one embodiment optionally
displays an error message at the infusion pump if the manual or auto—pro gram request is
inconsistent with a drug library. At least one embodiment analyzes the differences in the manual
program and the stale auto—program and saves the results of the analysis locally in the pump or
remotely in a remote server for subsequent review and/or data mining.
DESCRIPTION OF THE RELATED ART
[0002] Infusion pumps are commonplace among medical devices in modern hospitals. The
pumps serve as a useful tool for delivering medication to patients, and are particularly beneficial
for their great accuracy in delivering medication at a specific rate and dose. Moreover, medical
facilities have enabled hospital caregivers, such as nurses, to deliver medication to patients using
auto—programming features available for the infusion pump. Although auto—programming
features may reduce errors made manually by hospital caregivers, medical facilities still struggle
with identifying and responding to errors made when using an infusion pump. In a conventional
auto—programmable pump, error codes and messages may be sent surreptitiously from the pump
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to other areas of the medical network, but are not immediately accessible to a hospital caregiver
submitting an auto—program request at the infusion pump. Furthermore, these error codes often
do not specifically describe the error to the caregiver at the pump so that the caregiver may
immediately respond to the error.
[0003] In addition, known systems do not analyze potential acceptable events if the manual
program entered by the caregiver while waiting for an auto—program to arrive at the infusion
pump is acceptable. Known systems do not store or analyze the differences between the manual
program and the auto—program to determine response times, quality of data entry by the
caregiver, and do not learn from caregivers that are at the point of care and thus may
purposefully enter a different infusion rate or volume. Thus, there is a need for system and
method that matches delayed infusion auto—programs with manually entered infusion programs
and analyzes differences therein.
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BRIEF SUMMARY OF THE INVENTION
[0004] The following presents a simplified summary of the present disclosure in order to provide
a basic understanding of some aspects of the disclosure. This summary is not an extensive
overview of the disclosure. It is not intended to identify key or critical elements of the disclosure
or to delineate the scope of the disclosure. The following summary merely presents some
concepts of the disclosure in a simplified form as a prelude to the more detailed description
provided below.
[0005] Certain aspects disclose a method, comprising: receiving, at an infusion pump, an auto-
programming request, wherein the auto—programming request comprises IV drug container
information, infusion pump information, and optionally patient wristband information; receiving,
at the infusion pump, infusion program settings; comparing, at the infusion pump, the infusion
program settings with drug library program settings, wherein the drug library program settings
are provided in a drug library stored at the infusion pump; determining, at the infusion pump,
that the infusion program settings are inconsistent with the drug library program settings based
on the comparing; generating, at the infusion pump, an error message based on the determining;
and displaying, at the infusion pump, a screen, wherein the screen comprises the error message
and a recommended action.
[0006] Certain other aspects disclose a non—transitory computer—readable storage medium having
computer—eXecutable program instructions stored thereon that, when executed by a processor,
cause the processor to: receive an auto—programming request, wherein the auto—programming
request comprises patient wristband information, IV drug container information, infusion pump
information, and optionally patient wristband information; receive infusion program settings;
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compare the infusion program settings with drug library program settings, wherein the drug
library program settings are provided in a drug library stored at the infusion pump; determine
that the infusion program settings are inconsistent with the drug library program settings based
on the comparing; generate an error message based on the determining; and display a screen on
the infusion pump, wherein the screen comprises the error message and a recommended action;
and receive a command in response to the error message and the suggested action.
[0007] Certain other aspects disclose an apparatus comprising: a memory; a processor, wherein
the processor executes computer—eXecutable program instructions which cause the processor to:
receive an auto—programming request, wherein the auto—programming request comprises patient
wristband information, IV bag information, infusion pump information, and optionally patient
wristband information; receive infusion program settings; compare the infusion program settings
with drug library program settings, wherein the drug library program settings are provided in a
drug library stored at the infusion pump; determine that the infusion program settings are
inconsistent with the drug library program settings based on the comparing; generate an error
message based on the determining; and display a screen at the infusion pump, wherein the screen
comprises the error message and a recommended action.
[0008] One or more embodiments of the invention include a system and method that identify
delayed infusion programs at an infusion pump. At least one embodiment of the invention
includes a first computer including a computer network interface and at least one infusion pump.
In one or more embodiments, the first computer communicates with the at least one infusion
pump via the computer network interface.
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[0009] By way of one or more embodiments, the first computer receives at least one infusion
auto—program from a remote source. In at least one embodiment, the remote source may include
hospital information system, pharmacy information system or medication administration system
and the first computer may include a medication management unit (MMU), such as a server
equipped with Hospira MedNetTM software. In one or more embodiments, the at least one
infusion auto—program may include one or more of IV drug container information, infusion pump
information, and infusion program settings.
[0010] In at least one embodiment, the first computer transmits the at least one infusion auto-
program to the at least one infusion pump. In one or more embodiments, the first computer may
queue the at least one infusion auto—program when the first computer is unable to transmit the at
least one infusion auto—program to the at least one infusion pump. In at least one embodiment,
the first computer sends the at least one stale auto—program to the at least one infusion pump
when the at least one infusion pump communicates with the first computer.
[0011] According to one or more embodiments of the invention, at least one infusion pump may
receive at least one manual infusion program from a caregiver. In one or more embodiments, the
at least one manual infusion program may include one or more of a completed manual infusion
program or a running manual infusion program. In one or more embodiments, the at least one
infusion pump saves and executes the at least one manual infusion program received from the
caregiver, and compares the at least one stale auto—program to the at least one manual infusion
program. In at least one embodiment of the invention, the at least one manual infusion program
may be manually selected by a caregiver at the pump from a plurality of protocols that are
predefined and provided in a drug library stored in the memory of the at least one infusion pump.
In one or more embodiments, the comparison may be based on an approximate time of infusion
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administration and parameter matching logic including infusion administration parameters and
infusion pump operating parameters.
[0012] By way of at least one embodiment, the at least one infusion pump compares the infusion
pump operating parameters and the infusion administration parameters to identify potential
matches between the at least one stale auto—program and the at least one manual infusion
program. In one or more embodiments, the at least one infusion pump may evaluate the potential
matches using one or more configurable rules and determines if the potential matches are within
a predefined tolerance. In at least one embodiment, the at least one infusion pump may continue
to execute the at least one manual infusion program on the at least one infusion pump if the
potential matches are within the predefined tolerance.
[0013] In one or more embodiments, the at least one infusion pump saves differences in the at
least one manual infusion program and the at least one stale auto—pro gram locally in a processor
of the pump and/or remotely in the remote server. In at least one embodiment, the at least one
infusion pump locally and/or remotely saves a first event alert indicating the at least one manual
infusion program as an acceptable potential match of the potential matches, and locally and/or
remotely saves a second event alert indicating the at least one auto—program as an un—eXecuted
program because the at least one manual infusion program is an acceptable potential match.
[0014] According to at least one embodiment of the invention, the at least one infusion pump
may include an input screen, such that the caregiver may input the at least one manual infusion
program via the input screen.
[0015] In one or more embodiments, the at least one infusion pump may save identification data
of the caregiver locally and/or remotely in the remote server. In at least one embodiment of the
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invention, the at least one infusion pump compares the at least one manual infusion program
from the caregiver to the at least one stale auto—program to determine a scoring of accuracy. In at
least one embodiment, the scoring of accuracy may include an acceptability level of the at least
one manual infusion program from the caregiver.
[0016] By way of one or more embodiments of the invention, the at least one infusion pump may
generate at least one report from the comparison of the at least one manual infusion program to
the at least one stale auto—program. In at least one embodiment, the report generated by the at
least one infusion pump may include one or more of a time differential between completion time
of the at least one manual infusion program and completion time of the at least one stale auto-
program, a scoring of accuracy including an acceptability level between infusion administration
parameters of the at least one manual infusion program and the at least one stale auto—pro gram,
and a rating of the caregiver.
[0017] In one or more embodiments, the at least one infusion pump may transmit the at least one
manual infusion program from the caregiver to the first computer. In at least one embodiment,
the first computer may save the at least one manual infusion program from the caregiver and may
save identification data of the caregiver. In one or more embodiments, the first computer may
compare the at least one manual infusion program from the caregiver to the at least one stale
auto—program to determine a scoring of accuracy. In at least one embodiment, the scoring of
accuracy may include an acceptability level of the at least one manual infusion program from the
caregiver, or analyze and save the program for review if the outcome for the patient results in
improved care for example.
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[0018] By way of one or more embodiments of the invention, the first computer may generate at
least one report from the comparison of the at least one manual infusion program to the at least
one stale auto—program. In at least one embodiment, the report generated by the first computer
may include one or more of a time differential between completion time of the at least one
manual infusion program and completion time of the at least one stale auto—program, a scoring of
accuracy including an acceptability level between infusion administration parameters of the at
least one manual infusion program and the at least one stale auto—program, and a rating of the
caregiver. Data mining may be utilized to determine the manual programs that result in
improved outcomes, less drug use, shorter patient stay or any other parameter.
[0019] The details of these and other embodiments of the disclosure are set forth in the
accompanying drawings and description below. Other features and advantages of aspects of the
disclosure will be apparent from the description, drawings, and claims.
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BRIEF DESCRIPTION OF THE DRAWINGS
[0020] The above and other aspects, features and advantages of at least one embodiment of the
invention will be more apparent from the following more particular description thereof,
presented in conjunction with the following drawings wherein:
Figure 1 shows an illustrative schematic diagram of a network for communication
with an infusion pump;
Figure 2 shows an illustrative flowchart for auto—programming an infusion pump
without an error being encountered;
Figure 3 shows an illustrative flowchart for auto—programming an infusion pump
with an error being encountered and handled, and acceptable manual
programs according to the present invention;
Figure 4 shows an illustrative infusion pump;
Figures 5 and6 show illustrative flow diagrams for displaying error messages and
acceptable manual programs at an infusion pump;
Figure 7 shows an illustrative flowchart for displaying error messages and
acceptable manual programs.
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DETAILED DESCRIPTION OF THE INVENTION
[0021] The following description is of the best mode presently contemplated for carrying out at
least one embodiment of the invention. This description is not to be taken in a limiting sense, but
is made merely for the purpose of describing the general principles of the invention. The scope
of the invention should be determined with reference to the claims.
[0022] illustrates an exemplary schematic diagram of a system for administering
medication via an infusion pump. The medication management system (MMS) shown in
comprises a medication management unit (MMU) 3108 and a medical device, such as infusion
pump 3130, typically operating in conjunction with one or more information systems or
components of a hospital environment.
[0023] Intravenous (IV) fluid(s) and/or medication(s) 3100 in containers 3102 may be
administered to a patient 3104 using the system shown in Although the system shown in
exemplary utilizes barcodes and a barcode reader as apparatus to input and read machine
readable information, those skilled in the art will appreciate that other apparatus for reading or
inputting information may be utilized. Machine readable indicia or identifying information may
be provided by a transmitter, radio frequency identification (RFID) tag, or transponder and read
by a radio frequency receiver or transceiver. The system may also utilize digital photography or
imaging and scanning technology. Human biometric data, including retina patterns, voice, skin,
fingerprints, and the like may also be recognized by an appropriate scanner or receiver.
Moreover, POC client 3126 may comprise an identification receiver 32 adapted to recognize
such indicia may be provided in the MMS.
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[0024] In certain aspects, the IV fluids and/or medications 3100 in container 3102 may be
provided with new or supplemental labels with a unique infusion order identifying barcode by a
pharmacist according to certain hospital practices. Specifically, drug container specific
identification information, such as barcoded information on the container 3102 may include
patient identification information, including a patient name, patient number, medical record
number for which the medication has been prescribed, medication identification information
such as a medication name or solution within the IV container 3102, universal identification
information which may be created or assigned at the hospital, medical device delivery
information, such as the operating parameters to use in programming an infusion pump to deliver
fluids and/or medication 3100 to the patient 3104, and/or medication order information, such as
one or more of above information items and/or other medication order information specific to a
particular patient 3104, and which may be a part of a medication order for a particular patient.
