Patent Description:
The present invention relates to patient repositioning, and more particularly, to a system that reduces and relieves interface pressures between a patient and a bed support surface by reducing concentrated forces on the patient, such as friction and shear forces, in order to reduce the likelihood of discomfort, pressure ulcers, and/or other injuries to the patient.

<CIT> discloses a system and method for patient transfer, including patient transfer from a bed to a rollable chair and patient transfer from a wheelchair to a bed. A docking assembly can connect a rollable chair to a bed for transfer. <CIT> discloses an arrangement of a wheelchair with a movable seat and leg rest and a bed equipped with transfer apparatus including rollers, a movable sheet, a lift member, and a control system for transporting an invalid comfortably across the bed to a sitting position on the wheelchair.

Applicant's presently pending '<NUM> application discloses various details and embodiments of a patient repositioning system wherein the system moves a sheet and the patient supported thereon toward a head end of the bed, such as a healthcare bed that articulates to improve patient comfort. The '<NUM> application discloses numerous features and details related to the general concept of patient repositioning in this manner, such as the sheet having a width greater than that of the mattress.

Nonetheless, the '<NUM> application focuses on reducing and simplifying the efforts needed by a caregiver to reposition a patient toward a head end of the bed. Generally, the caregiver repositions the patient by physically activating the inputs to the system, and those inputs are part of, or at least associated with, a sheet receiver located partially below the top surface of the mattress.

The present disclosure focuses on additional aspects of the patient repositioning system shown in the '<NUM> application. That is, the present disclosure focuses on a patient monitoring and repositioning system for detecting and identifying the need to reposition a patient, prior to the actual repositioning of the patient via such a patient repositioning system. This feature is helpful in reducing the occurrence of pressure ulcers with the patient, which could otherwise be caused by the patient remaining in an undesirable position rather than a desirable, predetermined position on the mattress. According to various embodiments of the patient monitoring and repositioning system disclosed herein, there is no need for a caregiver to be physically present, next to the bed, to detect that a patient has migrated down in the bed to an undesirable position and needs to be repositioned to a desirable position, which may also be referred to herein as a predetermined position or a normal position. Rather, the need for repositioning can be communicated to the caregiver via an alarm and/or some other indicator or call system, or it could be addressed automatically at the bed, with or without an alarm or indicator.

Once the need to reposition the patient has been detected, then that need can be addressed in any one of several ways. For example, the monitoring system can communicate to the repositioning system to automatically reposition the patient. The monitoring system can communicate the need for patient repositioning without prompting the repositioning system to automatically reposition the patient, such as requesting human intervention to reposition the patient at the bed-side, or requesting remote activation from a separate location, a central control station in another portion of the building, or even miles away at another location. In the context of this specification, a controller may be located on or near the bed or remotely from the bed for communicating with the bed via a wired or a wireless connection. With such remote patient repositioning capabilities and a plurality of such patient repositioning systems in place in a single facility, any desired number of such repositioning systems could be monitored and activated at the same time. Thus, any desired number of patients could be remotely repositioned at the same time, without requiring a like number of caregivers to interact with each repositioning system. However, for practical reasons, it may be that the actual patient repositioning is not performed remotely, but is instead initiated by a caregiver, or by the patient, who is physically present. But even in that case, the caregivers can be more efficient with their available time, because the present system is capable of simultaneously detecting, identifying, and communicating the need for repositioning of patients to one or more caregivers. In other words, this disclosure focuses on the coupling of a monitoring system for detecting patient position with a repositioning system for repositioning the patient, so that ultimately the patient can be repositioned, whether remotely or with a caregiver physically present. In addition, the control system, such as a central control system in the form of a hospital information system, operatively connects to the patient monitoring and repositioning system. The control system may further monitor the patient not being in the predetermined position, a time that the patient is not in the predetermined position, an amount of patient repositionings, a frequency of patient repositionings in a facility, an amount of sheet already used, a need to change or reset the sheet on the bed, a distance migrated by the patient on the bed, a time of the patient in each position on the bed, a time delay before repositioning the patient on the bed, a duration of repositioning the patient on the bed, a position of the patient on the bed, a time of day the patient was repositioned, and a frequency of patient repositionings executed on the bed.

According to one aspect of a patient monitoring and repositioning system of the type disclosed herein, each of a plurality of patient repositioning systems (of the type disclosed in the '<NUM> application) is preferably equipped with a sensor arrangement for sensing the position of the patient. The sensor arrangement could employ one or more load cells, infrared beams, capacitors, resistors, cameras with image detection, magnets, or any other type of structure for sensing the position of the patient on the mattress (e.g., acoustic, sonar, ultrasonic, etc.).

