System and method for dynamically adjusting patient therapy

• US 7,860,583 B2
• Filed: 08/25/2004
• Issued: 12/28/2010
• Est. Priority Date: 08/25/2004
• Status: Active Grant

• Current Assignee: Carefusion 303 Incorporated (Becton, Dickinson & Co)
• Original Assignee: Carefusion 303 Incorporated (Becton, Dickinson & Co)
• Inventors: Morling, Simon, Condurso, Joseph, Yamaga, Cynthia, Butterfield, Robert, Vanderveen, Timothy, Crass, Richard, West, Patricia, Pait, Clifton
• Primary Examiner(s): Hartman, Jr.; Ronald D
• Application Number:
  US10/925,511
• Publication Number:
  US 20060047538A1
• Time in Patent Office: 2,316 Days
• Field of Search: 700/79, 700/2, 700/9, 700/17, 700/83, 340/3.1, 702/188
• US Class Current: 700/2
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/002 Monitoring the patient using a local or closed circuit, e.g. in a room or building A61B5/0017 takes precedence
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/14546 for measuring analytes not otherwise provided for, e.g. ions, cytochromes
• CPC Class Codes: A61B 5/4839 combined with drug delivery
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• CPC Class Codes: A61M 2205/18 with alarm
• CPC Class Codes: A61M 2205/3576 with non implanted data transmission devices, e.g. using external transmitter or receiver
• CPC Class Codes: A61M 2205/50 with microprocessors or computers
• CPC Class Codes: A61M 5/172 electrical or electronic A61M5/16804, A61M5/16831 take precedence
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/17 delivered via infusion or injection
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders
• CPC Class Codes: G16H 70/00 ICT specially adapted for the handling or processing of medical references
• CPC Class Codes: G16H 70/40 : relating to drugs, e.g. their side effects or intended usage
• CPC Class Codes: G16H 70/60 : relating to pathologies

Abstract

A system and method of managing therapy provided to patients in an institution. The system monitors all aspects of the medication delivery to a patient, as well as other information related to the patient, such as values of vital signs, laboratory results and patient factors such as history, diagnosis, allergies and the like. The system includes one or more databases of information, including institutionally developed rules, guidelines and protocol representing the best medical practices of the institution. The system provides alerts and/or recommendations based on the application of the rules to the information being monitored, and alerts care givers accordingly, providing for dynamic adjustment of the patient'"'"'s therapy. The system also monitors the status of the alerts, and if no action is taken in a selected period of time, may escalate the priority of the alert and/or halt the delivery of medication to the patient until the alert is resolved.

Claims

1. A system for managing therapy provided to a patient, comprising:

a communication system, the communication system configured to provide two way transmission of information over the communication system;

a medication delivery device having a processor and a memory associated with the processor for storing programs for operating the processor to control the medication delivery device, the medication delivery device also including a communication means, an input device for entering medication delivery parameters, and a display, all in operable communication with the processor, the medication delivery device capable of communicating over the communication system through its communication means;

at least one server operably connected to the communication system, the at least one server configured to access a database representative of at least one institutionally determined rule, and also configured to monitor activity of the medication delivery device and provide the medication deliver device with patient and drug information and operating commands;

wherein medication delivery parameters entered into the medication delivery device using the input device is communicated to the server and the server compares the communicated medication delivery parameters to information stored in the database of at least one institutionally determined rule to determine if the communicated medication delivery parameters fall within a range of values indicated as acceptable by the at least one institutionally determined rule; and

wherein if the comparison indicates that the communicated medication delivery parameters do not fall within a range of values indicated as acceptable;

the at least one server provides an alert to a caregiver and dynamically adjusts the medication delivery parameters to acceptable values.

2. The system of claim 1, wherein the server monitors a status of the alert, and if a selected period of time elapses without a change in the status of the alert, increases a priority of the alert.