The IV fluids and/or medications 3100 in barcode—identified containers 3102 may be supplied to
hospitals by various vendors, with preexisting unique barcode identifiers which include
medication information and other information, such as a National Disease Center (NDC) code,
expiration information, drug interaction information, and the like.
[0025] In some aspects of the disclosure, the universal identification information on the
container 3102 may be a unique medication order identifier that, by itself, identifies the order
associated with the container. In other aspects, the identification information on the container
3102 may be a composite patient/order code that contains both a patient ID (such as a medical
record number) and an order ID unique only within the context of the patient. In certain aspects,
the identification information on the container 3102 may comprise a medication ID. Within a
particular hospital, all medication prepared or packaged for patients by the pharmacy may
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contain either a composite patient/order ID or a universally unique order ID, but generally not
within the same hospital. The medication ID alone option may be used only for medication that
are pulled by a nurse directly from floor stock at the point of care.
[0026] The system identified in may comprise a drug library editor (DLE) or DLE
computer 3106, such as a notebook, desktop or server computer. The DLE computer 3106 may
comprise DLE software that runs on the DLE terminal, computer or workstation 3106, shown as
DLE Client in As described above, a medication management unit (MMU) or computer
3108, such as a server, may have MMU software that is installed and runs on the MMU server
3108. The drug library and other databases may be stored on the MMU server 3108, a separate
server, and/or in remote locations.
[0027] Hospital information systems (HIS) 3110 may include one or more computers connected
by cabling, interfaces and/or Ethernet connections. Alternatively wireless connections and
communications may be used in whole or in part. Servers provide processing capability and
memory for storage of data and various application programs or modules, including but not
limited to a module for admissions—discharge—and—transfer (ADT) 3112, a computerized
physician order entry (CPOE) module 3114, and a pharmacy information system (PIS) module
3116. Hospital personnel, such as admission clerks 3118, physicians 3120, and pharmacists
3122, respectively, may be authorized to access these modules through client workstations
connected to the servers in order to enter data, access information, run reports, and complete
other tasks.
[0028] In the embodiment shown in the HIS 3110 may also include a point of care
(POC) system 3125 including a server or POC computer 3124 (sometimes referred to as a
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barcode point of care server or computer), or the POC computer 3124 may be separate from the
HIS 3110. The POC computer 3124 may act as a part of a point of care (POC) system 3125
(sometimes referred to as the barcode point of care system or BPOC) and may be able to
wirelessly communicate through a plurality of wireless communication nodes located throughout
the hospital, utilizing a wireless communications protocol, such as IEEE 801.11, IEEE 802.11, or
Bluetooth. The POC computer 3124 may communicate wirelessly with a portable thick client
POC or input device 3126 carried by a caregiver. The POC client device 3126 may be a personal
digital assistant (PDA) that comprises significant memory, display and processing capabilities.
The POC client device may execute a variety of programs stored in its memory in some degree
independently of the POC computer 3124.
[0029] In one embodiment of the MMU server 3108 may be hard—wired to the DLE
client desktop computer/workstation 3106 and to a MMU client computer/workstation 3128.
Alternatively, the MMU and DLE client functions may be combined onto a single client
computer/workstation or may reside together with the MMU server 3108 on a single combined
MMU/DLE server. The MMU server 3108 may reside in a location remote from the patient's
room or treatment area. For instance, the MMU server 3108 may reside in a secure, climate
controlled information technology room with other hospital servers and computer equipment and
its client terminals may be located in the pharmacy, biomedical engineering area, nurse station,
or ward monitoring area. One MMU server 3108 may monitor, coordinate and communicate
with many infusion pumps 3130. For example, in one embodiment, the MMU software running
on the MMU server 3108 may support up to one thousand infusion pumps concurrently.
[0030] In embodiment of the client PDA 3126 in the POC computer system 3125 may
communicate through the POC server 3124with the MMU server 3108. The MMU server 3108
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may interface or communicate wirelessly with the infusion pump 3130 through the same wireless
nodes 84 utilized by the POC system 3125 and a connectivity engine and antenna on or in the
infusion pump 3130. Communication between the infusion pump 3130 and the POC
client 3126 may take place through the MMU server 3108 and POC server 3124. The MMU
computer 3108 may store in an associated memory both the logical ID and the network ID or
Internet Protocol (IP) address of the infusion pump(s) 3130, such that only the MMU
computer 3108 may communicate in a direct wireless manner with the infusion pump 3130.
Alternatively the MMU 3108 may provide the IP address and other information about the
pump 3130 to the POC system 3125 to facilitate direct communication between the POC
system 3125 and the pump 3130.
[0031] Upon admission to the hospital, the admission clerk 3118 or similar personnel may enter
demographic information about each patient 3104 into an associated memory of the ADT
computer or module 3112 of an HIS database stored in an associated memory of the HIS
system 3110. Each patient 3104 may be issued a patient identification wristband, bracelet or tag
112 (or other patient identification device) that may include an identifier 3103, such as a barcode
or RFID tag for example, representing a unique set of characters, typically a patient ID or
medical record number, identifying the patient, sometimes referred to as patient specific
identification information. The wristband, bracelet or tag 112 may also include other
information, in machine readable or human—readable form, such as the name of the patient's
doctor, blood type, allergies, and the like as part of the patient specific identification information.
[0032] The patient's doctor 3120 may prescribe medical treatment by entering an order into the
CPOE computer terminal or module 3120 within the HIS system 3110. The order, as prescribed,
may specify a start time, stop time, a range of allowable doses, physiological targets, route, and
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site of administration. In the case of an order for infusion of fluids or medication, the order may
be written in various formats, but typically includes the patient's name, patient ID number, a
unique medication order or prescription number, a medication name, medication concentration, a
dose or dosage, frequency, and a time of desired delivery. This information may be entered into
the memory of the CPOE computer 3124, and may be stored in a memory associated with at least
the POC server or computer 3124.
[0033] The medication order may also be delivered electronically to the PIS computer 3116 in
the pharmacy and may be stored in an associated memory. The pharmacist 3122 may screen the
prescribed order, translate it into an order for dispensing medication, and prepare the medication
or fluids with the proper additives and/or necessary diluents. The pharmacist 3122 may prepare
and affix a label 102 with drug container specific identifying information 3101 to the medication
or drug container 3102. In one embodiment, the label only includes in machine—readable
(barcode, RFID, etc.) form a unique sequentially assigned “dispense ID number” that may be
tied to or associated with the particular patient ID number and medication order number in the
HIS 3110, PIS 3116 and/or POC computer 3125. In another embodiment, the label may include
in machine readable form a composite identifier that includes an order ID and a patient ID,
which may be a medical record number. In another embodiment, the label does not include a
patient ID at all in barcode or machine readable format but includes in machine readable form
only a medication ID. Another embodiment may be useful for “floor stock” items that are
commonly stocked in operating rooms, emergency rooms, or on a ward for administration on
short notice with ad hoc or post hoc orders. In another embodiment, the label may include in
machine readable and/or human—readable form medical device specific delivery information
including but not limited to the dispense ID number, patient ID, drug name, drug concentration,
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container volume, volume—to—be—infused (“VTBI”), rate or duration, and the like. Only two of the
three variables VTBI, rate and duration may be required to be defined as the third may be
calculated when the other two are known. The labeled medication may be delivered to a secure,
designated staging location or mobile drug cart on the ward or floor near the patient's room or
treatment area. The medication order pending dispensing or administration may be posted to a
task list in the HIS system 3110 and POC system 3125 and stored in an associated memory.
[0034] The caregiver 3132 (e.g., a nurse) may use the identification receiver 32 associated with
the POC client 3126 to scan the caregiver specific identification information 3133 or barcode on
his/her caregiver identification badge 116 (or other caregiver identification device) and enter a
password, which logs the caregiver into the system and authorizes the caregiver to access a
nurse's task list from the POC system 3125 through the POC client 3126. The information within
the nurse's badge 116 is sometimes referred to as the caregiver specific identification information
herein. The caregiver 3132 may view from the task list that IV drugs are to be administered to
certain patients 3104 in certain rooms. The caregiver 3132 obtains the necessary supplies,
including medications, from the pharmacy and/or a staging area in the vicinity of the patient's
I'OO1’1’1.
[0035] The caregiver 3132 may take the supplies to a patient's bedside, turn on the infusion
pump 3130, verify that the network connection icon on the pump 3130 indicates a network
connection (for example, a wireless connection such as Wi—Fi or the like) is present, select the
appropriate clinical care area (CCA) on the pump, and mount the IV bag, container, or
vial 3102 and any associated tube set as required in position relative to the patient 3104 and
infusion pump 3130 for infusion. Another connection icon on the pump 3130 or pump user
interface screen can indicate that a wired or wireless connection to the MMU server 3108 is
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present. Using the identification receiver/reader integral to the POC client PDA 3126, the
caregiver 3132 may scan the barcode on the patient's identification wristband, bracelet or tag 112
or other patient identification device. A task list associated with that particular patient may
appear on the PDA 3126 screen. The task list, which may also include orders to give other forms
of treatment or medication by other routes (oral, topical, etc.), may be obtained from the HIS via
the POC server 3124 and communicated wirelessly to the POC client PDA 3126. In one
embodiment, the list is generated by matching the scanned patient ID with the patient ID for
orders in memory within the POC server 3124. In another embodiment, as will be described
below, the order information may be obtained by scanning the drug container specific
identification information for associated orders in memory within the POC server 3124, through
the following step(s).
[0036] The caregiver 3132 may scan the medication barcode label 102 containing medication
container specific identification information 3101 on the medication container 3102 with the
PDA 3126. The PDA 3126 may highlight the IV administration task on the task list and send the
scanned medication container specific identification information, such as dispense ID
information, from the medication container 3102, to the POC server 3124, which uses the
medication container specific identification information, such as the dispense ID, to pull together
the rest of the order details and send them back to the PDA 3126. The PDA 3126 may then
display an IV Documentation Form on its screen. One side of the IV Documentation Form screen
may show the order details as “ordered” and the other side may be reserved for a status report
from the infusion pump 3130. The status report from the infusion pump 3130 may be transmitted
to the PDA 3126 through the POC server 3124 and MMU server 3108, as will be described
below. The lower portion of the IV Documentation Form screen may provide the caregiver 3132
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with instructions (like to scan the infusion pump 3130 barcode) or identify whether the pump is
running or stopped.
[0037] The caregiver 3132 may then scan the barcode label 92 associated with the infusion
pump 3130 (or pump channel if the pump is a multi—channel pump). The barcode label 92
may contain medical device specific identification information 3131, such as the logical name
and/or logical address of the device or channel. The POC system 3125 then automatically
bundles the information into a program pump request containing the “order details” and in one
embodiment, without further interaction with the caregiver 3132, transmits this information to
the MMU server 3108.
[0038] The program pump request may include at least some of the following information (in
HIS/POC system format): a Transaction ID, which may include a Logical Pump ID, a Pump
Compartment, a Pump Channel ID, a Reference Device Address, a Caregiver ID, a Caregiver
Name, a Patient/Person ID (HIS identifier), a Patient Name, a Patient Birth Date & Time, a
Patient Gender, a Patient Weight, a Patient Height, and an Encounter ID which may include a
Room, a Bed, and a Building (including Clinical Care Area or CCA). The program pump request
may also include Order Information or “order details”, including an Order ID, a Start Date/Time,
a Stop Date/Time, a Route of Administration, a Rate, a Duration of Infusion (Infuse Over), a
Total Volume to be Infused (VTBI), an Ad Hoc Order Indicator, and Ingredients including HIS
Drug Name or HIS Generic Drug Name, HIS Drug Identifier or HIS Generic Drug ID, RX Type
(Additive or Base), Strength W/units, and Volume W/units. The program pump request may
further include Patient Controlled Analgesia (PCA) Orders Only information, such a PCA Mode-
PCA only, Continuous only, or PCA and Continuous, a Lockout Interval (in minutes), a PCA
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Continuous Rate, a PCA Dose, a Loading Dose, a Dose Limit, a Dose Limit Time w/units, a
Total Volume in vial or syringe, and Order Comments.
