Patent ID: 12257192

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is not intended to limit the scope, applicability, or configuration of the invention in any way. Rather, the following description provides practical illustrations for implementing exemplary examples of the present invention. Examples of constructions, materials, dimensions, and manufacturing processes are provided for selected elements, and all other elements employ that which is known to those of skill in the field of the invention. Those skilled in the art will recognize that many of the examples provided have suitable alternatives that can be utilized.

As described herein, operably coupled can include, but is not limited to, any suitable coupling, such as a fluid (e.g., liquid, gas) coupling, an electrical coupling or a mechanical coupling that enables elements described herein to be coupled to each other and/or to operate together with one another (e.g., function together).

FIG.1illustrates an isometric view of an example safety and security system100for generating an automated electronic anesthetic record (EAR) or electronic medical record (EMR) located proximate to a patient. Some aspects ofFIG.1are also described with respect to the description of other figures, includingFIG.14.

As shown inFIG.1, the safety and security system for intravenous (IV) medications100may be attached to and portions can be stored within a module101. The module101can conveniently provide direct access to the patient102. An IV pole105may provide a convenient mounting support location for the safety and security system for IV medications100(hereinafter, “safety and security system100”). In some examples, the components and systems of the safety and security system100of this disclosure can be supported by other mounting supports, including but not limited to a boom-mounted rack system, a wheeled rack system and a bed103mounting bracket. One or more computers including processing circuitry157, of the safety and security system100of this disclosure may be conveniently and safely housed inside the module101.

In some examples, it is anticipated that some or all of the components of the safety and security system100of this disclosure could be used in other healthcare settings such as the intensive care unit, the emergency room or on the ward. As shown inFIG.1, the module101may be mounted on an IV pole105or other suitable mounting structure located near the patient102.

In some examples, a touch-screen electronic record display126can convert to a qwerty-type keyboard to allow uncommon anesthetic and surgical events or deviations from pre-recorded scripts, to be manually documented. This allows the standard computer keyboard that is used for data entry in most electronic anesthetic records, to be eliminated. Standard keyboards are known to be contaminated with pathogenic organisms and are nearly impossible to clean and decontaminate due to their irregular surfaces. In contrast, the smooth glass or plastic face of a touch-screen monitor is easy to clean with no crevasses to hide organisms.

In some examples, the safety and security system for IV medications100of this disclosure can include a system for automatically measuring and recording the administration of IV medications. In some examples, the system for automatically measuring and recording the administration of IV medications includes a medication identification and measurement system128. In some examples, aspects of the safety and security system100can be provided together with or separately from other aspects of the IV medication identification and measurement system128(hereinafter, “medication identification and measurement system128”). Likewise, aspects of the medication identification and measurement system128can be provided together with or separately from other aspects of the safety and security system100.

FIG.2illustrates an isometric view of an example safety and security system200for generating an automated electronic anesthetic record located proximate to a patient202. Features of the safety and security system100ofFIG.1may be included in the safety and security system200ofFIG.2, and vice-versa, therefore all aspects may not be described in further detail. Like numerals can represent like elements. Aspects ofFIGS.1and2may also be described together. Some aspects ofFIG.2, including an IV fluid identification and measurement system130, are described with respect other figures, including the description of IV fluid identification and measurement system1430ofFIG.14.

As shown inFIG.2, an example medication identification and measurement system228may be attached to a relocation module201that may be advantageously positioned proximate the patient202, such as near the patient's head on a surgical table212. In this position medications can be conveniently administered by medical personnel while also tending to and observing the patient202during surgery.

In some examples, the medication identification and measurement system128(FIG.1),228(FIG.2) may include one or more sensors, such as one or more of: a barcode reader or QR code reader (e.g.,436,FIG.4), a radio-frequency identification (RFID) interrogator (e.g.,438,FIG.4), or any other suitable sensor for accurately and reliably identifying a medication for IV administration. As defined herein, a barcode reader can include any other type of identifying reader, such as, but not limited to, a QR code reader. Likewise, the RFID interrogator can be any type of interrogator and is not limited to those interrogators based on radio frequency. Examples of such sensors are described herein, such as inFIGS.4and5.

In some examples, instead of, or in addition to one or more of an RFID interrogator438and a barcode reader436, the medication identification and measurement system128,228can receive an input to determine the identity. For example, the medication identification and measurement system128,228can include one or more of: a sensor, such as barcode reader436ofFIG.4, configured to identify the one or more IV medications or fluids, or an input configured to receive the identity of the one or more IV medications or fluids, such as via the anesthetic record input component224.

In some examples, the barcode reader (e.g.,436,FIG.4) may be a “computer vision” or “machine vision” camera with the capability of reading barcodes. The term “machine vision” is often associated with industrial applications of a computer's ability to see, while the term “computer vision” is often used to describe any type of technology in which a computer is tasked with digitizing an image, processing the data it contains and taking some kind of action. In this disclosure the terms “machine vision” and “computer vision” may be used interchangeably. Traditionally, machine vision includes technology and methods used to provide imaging-based automatic inspection and analysis, process control, and robot guidance. Machine vision is sometimes used in manufacturing environments. Machine vision refers to many technologies, software and hardware products including processing circuitry, integrated systems and methods.

