Field of the Invention

The present invention relates generally to systems and methods for managing the administration of medication to patients, and more particularly to electronic systems for facilitating the same.

Background to the Invention

Doctors and other healthcare professionals authorised to prescribe medication to patients must be aware of the medication history of the patient and any drug sensitivities or allergic reactions. Care must be taken to ensure that the prescribed medication does not interact adversely with any current medication being administered to the patient whether that medication is other prescription medication, over the counter medication or a complementary or alternative medicine.

Prescriptions are typically written on sheets of prescription paper provided in a pad form. Prescription paper is usually preprinted with the name, address and healthcare provider number of the prescribing physician. Some prescription paper pads include carbon paper enabling the original prescription to be provided to the patient to be taken to a pharmacy where a pharmacist fills the prescription based on the physician's instructions. The prescription copy is retained by the prescribing healthcare professional to be recorded in the patient's medical record.

In a hospital setting, an in house pharmacist or pharmacy department is usually provided to coordinate the dispensing of medications to patients of the hospital. In this case, the prescribing physician may write one or more prescriptions on a medication chart which must be removed from the ward and taken to the hospital pharmacy to enable the hospital pharmacist to fill the prescription. The medication chart is also required by the nursing staff to ensure that the correct medication is administered to the patient at the right time and the correct dose and via the right route, and also to maintain a record of the medication, dose and time of administration for the patient.

Handwritten prescriptions and medication charts are frequently misinterpreted, or may be completely illegible to the dispensing pharmacist.

Where handwritten prescriptions are only legible in part, there is a high risk that the medication will not be administered to the patient in accordance with the prescribing physicians intended instructions. Another problem with the current system is that the medication chart is delivered to the hospital pharmacy for dispensing of the medication and therefore will not be available on the ward for the period of time until the prescription is filled and the medication chart is returned to the ward. Errors in medication administration or missed medications are not uncommon and place the wellbeing of patients at risk.

The discussion of the background to the invention included herein is included to explain the context of the invention. This is not to be taken as an admission or suggestion that any of the material referred to were published, known or part of the common general knowledge as at the priority date of the claims.

Summary of the Invention

According to an aspect of the present invention, there is provided a system for managing the administration of medication to a patient, the system including:

(a) an electronic prescription component to enable a healthcare professional to prescribe a medication to be administered to the patient;

(b) a dispensing component to enable the medication to be issued to the patient from a dispensary; and

(c) a medication administration component for maintaining a record of the medication administered to the patient; wherein the components are connected to form an integrated system.

In one embodiment of the invention, the system further includes an authorisation component for assigning an authorised prescriber role to one or more healthcare professionals who are authorised to prescribe one or more classes of medication to patients. In another form of the invention, the dispensing component issues medication to the patient from pharmacy or ward stock.

Preferably, the dispensing component includes an inventory control component to enable the medication to be issued to the patient from an inventory.

In yet another embodiment of the invention, the electronic prescription component checks drug allergies, drug interactions and drug contra indications to the patient's condition before validating a prescription.

Preferably, the system includes integrated access to clinical data records which record clinical data pertaining to the patient.

More preferably, the system further includes an audit component enabling a user to review all activities pertaining to a particular patient and/or medication.

According to an embodiment of the invention, the system further includes an identification component associated with the system for identifying a patient and confirming the medication due to be administered to the patient.

In a preferred form of the invention, the system further includes a workflow component for generating work lists relating to one or more of the following: (a) medication that has been prescribed for a patient and requires approval and/or dispensing by the dispensary; or

(b) medication to be administered to a patient so that the user knows what and when medications are due.

Preferably, the system further includes an alerting component for issuing system alerts to remind a user if a medication has not been dispensed and/or administered in a timely manner.

In another preferred embodiment of the invention, the system further includes a fluid balance component to enable a fluid entered via the medication administration component to be automatically directed to a fluid balance chart to record fluid intake by the patient.