[0039] The MMU 3108 may map or convert the wide range of expressions of units allowed by
the HIS system 3110 or POC system 3125 for PDA 3126 requests into the much more limited set
of units allowed in the MMU 3108 and infusion pump 3130. For example, the PDA 3126 request
may express “g, gm, gram, or grams” whereas the MMU 3108 and/or infusion pump 3130 may
accept “grams” only. Infusion pump 3130 delivery parameters or infusion pump 3130 settings
are mapped or converted from corresponding order information or “order details” of the program
pump request.
[0040] The MMU 3108 may store in an associated memory a mapping or translation table that
keep track of the logical ID, serial number or other identifier of an infusion pump 3130 and the
corresponding current network (static or dynamic) address (Internet Protocol (IP) address) or ID
of the infusion pump 3130 on the network, which in this example is a wireless network. The
MMU 3108 may be able to translate or associate a given identifier of the infusion
pump 3130 with its network address in the translation table and provide the network IP address
to the requesting POC system 3125 or device. The MMU 3108 may also store in an associated
memory and/or may look up the drug library applicable to the scanned infusion pump 3130 and
may also convert the Drug ID and Strength from the pump program request into an index number
of the medication at the desired strength or concentration from the drug library. The duration of
the infusion may come from the POC system 3125 in hours and minutes and may be converted to
just minutes for the infuser to recognize it. Volume or VTBI may be rounded to provide a value-
specific and infuser—specific number of digits to the right of the decimal point. Units (of drug)
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may be converted to million units where appropriate. Patient weight may be converted and either
rounded according to infuser—specific rules or not sent to the infuser.
[0041] Once the MMU 3108 transforms the information from the program pump request into
infusion pump settings or delivery parameters and other information in a format acceptable to the
infusion pump 3130, the MMU3108 may wirelessly download a command message to the
infusion pump 3130. If the infusion pump 3130 is not already equipped with the latest
appropriate version of the hospital—established drug library, the MMU 3108 may also
automatically download a drug library to the infusion pump 3130. The hospital—established drug
library may be maintained in a separate process undertaken by the biomedical engineer or
pharmacist 3122 to place limits on the programming of the infusion pump 3130, as well as other
infusion pump operating parameters such as default alarm settings for air in the line, occlusion
pressure, and the like. The drug library may set up acceptable ranges or hard and/or soft limits
for various drug delivery parameters in the infusion pump 3130.
[0042] The MMU 3108 may also download to the infusion pump new versions, patches, or
software updates of the infusion pump's internal operating system software. The infusion settings
or delivery parameters and other information from the MMU 3108 may be entered into the
memory of the infusion pump 3130 and the infusion pump 3130 settings may automatically
populate the programming screen(s) of the infuser, just as if the caregiver 3132 had entered the
information and settings manually. The infusion pump 3130 screen may populate with the name
of the drug and drug concentration based on the drug library index number, patient weight (if
applicable), rate, VTBI, and duration (only two of the last three variable are sent by the
MMU3108 because the pump 3130 may calculate the third from the other two). A return
message of confirmation signal may be sent to the MMU 3108 by the infusion pump 3130 to
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indicate that the command message has been received. At this point, if necessary, the caregiver
3104 may manually enter any additional infusion settings or optional information that was not
included in the command message.
[0043] The infusion pump 3130 may then prompt the caregiver 3132 to start the infusion
pump 3130 by pressing the start button. When the caregiver 3132 presses the start button, a
confirmation screen with the infusion settings programmed may be presented for confirmation
and an auto—pro gram acknowledgment message can be sent to the MMU server 3108 to forward
without request (i.e., pushed in a near real—time manner) or provide to the POC system 3125
when requested or polled. When the caregiver 3132 presses the button to confirm, the infusion
pump 3130 may begin delivering fluid according to the programmed settings. The infusion
pump 3130 may send a status message to the MMU 3108 indicating that the infusion
pump 3130 was successfully auto—programmed, confirmed and started by the caregiver 3132, and
is now delivering fluid. This information may also be displayed at the infusion pump. The
MMU3108 may continue to receive logs and status messages wirelessly from the infusion
pump 3130 periodically as the infusion progresses or when alarms occur.
[0044] The MMU 3108 may report a portion of the initial status message to the PDA 3126
through the POC server 3124 (in MMU format) to indicate that the infusion pump 3130 has been
auto—programmed and the caregiver 3132 has confirmed the settings. The MMU 3108 may
communicate to the POC system 3125 and/or at the infusion pump 3130 the actual Rate, VTBI
and Duration. A notation at the bottom of the PDA screen and/or the infusion pump may indicate
that the infusion pump 3130 is running. The infusion pump 3130 may compare and give a visual,
audio or other type of affirmative signal if the pump information matches or acceptably
corresponds with the ordered information. An initial determination of whether the pump
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information matches the order may be done in the MMU 3108 and communicated to the
PDA 3126 through the POC server 3124. Alternatively, the POC server 3124 or the infusion
pump 3130 may make the necessary comparisons. If the pump information does not match the
order, the infusion pump 3130 at the display 88 may output a visual, audio or other type of
negative signal, which may include an error message.
[0045] At least one embodiment of the invention includes a first computer, such as a medication
management unit (MMU) 3108, including a computer network interface and the at least one
infusion pump 3130. In one or more embodiments, the first computer communicates with the at
least one infusion pump 3130 via the computer network interface.
[0046] By way of one or more embodiments, the first computer receives at least one infusion
auto—program from a remote source. In at least one embodiment, the remote source may include
a hospital information system, pharmacy information system or medication administration
system and the first computer may include the medication management unit (MMU) 3108, such
as a server equipped with Hospira MedNetTM software. In one or more embodiments, the at least
one infusion auto—program may include one or more of IV drug container information, infusion
pump information, and infusion program settings.
[0047] In at least one embodiment, the first computer transmits the at least one infusion auto-
program to the at least one infusion pump 3130. In one or more embodiments, the first computer
may queue the at least one infusion auto—program when the first computer is unable to transmit
the at least one infusion auto—program to the at least one infusion pump 3130. In at least one
embodiment, the first computer sends the at least one stale auto—program to the at least one
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infusion pump 3130 when the at least one infusion pump 3130 communicates with the first
computer.
[0048] According to one or more embodiments of the invention, the at least one infusion pump
3130 may receive at least one manual infusion program from the at least one caregiver 3132. In
one or more embodiments, the at least one manual infusion program may include one or more of
a completed manual infusion program or a running manual infusion program.
[0049] The caregiver 3132 may be prompted to review and press a save button on the infusion
pump 3130 if the order has been begun as desired or any variations are acceptable. The MMU
3108 may receive status, event, differences and variation information from the infusion pump
3130 and pass such information to the POC system 3125. In a separate subsequent step, the nurse
may electronically sign the record and presses a send button on the POC client PDA 3126 to
send the information to the patient's electronic medication record (EMR) or medication
administration record (MAR).
[0050] Referring now to FIGS. 2 and 3, flowcharts further illustrate a system and method for
notifying a caregiver (e.g., caregiver 3132, such as a nurse) at an infusion pump 3130 of the
status of administration of fluid and/or medication 3100 to a patient 3104 according to aspects of
the disclosure. In one embodiment, the POC system 3125 sends a program pump message
containing infusion pump settings to the MMU computer 3108, which looks up the targeted
infusion pump 3130 according to its identifier and relays the infusion pump settings to the pump
3130. In another embodiment, when the POC system 3125 is auto—programming the infusion
pump 3130, the POC system 3125, including the POC computer 3124 and/or the POC client
3126 may request the MMU 3108 for permission to program the infusion pump 3130. The
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MMU computer 3108 may grant this permission and then the POC system 3125 may
communicate directly with the infusion pump 3130, without intervention by the MMU computer
3108. The MMU computer 3108 may continually receive asynchronous or synchronous near
real—time status messages and event logs from the infusion pump 3130 and store this information
in an associated memory for purposes of at least displaying infusion pump 3130 status and
generating reports.
[0051] In certain aspects of the disclosure, prior to beginning the workflow illustrated in FIGS. 2
and 3, a caregiver 3132 may first be required to use POC system 3125 to scan an identifier of the
caregiver’s ID badge 116. The POC system 3125 may then determine if the caregiver 3132 is a
valid POC system 3125 user. The POC system 3125 may also require the caregiver 3132 to
enter a password, user name, and/or other information.
[0052] As shown in FIGS. 2 and 3, the caregiver 3132 may initiate the workflow for
automatically programming the infusion pump 3130 by scanning the patient’s wristband (step
201), scanning the IV bag (step 203), and scanning the infusion pump (step 205). At step 201,
the caregiver 3132 may use a scanner, such as identification receiver 32 at POC client 3126, to
scan the identifier on the patient’s wristband, bracelet, or tag 112. The patient ID, which may be
a medical record number, an account number or some other identifier that the care facility uses to
positively identify the patient, may be retained in a memory in the POC client 3126.
[0053] At step 203, the caregiver 3132 may use the POC client 3126 to scan the identifier 3101
on the identification label 102 on the IV bag 3102. The container ID 3101 may comprise
machine—readable indicia such as a bar code, RFID tag, or the like. The container ID 3101 may
be a universally unique order ID so that the HIS 3110 or POC system 3125 may retrieve
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information about the association medication order without having to scan the patient ID on the
patient wristband, bracelet, or tag 112 (or other patient identification device) or rely on such
patient ID information for comparison purposes. Alternatively, the container ID may be a
composite ID that includes patient ID or some portion thereof and an order ID related to that
particular patient. Alternatively, the container ID may be an absolute or unique pharmacy order
identifier that may be generated by the order entry or pharmacy information systems.
Alternatively, for commonly used containers that are stocked on the ward or patient care floor,
like dextrose, saline or other solutions, the container ID may be a medication ID that includes
only medication—specific information, including but not limited to medication name,
concentration (if applicable) and volume.
[0054] At step 205, the caregiver 3132 may use the POC client 3126 to scan the barcode label 92
or RFID tag on the infusion pump 3130 or a channel of the pump to obtain medical device
specific identification information 3131 on the identifier. Thus, the POC client 3126 may
receive or capture the pump ID or identifier information. Steps 201, 203, and 205 may be
performed in any order. For instance, the caregiver 3132 may perform step 203 first, followed
by steps 201 and 205, or may perform step 205 first, followed by steps 203 and 201, and the like.
[0055] As shown in FIGS. 2 and 3, the information scanned by the caregiver 3132 at steps 201,
203, and 205 may be transmitted to the patient’s electronic medical records (EMR) and/or the
barcode medication administration (BCMA). In certain aspects, the caregiver 3132, after
performing the scans with the POC client 3126, may select a button (such as a “start” or “done”
button) on the POC client 3126. Selection of the button may cause the POC client 3126 to
transmit the scanned information to the EMR/BCMA. The BCMA may comprise, for example,
POC system 3125.
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[0056] Based on the received scanned information, the EMR/BCMA within the HIS 3110 may
look up patient demographic information it received from the Admission, Discharge and
Transfer (ADT) system 3112 and an infusion order for the patient or medication it received from
the Pharmacy Information System (PIS) 3116. Software in POC system 3125 may then perform
a variety of safety checks, comparisons or matching functions to ensure that the right drug is
administered to the right patient, at the right rate, in the right dose, at the right time, via the right
route, and by an authorized or right caregiver, etc. as is conventional in the BCMA art. The
BCMA/POC system 3125 then transmits an auto—programming message containing infusion
pump settings to the MMU 3108.