The inventors have discovered that machine vision can be useful beyond its traditional uses. The inventors discovered that machine vision can be advantageous in implementing a safety and security system100,200because it offers reliable measurements, gauging, object recognition, pattern recognition and liquid fill level measurements. Machine vision does not get tired or distracted. Machine vision excels at quantitative measurement of a structured scene because of its speed, accuracy and repeatability. However, it does require the scene to be structured to perform the desired function.

Machine vision can be very accurate for measuring size of an object at a known distance or the distance of an object of known size. However, it cannot do both. Therefore, in some examples it is important to know the exact location of a syringe (e.g.,406,FIG.4) and thus know the distance from the camera (e.g.,436,FIG.4) to the syringe (e.g.,406,FIG.4) in order for the machine vision to calculate the distance of the movement of the plunger (e.g.,446,FIG.5) within the syringe (e.g.,406,FIG.5). This is what we mean by the “scene being structured.”

Machine vision may be advantageous for the safety and security system100,200of this disclosure because it “sees” and measures, but does not touch or interfere with the healthcare provider doing their normal job of injecting medications or administering IV fluids. Further, the same visual image that is used by the machine vision software can be transmitted and displayed on a screen126,226to give the operator (whose fingers can be pushing the plunger446of the syringe406, a close-up view of the syringe406.FIG.5is a cross-section view taken at 5-5 ofFIG.4. The machine vision camera436can be looking at the same view of the syringe406as the operator and it is the same or similar view that the operator would see if they were injecting IV medications the traditional way.

The machine vision camera, or digital camera, can include machine vision software, or the machine vision camera can be in electrical communication with (e.g., operably coupled to) one or more hardware processors, such as processing circuitry157,257and one or more machine-readable mediums159,259. The one or more machine-readable mediums159,259can include instructions (e.g., software), that when implemented on the processing circuitry157,257, can perform the functions described herein. The processing circuitry157,257can be stored in the module101, relocation module201or remote from the modules101,201(e.g. in a wired or wireless manner). The one or more machine-readable mediums159can be a storage device, such as a memory located in the module201or remote from the module101,201.

In some examples, the RFID interrogator438may be either High Frequency (HF) or Near Field (NF) RFID in order to advantageously limit the read-range to a distance of less than 12 inches. In some examples, the RFID read-range may advantageously be limited, such as to less than 8 inches so that only a specific medication injection is identified at any time. In a possibly more preferred example, the RFID read-range may be limited to less than 4 inches to further prevent mis-readings. NF-RFID has a short read-range by definition and the read-range of HF-RFID can be easily limited by restricting the size of the antenna on the tag. In contrast, longer read-range RFID such as Ultra-high Frequency (UHF-RFID) may confusingly interrogate every RFID tag in the operating room and thus be unable to identify which medication is being delivered to the medication identification and measurement system128,228. However, any suitable RFID range for a particular application may be used.

FIG.3illustrates a plan view of an example of preloaded syringes306A and306B that can be used with the safety and security system200ofFIG.2.

The one or more preloaded syringes306A and306B may be labeled with a unique barcode label307or an RFID tag308that may identify one or more of the drug, the concentration, the lot number, the expiration date, the manufacturer and other important information. In some examples, a unique barcode label307may be a “2-D” barcode label in order to include more information on a smaller area than traditional barcode labels. In some examples, the barcode label307or RFID tag308includes the drug identifying label309A and309B for convenient use by the caregiver.

In some examples, the syringes306A and306B can be filled at the point of use and may be labeled with drug labels309A and309B and either barcode labels307or RFID tags308that are removably attached to the drug bottle or vial at the factory or pharmacy. The drug labels309A and309B and either barcode labels307or RFID tags308may be easily removed from the drug bottle or vial and adhesively attached to the syringe306A or306B at the time that the syringe306A or306B is loaded with the drug by the caregiver. Instead of, or in addition to the barcode labels307or RFID tags308, any other suitable “tag/reader” system known in the arts, may be used.

FIGS.4-10illustrate examples of medication identification and measurement systems428,628,828that can be used with the safety and security systems100,200ofFIGS.1and2. However, aspects of the medication identification and measurement systems428,628and828may be used with other systems, and other medication identification and measurement systems may be used with the safety and security systems100,200. Furthermore, some examples of the safety and security systems100,200can omit aspects of the medication identification and measurement systems, or can omit a medication identification and measurement system altogether.FIG.4illustrates a portion of a safety and security system400including a side view of an example medication identification and measurement system428and a syringe406that can be used with the safety and security systems100,200ofFIGS.1and2, to monitor drug delivery.FIG.5illustrates a cross-sectional view of the medication identification and measurement system428and the syringe406(not shown in cross-section) ofFIG.4, taken along line5-5.FIGS.4and5are described together.