According to another aspect of the invention, with the sensor arrangement in place, and operatively connected to the drive mechanism, and the sensor arrangement also operatively connected to an alarm and/or a control system, the monitoring system senses when the patient has moved toward the foot end of the bed. More particularly, the sensor arrangement senses substantially the entire top surface of the mattress for sensing patient movement. When such patient moves toward the foot end from the desirable position to the undesirable position, and the sensor arrangement detects and signals that the patient has moved toward the foot end of the bed, the monitoring system automatically requests the repositioning system to reposition the patient and/or uses an indicator, such as an alarm, to communicate the need to reposition the patient to the caregiver. As such, the indicator operatively indicates the position of the patient relative to the mattress at all times during use. Any one or more of a number of different types of visual and/or audible indicators may be used. For example, the indicator may be a display, one or more LEDs, a graphic display message, an audible signal, a wired transmission message, a wireless transmission message, and/or a parallel or serial message. Thereafter, the patient can be repositioned toward the head end of the bed automatically or either via remote actuation of the drive mechanism without a caregiver physically present proximate to the bed, or via actuation of the drive mechanism by the caregiver who is physically present proximate to the bed via a user interface. This repositioning can then also be detected by the monitoring system to indicate that a logical sequence of events has been completed, and that the patient is in the predetermined position. Once the patient has been restored to the predetermined position, the monitoring system ceases to indicate and/or communicate the need to reposition the patient. The monitoring system may alternatively or additionally communicate that the patient was repositioned.

Still further, with a plurality of such patient monitoring and repositioning systems of this type in use in a facility, and operatively connected to a central control station, the central control station can enable the operator of the facility to monitor various events and parameters, including the patient not being in the predetermined position, a time that the patient is not in the predetermined position, an amount of patient repositionings, a frequency of patient repositionings in a facility, an amount of sheet already used, a need to change or reset the sheet on the bed, a distance migrated by the patient on the bed, a time of the patient in each position on the bed, a time delay before repositioning the patient on the bed, a duration of repositioning the patient on the bed, a position of the patient on the bed, a time of day the patient was repositioned, and a frequency of patient repositionings executed on the bed.

In use, according to an exemplary embodiment, the patient rests on a mattress, but slides from the predetermined position toward the foot end of the bed to an undesirable position. The sensor arrangement detects the undesirable position of the patient and identifies the need to reposition the patient from the undesirable position to the predetermined position. A controller, operatively connected to the sensor arrangement, automatically directs the drive mechanism to pull the sheet toward the head end and, in turn, return the patient to the predetermined position. According to another example, the controller, operatively connected to the sensor arrangement, is further connected to an indicator, such as an audible alarm. The controller activates the audible alarm in order to indicate to a caregiver that the patient has moved to an undesirable position. In turn, the caregiver operatively actuates the drive mechanism to pull the sheet toward the head end and, in turn, return the patient to the predetermined position. The caregiver may operatively actuate the drive mechanism by interacting with a user interface proximate to the bed or by remotely directing the drive mechanism. In turn, the audible alarm is deactivated to signal that the patient is in the desirable position. By way of example, the above scenarios may be completed by the patient repositioning system disclosed in the '<NUM> application in conjunction with the patient monitoring and repositioning system described herein.

With reference to <FIG>, a patient monitoring and repositioning system 10a includes a sensor arrangement 12a, a sheet receiver 14a, and a sheet <NUM> for use with a health care bed <NUM>. The sensor arrangement 12a is more particularly a plurality of sensors <NUM> configured to detect a position of a patient <NUM> resting on the health care bed <NUM>. The sensor arrangement 12a is at least one sensor <NUM>, which senses the position of the patient <NUM> and indicates to a controller <NUM> whether or not the patient <NUM> is in a desirable, predetermined position relative to a mattress <NUM> of the health care bed <NUM>. In the event that the patient <NUM> migrated along the mattress <NUM> to an undesirable position, which may also be referred to herein as not being in the predetermined position, the controller <NUM> automatically signals a drive mechanism <NUM> within a housing <NUM> of the sheet receiver 14a to pull the sheet <NUM> and, in turn, pull the patient <NUM> resting on the sheet <NUM> until the patient <NUM> returns to the predetermined position. As an alternative to automatic repositioning by the controller <NUM>, the caregiver may direct the controller <NUM> to pull the sheet <NUM>, such as in response to one or more indicators <NUM>, <NUM>, <NUM> described below in additional detail. As described herein, the term "predetermined position" means the desirable position and/or range of positions relative to the mattress <NUM> in which the patient <NUM>, resting on the mattress <NUM>, benefits from a reduced likelihood of injury, such as by pressure ulcers, and an increased likelihood of patient comfort. This desirable position and/or range of positions may refer to the patient's translational position relative to the mattress <NUM>, the patient's rotational position relative to the mattress <NUM>, or any combination thereof. To this end, the predetermined position may be an approximation based on a typical patient or tailored uniquely to a particular patient. Similarly, the term "undesirable position" generally refers to any patient position on the mattress <NUM> in which the patient <NUM> is not within the predetermined position. Furthermore, it will be appreciated that the term "sense" with respect to the sensor arrangement 12a may refer to actively sensing the patient <NUM> in both the predetermined position and the undesirable position or actively sensing the patient <NUM> in only one of the predetermined and undesirable positions. As such, the patient monitoring and repositioning system 10a may infer the patient position if the patient is not actively sensed by the sensor arrangement 12a. The term "sense" is thus not intended to be limited to only actively sensing the patients <NUM>. Thus, according to one embodiment, the controller <NUM> continuously senses the position of the patient relative to the mattress <NUM> while the patient <NUM> rests on the mattress <NUM>.