[0057] At step 209, based upon the pump identification information contained in the auto-
programming message, the MMU 3108 may then look up the infusion pump network location to
determine the pump that is targeted to receive the infusion pump settings contained in the auto-
programming message.
[0058] At step 211, the MMU 3108 may send the infusion pump settings to the infusion pump
3130 using the pump’s IP address. At step 213, the infusion pump 3130 may receive the
infusion pump setting and then verify the infusion program settings against the installed drug
library. In other words, the infusion pump 3130 may ensure that the received program settings
for the patient 3104 are consistent with the information provided in the drug library. Steps 215,
217, and 219 shown in illustrate exemplary steps that may be performed after the infusion
pump has determined that the program settings are consistent with the permissible settings
specified in the drug library of the pump 3130. As discussed further below, steps 315, 317, and
319 shown in illustrate exemplary steps that may be performed after the infusion pump
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has determined that the program settings are inconsistent with the permissible settings specified
in the drug library of the pump 3130.
[0059] As shown in at step 215, after the infusion pump 3130 has verified that the
program settings are consistent with the drug library, the infusion pump may populate the
program settings, for example at display screen 88. The infusion pump 3130 may display one or
more program settings at display screen 88, such as drug name, drug concentration, container
volume, VTBI, rate or duration, and the like. The infusion pump 3130 may also display a
request for a nurse to confirm the displayed program settings.
[0060] At step 217, the caregiver 3132 may review and verify that the displayed infusion
program settings were correctly populated. The caregiver 3132, in some aspects, may be
required to select a button at the infusion pump 3130 in order to indicate confirmation that the
infusion program settings were correctly populated. In response, the infusion pump 3130 may
display a start button on screen 88 that enables the caregiver 3132 to start the infusion in
accordance with the final confirmed programmed pump settings. The caregiver 3132 may select
the start button to start the infusion program at step 219.
[0061] Referring now to workflow steps illustrate an exemplary process in which the
infusion pump settings are inconsistent with the settings stored in the drug library. The process
illustrated in comprises the same steps 201, 203, 205, 207, 209, 211, and 213 as
However, the auto—programming workflow illustrated in comprises exemplary steps 315,
317, 319, 321, 323 and 325 not performed at and which may be performed after infusion
pump 3130 determines that the infusion program settings are inconsistent with the drug library at
step 213 or in the case of steps 321, 323 and 325, if the manual program is acceptable, yet
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perhaps not an exact match for a stale auto—pro gram that arrives after or during a manual infusion
for example. Embodiments generally analyze and save these events wherein the caregiver may
also be notified that an auto—program has arrived, but that the caregiver has successfully
manually programmed the infusion pump, whether exactly or acceptably when compared to the
auto—pro gram.
[0062] At step 315, infusion pump 3130 may display an error message. The error message may
be reported to the MMU 3108 at step 315a. The error message may be relayed and reported to
the EMR/POC system 3125 via the MMU server 3108 at step 315b. Alternative, the error
message can be reported directly from the pump 3130 to the EMR/POC system 3125 through
any wired or wireless networks available in the hospital. Most importantly, the error message
may be displayed at or on the display screen 88 of infusion pump 3130. Thus, even if the
caregiver has limited or no access to the POC client or other computer systems within the
hospital at the time, they will be advised of auto—programming errors at the pump 3130. As will
be discussed in greater detail below, the error message may notify the caregiver 3132 of the
rejection of the auto—programming request. The error message may comprise an error code and a
brief description of the error cause. The error message may further comprise suggested actions
for the caregiver 3132 to perform in response to the error message. For example, if the keypad is
locked, the infusion pump 3130 may output an error message KLO00017 stating “The auto-
program is not valid because the keypad is locked.” The infusion pump 3130 may also display,
on the same screen, a suggested or recommended action, e.g., “Unlock the keypad”. A table of
errors, including exemplary code numbers, descriptions and recommended actions are included
below in Table 1.
[0063] Table 1 — Messages and Suggested Actions Relating to Auto—Programs
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Error Code Message Action
EPC0000l Order rejected. Physician’ s Recheck the order with
order for an automatically pharmacy or physician.
programmed therapy exceeds
the capabilities of the pump.
HLV00002 Order rejected. Physician’ s Recheck the order with
order for an automatically pharmacy or physician.
programmed therapy exceeds
a hospital—defined drug library
hard limit.
NTA00003 The auto—pro gram received Press [OK] now, or wait for
contains duration information, this screen to automatically
and you cannot titrate the dismiss.
duration of a delivery with this
dosing unit(s).
MRI00004 The auto—pro gram received Press [OK] now, or wait for
did not contain all required this screen to automatically
information. dismiss.
SLV00005 The auto—pro gram received Press [OK] now, or wait for
contains a value that exceeds a this screen to automatically
system limit. Or the values dismiss.
cause a calculated parameter
to exceed a system limit.
MCD00006 The auto—pro gram received Press [OK] now, or wait for
contained a medication which this screen to automatically
is different from what is dismiss.
delivering on the programmed
line.
UPD00007 The auto—pro gram is for a line Resubmit the auto—pro gram.
that contains unconfirmed All unconfirmed data will be
programming data. cleared.
LIS00008 The auto—pro gram is for a line Clear this line and resubmit
which is in Standby. the auto—program.
LDS00009 The auto—pro gram is for a line Clear this line and resubmit
which is in Delay Start. the auto—program.
ACP000l0 The auto—pro gram is for a line Clear alarm condition and
that has an active alarm that resubmit the auto—pro gram.
stops or prevents delivery,
thus the auto—program is not
valid in this alarm condition.
COV000ll The auto—pro gram is not valid Press [OK] now, or wait for
due to concurrency violation. this screen to automatically
Delivery A+B greater than dismiss.
500 mL/hr or less than 0.5
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mL/hr for each line.
NIB000l2 The auto—pro gram is not valid Press [OK] now, or wait for
for line B. The medication this screen to automatically
delivering on line A cannot be dismiss.
interrupted.
NMW000l3 The auto—pro gram is not valid Press [OK] now, or wait for
because the weight in the this screen to automatically
auto—pro gram does not match dismiss.
the weight on the program
delivering on the other line.
NMH000l4 The auto—pro gram is not valid Press [OK] now, or wait for
because the height in the auto— this screen to automatically
program does not match the dismiss.
height on the program
delivering on the other line.
NMB00027 The auto—pro gram is not valid Press [OK] now, or wait for
because the BSA in the auto— this screen to automatically
program does not match the dismiss.
BSA on the program
delivering on the other line.
NCS000l5 The auto—pro gram is not valid Select a CCA and resubmit the
because a CCA has not been auto—pro gram.
selected on the infuser.
NVD000l8 The auto—pro gram is not valid Press [OK] now, or wait for
because the received this screen to automatically
parameters will not result in a dismiss.
valid dose.
NDT000l6 The auto—pro gram is not valid Press [OK] now, or wait for
because the drug in the this screen to automatically
confirmed program was a “No dismiss.
Drug Selected” auto—pro gram
and titration is not allowed.
ZVV000l9 The auto—pro gram is not valid Press [OK] now, or wait for
because the Rate cannot be this screen to automatically
titrated when VTBI is 0. dismiss.
NCP00020 The auto—pro gram is not valid Press [OK] now, or wait for
because it is a titration for a this screen to automatically
line that has no confirmed dismiss.
program.
KLO000l7 The auto—pro gram is not valid Unlock the keypad.
because the keypad is locked.
MLV0002l The auto—pro gram is not valid Press [OK] now, or wait for
for a line with a Multistep or this screen to automatically
Loading dose program. dismiss.
NIA00022 The auto—pro gram is not valid Press [OK] now, or wait for
WO 2016/044232 PCT/US2015/050128
for line A. The medication in this screen to automatically
the auto—program is not dismiss.
interruptible and Line B is
delivering a Piggyback
infusion.
ICD00023 The auto—pro gram for this Press [OK] now, or wait for
infuser was rejected by this screen to automatically
Hospira MedNet due to dismiss.
incomplete or corrupt data.
DLI00024 The auto—pro gram for this Press [OK] now, or wait for
infuser was rejected by this screen to automatically
Hospira MedNet due to drug dismiss.
library incompatibility.
PPL00025 The auto—pro gram is rejected Press [Clear] and resubmit the
because of a partially auto—pro gram. All
programmed line. unconfirmed data will be
cleared.
ITP0026 The auto—pro gram is rejected Press [OK] now, or wait for
because auto—programming is
performed on a line in the
PENDING or PUMPING state
and the Post Infusion Rate
(KVO or RATE) is interpreted
as not being a titration.
A pump with an installed
cassette was started. The
CCA was selected. Line A
was programmed and delivery
was started. A barcode was
scanned and an order on line
A was placed. The auto-
pro gram for line A was sent to
the infuser.
The infuser determines that
the auto—pro gram is a new
delivery based on titration
rules and rejects the auto-
program.
this screen to automatically
dismiss.
[0064] At step 317, the caregiver 3132 may review and respond to the error message displayed at
the infusion pump 3130. The caregiver 3132 may provide a response that comprises at least one
WO 2016/044232 PCT/US2015/050128
of a modification to the auto—programming request, performing the actions suggested at the pump
3130, and/or rejecting or clearing the error message and suggested action. Based on the response
to the error message received at step 317, pump 3130 may perform an operation at step 319. For
example, after displaying the error message provided above and suggested action “Unlock the
keypad”, infusion pump 3130 may receive a response from the caregiver 3132 that the keypad
has been unlocked. The caregiver’s action of unlocking the keypad may itself serve as the
response to the error message at step 317. Thereafter, the operation performed at step 319 may
comprise the infusion pump starting the infusion program similar to or the same as step 219
illustrated in Thus, if the caregiver 3132 responds to the error message at step 317 by
performing the suggested action, the infusion pump 3130 may, at step 319, automatically start
the requested infusion auto—program. The caregiver 3132 may respond to the error message by
adjusting program settings such as dose, rate, VTBI, duration, and the like on the infusion pump
3130.
[0065] In some aspects, the caregiver 3132 may reject or override the error message displayed at
step 315. The caregiver 3132 may override the error message at step 317 in cases of soft limit
violations. Some limit violations may require entry of a special override code or input of a code
from a second caregiver or supervisory personnel. In another aspect of the invention, the
infusion pump 3130 may display an error message that a pump channel is “Already in Use”. The
caregiver 3132 may investigate and determine that the pump is not in use. The caregiver 3132
may send a response rejecting the error message and indicating that the pump channel is not
currently in use. The pump 3130 may then return to step 213 to verify infusion program settings
against the installed drug library or may automatically start the infusion program at step 219.
WO 2016/044232 PCT/US2015/050128
[0066] In certain aspects, the caregiver 3132 may not input a response into infusion pump 3130
within a predetermined time. The lack of a response within this predetermined time may itself
server as a response to error message 317. Specifically, the infusion pump 3130 may be
configured (for example, by the manufacturer or the hospital via the user customized drug library
configuration settings downloaded to the pump by the MMU) to timeout after a predetermined
time. The predetermined time may be about 15 seconds, 30 seconds, 35 seconds or any other
amount of time. If the infusion pump 3130 does not receive a response within the timeout period
(or predetermined time), the infusion pump 3130 may reject the auto—program and display a
previous or home screen at display screen 88. In this case, the operation performed at step 319
may comprise clearing the error message and displaying a previous or home screen at the pump
3130.
[0067] In one or more embodiments, the at least one infusion pump 3130 saves and executes the
at least one manual infusion program received from the at least one caregiver 3132. At step 321,
in at least one embodiment, the at least one infusion pump 3130 compares the at least one stale
auto—program to the at least one manual infusion program that has been completed or is running.