As shown inFIGS.4and5, the medication identification and measurement system428may include at least one injection portal411. The injection portal411may be a receptacle for accommodating a syringe406in a fixed and known location and can be configured to orient the Luer taper connector513to mate with an injection port515. The injection port515can be secured within the injection portal411and can be in fluid communication with IV tubing520. In some examples, the injection portal411may include an injection portal tube416, such as a transparent tube that is sized to receive and accommodate a syringe barrel418of a syringe406. In some examples, the injection portal can be configured to receive a specific size syringe barrel418. In some examples, multiple injection portals411can be provided to accommodate syringes406of different sizes.

FIG.6illustrates a portion of a safety and security system600including a side view of a second example of a medication identification and measurement system628and a syringe606that can be used with the safety and security systems100,200ofFIGS.1and2, to monitor drug delivery.FIG.7illustrates a cross-sectional view of the second example of a medication identification and measurement system628and the syringe606(not shown in cross-section) ofFIG.6, taken along line7-7.FIGS.6and7are described together.

As shown inFIGS.6and7, the injection portal611of the medication identification and measurement system628may be large enough to accommodate syringes606of multiple sizes within the space defined by a real or imaginary injection portal tube616. In this example, accurately orienting the Luer taper connector713to mate with an injection port715may be accomplished by one or more orienting members such as one or more spring positioning members622A-F that engage with the syringe barrel618to center it in the injection portal611. In some examples, there may be two or more rows of spring positioning members622A-F. For example, spring positioning members622A, B, E, F may be located near the entrance to the injection portal611and spring positioning members622C, D may be located near the injection port715to assure accurate positioning for mating with the Luer taper connector713. Spring positioning members622A-F may include not only spring wires or metal or polymer or plastic spring pieces but any flexible material or combination of materials or shapes that can be deformed by the syringe barrel618entering the injection portal611and retain a memory (e.g., elastically deformable, substantially elastically deformable, resiliently deformable, resilient member) so as to urge the syringe barrel618into a centered position within the space defined by a real or imaginary injection portal tube616.

One objective of the spring positioning members622A-F can be to “automatically” center and align the Luer taper connector713of the syringe606with the injection port715, so that the operator can simply and conveniently push the syringe606into the injection portal611and no further manual alignment may be needed. The spring positioning members622A-F can also obviate the need for the operator to touch either the Luer taper connector713of the syringe606or the injection port715, thus beneficially preventing accidental infectious contamination by the operators' fingers and gloves.

FIG.8illustrates a portion of a safety and security system800including a side view of a third example of a medication identification and measurement system828and a syringe806that can be used with the safety and security systems100,200ofFIGS.1and2.FIG.9illustrates a cross-sectional view of the third example of a the medication identification and measurement system828and the syringe806(not shown in cross-section) ofFIG.8, taken along line9-9.FIGS.8and9are described together.

As shown inFIGS.8and9, a syringe barrel818may be centered and held in place by one or more orienting members, such as compression positioning members842A, B. The compression positioning members842A, B may be urged apart by inserting the syringe barrel818there between. Springs844A-D can compress and create a pressure pushing the compression positioning members842A, B against syringe barrel818. The compression positioning members842A, B shown inFIGS.8and9are merely illustrative, and many other sizes, shapes, numbers and locations of compression positioning members842are anticipated.

Compression positioning members842A, B may be simple spring844A-D activated devices (e.g., resilient members) as shown inFIGS.8and9or may be any mechanism that can expand (e.g., resiliently expand) to accommodate syringe barrels of various sizes and urge the syringe barrel818into a centered position within the space defined by a real or imaginary injection portal tube816. This example shows spring844A-D activated compression positioning members842A, B but many other mechanical activation mechanisms are anticipated. The compression positioning members842A, B can be elastically deformable, substantially elastically deformable, resiliently deformable, include one or more resilient members.

Other examples of positioning members designed to hold an inserted syringe806in the center of the injection portal811and thus orienting the Luer taper913for mating with the injection port915are anticipated. Positioning the inserted syringe806in the center of the injection portal811allows the machine vision to work from a known distance and thus calculations of syringe plunger948movement can be very accurate.

In some examples, instead of the positioning members shown in the examples ofFIGS.6-9holding a syringe centrally, the positioning members622A-F or842A, B can be designed to hold an inserted syringe606,806at a known, but off center position in the injection portal611,811, such as when the injection port715,915(FIGS.7and9) is positioned off center in the injection portal611,811. Any arrangement of at least one positioning member that aligns an inserted syringe at a known position may be provided.

In some examples, and as shown inFIGS.4,6and8the medication identification and measurement system428,628,828of this disclosure may include one or more “machine vision” cameras436,636,836that input digital images into one or more processors having processing circuitry157,257as shown and described inFIGS.1,2, that is programed to analyze machine vision images. In some examples, one of the images that the machine vision cameras436,636,836may “see” is a barcode label307on the syringe406,606,806, that has been inserted into the injection portal411,611,811, for identifying the medication in the syringe406,606,806. As previously noted, the barcode label307can identify the brand name and/or generic name of the medication in the syringe. In some examples, the barcode label307also may identify one or more of the concentration of the medication, the lot number, the expiration date and other information that may be useful for inventory management.

