Abstract:
A computerized system for promoting an effective strategy for reducing excess pain in patients is provided wherein the system identifies a subset of pain symptoms to automatically generate a reminder at a nurse&#39;s station for following up with the patient. The computerized system includes a program configured to automatically remind a caregiver to reassess a patient&#39;s pain level and logs error reports when a caregiver fails to perform reassessments.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to U.S. Provisional Application Ser. No. 60/990,399 filed Nov. 27, 2007, entitled: “Reminder System for Reducing Excess Pain among Hospitalized Patients,” the disclosure of which is hereby expressly incorporated by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    Evidence-based literature has demonstrated that pain in hospitalized patients remains frequent, with in-patient prevalence of severe pain ranging between 15% to 36%. Recent analyses and systematic reviews conclude that the application of traditional strategies for improvement of outcomes in pain management have failed. Given the established efficacy, safety, and availability of analgesic medications and therapies, these findings strongly suggest that new approaches to pain management in hospitalized patients are needed. 
       SUMMARY OF THE INVENTION 
       [0003]    The present invention provides a computerized system for promoting an effective strategy for reducing excess pain in patients. Importantly, the system identifies a subset of pain symptoms (pain that is characterized as severe or greater) to automatically generate at the nurse&#39;s station a reminder for nurse follow-up. Critically, the reminder blocks use of the nurse&#39;s station only temporarily until closed by the nurse, providing a balance between being an effective reminder and accommodating the nurse&#39;s need to prioritize his or her activities regardless of the reminder. The reminder period is set to be slightly greater than recommended clinical reminder time so as to provide a system that respects the nurse&#39;s autonomy, serving only as a backup. A second timer may be activated if a follow-up is not completed after a substantially greater period of time upon which a medical error is logged in an associated database. The logged errors are periodically and automatically summarized in confidential error reports. The error reports identify error rate for each nurse as well as hospital unit, and allow for focused behavioral intervention by the nurse-manager. 
         [0004]    In this way, a practical reminder system is implemented that both encourages self compliance by nurses while ensuring a high compliance level and self-improvement. 
         [0005]    Accordingly, a pain management system according to the present invention includes a nurse&#39;s workstation having a graphical user interface and a data entry device in communication with an electronic computer. The system includes a stored program stored on and executed by the electronic computer. The program is configured to receive a patient pain assessment score from a caregiver associated with the patient. The received score is then compared to a predetermined minimum level and if the score exceeds the predetermined minimum level, a reminder timer is initiated. The reminder time has a first time value that exceeds a minimum clinical follow-up period. The program is configured to generate a pop-up window on the graphical user interface to remind the caregiver to check the status of a monitored patient. The pop-up window is sized to block use of the graphical user interface and is configured to execute an accept signal from the data entry device thereby allowing the nurse to close the pop-up window. 
         [0006]    Thus, it is an object of the present invention to provide a pain management system that automatically notifies a caregiver when a subsequent pain assessment of a particular patient is necessary. 
         [0007]    The stored program of the pain management system may additional receive a caregiver signal directing the program to close the pop-up window temporarily such that the pop-up window will return without initiation of a reminder timer. 
         [0008]    Thus, it is a further object of the present invention to allow a caregiver utilizing the present invention to momentarily remove the pop-up window so as to allow the caregiver to tend to other duties while also automatically reminding the caregiver to follow up with the patient. 
         [0009]    The program of the pain management system may also be configured to receive a subsequent pain assessment. If the subsequent pain assessment exceeds a minimum predetermined level, a reminder time is initiated having a first time value exceeding a minimum clinical follow-up period. If the subsequent pain assessment does not exceed the minimum predetermined level, the reminder timer is cancelled. 
         [0010]    As such, it is another object of the present invention to provide a pain management system that automatically adjusts its operation upon entering of a subsequent pain assessment. 
         [0011]    The program of the pain management system may further be configured to generate an error report providing data describing a caregiver delay in providing a subsequent pain assessment. 
         [0012]    Accordingly, it is an object of the present invention to provide a pain management system configured to give administrators a method of evaluating a caregiver response to pain management of their patients. 