[0068] In at least one embodiment of the invention, the at least one manual infusion program
may be entered at the infusion pump and/or accessed as provided in a library stored at the at least
one infusion pump 3130. In one or more embodiments, the comparison may be based on an
approximate time of infusion administration and parameter matching logic including infusion
administration parameters and infusion pump operating parameters, for example volume to be
infused, rate, or any other characteristic available in the system.
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[0069] By way of at least one embodiment, the at least one infusion pump compares the infusion
pump operating parameters and the infusion administration parameters to identify potential
matches between the at least one stale auto—program and the at least one manual infusion
program. In one or more embodiments, the at least one infusion pump 3130 may evaluate the
potential matches using one or more configurable rules and determines if the potential matches
are within a predefined tolerance. In at least one embodiment, the at least one infusion pump
3130 may continue to execute the at least one manual infusion program on the at least one
infusion pump 3130 if the potential matches are within the predefined tolerance. Any type of
logic including neural networks, rule based, threshold or range based may be utilized to
determine whether an acceptable manual program has executed or is executing when compared
with the stale auto—program.
[0070] At step 323, in one or more embodiments, the at least one infusion pump 3130 saves
differences in the at least one manual infusion program and the at least one stale auto—pro gram in
the remote server or MMU 3108 for later analysis and/or data mining. This may allow the
management system to determine which caregivers are accurate or even may be utilized to
determine whether better outcomes of care result from a slightly different, yet acceptable manual
program when compared to the auto—program as well as determine whether cost saving may be
made while maintaining a given level of service, for example with shorter patient stays or less
drug volume used overall. Any other large data analysis is in keeping with the invention when
comparing manual programs and stale auto—programs and any parameters associated with the
patient, drug, volume to be infused, rate, or any patient characteristics such as age or time of stay
or any other parameter.
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[0071] In at least one embodiment, the at least one infusion pump 3130 remotely saves a first
event alert indicating the at least one manual infusion program as an acceptable potential match
of the potential matches, and remotely saves a second event alert indicating the at least one auto-
program as an un—eXecuted program because the at least one manual infusion program is an
acceptable potential match.
[0072] At step 325, in one or more embodiments, the at least one infusion pump 3130 may
optionally notify the at least one caregiver 3132 of the acceptable at least one manual infusion
program using the first event alert, and optionally notify the at least one caregiver 3132 of the at
least one auto—pro gram as an un—eXecuted program using the second event alert.
[0073] According to at least one embodiment of the invention, the at least one infusion pump
3130 may include a graphical user interface comprising keys and a display screen 88 or an
input/output touch screen 88 on the at least one infusion pump, such that the at least one
caregiver 3132 may input the at least one manual infusion program via the graphical user
interface.
[0074] In one or more embodiments, the at least one infusion pump 3130 may save identification
data of the at least caregiver 3132. In at least one embodiment of the invention, the at least one
infusion pump 3l30 compares the at least one manual infusion program from the at least one
caregiver 3132 to the at least one stale auto—program to determine a scoring of accuracy. In at
least one embodiment, the scoring of accuracy may include an acceptability level of the at least
one manual infusion program from the at least one caregiver.
[0075] By way of one or more embodiments of the invention, the at least one infusion pump
3130 may generate at least one report from the comparison of the at least one manual infusion
WO 2016/044232 PCT/US2015/050128
program to the at least one stale auto—pro gram. In at least one embodiment, the report generated
by the at least one infusion pump 3130 may include one or more of a time differential between
completion time of the at least one manual infusion program and completion time of the at least
one stale auto—program, a scoring of accuracy including an acceptability level between infusion
administration parameters of the at least one manual infusion program and the at least one stale
auto—program, and a rating of the at least one caregiver 3132.
[0076] In at least one embodiment of the invention, the accuracy/effectiveness history or rating
of the at least one caregiver 3132 may determine if the at least one manual infusion program
received from said at least one caregiver 3132 is acceptable and/or more accurate or effective
than the at least one auto—program. The at least one stale auto—program is aggregated and
compared using matching logic (either statically residing on the pump or dynamically provided
with the auto—pro gram) to the at least one manual infusion program received from the at least one
caregiver 3132 at the at least one infusion pump 3130. This comparison generates an auto-
program compliance information / rating or contributes to an overall auto—program compliance
information / rating for the at least one caregiver 3132. The at least one infusion pump 3130
would subsequently display the at least one caregiver 3132 compliance information (rating) for
the at least one caregiver 3132 at the next attempt to auto—program the infusion pump. Auto-
program compliance information is saved in a memory of the pump and, whether or not
displayed on the pump, can be subsequently transmitted or relayed to the first computer, another
medical device or infusion pump or a remote computer for storage, analysis, display or use.
[0077] In one or more embodiments, the at least one infusion pump 3130 may transmit the at
least one manual infusion program from the at least one caregiver 3132 to the first computer. In
at least one embodiment, the first computer may save the at least one manual infusion program
WO 2016/044232 PCT/US2015/050128
from the at least one caregiver 3132 and may save identification data of the at least one caregiver
3132. In one or more embodiments, the first computer may compare the at least one manual
infusion program from the at least one caregiver 3132 to the at least one stale auto—program to
determine a scoring of accuracy or effectiveness. In at least one embodiment, the scoring of
accuracy may include an acceptability level of the at least one manual infusion program from the
at least one caregiver 3132.
[0078] By way of one or more embodiments of the invention, the first computer may generate at
least one report from the comparison of the at least one manual infusion program to the at least
one stale auto—program. In at least one embodiment, the report generated by the first computer
may include one or more of a time differential between completion time of the at least one
manual infusion program and completion time of the at least one stale auto—program, a scoring of
accuracy including an acceptability level between infusion administration parameters of the at
least one manual infusion program and the at least one stale auto—pro gram, and a rating of the at
least one caregiver 3132.
[0079] illustrates an enhanced view of the exemplary infusion pump 3130 comprising
display screen 88. The exemplary screens provided in FIGS. 5 and 6 may be displayed at display
screen 88. The infusion pump 3130 may display error messages, error codes, and suggested
actions at display screen 88. The display screen 88 includes a plurality of areas or regions such
as a status region 88A, a working region 88B, and a message region 88C. The pump may
comprise a memory, a processor, a clock (real time or otherwise) and other components. The
memory may store computer—executable program instruction. Moreover, the processor may
execute the computer—executable program instructions, which may cause the processor to
perform one or more steps recited in the present disclosure.
WO 2016/044232 PCT/US2015/050128
[0080] FIGS. 5 and 6 illustrate exemplary flow diagrams for displaying error messages at display
screen 88. Prior to turning on the multi—channel infusion pump 3130, a cassette may or may not
first be required to be installed in the infuser. A caregiver 3132 may install the cassette into the
door of pump 3130 and then close the door. Next, the nurse may turn on the infusion pump 3130
by pressing an ON/OFF button, such as the ON/OFF button 405 shown in After the
ON/OFF button 405 is pressed, infusion pump 3130 may begin its startup process. After the
startup process, which may take up to a few minutes, the infusion pump 3130 may be prepared to
accept an auto—programming request.
[0081] At this point, infusion pump 3130 may display screen 501. Display screen 501 may be
referred herein as the A/B screen or home screen. As shown in screen 501 may display
(in the working region 88B or elsewhere) delivery information for channel A and channel B,
such as the rate and volume infused or volume to be infused (VTBI). Because an auto-
programming request has not yet been received, the initial values for the delivery information
may be set at 0 as shown in screen 501. The home screen 501 may also display a selected CCA
(here shown directly below the Volume Infused or Volume To Be Infused (VTBI) as “ICU,”
which represents an intensive care unit). Home screen 501 may also display instructions or
suggested actions that could be taken by a caregiver 3132. For example, screen 501 may initially
display suggested action “Select Line A/B to program” as shown in The suggested
action may alert the caregiver 3132 of the next steps to be taken in order to submit a manual or
an auto—program request. In certain aspects, infusion pump 3130 may display the suggested
actions at screen 88 in a different color and/or with different shading than other information
displayed on the screen. Exemplary screens shown in FIGS. 5 and 6, for example, display the
suggested actions in white text with black shading in contrast to other information displayed in
WO 2016/044232 PCT/US2015/050128
black text and white shading. Moreover, the suggested actions may be displayed in a particular
section, region or area of each screen, such as in the message region near the bottom of each
screen shown in FIGS. 5 and 6.
[0082] The screens displayed at the infusion pump 3130 may include other indicators, such as a
battery life indicator 563 (which may indicate the amount of battery life remaining for the pump
3130), a wireless signal indicator 565 (which may indicate the strength of the wireless signal
connection at pump 3130), and a two—way arrow 561 (which may indicate connection between
the MMU and the pump and thus the capability of pump 3130 to upload and download
information to and from the MMU server 3108).
[0083] Screens, as shown in FIGS. 5 and 6, may further comprise various input options. The
input options may be presented in a row at the bottom of the screen (such as directly below the
suggested actions as shown in FIGS. 5 and 6). Each input option may be an option that may be
selected by a caregiver 3132. In some aspects, the caregiver 3132 may touch the screen itself to
select an input option, and in other aspects, the caregiver 3132 may select a corresponding soft
key or button directly below the input option. See the triangles below the screen 88 and the input
options in Other options and text, such as “OK”, “Continue”, “Reject”, “Yes”, “No”,
“Standby”, “Standby Confirmation”, “Delay Start”, “Retum to A/B”, etc. may be displayed in
the message region 88C and selected by caregiver using a touchable screen or the corresponding
soft key below the displayed option or text. In response to the display at screen 501 and the
suggested action “Select Line A/B to program”, caregiver 3132 may select either input option
“A”, input option “B”, or input option “Settings/Vols/CCA”. Selecting option
“Settings/Vols/CCA” may cause infusion pump 3130 to display a screen in which caregiver 3132
may edit settings, the way volume is displayed (volume infused versus volume to be infused or
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VTBI), or a CCA for the infusion pump 3130. Selecting either option “A” or “B” may initiate
the auto—pro gram sequence for that selected channel.
[0084] At step 551, infusion pump 3130 may determine whether an auto—programming request
has been received. In other words, infusion pump 3130 may determine whether the steps
described with respect to FIGS. 1-3 have been performed, particularly steps 201, 203, 205, 207,
209, and 21 l.
[0085] At step 553, the infusion pump 3130 may determine whether it needs to change the auto-
program drug order to “No Drug Selected”. The analysis performed at step 553 is an example of
the various analyses that may be performed when the infusion pump 3l30 verifies the infusion
program settings against the installed drug library at step 213. Thus, as the pump 3l30 performs
its verification step 213, one of the plurality of verification actions it may perform may include
determining whether the medication selected by caregiver 3132 is stored in the drug library for
the selected CCA. For example, caregiver 3132 may select the CCA “ICU” prior to auto-
programming. Then the caregiver 3132 may select or scan medication using POC client 3126 at
step 203. After pump 3l30 receives the auto—programming request for the ICU CCA, pump
3130 may verify the program settings against installed settings stored in its drug library at step
213. One of the verification steps may include determining whether the selected or scanned
medication is included among the medications stored in the drug library for the ICU CCA. In
other words, a processor of the pump 3130 makes a comparison between the drug name,
concentration and dosing units provided in the auto—programming request to the same parameters
in the drug library for the particular clinical care area selected or active on the pump. If, in the
drug library, the selected medication is not among the listed medications available for the ICU
CCA, pump 3130 may be programmed to output “No Drug Selected” as a substitution alert error
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message. At step 553, if the pump 3130 determines that it must change the order to “No Drug
Selected”, it may display an error message such as screen 503.