As shown inFIGS.4,6and8, the safety and security system400,600,800of this disclosure can include one or more radio frequency identification (RFID) interrogation antennas438,638,838that input RFID information into a processor, such as processing circuitry157,257as shown and described inFIGS.1and2, that is programed to analyze RFID data. In some examples, the RFID interrogation antennas438,638,838can interrogate a RFID tag308(FIG.3) attached to the syringe406,606,806, that has been inserted into the injection portal411,611,811, for identifying the medication in the syringe406,606,806. In some examples, short range RFID such as near field (NF) or high frequency (HF) may be advantageous because they may only detect the syringe406,606,806that is adjacent to or inside the security system for IV medications400,600,800, and not detect the various other medication syringes that may be sitting on the worktable such as206A-206C inFIG.2.

As shown inFIGS.4,6and8the medication identification and measurement system428,628,828of this disclosure may include a RFID interrogator438,638,838. In some examples, the RFID interrogator438,638,838that can include antennas that may be located inside the medication identification and measurement system428,628,828. In some examples, the RFID interrogator antennas438,638,838may be located external to but proximate the medication identification and measurement system428,628,828. As the syringe406,606,806is brought into proximity of the medication identification and measurement system, the RFID interrogator438,638,838can interrogate the RFID tag308on the syringe406,606,806, thereby accurately and reliably identifying a medication for IV administration. In some examples, the RFID tag308or other marker may include one or more of: the generic and brand name of the drug, the concentration, the lot number, the expiration date, the manufacturer and other important information that may be recorded. In some examples, the generic and brand name of the drug and the concentration of the drug can be displayed in the injection section of a display such as the display126,226(FIGS.1,2).

Machine vision is very accurate for measuring the size of an object at a known distance or the distance of an object of known size. However, it cannot do both. Therefore, in some examples it is important to know the exact location of a syringe and thus know the distance from the camera to the syringe in order to accurately calculate the distance of the movement of the plunger within the syringe.

Syringes are available in multiple sizes such as 3 cc, 6 cc and 12 cc, each of which is a different diameter. The machine vision processor must know both the internal diameter of the barrel of the syringe and the distance that the syringe plunger moves down the barrel, in order to calculate the volume of medication injected, unless it has another source of information. The machine vision of this disclosure can measure the diameter of the syringe because in the examples the syringe406,606,806is held at known distance and in a centered location relative to the machine vision cameras436,636,836. Alternately, the security system for IV medications400,600,800of this disclosure may be programed to know that the particular hospital uses only Monoject® syringes for example and the internal diameter of each Monoject® syringe size may be pre-programed into the computer. In this case, the machine vision only needs to differentiate 3 cc, 6 cc and 12 cc syringe sizes from each other. The machine vision processor can determine the internal diameter of the barrel of the syringe. In some examples, the syringe size may be included in the information provided by the barcode307or RFID308(FIG.3).

In some examples, such as the examples ofFIGS.4-9, the machine vision system, including the machine vision camera436,636,836and the processor157,257ofFIGS.1and2(e.g., processing circuitry) in electrical communication with the machine vision camera436,636,836, can visually detect and determine other geometry information about the syringe406,606,806besides the outside diameter, such as determining the inside diameter, or the inner or outer length of the syringe. The medication identification and measurement systems428,628,828can use the geometry information to determine the size or type of the syringe406,606,806, or can use the geometry information to calculate a volume of the syringe406,606,806.

In some examples, as the syringe406,606,806is advanced into the injection portal411,611,811, the image of the syringe406,606,806entering the injection portal411,611,811is displayed in real time in an injection section126a,226aof the display126,226(FIGS.1and2). Therefore, the caregiver can watch the syringe406,606,806advance and engage with the injection port515,715,915. In some examples, the injection portal tube416,616,816or the spring positioning members622A-E or the compression positioning members842A, B, urge the syringe606,806into position to mate with the injection port715,915but the actual connection can also be observed as it is happening by the caregiver on the display126,226. Even though the caregiver is not physically holding the injection port515,715,915as they typically would, they can watch the engagement of the Luer connector513,713,913with the injection port515,715,915on a display126,226, the view is essentially identical to the thousands of injections that they have made during their career. In some examples, the actual image of the syringe406,606,806can be displayed on the display126,226, while in other examples the data obtained by the camera436,636,836can be converted to a representation of the syringe displayed on the display126,226.

In some examples, once the syringe406,606,806is securely connected to the injection port515,715,915, the caregiver pushes on the plunger446,646,846of the syringe406,606,806, injecting the medication into the injection port515,715,915and IV tubing520,720,920. The caregiver can visualize the plunger seal548,748,948move down the syringe barrel418,618,818and can determine the volume of medication injected by the graduated markings on the syringe406,606,806. Thus, the engagement of the Luer connector513,713,913with the injection port515,715,915and the injected volume are observed by the caregiver on the display126,226and the traditional method and routine of injection is minimally altered by implementing the safety and security system100,200including the example medication identification and measurement systems428,628,828.