With respect to <FIG>, a plurality of the patient monitoring and repositioning systems 10a, 10b, 10n may be operated within a single health care facility or throughout multiple health care facilities. Each of the patient monitoring and repositioning systems 10a, 10b, 10n includes respective sensor arrangements 12a, 12b, 12n and sheet receivers 14a, 14b, 14n. The sheet receivers 14a, 14b, 14n operatively connect to a network <NUM>, which also operatively connects to a control system <NUM>. The control system <NUM> is more particularly a central control system <NUM>, such as a hospital information system <NUM>. The hospital information system <NUM> may include a data information system, data management system, intranet, and/or software that interfaces with a hospital scheduling system, conventional web server, e-mail server, or any other software configured to indicate information concerning the patient monitoring and repositioning system 10a to the caregiver. The hospital information system <NUM> is typically a device that includes a processor, a memory, and a network interface and may commonly be referred to as a computer. From the hospital information system <NUM>, one or more caregivers may receive indications of patient position, verify automatic repositioning of the patients by the patient monitoring and repositioning systems 10a, 10b, 10n, verify repositionings of the patient <NUM> by the caregiver located at the bedside and/or direct the patient monitoring and repositioning systems 10a, 10b, 10n to perform patient repositioning as desired. Thus, the sheet receivers 14a, 14b, 14n and the hospital information system <NUM> are configured to communicate back and forth via the network <NUM>. It will be appreciated that any number of patient monitoring and repositioning systems 10a, 10b, 10n may be used in accordance with the principles discussed herein.

The sheet receiver 14a, as shown in <FIG>, includes the controller <NUM> operatively connected to the drive mechanism <NUM>, safety interlock <NUM>, and a transceiver <NUM> contained within the housing <NUM>. As shown, the controller <NUM> is in the sheet receiver 14a; however, the controller <NUM> may alternatively be positioned remotely from the sheet receiver 14a. The sheet receiver 14a also includes a user interface <NUM> operatively connected to the controller <NUM> and has the indicators <NUM>, <NUM>, <NUM> and input switches <NUM> configured for use by the caregiver to direct the controller <NUM>. The indicators <NUM>, <NUM>, <NUM> are more particularly in the form of a display <NUM>, such as a graphic touchscreen panel, one or more light emitting diodes ("LEDs") <NUM>, and one or more audible alarms <NUM> for indicating information to the caregiver. In one embodiment, at least one of the indicators <NUM>, <NUM>, <NUM> is configured to indicate to the caregiver that the patient <NUM> is in the predetermined and undesirable positions. Alternatively, one of the indicators <NUM>, <NUM>, <NUM> may only indicate the position of the patient <NUM> when the patient <NUM> is either in the predetermined position or the undesirable position.

The transceiver <NUM> sends information to and receives information from the network <NUM> such that the controller <NUM> communicates with the hospital information system <NUM> (see <FIG>). In some embodiments, the controller <NUM> may be a microprocessor or generally any processing computer device. The network <NUM> may include one or more networks, such as the Internet. In some embodiments, the network <NUM> may include one or more wide area networks (WAN) or local area networks (LAN). The network <NUM> may utilize one or more network technologies such as Ethernet, Fast Ethernet, Gigabit Ethernet, virtual private network (VPN), remote VPN access, a variant of IEEE <NUM> standard such as Wi-Fi, and the like. Communication over the network <NUM> takes place using one or more network communication protocols including reliable streaming protocols such as transmission control protocol (TCP). As such, the transceiver <NUM> is any device capable of communicating with both the controller <NUM> and the network <NUM>, such as by the exemplary controllers and networks discussed briefly above. The above examples of the controller <NUM>, the network <NUM>, and the transceiver <NUM> are illustrative and not intended to limit the present invention.