[0086] The error message may comprise a brief description of the error so that the caregiver
3132 may be able to quickly determine the cause of the error at the pump 3130 and perform
subsequent actions in response to the error. In the example provided at screen 503, processor of
the pump 3130 may perform a drug name, concentration, dosing units, or drug ID comparison
against the drug list in the drug library on the pump for the selected clinical care area or CCA
and display at display screen 88 the error message “The Auto—Program contains a medication
which is not available in the CCA (ICU)” and “For this order the medication ‘No Drug Selected’
has been substituted”. The pump 3130 may display a “Substitution Alert” in the status region or
elsewhere on screen 503 to notify caregiver 3132 that an error has occurred. The error message
may then notify the caregiver 3132 of the precise cause of the error (here, the selected CCA and
the fact that the auto—program contained a medication that, pursuant to the hospital’s best
practices as set forth in the customizable drug library, is not planned to be available in the CCA).
The error message may also, in some aspects display the actions taken by the pump 3130 in
response to the error (here, “No Drug Selected” has been substituted for the medication by the
processor of the pump because it found no match for the medication in the drug library entries
for the selected CCA).
[0087] Also shown in the message region or elsewhere on the screen 503 is the suggested action
“Continue with no drug selected or Reject program”. The suggested action may notify caregiver
3132 that s/he should either select the input option “Continue” in order to continue the auto-
program request with no drug selected substituted for the medication, or select the input option
“Reject” to cancel the auto—program request. The input options may be displayed immediately
WO 2016/044232 PCT/US2015/050128
below the suggested action, as shown in screen 503. If the caregiver 3132 selects the “Reject”
option, pump 3130 may deny the auto—program request and display a previous screen such as
home screen 501. A message concerning the rejection of the auto—program request may be sent to
the MMU server 3108, which then relays the message to the POC system 3125. In certain
aspects, screen 503 may be displayed for a predetermined amount of time, such as about 30
seconds. If no response or input option is selected within that predetermined amount of time,
pump 3130 may automatically reject the auto—programming request and display screen 501. If,
instead, the caregiver 3132 selects the “Continue” input option, pump 3130 may display screen
505 where the rest of the auto—programmed delivery information is pre—populated on the pump
screen 88 in the working region 88B or elsewhere as shown on screen 505. At screen 505,
caregiver 3132 may edit the delivery information, such as rate, VTBI, and duration. Screen 505
may continue to display “No Drug Selected” in or near the status region 88A at the top of the
screen and a suggested action “Enter value using keypad” in the message region 88C at the lower
portion of the screen 88. Pump 3130 may also highlight the field that may have its value edited
(here, e.g., “500” for VTBI in mL) or do so when activated by touch or other keys. The
caregiver 3132 may enter these values on the keypad 401 provided at the pump 3130, as shown
in
[0088] At step 555, pump 3130 may determine if the start button 403 ( has been selected
or pressed by the user. If so, pump 3130 may display a screen such as screen 507. The screen
507 may correlate with step 217 in which the caregiver 3132 verifies the infusion program
settings were correctly populated. Caregiver 3132 may select input option “No” to return to
screen 505 and edit one or more of the displayed delivery information values. Alternatively,
caregiver 3132 may select the “Standby” input option to standby for a predetermined or
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configurable period of time to await confirmation of the medication delivery. If the “Yes” input
option is selected, pump 3130 may start the infusion program at step 219 and may display screen
509. Screen 509 may notify the caregiver 3132 that medication is pumping on the selected
channel (here, channel A) at the selected rate (here, 250 mL/hr) and display a current Volume
Infused (here, 0.1 mL). Screen 509 may also display the suggested action “Select Line A/B to
program”, which may enable the caregiver 3132 to edit or submit another auto—program request
for channel A or B. In certain aspects, channel A may be a primary channel for administering
medication and channel B may be a secondary line for administering medication.
[0089] illustrates another example of a flow diagram of screens displayed at pump 3130.
The series of screens shown in begins at screen 601, which may be similar to screen 509
shown in In the example provided in a caregiver 3132 may request an auto-
program at pump 3130 even as channel A is pumping. Here the pump 3130 is pumping
Dopamine, a commonly prescribed vasoactive medication for controlling blood pressure.
Dopamine is prescribed based on the patient’s weight, which in this example is 70 kg. The
Dopamine is supplied at a concentration of 400 mg in a 250 mL container. The prescribe dose is
.0 mcg/kg/min, which the pump converts to a rate of 13.1 mL/hr. The pump 3130 has pumped
240 mL so far. Similar to step 551 of the pump 3130 may determine in step 651 whether
an auto—programming (AP) request has been received for channel A. The request may be
received after steps 201, 203, 205, 207, 209, and 211 have been performed. At step 213, pump
3130 may verify infusion program settings against program settings stored in the drug library. In
some aspects, pump 3130 may further verify the infusion program settings against settings hard-
coded into the pump. The verification step 213 of or may comprise step 653 of
in which pump 3130 may determine whether the auto—pro gram request for channel A is
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for the same medication or an acceptable alternative to the medication currently being delivered
at channel A. In one aspect, the concept of the “same medication” can comprise the same
medication by name (generic or brand), and one or more of concentration and dosing units. If
the medication in the auto—pro gram request for channel A is Dopamine, it might be okay and not
trigger a mismatched medication/concentration error (code MCD00006 in Table 1 above).
However, if the pump determines in step 653 that a different or non—equivalent medication is
specified in the auto—program request received in step 651, such as Morphine for example, the
pump 3130 displays the error message shown on screen 603.
[0090] Screen 603 may display “Rejection Alert” in the status region or another region of the
screen to notify caregiver 3132 of an error. Screen 603 may also display the error message, such
as “The Auto—Pro gram received contained a medication which is different from what is
delivering on the programmed line” in the working region or another region. Thus, the caregiver
3132 may be notified at the pump 3130 that there has been an error and the cause of the error. In
some aspects, this error message may also display the medication that is being delivered on the
channel, and/or other information such as the concentration and or dosing units of the medication
order. For example, the error message at screen 603 may display “The Auto—Program received
contained a medication [Morphine] which is different from [Dopamine] that is delivering on the
programmed line” or “The Auto—Program received contained a medication which is different
from the [Dopamine 400 mg/250 mL] that is delivering on the programmed line”. Screen 603
may also display the suggested action for this error message in the message region or another
region, in this case “Reject this order now, or wait for automatic rejection?” Pump 3130 may
provide one or more one input options at screen 603, e.g., an option to reject the auto—program
order. Caregiver 3132 may select the “Reject” option to return to screen 509. Alternatively,
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caregiver 3132 may not select an input option at all, in which case pump 3130 may automatically
reject the auto—pro gram order after the timeout period, such as about 30 seconds.
[0091] If, at step 653, pump 3130 determines that the medication in the auto—programming
request is the same or equivalent as the medication currently pumping on channel A, or that the
at least one manual infusion program is acceptable, pump 3130 may display screen 605. Similar
to screen 505, discussed above, screen 605 may enable a caregiver 3132 to modify the settings of
the delivery information values, such as concentration, rate, VTBI, and duration. Also shown at
screen 605 is an input option “Delay Start”. A caregiver 3132 may select the “Delay Start” input
option in order to select a later time in which to begin pumping of the auto—pro gram medication.
Alternatively, caregiver 3132 may select the “Return to A/B” input option to return to screen
509.
[0092] At step 655, pump 3130 determines if the start button 403 (as shown in has been
selected. If so, pump 3130 may display screen 607. Caregiver 3132 may be able to review the
information displayed at screen 607, similar to screen 507 as discussed above. Caregiver 3132
may then select the “Yes” input option to verify that the infusion program settings were correctly
populated at step 217. In response, pump 3130 may start the infusion program at step 219 and
the infusion pump 3130 may display screen 609.
[0093] Some other examples of error messages that may be displayed by the pump 3130, for
example at screens such as screens 503 and 603, will now be discussed in further detail. In
certain aspects, pump 3130 may determine an error at step 213 without any outside intervention
from, for example, MMU, HIS, BCMA, EMR, and the POC system. In some cases, pump 3130
may allow an auto—programming order to continue after displaying an error message. Pump
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3130 may also notify parties, such as MMU, HIS, BCMA, EMR, and the POC system of an error
and the error message that was displayed. Those of ordinary skill in the art will appreciate that
the error messages disclosed herein are exemplary, and may be modified without veering from
the scope of this disclosure.
[0094] Pump 3130 may display an error message such as associated with error code NTA00003
in Table 1 above, “The auto—program received contains duration information, and you cannot
titrate the duration of a delivery with this dosing unit”. This error message will be displayed
when the infuser receives an auto—program message with a titrated duration value and is for a
medication that normally has time—based alternative dosing units. For example, if the drug
involved in the program has time—based alternative dosing units the caregiver is not allowed to
change the duration because such an action would change the associated dose. Examples include
but are not limited to vasoactive drugs like nitroglycerin or Dopamine dosed in mcg/kg/min,
anti—coagulants like Heparin dosed in units/kg/hour, diabetes control drugs like Insulin dosed in
Units/kg/day, and oncolytic drugs like Taxol dosed in mg/m2/day. The particular drugs or
categories of drugs for which this type error is generated can be established by the hospital
according to their preferences in their user customizable drug library. On the same screen, pump
3130 may display the suggested action, e.g., “Press OK now, or wait for this screen to
automatically dismiss”. After selection of the “OK” input option or waiting for the screen to
automatically dismiss after the timeout period, pump 3130 may display the home A/B screen.
[0095] In some aspects of the disclosure, pump 3130 may display an error message such as “The
auto—program received did not contain all required information”. Generally, the auto-
programming message should include at a minimum the following information: pump channel,
drug name and concentration. If one or more of these elements, parameters or settings is
WO 2016/044232 PCT/US2015/050128
missing, the above—mentioned error message is displayed. On the same screen, pump 3130 may
display the suggested action, e.g., “Press OK now, or wait for this screen to automatically
dismiss”. As discussed above, after selection of the “OK” input option or waiting for the screen
to automatically dismiss after the timeout period, pump 3 130 may display the home A/B screen.
[0096] Pump 3130 may be programmed to generate and display an error message such as “The
auto—program received contains a value that exceeds a system limit. Or the values cause a
calculated parameter to exceed a system limit.” One or more system limits may be hard—coded
into pump 3130 and/or included in the drug library. The system limits may pertain to a rate. For
example, the pump 3130 may be able to pump at a maximum rate of 999 mL/hr. If an auto-
program request is received at a rate greater than 999 mL/hr., for example say 2000 mL/hr.,
pump 3 130 may display the error message. Similar system limits may exist for other information
such as duration, VTBI, and the like. Along with the error message, pump 3130 may display the
suggested action, e.g., “Press OK now, or wait for this screen to automatically dismiss”.
[0097] In some instances, pump 3130 may display an error message such as “The auto—program
is for a line that contains unconfirmed programming data”. This might happen if the caregiver
got called away on an emergency to help another patient or co—worker before confirming the
programming data. Pump 3130 may also display the corresponding suggested action “Resubmit
the auto—program. All unconfirmed data will be cleared.” Thus, in response to the error
message, caregiver 3132 may either resubmit the auto—program or reject the auto—program. If the
user elects to resubmit the auto—program, all of the unconfirmed data previously entered will be
cleared and thereafter replaced with the data from the resubmitted auto—program. If the caregiver
rejects the auto—program, the unconfirmed data will be maintained and the user is taken to the
last input screen used or the home A/B screen.
WO 2016/044232 PCT/US2015/050128
[0098] Pump 3130 may generate an error message at screen 603 stating “The auto—program is
rejected because of a partially programmed line.” A line is partially programmed when a drug is
selected for the line and the line program has not been cleared or confirmed. A pump with an
installed cassette was started. The CCA was selected. A new IV bag containing the same or
different drug was hung. The user manually selects one of the lines and a medication on the
pump. The user then switches part way through the programming sequence to the auto—program
process, wherein the barcode on the drug container is scanned and the order sent. The standard
auto—program for line A is sent to the infuser, which rejects the auto—pro gram because a manual
program was already partially input. On the same screen, the suggested course of action is
displayed: “Press [Clear] and resubmit the auto—program. All unconfirmed data will be cleared.”