In some examples, the processing circuitry157,257(FIGS.1and2) or a computer may also simultaneously generate data representing a running total of the volume and dosage of the injected medication and can transmit the generated data to the display126,226to display volume and dosage information on the display126,226. In some examples, the processing circuitry157,257or a computer may also generate its own graduated scale and transmit the generated graduated scale information to the display126,226to superimpose the scale on the image of the syringe406,606,806or next to the image of the syringe406,606,806, for added visual clarity of the injected volume and dose.

In some examples, the machine vision determination of the injected volume may be calculated by multiplying the internal cross-sectional area of the syringe (πr2) by the distance that the syringe plunger moves. The radius of the syringe may be determined in one or more ways. For example, the machine vision function may determine that the syringe approximates a 3 cc or 12 cc syringe and the computer is programed to know that the hospital uses a specific brand of syringes and the internal diameter (radius) of each of these syringe sizes is precisely known. (An example of diameter d, radius r is shown inFIG.12) Another example may require the machine vision camera to measure the outer diameter of the syringe and then subtract an approximated wall thickness (either measured or known value stored in a memory) from the measured diameter to determine the internal diameter. In another example, the internal diameter of the syringe may be supplied to the processing circuitry157,257or a computer as part of the RFID308or barcode307information. In another example, the machine vision may determine the inner diameter of the syringe by determining an outer diameter of the plunger as viewed through the transparent or semi-transparent syringe and determine the wall thickness, In yet another example, the machine vision may be able to visibly determine the inner diameter or radius directly through the transparent or semi-transparent syringe. Any other suitable determination, calculation or algorithm may be used to determine the radius, diameter and injected volume.

In some examples, the machine vision determination of the distance that the syringe plunger446,646,846moves may be by “observing” the movement of the black rubber plunger seal548,748,948against the visible scale printed on the syringe406,606,806. In this example, the machine vision can be programed to recognize the markings on the syringe406,606,806.

In some examples, the machine vision determination of the distance that the syringe plunger446,646,846moves may be by observing the movement of the black rubber plunger seal548,748,948relative to a scale calculated by the processing circuitry157,257(FIGS.1and2). The geometrical calculation of the scale that determines the distance that the syringe plunger446,646,846moves may be easiest to determine along the widest part of the syringe that corresponds with the center C (FIG.12) of the syringe406,606,806, which is a known distance from the machine vision camera436,636,836. Alternatively, the computer-constructed scale may be applied to the side of the syringe406,606,806facing the camera436,636,836, if the radius of the syringe406,606,806is subtracted from the known distance to the center C (FIG.12) of the syringe406,606,806in order to calculate the distance437from the machine vision camera436,636,836to the near side (e.g.,411A) of the syringe406,606,806.

In some examples, the movement of the black rubber plunger seal548,748,948of the syringe406,606,806can be clearly identifiable by the machine vision camera436,636,836and a scale to determine the distance moved by the plunger446,646,846can either be “visualized” or constructed by the machine vision computer (e.g., processing circuitry). Multiplying the distance that the plunger seal548,748,948moves by the known or measured internal diameter d (FIG.12) of the syringe406,606,806and thus cross-sectional area of the plunger seal548,748,948, allows the processing circuitry157,257or a computer in electrical communication with the processing circuitry157,257to calculate an accurate injected volume. The measured injection volume and dosage may be displayed on the display126,226of the module101,201(FIGS.1and2). Without interfering with or changing the anesthesiologists' normal or traditional medication injection routines, an unobtrusive machine vision camera436,636,836and computer (e.g., processing circuitry) can “observe” the medication injections and automatically record them in the EMR.

In some examples, the injected volume of medication may be determined by other sensors or methods. For example, the systems described herein can employ (e.g., substitute) other sensors such as a non-visual optical sensor436A in place of or in addition to the machine vision camera436,636,638described inFIGS.4-9. For example, a light source cab shine on one or more light sensitive elements such as photodiodes, and the position of the plunger of the syringe can be roughly determined by the obstruction of the light beam by the plunger. Other fluid measurement methods can have a sensor including adding magnetic material to the syringe plunger and detecting movement of the plunger with a magnetic proximity sensor. Alternatively, fluid flow may be measured with fluid flow meters in the IV fluid stream. These examples are not meant to be an exhaustive list but rather to illustrate that there are alternative technologies to machine vision (e.g., sensors), for noncontact measurement (e.g., sensing) of fluid flow from a syringe that are anticipated in this disclosure.