According to another aspect of the invention, there is provided a method for managing the administration of medication to a patient, the method including the following steps:

(a) a healthcare professional electronically prescribing a medication to be administered to the patient;

(b) transmitting the electronic prescription to a dispensary;

(c) the dispensary issuing the medication to the patient from an inventory;

(d) updating the inventory by adjusting stock numbers to reflect the medication issued to the patient;

(e) administering the medication to the patient in accordance with the healthcare professional's instructions;

(f) updating a record of the medication administered to the patient; wherein completion or non completion of each step is recorded in an electronic medication administration record.

In one form of the invention, the method further includes the step of authorising one or more healthcare professionals to electronically prescribe one or more classes of medication to patients.

Preferably, the method includes the step of checking drug allergies, drug interactions and drug contra indications to the patient's condition before validating an electronic prescription.

In another embodiment, the method includes the step of conducting an audit by reviewing all activities pertaining to a particular patient and/or medication. Preferably, the method further includes the step of issuing an alert to remind a user if a medication has not been dispensed and/or administered in a timely manner.

In a preferred embodiment of the invention, the method further includes the step of managing workflows relating to one or more of the following: (a) medication that has been prescribed for a patient and requires approval and/or dispensing from the dispensary; or

(b) medication to be administered to a patient so that the user knows what and when medications are due.

An advantage of the present invention is a reduction in delays between prescription and administration of medication to a patient.

Another advantage of the present invention is the provision of relevant clinical information corresponding to the patient at medication administration ensuring that nursing staff have access to clear and pertinent information for drug administration. Yet another advantage of the present invention is improved stock control and optimisation of both ward and pharmacy medication stock levels.

A further advantage of the present invention is that the system records all actions on a medication against a username associated with a healthcare

professional with a date and time of transaction, thereby improving audit capabilities.

Brief Description of the Drawings The invention will now be described in further detail by reference to the attached drawings illustrating example forms of the invention. It is to be understood that the particularity of the drawings does not supersede the generality of the preceding description of the invention. In the drawings:

Figure 1 is a screen view of an order entry to be completed by a healthcare professional when prescribing medication to be administered to a patient.

Figure 2 is a screen view of a medication chart according to an embodiment of the present invention.

Figure 3 is a screen view showing a form for recording parenteral administration of medication.

Figure 4 is a screen view showing a form for recording medication administered by fluid infusion.

Figure 5A is a screen view of a medication chart for nurse initiated medications. Figure 5B is a screen view of an order entry for a nurse initiated medication.

Figure 6 is a screen view showing a form for recording self administration of analgesics.

Figure 7 is a screen view of a medication administration list according to an embodiment of the present invention.

Detailed Description

A primary function of the system of the present invention is to maintain a record of the details of medication that has been administered to a patient by a healthcare professional. A record of medication administered to a patient must be maintained regardless of whether the medication itself is prescribed by a doctor or administered ad-hoc. The term medication is intended to include various classes of drugs including prescription and non prescription drugs, and intravenous infusions including parenteral nutrition, blood products, intravenous

fluids and patient controlled analgesics. The medication may be administered manually or via devices such as syringe pumps (e.g. an IVAC® pump). The healthcare professional may be a doctor, nurse or allied health professional depending on the roles that have been authorised for prescribing and administrating the medication.

The present invention provides an integrated system including an electronic prescribing component to enable a healthcare professional to prescribe a medication to be administered to a patient, a dispensing component to enable the medication to be issued to the patient from a dispensary, and a medication administration component for maintaining a record of the medication administered to the patient. The components are connected to form an integrated system configured for use in hospitals and similar healthcare institutions to streamline the medication administration process and avoid the duplication of effort and the occurrence of medication administration errors. Part of the complexity of patient care within a hospital setting is due to the multidisciplinary nature of the team that is assigned to care for each individual patient. For instance, in order to medicate a patient with a prescription medication, a minimum of three people is typically involved in ensuring that the medication is correctly administered to the patient. A doctor is required to prescribe an appropriate medication to be administered to the patient at a specified dose, at a specified frequency and for a specified duration. A pharmacist checks the prescription and issues the prescribed medication to the patient. A nurse finally administers the prescription medication to the patient on the ward. Each step of the processes needs to be recorded for future reference.