[0099] Caregiver 3132 may select a “Standby” input option at pump 3130 for a particular
channel. The standby input option is selected to suspend for an indefinite time, up to 72 hours,
an infusion that has already been programmed on a particular channel or infusion line. The
standby option can be used prior to an infusion being started if the caregiver is unsure of the time
the infusion should be started. For example, the caregiver can set up the pump and it can be
programmed, but the patient may not yet be present at their bed. However, unlike the delayed
start option which inserts a predetermined delay prior to the start of a programmed infusion, the
standby option also can be selected during the execution of a programmed infusion. It would be
undesirable in most cases for a previously programmed and started infusion program to be
automatically supplanted by a new set of infusion pump settings through an auto—programming
message or request. Thus, the pump 3130 may not accept an auto—pro gram request for a channel
or line that is already in standby mode. When a request is received for a line in standby, pump
3130 may display an error message such as “The auto—program is for a line which is in Standby”.
WO 2016/044232 PCT/US2015/050128
Similarly, pump 3130 may not accept an auto—program request for a channel or line that is
“Delay Start” mode. As discussed above, “Delay Start” may enable a caregiver 3132 to input
auto—program settings to be started automatically at a later time (X number of minutes or hours
later), wherein the later time may be predetermined, known and selected by the caregiver 3132.
If pump 3130 receives a request for auto—program on a line which is in “Delay Start” mode,
pump 3130 may display an error message such as “The auto program is for a line which is in
Delay Start”. For both the Standby and Delay Start error messages, pump 3130 may display a
suggested action, e.g., “Clear this line and resubmit the auto—program”. This suggested action
may advise the caregiver 3132 to clear the line that is in either “Standby” or “Delay Start” mode
and then resubmit the auto—pro gram request.
[00100] Pump 3130 may display the error message “The auto—program is for a line that has
an active alarm that stops or prevents delivery, thus the auto—program is not valid in this alarm
condition.” Pump 3130 may be capable of outputting alarms for various situations or conditions.
For example, the pump 3130 battery may be almost dead and not plugged in to a power source.
In another example, a high priority alarm may be in progress. During these situations, pump
3130 may not accept an auto—program request and, along with the error message, may display the
suggested action “Clear the alarm condition and resubmit the auto—program”. Clearing the alarm
may comprise eliminating the condition causing the alarm (such as replacing or charging the
pump battery).
[00101] Because of the unique concurrent delivery capabilities of the PLUMTM infusion
pump, two different medications can be delivered from two different source containers upstream
of the pump, effectively at the same time through a single line to the patient downstream of the
pump. The pump can also switch back and forth from delivering medication from lines A and B
WO 2016/044232 PCT/US2015/050128
respectively, and vice versa, making separate but coordinated “piggyback” delivery possible and
convenient. However, this can lead to some rather complex scenarios from an auto-
programming perspective. Many things can go wrong and lead to errors, including failures,
unintended consequences or problems. Previously many of these errors would not have been
communicated to the caregiver at the pump or on its display screen. Recall from above that the
pump may have a rate limit of 999 mL/hr. The pump may have certain low flow limitations too.
Thus, in certain aspects, pump 3130 may display an error message such as “The auto—program is
not valid due to concurrency violation. Delivery A+B greater than 500 mL/hr or less than 0.5
mL/hr for each line. Although the pump is physically capable of 999 mL/hr. through a single
line, when concurrent delivery is taking place through two lines (A and B) only 500 mL/hr. is
permitted for each of the lines A and B. Otherwise, if each line were to be programmed to
deliver 500 mL/hr. or more, the pump system rate limit of 999 mL/hr. would be exceeded. Also,
each line must also be programmed to deliver at least 0.5 mL/hr. or more for proper pump
operation. As discussed above, on the same screen, pump 3130 may display the suggested
action, e.g., “Press OK now, or wait for this screen to automatically dismiss”. For greater clarity
to the pump user, the specific cause for the concurrency violation could be specified. For
example, the error message could read “Delivery of A+B greater than 500 mL/hr” or “Delivery
A+B less than 0.5 mL/hr” depending upon the specific cause. Concurrency errors can result
from various situations as well. For example, an auto—pro gram can be rejected for a concurrency
violation when a new IV bag or container or rate change is requested for Line A or Line B when
B is running in concurrent, which would result in a concurrency violation, i.e., delivery greater
than 500 mL/hr. for the sum of the two lines or less than 0.5 mL/hr. on each line. Alternatively a
concurrency violation can happen on the first attempt to program an initial concurrent delivery
WO 2016/044232 PCT/US2015/050128
on Line B. The error messages can be tailored to more clearly indicate the specific situation that
caused the rejection of the auto—program.
[00102] In some aspects, infusion pump 3130 may be configured to pump primary
medications through line A and secondary medication through line B in a separate but
coordinated piggyback delivery in series. In some cases, an auto—program request for line B may
cause an interruption to the pumping medication in line A. This may be undesirable, particularly
when the medication pumping in line A is vital such as critical medications including but not
limited to Dopamine, Heparin or Insulin. Thus, when the infusion pump 3130 receives an auto-
program for line B in step 651, the infusion pump 3130 may at step 653 make a determination
whether a medication on that or another line is interruptible. If the answer is affirmative, then
the process can continue to screen 605, step 655, etc. If the answer is negative, the pump 3130
can display an error message at screen 603 such as “The auto—program is not valid for line B.
The medication delivering for line A cannot be interrupted.” Similarly, infusion pump 3130 may
display an error message such as “The auto—program is not valid for line A. The medication in
the Auto—Pro gram is not interruptible and Line B is delivering a Piggyback infusion.”
Correspondingly, pump 3130 may display the suggested action “Press OK now, or wait for this
screen to automatically dismiss”.
[00103] Pump 3130 may display the same suggested action on a screen with an error message
such as “The auto—program is not valid because the weight of the patient in the Auto—Program
does not match the weight of the patient on the program delivering on the other line.” The
infusion pump 3130 may generate this or similar error message when the weight or expected
weight range entered for a patient is inconsistent among the multiple lines. For instance, a nurse
may enter a weight of 75kg for a patient on line A and then a weight of 7.5 kg for the same
WO 2016/044232 PCT/US2015/050128
patient on line B. These inconsistent weights may cause infusion pump 3130 to display the error
message. Similarly, pump 3130 may display an error message such as “The auto—program is not
valid because the height of the patient in the auto—program does not match the height of the
patient on the program delivering on the other line.” In this case, pump 3130 may ensure that the
height or expected height range of the patient receiving medication is consistent on line A and
line B. Similarly, pump 3130 may display an error message such as “The auto—program is not
valid because the BSA in the auto—pro gram does not match the BSA on the program delivering
on the other line.” BSA means body surface area and is usually estimated or calculated based on
a patient’s body mass and height. BSA is also sometimes expressed as BMI or body mass index
and some drugs are dosed on this basis.
[00104] As discussed previously, a caregiver 3132 may be required to enter a CCA prior to
programming the pump 3l30 manually or submitting an auto—program request. If no CCA is
received or a CCA not stored in the drug library is received, infusion pump 3130 may display an
error message such as “The Auto—Program is not valid because a CCA has not been selected on
the infuser.” Pump 3130 may also suggest the action, e.g., “Select a CCA and resubmit the
Auto—Pro gram”.
[00105] Pump 3130 may comprise a lock to the keypad shown in When the keypad
is locked, pump 3130 may not receive commands submitted by selecting buttons on the keypad.
Pump 3130 also may not receive auto—programming requests when the keypad is locked. In
those cases, pump 3130 may display an error message such as “The auto—program is not valid
because the keypad is locked.” The infusion pump 3130 may also display the suggested action,
e.g., “Unlock the keypad.” After caregiver 3132 unlocks the keypad, pump 3130 may
automatically accept the auto—programming request.
WO 2016/044232 PCT/US2015/050128
[00106] The remaining error messages discussed below may be displayed in conjunction
with the suggested action, e.g., “Press OK now, or wait for this screen to automatically dismiss”.
As discussed above, after selection of the “OK” input option or waiting for the screen to
automatically dismiss after the timeout period, pump 3 130 may display the home A/B screen.
[00107] Pump 3130 may, in some cases, generate and display an error message such as
“The Auto—Program is not valid because the received parameters will not result in a valid dose.”
When two out of the three parameters or variables volume, (flow) rate and duration are provided
to the pump 3130, its processor can calculate a dose. Normally when a certain dosage is being
targeted or ordered by the doctor, it is based upon the weight of the patient. The drug may be
available as an amount or mass in a given volume of diluent such as 5 mg / 1000 mL IV
container. When there is no combination of values of flow rate and duration that will result in a
valid dose, this error message is generated.
[00108] Infusion pump 3130 may display an error message such as “The auto—program is
not valid because the Rate cannot be titrated when VTBI is 0.” This error message may be
displayed when a caregiver 3132 enters a rate for a medication to be pumped while also entering
a total volume of the medication to be infused of 0 mL. Pump 3130 may therefore require a
VTBI greater than 0. The auto—pro gram might be a change to a currently running program — a
“titration.” However, if there is no VTBI left to infuse in the program, the rate or other
parameters cannot effectively be changed because there is no volume left to be infused.
Similarly, infusion pump 3130 may display an error message such as “The auto—program is not
valid because it is a titration for a line that has no confirmed program.” A titration is by
definition a change in rate, duration or VTBI in a currently running or already programmed
WO 2016/044232 PCT/US2015/050128
infusion. Thus, you cannot auto—program a titration or change for a line or pump channel until
after it has a prior program that has been confirmed.
[00109] In certain aspects, pump 3130 may display an error message such as “The auto-
program is not valid for a line with a Multistep or Loading dose program.” If the line is busy
with a multistep infusion or loading dose program, that program must be completed or cleared
before any new auto—pro gram request can be received and executed.
[00110] Infusion pump 3130 may display an error message such as “The Auto—Program
was rejected by Hospira MedNet due to incomplete or corrupt data.” This might be highlighted
by a checksum failure or handshake failure. Part of the auto—program message may have been
lost or corrupted for one reason or another.
[00111] Pump 3130 may display an error message such as “The Auto—Program for this
infuser was rejected by Hospira MedNetTM due to drug library incompatibility.” The drug library
identified in the device manifest for the auto—program message is not recognized. In other
words, the active drug library mentioned in the auto—program manifest does not match what the
MMU server 3108 and/or the pump itself thinks is the appropriate drug library that is in the
pump. For example, the drug library has an identifier (perhaps an alphanumerical string) that
may include the pump type and version of the drug library. For some reason, the drug library
version may get out of synch between the infusion pump and the MMU such that drug library
identifier in the auto—pro gram request does match the drug library that is currently in the infusion
pump.
[00112] illustrates a flow chart of a process 700 in accordance with aspects of the
disclosure. Process 700 may be carried out using infusion pump 3130 shown in Step
WO 2016/044232 PCT/US2015/050128
701 may comprise receiving an auto—programming request, wherein the auto—programming
request may comprise IV bag or drug container information such as drug name, concentration or
other drug identifying information, and infusion pump information, and optionally patient
identification information. Step 703 may comprise receiving infusion program settings,
parameters or variables including but not limited to dose, flow rate, duration and volume. Step
705 may comprise comparing the infusion program settings with drug library program settings,
wherein the drug library program settings are included in rule sets that place soft (breachable)
limits and hard (non—breachable) limits provided in a drug library stored at the infusion pump.
Step 707 may comprise determining whether the infusion program settings are consistent or
inconsistent with the drug library program settings based on the comparing.