         [0013]    The pop-up window of the present invention may be configured to provide additional data relating to the patient identified by the pop-up window including an indication of the whether the patient&#39;s pain status has been reviewed, an indication as to whether the patient is being monitored for pain, patient identification information, patient location information, patient pain ratings, and previous patient pain ratings. 
         [0014]    Thus, it is an object of the present invention to provide a caregiver with a summary of a particular patient&#39;s pain management. 
         [0015]    These particular objects and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         [0016]      FIG. 1  is a simplified representation of a standard nurse&#39;s station showing a wireless computer terminal in communication with a central server executing the program of the present invention; 
           [0017]      FIG. 2  is a flow chart of the first portion of the program of the present invention as triggered by an assessment of severe pain in a patient as diagnosed by a nurse; 
           [0018]      FIGS. 3   a  and  3   b  are flowcharts similar to that shown in  FIG. 2  of a later portion of the program triggered when a reminder time has been exceeded; 
           [0019]      FIG. 4  is a figure similar to that of  FIG. 3  of an additional portion of the program triggered when a compliance time is exceeded; 
           [0020]      FIG. 5  is a simplified representation of the effect of an example pain medication showing various times used by the program portions of  FIGS. 2-4 ; 
           [0021]      FIG. 6  is a fragmentary view of a pull-down menu displayed on the terminal of  FIG. 1  for entering a pain assessment in one of two forms; 
           [0022]      FIG. 7  is a pop-up screen produced by the program of  FIG. 2  when the reminder time has been exceeded; and 
           [0023]      FIG. 8  is a fragmentary view of a medical error report as may be logged on the server of  FIG. 1 . 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0024]    Referring now to  FIG. 1 , a nurse&#39;s station  10  may include a cart or other mobile support  14  holding a wireless computer terminal  16  communicating via radio waves  18  or other means with a central server  20 . A program  22  residing in either or both of the terminal  16  and central server  20  may communicate with a database  24  holding patient records and used for logging purposes and for the generation of error reports  25  as will be described below. 
         [0025]    Referring to  FIG. 2 , the program  22  of the present invention may be triggered, as indicated by event block  26 , by the entry of a pain assessment by a nurse using the station  10 . Referring momentarily to  FIG. 6 , the pain assessment may be entered into the terminal  16  using, for example, a pull-down menu  28  activated by the nurse using conventional means and displaying a pain scales  30  and  32 . In the present example, the pain scale may consist of successive integers from 0 to 10, where 0 corresponds to no pain and 10 corresponds to extreme pain. Alternatively or in addition descriptions  32 , for example, “none”, “mild”, “moderate”, and “severe”, may be provided. Either a number or a description may be selected by the nurse for entry into the program  22 . 
         [0026]    Other pain scales may be used in addition or alternatively including, for example, the well-known pediatric scale or an observable pain behavior question set. 
         [0027]    Any of these scales may be mapped to an underlying numeric scale that is compared at decision block  35  of  FIG. 2  to a predetermined threshold level indicating whether the pain is severe or not. In the preferred embodiment, a recording of severe pain is indicated by a numeric value of seven or greater. 
         [0028]    If the pain is not severe as determined by decision block  35 , the program  22  exits at process block  36 . If, however, the pain is severe, then the program proceeds to process block  38  where a reminder timer and error timer are started. These timers may be implemented in software according to methods well known in the art. 
         [0029]    Referring now to  FIG. 3   a,  an expiration of the reminder timer may initiate a second portion of the program, as indicated by event block  40 . The reminder timer will be set to expire at a reminder time T 1 , as will be described below, which generally indicates a time at which a follow-up consultation with the patient with respect to the patient&#39;s pain should be had. The expiration of the reminder timer causes a pop-up window to open, as indicated by process block  42 . 
         [0030]    Referring momentarily to  FIG. 7 , the pop-up window  44  is sized to partially block the display screen  45  of the terminal  16  so as to preserve a visual reference to the display screen  46  and the underlying medical program executing on the terminal  16 , while preventing practical use of the underlying medical program (including the logging of pain assessments per the program portion of  FIG. 2 ) until the user logs out of the terminal  16  typically by folding down the display of the terminal  16  over its keyboard (as determined at decision block  48 ) or the pop-up window  44  is closed using the close button  47  on the pop-up window  44 , for example, by a mouse click, (as determined at decision block  49 ). 