3. The system of claim 2, wherein the server transmits the alert with the increased priority to a care giver through the communication system.

4. The system of claim 1, wherein the server monitors information communicated through the communication system to determine if a required laboratory test for a patient has been performed within a selected period of time, and wherein if the test has not been performed, communicates an alert to a care giver.

5. The system of claim 4, wherein the server monitors a status of the alert, and if a selected period of time elapses without a change in the status of the alert, increases a priority of the alert and communicates the alert with the increased priority to the caregiver.

6. The system of claim 5, wherein the server monitors a status of the alert with the increased priority, and if a selected period of time elapse without a change in the status of the alert with the increased priority, communicates an alert with a further increase of priority to the care giver.

7. The system of claim 6, wherein the server also communicates a command to the processor of the medication delivery device to stop delivery of the medication.

8. The system of claim 1, wherein the server stores records containing information related to the alert in a memory, and wherein the server analyzes the stored records and generates reports of the information related to the alerts.

9. The system of claim 1, wherein the at least one institutionally determined rule is a pharmacokinetic model.

10. The system of claim 1, wherein the at least one institutionally determined rule is a pharmacodynamic model.

11. The system of claim 1, wherein the at least one institutionally determined rule contains information related to drug incompatibilities.

12. The system of claim 11, wherein the medication delivery device is an infusion pump and the processor monitors medication identification information entered by the input device and compares the entered information with medication identification information of a medication already being infused by the pump and accesses the drug incompatibility information stored on the server and, if the comparison indicates that entered medication is incompatible with the infusing medication, the processor communicates an alert to the care giver.

13. The system of claim 12, wherein the processor accesses the server and retrieves at least one recommendation for altering a prescribed treatment regimen and communicates the at least one recommendation to the care giver.

14. A method of managing patient therapy, comprising:

communicating information between therapy delivery devices,

monitoring devices and institutional information systems;

monitoring information communicated between the therapy delivery devices, monitoring devices and institutional information systems;

comparing the communicated information with a database of institutionally determined rules related to therapies to be delivered to patients in an institution;

identifying instances when a proposed therapy to be delivered to a patient violates at least one rule of the database of institutionally determined rules;

communicating an alert to a care giver that the proposed therapy violates the at least one rule; and

dynamically adjusting the proposed therapy to comply with the at least one rule.

15. The method of claim 14, further comprising:

monitoring the information communicated between the therapy delivery devices, monitoring devices and institutional information systems for information related to a specific patient, and alerting the care giver if any of the monitored patient specific information violates the at least one rule of the database of institutionally determined rules.

16. The method of claim 15, wherein monitoring the information includes monitoring for information generated by monitoring devices associated with the specific patient.

17. The method of claim 15, wherein monitoring the information includes monitoring for information generated by laboratory tests associated with the specific patient;

comparing the information generated by the laboratory test to the at least one rule; and

alerting the care giver if the information generated by the laboratory test violates the at least one rule.

18. The method of claim 14, further comprising:

monitoring a status of the alert;

increasing a priority of the alert if the monitored status of the alert indicates that the status of the alert has not changed within a selected period of time; and

communicating the alert with the increased priority to the care giver.

19. The method of claim 14, further comprising:

providing the care giver with recommendations for resolving a cause of the alert.

20. The method of claim 14, wherein the at least one rule includes information related to drug incompatibilities.

21. The method of claim 14, further comprising:

storing information related to a condition of the patient when the alert is communicated;

storing information related to the therapy being delivered when the alert is communicated; and

storing information related to the alert when the alert is communicated;

analyzing the stored patient condition information, the therapy delivery information and the alert information; and

reporting the analyzed information to the care giver.

22. The method of claim 21, further comprising:

providing recommendations for altering at least one rule in the database of institutionally determined rules in response to the analyzed information.