The sensor arrangement 12a is positioned proximate to the mattress <NUM> so as to detect the patient <NUM> on the mattress <NUM> and communicate that detection to the controller <NUM> in order to indicate whether or not the patient <NUM> is in the predetermined position resting on the mattress <NUM> with the sheet <NUM> positioned therebetween. Specifically, the sensor arrangement 12a in conjunction with the controller <NUM> may be configured to determine the patient's translational position relative to the mattress <NUM>, the patient's rotational position relative to the mattress <NUM>, or any combination thereof. After receiving instructions automatically or manually from at least one of the user interface <NUM> and the hospital information system <NUM>, the controller <NUM> directs the drive mechanism <NUM> to pull the sheet <NUM> only if the safety interlock <NUM> communicates to the controller <NUM> that the appropriate conditions exist for the repositioning of the patient <NUM>. For example, the safety interlock <NUM> may include more than one lock out condition for preventing operation of the drive mechanism <NUM> by the controller <NUM>, such as the bed head deck angle being too high, the sheet being improperly loaded, the absence of the patient <NUM> on the mattress <NUM>, sheet contamination such as by a contamination sensor (e.g., high moisture content, soiling, bacteria presence, ascetic detection, image detection, etc.), and improper positions of a hinged access door <NUM> of the sheet receiver 14a. It will be appreciated that other lock out conditions may be used and, as such, the invention is not limited to the safety interlock <NUM> described herein.

With the conditions for repositioning the patient <NUM> determined to be appropriate by the controller <NUM> as signaled by the sensor arrangement 12a and the safety interlock <NUM>, the controller <NUM> directs the drive mechanism <NUM> to pull the sheet <NUM>. As discussed herein, the '<NUM> application describes one example of a patient repositioning system as follows:.

With respect to <FIG>, the patient <NUM> is shown after migrating from a head end <NUM> of the mattress <NUM> toward a foot end <NUM> of the mattress <NUM>. In other words, the patient <NUM> is in the undesirable position with an increased risk of injury and discomfort. The drive mechanism <NUM> thereby pulls the sheet <NUM>, as indicated by arrow <NUM>, about the head end <NUM> of the mattress <NUM>, through a slot <NUM> in the housing <NUM>, and into the sheet receiver 14a. Thereby, the patient <NUM>, resting directly on the sheet <NUM>, is similarly pulled toward the head end <NUM> of the mattress <NUM> until the patient <NUM> reaches the predetermined position.

The sensor arrangement 12a configured to sense the position of the patient <NUM> relative to the mattress <NUM> is shown in <FIG>. The sensor arrangement 12a includes the sensors <NUM> positioned on an upper surface <NUM> of the housing <NUM>, a lower surface <NUM> or inner region of the mattress <NUM>, and on a bed deck <NUM> of the health care bed <NUM>. More particularly, sensors <NUM> are positioned on respective head and foot ends <NUM>, <NUM> of the mattress <NUM> and on a head deck portion <NUM>, a central deck portion <NUM>, and a foot deck portion <NUM>, respectively for sensing the patient's position along substantially the entire top surface of the mattress <NUM>.

The sensor arrangement 12a senses the position of the patient <NUM> by detecting patient weight along the health care bed <NUM> and communicating the detected weight to the sheet receiver 14a. As shown in <FIG>, each of the sensors <NUM> is in the form of a capacitive sensor <NUM>. The force of the patient's weight sandwiches a top contact <NUM>, a compressive dielectric material <NUM>, and a bottom contact <NUM> together. As such, the capacitive sensor <NUM> detects a change in capacitance value for communication to the controller <NUM>. The controller <NUM> collects the information from each of the sensors <NUM>, analyzes the collective information regarding the weight distribution of the patient <NUM> as detected by the sensors <NUM>, and determines the patient position based on detected capacitance from the entirety of the sensor arrangement 12a.

According to another exemplary embodiment shown in <FIG>, a sensor <NUM> is in the form of a resistive sensor <NUM>. The force of the patient's weight directs a top contact <NUM> against a bottom contact <NUM>. As such, the resistive sensor <NUM> detects a change in resistance value for communication to the controller <NUM>. The controller <NUM> collects the information from each of the sensors <NUM>, analyzes the collective information regarding the weight distribution of the patient <NUM> as detected by the sensors <NUM>, and determines the patient position based on detected resistance from the entirety of the sensor arrangement 112a.