[00113] Step 709 may comprise generating an error message based on the determining that the
infusion program settings are inconsistent with the drug library settings. Step 711 may comprise
displaying a screen, wherein the screen comprises the error message and a suggested action. In
some aspects, other steps may be performed as discussed above in connection with FIGS. 1-6.
[00114] In at least one embodiment of the invention, if the infusion program settings are
consistent with the drug library program settings based on the comparing, at step 713 the at least
one infusion pump 3130 compares the at least one stale auto—program received to the at least one
completed or running manual infusion program based on an approximate time of infusion
administration and parameter matching logic including infusion administration parameters and
infusion pump operating parameters, to determine if the at least one previously completed or
running manual infusion program is acceptable based on the potential matches as discussed
previously.
WO 2016/044232 PCT/US2015/050128
[00115] At step 715, in one or more embodiments, the at least one infusion pump 3130 saves
the acceptably completed or running manual infusion programs for later analysis. In at least one
embodiment, at step 715, the at least one infusion pump may optionally notify the at least one
caregiver 3132 of the acceptable at least one completed or running manual infusion program
instead of the at least one auto—pro gram as the acceptable program.
[00116] It will be apparent to those skilled in the art that numerous modifications and
variations of the described examples and embodiments are possible in light of the above
teaching. The disclosed examples and embodiments are presented for purposes of illustration
only. Other alternate embodiments may include some or all of the features disclosed herein. For
example, the first computer can be in the HIS/POC or other computer system inside or outside
the healthcare facility such that the MMU 3108 is not required to communicate with the infusion
pump 3130. Therefore, it is the intent to cover all such modifications and alternate embodiments
as may come within the true scope of this invention.
WO 2016/044232 PCT/US2015/050128
Claims (9)
- l. A system that identifies acceptable manual programs that correspond to delayed infusion auto—programs that arrive at an infusion pump comprising: a first computer comprising a computer network interface; and, at least one infusion pump; wherein said first computer communicates with said at least one infusion pump via said computer network interface; wherein said first computer receives at least one infusion auto—pro gram from a remote source, wherein said at least one infusion auto—pro gram comprises IV drug container information, infusion pump information, and infusion program settings, transmits said at least one infusion auto—pro gram to said at least one infusion pump, queues said at least one infusion auto—program when said first computer is unable to transmit said at least one infusion auto—pro gram to said at least one infusion pump, and, sends at least one stale auto—program to said at least one infusion pump when said at least one infusion pump communicates with said first computer; and, wherein said at least one infusion pump receives at least one manual infusion program from a caregiver, wherein said at least one manual infusion program comprises one or more of a completed manual infusion program or a running manual infusion pI'OgI'3.l’1’l, WO 2016/044232 PCT/US2015/050128 saves and executes said at least one manual infusion program received from said caregiver, compares said at least one stale auto—pro gram to said at least one manual infusion program, wherein said comparison is based on one or more factors comprising an approximate time of infusion administration or parameter matching logic comprising infusion parameters, compares the infusion parameters to identify potential matches between said at least one stale auto—pro gram and said at least one manual infusion program, evaluates the potential matches using one or more configurable rules and determines if said potential matches are within a predefined tolerance, continues to execute said at least one manual infusion program on said at least one infusion pump if said potential matches are within said predefined tolerance, saves differences in said at least one manual infusion program and said at least one stale auto—pro gram, saves a first event alert indicating the at least one manual infusion program as an acceptable potential match of said potential matches, and saves a second event alert indicating the at least one auto—pro gram as an un—eXecuted program because the at least one manual infusion program is an acceptable potential match.
- 2. The system of claim 1, wherein said at least one manual infusion program is provided in a library stored at said at least one infusion pump. WO 2016/044232 PCT/US2015/050128
- The system of claim 1, wherein said differences in said at least one manual infusion program and said at least one stale auto—pro gram are saved to a remote server.
- The system of claim 1, wherein said at least one infusion pump saves identification data of said caregiver.
- The system of claim 1, wherein said at least one infusion pump compares said at least one manual infusion program from said caregiver to said at least one stale auto—pro gram to determine a scoring of accuracy comprising an acceptability level of said at least one manual infusion program from said caregiver.
- The system of claim 4, wherein said at least one infusion pump generates at least one report from said comparison, and wherein said report comprises one or more of a time differential between completion time of said at least one manual infusion program and completion time of said at least one stale auto—program, a scoring of accuracy comprising an acceptability level between infusion administration parameters of said at least one manual infusion program and said at least one stale auto—program, and a rating of said caregiver.
- The system of claim 1, wherein said at least one infusion pump transmits said at least one manual infusion program from said caregiver to said first computer, and wherein said first WO 2016/044232 PCT/US2015/050128 computer saves said at least one manual infusion program from said caregiver and saves identification data of said caregiver.
- 8. The system of claim 6, wherein said first computer compares said at least one manual infusion program from said caregiver to said at least one stale auto—pro gram to determine a scoring of accuracy comprising an acceptability level of said at least one manual infusion program from said caregiver. 9. The system of claim 7, wherein said first computer generates at least one report from said comparison, and wherein said report comprises one or more of a time differential between completion time of said at least one manual infusion program and completion time of said at least one stale auto—program, a scoring of accuracy comprising an acceptability level between infusion administration parameters of said at least one manual infusion program and said at least one stale auto—program, and a rating of said caregiver. 10. A method for identifying delayed infusion programs at an infusion pump comprising: providing a first computer comprising a computer network interface; and, providing at least one infusion pump; communicating with said first computer and said at least one infusion pump via said computer network interface; WO 2016/044232 PCT/US2015/050128 receiving via said first computer, at least one infusion auto—pro gram from a remote source, wherein said at least one infusion auto—pro gram comprises IV drug container information, infusion pump information, and infusion program settings, transmitting said at least one infusion auto—program to said at least one infusion pump, queuing said at least one infusion auto—pro gram when said first computer is unable to transmit said at least one infusion auto—pro gram to said at least one infusion pump, and, sending at least one stale auto—pro gram to said at least one infusion pump when said at least one infusion pump communicates with said first computer; and, receiving via said at least one infusion pump, at least one manual infusion program from caregiver, wherein said at least one manual infusion program comprises one or more of a completed manual infusion program or a running manual infusion program, saving and executing said at least one manual infusion program received from said caregiver, comparing said at least one stale auto—pro gram to said at least one manual infusion program, wherein said comparing is based on an approximate time of infusion administration and parameter matching logic comprising infusion administration parameters and infusion pump operating parameters, WO 2016/044232 PCT/US2015/050128 comparing the infusion pump operating parameters and the infusion administration parameters to identify potential matches between said at least one stale auto- pro gram and said at least one manual infusion program, evaluating the potential matches using one or more configurable rules and determines if said potential matches are within a predefined tolerance, continuing to execute said at least one manual infusion program on said at least one infusion pump if said potential matches are within said predefined tolerance, saving differences in said at least one manual infusion program and said at least one stale auto—pro gram, saving a first event alert indicating the at least one manual infusion program as an acceptable potential match of said potential matches, and saving a second event alert indicating the at least one auto—pro gram as an un—eXecuted program because the at least one manual infusion program is an acceptable potential match. ll. The method of claim 10, further comprising providing said at least one manual infusion program in a library stored at said at least one infusion pump. 12. The method of claim 10, further comprising saving said differences in said at least one manual infusion program and said at least one stale auto—program to a remote server. PCT/US2015/050128 WO 2016/044232 v_§Ez mmE_>: _|v masaza +--.§6<>>o:s,a.---- 52% EOE % v_§Ezax_>: . ............................ 30:22 ..... ..v I %_§_>__>_ z_2e:>m AIao6<>>o:§a| Q23 as masfiza hA|/I ,0 E95 5232 v_§Ez§z_>s>z_ zo_§z_ _ 2: &/ UI >>?__$_ .|5z>>o:§a| zmim >>Z_>=a emzz$_:_>=a 2: _s_§a___§ 92$: _ . _ . . 8% Em__._u m_._n_ _>E§ \. . 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DU_ E\._E E\._E omm Bax :_E:E ooumo :o_o.S:Q o 3% omm E 8m _m:> E\._E E\._E omm Bax UwUw_wm 9:0 oz UwUw_wm 9:0 oz m_ oz_.=>:: < Eemoa Eecoo _8bm_mm 925 oz EEOOE EE:ou < wzczcou m Efimofi Uw.Em_ .0 _owUw_wm mE_o oc 53> wscrcou :_ w_o_m_ :o_..mu__owE 2: ._w_o._o m_£ ._o“_ m mc_S:ou Em._mo.i-oS< 2? _ow..3_..8_:m :wwo_ mm; =_8Uw_wm 9.5 oz‘. So: <8 2: _m>m Ho: m_ ;oE>> :o_..mo__owE m_ tw_< :o:B_§_:m < .._8Uw_mm QE3n_ 9:0 oz: 9. EEO mwmcmsu <uu \.u._o> hmcfimm m_ < u Eemoa m_\< w:_._ Uw_wm :_rC o E _o> o o 3% o < _ou_ Uw>_wuw_ PCT/US2015/050128 WO 2016/044232 OZ >o__ocSm mw> m co_..mEEcoU >o__ocSm ”>o_UcSm ..__om_ “oz \c_w>__w_o tfim Mw> :_E:E 39 :o:.S:Q ._E omm _m_._.> E\._E <2 Bax :_E\9_\9E o.m mmoo ._E omm BE 8.» E8 mz__>_<¢oo Emaoi ::_uEou < <uu \.u._o> \mmc_:mm m_ < m Eemoa 9. m_\< wc_._ Uw_wm o uE_ _o> _.o E\._E o Sam >n_oc8.m ._E omm BE 8.» mz_.>_Eoe m_ UZE_>_Dn_ < _, Bo .\ » //moo ©._U_n_ m_\< tfim >m_wQ Uwfim
- 9. E33. m ~.co_Uw.m: u_..mEo..:m .8 <8 \.u._o> _omQ>wv_ 9:3 w:_m> .wEm_ .._m>> .0 30: .220 25 swam \.u.m:_:wm < m_ Eocsm w:__ UWEESQQQ m Eemoa 9. m_\< wc_._ Um_mm 9: co ::w>__wU m_ :_E:E moi co_..mSQ ..m;>> Eoc Ew$t_U m_ ;uE>> ._E omm _m_._.> :o:.mu_UmE m Uwczficou o .E_ _o> owm E\._E _.m_ Bax . . m . I Uw>_wuw_ ES oE-o..:< 9? E\._E ._E omm \©E oow ucou o wwmm —.m— m_z__>_<mOQ mz_.>_Eoe . ._E omm BE 8.» Eemoa < :m_< :o_Um.$_ < mz_.>_§oa mock m8\ m_ oz_.=>_E < < co \Cw>__w_o mm u:ou\_ow_>_ wEmm .0 w_o_SQwuu< < .0“. _ow>_wuw_ _, r so WO 2016/044232 Receive an auto—programming request, wherein the auto—programming request comprises IV drug container information, infusion pump information, and optionally patient identification information Receive infusion program settings Compare the infusion program settings with drug library program settings, wherein the drug library program settings are provided in a drug library stored at the infusion pump Determine whether the infusion program settings are consistent or inconsistent with the drug library program settings based on the comparing PCT/US2015/050128 ‘I-700 Inconsistent Consistent y Generate an error message based on the determining that the infusion program settings are inconsistent with the drug library settings Compare stale auto program received to completed or running programs by approximate time of infusion and determine if previously run or currently running program is acceptable Display a screen, wherein the screen comprises the error message and a suggested action Save acceptably completed program and stale auto program for later analysis and optionally display acceptable program run instead of auto program
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Application Number | Priority Date | Filing Date | Title |
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US62/050536 | 2014-09-15 | ||
US14/853198 | 2015-09-14 |
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