23. A system for managing therapy provided to a patient, comprising:

a communication system, the communication system configured to provide two way transmission of information over the communication system;

a medication delivery device having a first processor and a memory associated with the processor for storing programs for operating the processor to control the medication delivery device, the medication delivery device also including a communication means, an input device for entering medication delivery parameters, and a display, all in operable communication with the processor, the medication delivery device capable of communicating over the communication system through its communication means;

a second processor operably connected to the communication system, the second processor configured to access a database representative of at least one institutionally determined rule, and also configured to monitor activity of the medication delivery device and provide the medication delivery device with patient and drug information and operating commands;

wherein medication delivery parameters entered into the medication delivery device using the input device is communicated to the second processor and the second processor compares the communicated medication delivery parameters to information stored in the database of at least one institutionally determined rule to determine if the communicated medication delivery parameters fall within a range of values indicated as acceptable by the at least one institutionally determined rule; and

wherein if the comparison indicates that the communicated medication delivery parameters do not fall within a range of values indicated as acceptable, the second processor provides an alert to a caregiver and dynamically adjusts the medication delivery parameters to acceptable values.

24. The system of claim 23, wherein the database includes at least one rule related to drug incompatibility.

25. The system of claim 23, wherein the database includes at least one rule related to drug contra-indications.

26. The system of claim 23, wherein the medication delivery device is an infusion pump.

27. The system of claim 26, further comprising a second infusion pump having a third processor and a memory associated with the third processor for storing programs for operating the processor to control the medication delivery device, the medication delivery device also including a communication means, an input device for inputting patient and drug information, and a display, all in operable communication with the processor, the medication delivery device capable of communicating over the communication system through its communication means to the second processor, and wherein the second processor monitors the activity of the second infusion pump, and compares the drugs being infused on the first and second infusion pumps to determine if the drugs are compatible.

28. The system of claim 27, wherein the medication delivery device further includes a means for notifying a caregiver of an alert, and wherein the an alert provided by the second processor is also provided to the care giver by the means for notifying the care giver of the second infusion pump.

29. The system of claim 23, wherein the database includes at least one rule pertaining to drug incompatibility, and the first processor is programmed to compare a currently prescribed drug to at least one previously delivered drug to determine the presence of an incompatibility between the currently prescribed drugs and the at least one previously delivered drug.

30. A system for managing therapy provided to a patient, comprising:

a communication system, the communication system configured to provide two way transmission of information over the communication system;

a medication delivery device having a processor and a memory associated with the processor for storing programs for operating the processor to control the medication delivery device, the medication delivery device also including a communication means, an input device for inputting patient and drug information, and a display, all in operable communication with the processor, the medication delivery device capable of communicating over the communication system through its communication means;

at least one server operably connected to the communication system, the at least one server configured to access a database representative of at least one institutionally determined rule, and also configured to monitor activity of the medication delivery device and provide the medication deliver device with patient and drug information and operating commands;

wherein information entered into the medication delivery device using the input device is communicated to the server and the server compares the communicated information to information stored in the database of at least one institutionally determined rule to determine if the communicated information falls within a range of values indicated as acceptable by the at least one institutionally determined rule; and

wherein if the comparison indicates that the communicated information does not fall within a range of values indicated as acceptable;

the at least one server provides an alert to a caregiver, and

wherein the server monitors information communicated through the communication system to determine if a required laboratory test for a patient has been performed within a selected period of time, and wherein if the test has not been performed, communicates an alert to a care giver.

31. The system of claim 30, wherein the server monitors a status of the alert, and if a selected period of time elapses without a change in the status of the alert, increases a priority of the alert and communicates the alert with the increased priority to the caregiver.

32. The system of claim 31, wherein the server monitors a status of the alert with the increased priority, and if a selected period of time elapse without a change in the status of the alert with the increased priority, communicates an alert with a further increase of priority to the care giver.

33. The system of claim 32, wherein the server also communicates a command to the processor of the medication delivery device to stop delivery of the medication.