Securing the injection port515,715,915within the injection portal411,611,811prevents the caregiver from touching the injection port515,715,915. Normally caregivers wear gloves to protect themselves from infectious contaminates from the patient and operating room and their gloves are nearly always contaminated. Anything they touch will be contaminated. They typically pick up and hold the IV injection port515,715,915with one hand while inserting the Luer taper connector513,713,913of the syringe406,606,806into the injection port515,715,915. In the process, the injection port515,715,915is frequently contaminated with pathogenic organisms from their gloves that can enter the patient's blood stream with the next injection, causing serious infections. It is therefore advantageous from the infection prevention point of view, if the Luer connection and injection can be accomplished while never touching the injection port515,715,915.

In some examples as shown inFIGS.4,6and8the medication identification and measurement system428,628,828can include one or more ultraviolet (UV) lights440A,440B,640A-D,840A-D that shine on the injection port515,715,915. The one or more UV lights can be located inside the module (e.g.,101,FIG.1) of the medication identification and measurement system128,228,428,628,828, keeping the injection portal411,611,811and the injection port515,715,915disinfected. In some examples, the UV lights440A,440B,640A-D,840A-D may preferably be in the UV-C part of the light spectrum. UV-C light has been shown to have superior germicidal powers over other parts of the UV spectrum. The UV lights440A,440B,640A-D,840A-D may shine continuously or intermittently. By making the injection port515,715,915untouchable because it is inside the module101and radiating the injection port515,715,915with UV-C light, the injection port515,715,915should be effectively disinfected between each injection and thereby eliminate injection port515,715,915contamination as a source of bloodstream infection.

In some examples as shown inFIGS.1and2, the safety and security system100,200may include an external reader, such as barcode reader180,280on the module101,201to read a barcode, QR code or the like for identification. This barcode reader180,280may be used to identify the healthcare provider injecting a medication by reading a barcode or QR code1186on the user's ID badge for example (FIG.11). In some examples as shown inFIGS.1and2, the safety and security system100,200may include an external RFID reader182,282on the module101,201. This RFID reader182,282may be used to identify the healthcare provider injecting a medication by reading an RFID tag1188on the user's ID badge1184B for example (FIG.11). In some examples as shown inFIGS.4,6and8, the safety and security system400,600,800may include an internal RFID reader438,638,838in the module101,201. This RFID reader438,638,838may also be used to identify the healthcare provider injecting a medication by reading an RFID tag on the user's ID badge for example.

It is an important part of the record to know who injected the medication and their identity can be easily verified and documented by the safety and security system400,600,800using either barcode, QR code or RFID. Other identification technologies are also anticipated.

FIG.10illustrates an example injection port cassette1054that can be used with the safety and security systems100,200ofFIGS.1and2, as detailed inFIGS.5,7and9. As shown inFIG.10, the injection port1015may be mounted on an injection port cassette1054in order to make the attachment to the safety and security system100,200,400,600,800easier and more secure. The injection port cassette1054may be a piece of molded polymer or plastic onto which the injection port1015and IV tubing1020may be attached. The injection port cassette1054may be shaped and sized to fit into a slot in the safety and security system100,200,400,600,800. When the injection port cassette1054is fit into a slot in the safety and security system100,200,400,600,800, the injection port1015can be positioned substantially in the center of the injection portal411,611,811for mating with the Luer tapers513,713,913. The injection port cassette1054can also be configured to be removed intact from the safety and security system400,600,800so that the patient can be transferred and the IV tubing1020can be moved with the patient and continue to operate normally.

In some examples, and as shown inFIG.10, the injection port cassette1054can include an IV bypass channel1056in the IV tubing1020. The IV bypass channel1056can allow the IV fluids to flow unencumbered by the medication injection apparatus. The injection port cassette1054can include a medication channel1058in the IV tubing1020and, the medication channel1058may include one or more stop-flow clamps1060A, B. The one or more stop-flow clamps1060A, B may be activated by the safety and security system100,200,400,600,800if a medication error is identified. The one or more stop-flow clamps1060A, B may be powered by one or more electromechanical solenoids that squeeze the IV tubing in the medication channel1058flat, obstructing the flow. Other electromechanical flow obstructers are anticipated.

In some situations, such as when administering a drug to a patient allergic to that drug, or administering potent cardiovascular drugs to a patient with normal vital signs, or administering a drug with a likely mistaken identity, the computer, such as processing circuitry157,257(FIGS.1and2) for the safety and security system100,200,400,600,800of this disclosure can automatically activate the stop-flow clamps1060A, B to compress the medication channel1058tubing upstream and/or downstream from the injection port1015. Compressing the IV tubing both upstream and downstream from the injection port1015prevents the injection of any medication into the IV tubing1020. An alert to the adverse condition of the injection may be displayed on display126,226where the stop-flow condition can be over-ridden by the operator touching a manual override switch on the display126,226or the module101,201, if the injection was not erroneous. While the stop-flow can occur in the medication channel1058, the IV fluid flow can continue normally in the parallel bypass channel1056.

The stop-flow clamps1060A, B can allow the processing circuitry157,257(e.g., processor, hardware processing circuitry) of the safety and security system100,200,400,600,800to not only warn the operator of a pending medication error, but physically prevent the injection. Perhaps equally as important is that the stop-flow clamps1060A, B can be quickly released by the operator touching a manual override switch in the event that the apparent error was in fact a planned event or otherwise desired by the operator.