         [0031]    If at decision block  48 , the user logs out of the terminal  16 , then upon logging in, as indicated by process block  51 , the pop-up window  44  returns. 
         [0032]    If at decision block  49 , the user closes the pop-up window  44  using the close button  47 , the pop-up window  44  is removed as indicated by process block  52  allowing access to the underlying medical program to be used, for example, so that the user may perform a new pain assessment. Optionally, after the window is closed at process block  52 , a time delay may be implemented through an additional timer as indicated by process block  53 , and at the conclusion of that time if the reminder timer is still greater than T 0 , (as indicated by decision block  54 ) then the pop-up window  44  returns as indicated by process block  42 . Thus, the pop-up window  44  presents a persistent but avoidable reminder to the nurse. 
         [0033]    Referring now to  FIG. 3   b,  at any time after the initial entry of a pain assessment that is severe per the program portion of  FIG. 2 , a new pain assessment may be made by the nurse as indicated by event block  56 . This second pain assessment after a severe pain assessment causes a resetting of the timers previously set in process block  38  and as indicated by process block  57 . The program then exits at event block  58 . It will be understood that this resetting of the timers may prevent the event block  40  from occurring and more generally from the reminder timer or error timer from expiring, the latter which will now be described. 
         [0034]    Referring now to  FIG. 4 , at any time that the error timer exceeds a second time T 2,  as indicated by process block  59 , a medical error is indicated and logged in the database  24  as indicated by process block  60 . The program then exits at event block  61 . 
         [0035]    Referring now to  FIG. 5 , the effectiveness of a pain medication will generally follow an upward and downward trajectory indicated by plot  62 , first rising during an initial activation period  63 , being the time it takes the medication to begin to working, and then reaching clinical effectiveness at time T 0 . At any time after this initial activation period  63 , a reassessment may be performed resetting the reminder timer and error timer to zero. If a reassessment is not done, then at time T 1  (intentionally set to be larger than T 0 ) the pop-up window  44  will occur. For example, typically an initial activation period  63  might be approximately 10 minutes and T 0  period one hour. In this case, T 1  may be set to 65 minutes. Time T 2  may then, for example, be set to two hours such that an error will occur (and thereby will be logged as such in the database  24 ) if no follow-up pain assessment occurs for an hour after the assessment should have occurred. 
         [0036]    Referring again to  FIG. 7 , the pop-up window  44  may provide additional data about the status of patients who are currently or have previously been in severe pain. This data, for example, may be provided in a row of a table whose first column  70  indicates whether the nurse has reviewed the pain of the patient (allowing patients with severe pain to remain recorded on the screen without the reminder being invoked because a follow-up has been made). This first column may contain a “yes” or a “no” indication. The next column  72  indicates whether the patient is being monitored for pain, and column  74  may provide for patient identification including a tracking number and patient name. Column  76  may provide for the patient location, for example his or her bed and room. A pain rating may be provided in column  78  and the time of last assessment may be provided in column  80 . Each row may be a different patient up to a limit easily presented on the pop-up window  44 . In this way the pop-up window  44  may provide additional data to the nurse beyond the reminder function. 
         [0037]    Referring now to  FIG. 8 , the error report  25  may provide complete statistics of the reassessment process on an individual or nursing-unit basis. These error reports  25  may be automatically generated and disseminated and used to encourage improved performance. Preferably, these error reports  25  are configured to provide data describing caregiver delay in providing subsequent or new pain assessments after an initial pain assessment. 
         [0038]    It should be understood that the invention is not limited in its application to the details of construction and arrangements of the components set forth herein. The invention is capable of other embodiments and of being practiced or carried out in various ways. Variations and modifications of the foregoing are within the scope of the present invention. It also being understood that the invention disclosed and defined herein extends to all alternative combinations of two or more of the individual features mentioned or evident from the text and/or drawings. All of these different combinations constitute various alternative aspects of the present invention. The embodiments described herein explain the best modes known for practicing the invention and will enable others skilled in the art to utilize the invention.