Using the system of the present invention, this process is streamlined. The doctor completes a medication order using the electronic prescribing component of the system as shown on Figure 1. The medication order will include details pertaining to the drug prescribed, instructions for administration including quantity and duration and any additional comments. The completed medication order is transmitted to a dispensary to enable the prescription to be filled by a pharmacist. In the event that the prescription can be filled from ward stock, the electronic prescription may be transmitted to the dispensary for the purpose of having the medication order approved by a pharmacist. The

dispensary actually receives the medication order immediately after the doctor has prescribed the medication by completing the medication order.

Upon receipt of the medication order, the pharmacist approves and/or issues the prescribed medication the patient. Once the medication has been dispensed (whether from dispensary stock or ward stock), it appears on the patient's medication chart as shown in Figure 2. The medication chart is then used by nursing staff to record the administration or non administration of the prescribed medication. A record is maintained by entering details of each medication administration event in the system. For example, in the case of a medication which is administered parenteral, the details recorded will include information relating to the medication administered, the administration route, the dose administered and the administration method as shown in Figure 3. In another example, if the mediation is administered via fluid infusion, the details recorded will include the medication administered, the fluid batch, infusion start time and infusion completion time as shown in Figure 4.

The system includes an integrated workflow management component which generates lists and may provide alerts to assist system users in keeping track of tasks requiring completion. For instance, the system generates work lists for nursing staff which includes a list of what and when medications are to be administered to a patient. The system further generates work lists for pharmacists so that the pharmacist is aware of prescribed medication which requires approval and/or dispensing. For instance, in some cases, medication may require approval from a pharmacist but is to be issued to the patient from ward stock. Functionality is provided to enable the system to determine medication administration schedules for nursing staff or other healthcare professional responsible for the administration of medication. The medication administration schedule can be based on prescribed frequencies and predefined ward medication administration times. For example, the system schedules medication administration times for a drug to be administered to a patient on Ward 1 three times per day, in accordance with predefined Ward 1 medication administrations times (e.g. to be administered at 6am, 2pm, 10pm) wherein a drug to be administered to a patient on Ward 2 three times per day may be scheduled for different times in accordance with predefined Ward 2 medication

administration times (e.g. to be administered at 8am, 4pm, 12am). This enables medication administrations times to be customized to fit in with the nurse's work schedules.

The system also provides integrated fluid balance chart functionality for monitoring the fluid input and output of a patient. When fluids are entered on the medication administration chart, the volume of fluid infused is automatically directed to the fluid balance chart. When an intravenous fluid is prescribed, the date and time of the start of the infusion is recorded in the fluid balance chart. On completion of the intravenous fluid, the total volume infused is recorded in the fluid balance chart.

From the point of view of the user, the system consists of two main screens, namely a medication planner screen (as shown in Figure 7) and a medication chart (as shown in Figure 2). The medication planner indicates what medications are due, over due, scheduled or to be administered according to need (i.e. PRN). In accordance with the default setup, the medication planner displays medications details for an entire ward. Selecting a patient name from those displayed on the medication planner will open the corresponding medication administration chart for that patient. The medication administration chart indicates all medications and/or fluids which have been prescribed for the patient and includes recorded details regarding their administration.

It will be evident to those skilled in the art that all healthcare professionals who are involved in the care of a particular patient require access to an up to date medical record for the patient. This includes access to certain pertinent information regarding the various medications that are being administered to the patient, including dosage rates, administration frequency. Moreover, pertinent clinical information from the patients' medical record, such as allergies, the patient's height and weight should be displayed to the healthcare professional for review when undertaking to medicate a patient, either when medication is being prescribed electronically, or when medication is to be administered.

The system is also configured to deal with non electronically prescribed medication orders, e.g. verbal orders or telephone orders. In some cases, it may be desirable to have verbal orders authorised by a supervising physician.

This function can be provided for within the system. The system also provides for self administration of medication by patients, for example, in the case of patient controlled analgesics. In such cases, a nurse will monitor self administration of the medication and will maintain a medication administration record on this basis as shown in Figure 6.