<FIG> shows a second embodiment of a sensor arrangement 212a integrated within the health care bed <NUM>. The sensor arrangement 212a includes a plurality of sensors <NUM>, which are each in the form of strain gages <NUM>. The force of the patient's weight effectively bends the strain gauge <NUM> so as to change a resistance value of the strain gauge <NUM>. As such, the strain gauge <NUM> detects the changing resistance values for communication to the controller <NUM>. In addition, strain gauges <NUM> have been included on pedestals <NUM> positioned between the bed deck <NUM> and a remaining frame <NUM> of the health care bed <NUM> supporting the bed deck <NUM> thereon. The controller <NUM> collects the information from each of the sensors <NUM>, analyzes the collective information regarding the weight distribution of the patient <NUM> as detected by the sensors <NUM>, and determines the patient position based on detected resistance values from the entirety of the sensor arrangement 212a.

A third exemplary embodiment of a sensor arrangement 312a is shown in <FIG>. The sensor arrangement 312a includes a plurality of sensors <NUM>, which are each in the form of a light sensor <NUM>. A light source <NUM> directs light, as indicated by arrows <NUM>, along fiber-optic cable <NUM>. The force of the patient's weight effectively bends the fiber-optic cable <NUM> so as to change an amount of light passing through the fiber-optic cable <NUM>. As such, the light sensor <NUM> detects the changing light values for communication to the controller <NUM>. The controller <NUM> collects the information from each of the sensors <NUM>, analyzes the collective information regarding the weight distribution of the patient <NUM> as detected by the sensors <NUM>, and determines the patient position based on detected light from the entirety of the sensor arrangement 312a.

A fourth exemplary embodiment of a sensor arrangement 412a is shown in <FIG>. The sensor arrangement 412a includes a plurality of sensors <NUM>, which are each in the form of an optical sensor <NUM>. Generally, the optical sensors <NUM> work in opposing pairs such that an infrared beam (not shown) is directed therebetween. The presence of the patient <NUM> between the pair of optical sensors <NUM> interrupts the infrared beam so as to indicate the position of the patient <NUM>. As such, the optical sensors <NUM> detect the changing infrared beam for communication to the controller <NUM>. The controller <NUM> collects the information from each of the sensors <NUM>, analyzes the collective information regarding blockage and/or non-blockage of the infrared beams by the patient <NUM> as detected by the sensors <NUM>, and determines the patient position based on the detected infrared beams from the entirety of the sensor arrangement 412a.

In addition, the sensor arrangement 412a further includes a camera <NUM> positioned proximate to the mattress <NUM> for viewing the patient <NUM> on the mattress <NUM>. For example, the camera <NUM> may be attached to the health care bed <NUM> or on a surface within the facility, such as a head wall, foot wall, ceiling, or other location proximate to the bed <NUM>. The camera <NUM> visually collects light representing the patient <NUM> and directs the representation to the controller <NUM>. The controller <NUM> is further configured to analyze the representation and identify the position of the patient <NUM> relative to the mattress <NUM>.

Claim 1:
A patient monitoring and repositioning system in combination with a bed having a deck, comprising:
a mattress (<NUM>) residing on the deck and having a head end, a foot end, and an upper surface;
a sheet (<NUM>) residing on the upper surface;
a drive mechanism (<NUM>) located near the head end of the mattress and operable to pull the sheet toward the head end of the mattress to thereby reposition the sheet relative to the mattress, and also reposition a patient residing on the sheet;
characterized in that the system comprises:
a housing (<NUM>) containing the drive mechanism, the housing including a slot (<NUM>) extending therealong, and the drive mechanism being operable to pull the sheet into the housing via the slot, the housing further including an access door (<NUM>) movable relative to the housing to thereby permit access to the inside of the housing; and
a sensor arrangement (<NUM>; 112a) operatively connected to the drive mechanism, the sensor arrangement being configured to sense a position of the patient relative to the mattress on the bed over substantially the entire top surface of the mattress, and to generate a signal in response to the patient moving from a predetermined position, and the drive mechanism being configured to pull the sheet so as to reposition the patient to the predetermined position upon receiving the signal from the sensor arrangement, wherein the predetermined position is a desirable position and/or range of positions relative to the mattress in which the patient, resting on the mattress, benefits from a reduced likelihood of injury, such as by pressure ulcers, and an increased likelihood of patient comfort.