In some examples, a part of the safety and security system100,200,400,600,800can include the ability for the computer (e.g., machine) to know the patient's medical history, medication orders, vital signs, current medications, medication orders and other important information about that patient. In some examples, the medication in syringe306can be identified by RFID tag308(FIG.3) and is detected by RFID interrogator438,638,838as the syringe306enters injection portal411,611,811. The processing circuitry (e.g.,157,257) of the safety and security system100,200,400,600,800can cross-reference the proposed injection to the patient's medical history, medication orders, vital signs, current medications and other important information about that patient, providing a safety “over-watch” guarding against medication errors. In some examples, the processing circuitry (e.g.,157,257) of the safety and security system100,200,400,600,800may include algorithms and/or “artificial intelligence” that can provide alternative medication suggestions based on patient's medical history, medication orders, vital signs, current medications and other important information about that patient.

In some examples, the EMRs that were created by the safety and security system100,200,400,600,800of this disclosure can provide accurate and temporally correlated information about the relationship between any injected medication and the resulting physiologic response. This is uniquely accurate dose-response data. In some examples, the EMRs that were created by the safety and security system100,200,400,600,800for hundreds of thousands or even millions of patients, may be aggregated and analyzed as “big data.” The “big data” from these EMRs may be used for a variety of purposes including but not limited to medical research, patient and hospital management and the development of “artificial intelligence” algorithms that can provide alternative medication suggestions. Ongoing “big data” from more and more EMRs can be used to continually improve and refine the “artificial intelligence” algorithms, much like the “artificial intelligence” algorithm development process being used to develop self-driving vehicles. These “artificial intelligence” algorithms can be used to provide automated (“self-driving” or “partially self-driving”) anesthesia during surgery or automated medication delivery.

It is well known that scheduled drugs such as Fentanyl and other narcotics are frequently stolen by drug addicted healthcare personnel. The final link in the “chain of custody” between when the drugs are checked out from a vending system such as a pharmacy or Pixis medication dispenser, and when the drugs are injected into the patient is missing. The final link in the “chain of custody” between when the drugs are checked out from the pharmacy and when the drugs are injected into the patient is totally dependent on the personal integrity of the healthcare provider. It is also impractical for each narcotic injection to be personally monitored by a second healthcare provider. Without a complete “chain of custody,” even a second provider monitoring the injection may not be adequate to prevent medication pilferage. Addicted healthcare providers frequently substitute saline for a clear medication such as the narcotic Fentanyl—injecting the saline and keeping the Fentanyl for themselves. Addicted healthcare providers have been known to successfully steal their patient's narcotics for years before being caught.

In some examples, the safety and security system100,200,400,600,800of this disclosure provides a “chain of custody” between when drugs are checked out from the pharmacy or Pixis medication dispenser, and when the drugs are injected into the patient. The “chain of custody” provides security especially for scheduled drugs such as narcotics. The “chain of custody” provided by the safety and security system100,200,400,600,800makes it nearly impossible to steal the patient's narcotics. The added security provided by the safety and security system100,200,400,600,800significantly increases the chances of getting caught, thus creating a disincentive for addicted healthcare providers stealing their patient's drugs.

FIG.11illustrates a plan view of an example of healthcare provider ID badges1184A and1184B that can be used with the system ofFIGS.1and2, in accordance with at least one example. In some examples, the “chain of custody” may begin by electronically identifying the healthcare provider as the drugs are checked out from the pharmacy or Pixis medication dispenser. In some examples and as shown inFIG.11, each provider can have a personalized RFID tag1186, attached to their hospital ID badge1184A. In some examples each provider can have a personalized barcode1188, attached to their hospital ID badge1184B for example. When the drugs are checked out, the personalized RFID tag1186may be read by an RFID interrogator or the personalized barcode1188read by a barcode reader in the pharmacy and the ID of the provider checking the drugs out may be noted in the hospital's computer and/or the processing circuitry157,257(FIGS.1and2) for the safety and security system100,200,400,600,800(FIGS.1,2,4,6and8). The specific RFID308or barcode307(FIG.3) identification of the injectable drug may also be recorded before the drug leaves the pharmacy and that information may be transmitted to the processing circuitry157,257of the safety and security system100,200,400,600,800of this disclosure. In some examples, instead of an RFID tag1186and RFID reader, other provider identification information and sensors for identifying the provider can be used, such provider identification information may include: a barcode, a QR code with the sensor being able to read such codes. In other examples, the sensor can include a retinal scanner, fingerprint reader or a facial recognition scanner that identifies the provider by personably identifiable information (e.g., provider identification information) may be used.

In some examples, non-refillable preloaded syringes may be used to prevent pilferage of the drugs between leaving the pharmacy and arriving at the patient's bedside. It is a well-known practice for providers to steal drugs by pocketing the bottle, vial or ampule and then filling the syringe with saline for injection into the patient. Pre-loaded syringes remove the opportunity for the provider to pilfer drugs while loading a syringe from a bottle, vial or ampule. A non-refillable syringe makes it difficult or even impossible to discharge the narcotics from a preloaded syringe into a second syringe and then refill the discharged syringe with saline or other clear fluids.