The system may include an authorisation component to enable certain healthcare professionals to be nominated as authorised prescribers. A setup program based on assigning roles to certain users of the system enables a healthcare professional to use the system to electronically prescribe either all medications or a subset of all medications. The system also makes provision for nurse initiated medication, for example in the case of non prescription medications. An example of a medication chart is shown in Figure 5A. An example of the associated medication order is shown in Figure 5B. If desired, the system may be configured to require nurse initiated medications to be authorised by a co signor. For instance, it may be desirable to configure the system to notify the supervising physician when a particular medication has been administered to the same patient a specified number of times in a specified period of time. It is to be understood that the system also provides for recording of ordering and administration of non prescription medications, or medication which is issued to a patient from ward stock.

The dispensing component will preferably include means for managing an inventory, that is, stock numbers are automatically updated as medication is dispensed from pharmacy or ward stock. When ward stock reaches a threshold minimum level stipulated for ordering, the system can be configured to automatically lodge an order with the pharmacy for additional ward stock. Pricing of medications may be included to permit analysis of cost of treatment versus treatment outcomes, billing functions and the like.

Prior to validating electronic prescriptions, the electronic prescription component runs a check for any drug allergies, drug interactions and other drug contra indications before validating the prescription. If the prescription is not validated by the electronic prescription component, provision exists for an authorised healthcare professional to override the non validation. A reason for overriding the non validation is required for future audit purposes.

The system includes an audit component which permits all activities pertaining to a particular patient and/or medication to be reviewed. For instance, the system enables an audit trial to be reviewed which includes detail pertaining to when and by whom the medication was prescribed, who dispensed the medication and who, when, how and how much of the medication was administered to the patient. The system maintains a record of when each user accessed the system, which system functionalities were employed by the user and the action that was carried out, for example, adding a new record, editing an existing record, when medication was administered, when medication was scheduled to be administered and the like.

An identification component may be associated with the system to automate identification of patients to confirm the medication due to be administered to the patient. The identification component may be provided in the form of a bar code reader or similar device. The system is configured to enable the medication planner to display medication due for more than one patient so that the healthcare professional knows what medications are due and can prepare the medication accordingly. The medication planner can be printed for ease of reference. An example of a medication planner is shown in Figure 7. Various filters may be applied to customise the screen display to the healthcare professional's requirements. For example, the user may wish to see only a list of medications scheduled to be administered at a particular, or display all medications administered to a patient over a particular date range.

The system enables particular patients to be assigned to a specified healthcare team. Where patients are assigned to a healthcare team, the system generates a team worklist. When a team member has completed a specified task, the task may be removed from the worklist or remain on worklist with a visual indicator to indicate the task has been completed. If one team member signs off duty without having completed all tasks on the worklist, the uncompleted tasks will be allocated to the- next team member assigned to that particular patient. The system will also allow for healthcare professional which have not been assigned to care for a particular patient to carry out a task pertaining to that patient. For example, the system may be set up to enable a nurse working on the same ward to view tasks assigned to another nurse since

it is not unusual to have a nurse taking action with respect to a colleague's patient.

The system may include an alerting component which issues system alerts to remind a healthcare professional if a medication has not been approved, dispensed or administered for or at the scheduled time. The system may be configured to allow a certain amount of time to pass before issuing such a reminder, for instance the medication should be administered within 30 minutes of the scheduled time.

The medication administration system is intended for use within a hospital environment and should preferably be accessible to healthcare professional in close proximity to patients. The system is intended to be accessible over any suitable telecommunications network such as an intranet or the internet. Medication administration may be carried out using a portable hand held electronic device, e.g. PALM PILOT®. An advantage of the invention is that delays in medication administration due to the medication chart being at the pharmacy are avoided.

Another advantage of the invention is the coordination of all available medical information to ensure that the patient receives treatment in the most appropriate and timely manner, increasing rate of recovery and reducing length of patient stay.

Yet another advantage eof the invention is that it offers improved responsiveness since information and/or orders entered by one healthcare professional is available for viewing by all other healthcare professionals involved in the patient's care in real-time. It is to be understood that various additions, alterations and/or modifications may be made to the parts previously described without departing from the ambit of the invention.