Data processing: generic control systems or specific application – Specific application – apparatus or process – Article handling
Reexamination Certificate
1998-10-16
2002-01-15
Grant, William (Department: 2121)
Data processing: generic control systems or specific application
Specific application, apparatus or process
Article handling
Reexamination Certificate
active
06339732
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates generally to computerized medication management and dispensing stations. More particularly, the present invention relates to a system, method, and apparatus for controlling the dispensing and inventory of anesthesiology items in a health care institution.
2. Description of Related Art
Medication management in anesthesia presents a challenge for both the pharmacy and the anesthesia departments in health care institutions. Anesthesia requires open, unrestricted access to many medications, including narcotics as well as supplies. Pharmacies, on the other hand, must control access to medications and impose security measures. Organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Drug Enforcement Agency, and the State Boards of Pharmacy require strict documentation and record keeping of narcotic usage. The JCAHO provides accreditation to member hospitals. In order to earn and keep the JCAHO accreditation, hospitals must adhere to strict access and control policies for medications or risk potential fines and possible shut down of the facility. Fines related to improper management of narcotics in one operating room can be $15,000.00 or more per offense. A study found that 11% of all hospitals reviewed by the JCAHO received a recommendation for improvement based on improper handling of narcotics.
The pharmacy is responsible for medications, particularly from a regulatory perspective, but is able to manage the medications only remotely. As a consequence, a serious responsibility gap exists in medication control from the time the medications are issued to anesthesiologists until the end of the day when remaining medications are returned. Complying with federal regulations is often a tedious task. Anesthesia records are often incomplete with respect to accurate medication usage documentation during and after a procedure. Current methods of anesthesia narcotic medication management are labor intensive for pharmacists and anesthesiologists, often leading to costly errors. Currently, narcotics are generally tracked in one of two fashions.
A first method of tracking narcotics, the satellite pharmacy, is used at some of the larger hospitals. Affluent hospitals often provide a satellite pharmacy that services the special needs of the operating room. The anesthesiologist signs out narcotics from the satellite pharmacy by going to the pharmacy and interacting with a pharmacist. If a pharmacist is not available, one must be paged. The anesthesiologist returns to the satellite pharmacy when a free moment is found to reconcile the unused medications with a pharmacist. Reconciling unused medications requires documenting on the patient record or returning to the pharmacy all medications that were signed out by the anesthesiologist. The pharmacy disposes of contaminated medications (referred to as “waste”) or returns unused medications to stock. This process is time-consuming and cumbersome to both the pharmacy and the anesthesiologist. The task requires a pharmacist to be available at all times that the operating room is in operation. Anesthesiologists must take time away from patient care to reconcile medication usage with the pharmacy. To mitigate these constraints, anesthesia and nursing staff have unsupervised access to the satellite pharmacy during off hours. The burden of narcotic tracking, however, still falls on the pharmacy during these off hour periods and the healthcare facility is exposed to potentially severe regulatory agency repercussions.
Satellite pharmacies are becoming rare due to the expense and overhead of running a specialized pharmacy. As an alternative, many hospitals are using a second method of tracking narcotics called the tackle-box method. The tackle box is a small, locked container that is prepared by the main pharmacy for each anesthesiologist. The anesthesiologist picks up his or her tackle box in the morning from the main pharmacy or from a locked room in the operating room. The location usually depends upon the pharmacy's delivery capabilities. The tackle box usually contains a usage sheet where the anesthesiologist records the medications that were used, the patients on which the medications were used, and the quantities dispensed. The completed sheet and unused medications are returned at the end of the day to the main pharmacy or to the locked room. The pharmacy must inspect each medication record to insure accuracy and compliance. Any inconsistencies must be addressed with the anesthesiologist. However, the inconsistencies may not be addressed for several days at which point the anesthesiologist may not remember the exact circumstances surrounding the medication discrepancy. The hospital is in direct violation of the regulations until the discrepancy is resolved.
Attempts to automate the medication management process in anesthesia have been made. One product that is currently available is a semi-automated tackle-box system of narcotic medication control made by Secure-1, Inc. of Hamilton, Ohio. A small (about the size of a loaf of bread) metal box with a LCD screen and keypad on its face is used to perform narcotic medication control. The anesthesiologist signs out a box from a storage location. After the box has been removed from the storage location, only the anesthesiologist who signed out the box may open it. Once open, all the medications, including narcotics, are readily accessible. Documentation is provided via the small LCD screen and keypad. Dosages are recorded in the system by time and patient. Although the system provides some electronic information capture, there is still much legwork to be done. First, the anesthesiologist must go someplace to sign out the box. Because of the small size, only narcotics may be stored in the box. The anesthesiologist must gather the required non-narcotics via the old methods described above—either through a satellite pharmacy or a medication cabinet located somewhere outside the operating room. When a case is over, the anesthesiologist must return the box to its storage location where the pharmacy retrieves it to verify and refill contents usage. This product still requires a great deal of manual labor to complete the tracking process. The anesthesiologist is required to carry the box throughout the day. In addition, the anesthesiologist must personally remove the box from a storage location (e.g., outside the operating room) and return it to the same storage area at the end of the day.
The above two scenarios form the basis for medication management in the operating room today. Each requires both time and people to complete the tracking process. Even in a perfect environment, mistakes are made, medications are not documented, documentation is not accurate, or items are diverted without a record. Often, the mistakes are due to uncontrollable events that occur during a procedure. In some cases, an anesthesiologist may require additional medications not anticipated prior to a case. A circulating nurse must then leave the procedure room to retrieve the needed item. This requirement adds unnecessary and costly delays to the procedure. Whatever the case, the result is inaccurate medication usage documentation.
In addition to control of narcotic medications, management of non-narcotic medications and supplies is often inefficient and leads to costly errors. To manage non-narcotic medications and supplies, anesthesiologists typically use a system separate from narcotic management. Anesthesiologists employ a non-secured, non-automated mobile drawer cart, often a Blue Bell Cart or a Sears Craftsman tool chest, to store these non-secured items. Narcotics are not stored in these carts because the cart is not locked. Therefore, a separate system for narcotic management is still required. Typically, every operating room has its own cart so that non-narcotics and supplies are readily available for use by any anesthesiologist using the room.
This non-automated, non-secured practice often results in
Chang Steven W.
Kurtz Michael
Phoon Florence H.
Radziminski Thomas E.
Richter-Dycaico Paula A.
Gain, Jr. Edward F
Grant William
Pyxis Corporation
Standley Jeffery S.
Steffensmeier Michael D.
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