In some examples, when the provider arrives at the patient's bedside, the provider may be identified by their ID badge1184A, B. In some examples, an ID badge1184A that has an RFID tag1186may be read by RFID reader182,282(FIGS.1and2) that can be located on the safety and security system100,200,400,600,800or by RFID reader438,638,838(FIGS.4,6and8) located inside the safety and security system100,200,400,600,800(FIGS.1,2,4,6and8). In some examples, an ID badge1184B that has a barcode1188may be read by barcode reader180,280that can be located on the safety and security system100,200,400,600,800. In some examples, a retinal scanner may be located on or near module101,201in order to positively identify the provider by their retinal vasculature. Other scanners including but not limited to facial recognition scanning are also anticipated in order to positively identify the provider doing the injection in order to automatically document this information to an EMR or other record.

In some examples, the provider's photograph may be taken by camera190,290(FIGS.1and2) for further identification before allowing the injection of scheduled drugs. In some examples, the camera190,290may be triggered, such as by processor157,257(FIGS.1and2), when a syringe e.g.,306B filled with a scheduled drug such as a narcotic is identified as it enters the injection portal411,611,811and the RFID interrogator438,638,838interrogates the RFID tag308(FIG.3) or the machine vision camera436,636,836reads the barcode307(FIG.3) on the syringe306A. Non-scheduled medications may not need the added security of a photograph.

In some examples, when the syringe, such as406,606,806, filled with a scheduled drug such as a narcotic enters the injection portal411,611,811, the RFID interrogator438,638,838interrogates the RFID tag308or the machine vision camera436,636,836reads the barcode307on the syringe306A,306B. At that point, the safety and security system100,200,400,600,800of this disclosure can have documented, such as by recording to memory one or more of: 1.) the specific drug syringe that was checked out of the pharmacy and is now inside the injection portal411,611,811; 2.) the ID of the provider injecting the drug; 3.) the ID of the provider who checked the drug out of the pharmacy 4.) the patient who is being injected and 5) the time of the injection. The processing circuitry157,257can include or be electrically connected to a timer and a memory to facilitate recording the time.

In some examples, the machine vision camera436,636,836of the safety and security system100,200,400,600,800“watches” the injection occur and documents that it occurred. When the injection has occurred, the “chain of custody” is complete for that dose of the scheduled drug. If all of the drug in the syringe is not injected, the safety and security system100,200,400,600,800can document the non-injected drug. The remaining non-injected drug may be “closed out” in the system by being administered to the patient in a second or third injection or by being properly disposed of and manually documented.

In some examples, in order for the safety and security system100,200,400,600,800to assure a “chain of custody” for a given drug, the drug may come from the pharmacy in a pre-loaded syringe that may be tamper-proof and non-refillable. There are many ways that narcotics such as Fentanyl have been pilfered by healthcare personnel. First, if the drug is delivered in a vial, ampule or bottle, it may not be transferred into the injection syringe by the provider. The syringe may be refilled with another fluid such as saline instead and the narcotic may be put in the provider's pocket. Therefore, in some examples, prefilled syringes may be desirable to assure the last link in the “chain of custody” between the pharmacy and the patient is complete.

Another well-known opportunity for stealing drugs in the healthcare setting is from a syringe that has been filled with a drug such as a narcotic. Very simply, some or all of the drug in the syringe can be discharged into another syringe or container and then the first syringe can be refilled with saline looking exactly like it did before the discharge. To prevent this method of drug pilferage, the syringes used for narcotics should be non-refillable. Filling a standard syringe is normally accomplished by pulling on the plunger that is attached to the plunger seal—a rubber gasket mounted on the end of the plunger. The distal end of the plunger is knob-shaped and it fits into a pocket-like receptacle in the plunger seal that captures the knob of the plunger and pulls the plunger seal along when the plunger is pulled from the syringe.

FIG.12illustrates a longitudinal cross-sectional view of an example of a medication security syringe that can be used with the system ofFIGS.1and2. In some examples, and as shown inFIG.12, the normal method of filling a syringe1206can be prevented by replacing the knob-shaped distal end of the traditional plungers (e.g.,446,646,846) with a tubular-shaped distal end1292as of plunger1246. If the plunger1246is retracted from the syringe1206, the relatively smooth sides of the distal end1292of the plunger1246disengage easily from the plunger seal1248, preventing the plunger seal1248from creating the vacuum necessary to refill the syringe1206.

In some examples, an enterprising drug thief could overcome the fact that relatively smooth sides of the distal end1292of the plunger1246disengage easily from the plunger seal1248, by forcing fluid into the open end1294of the Luer taper1213. Fluid such as saline under pressure would fill the syringe from the Luer taper end1213and force the plunger seal1248rearward as the syringe1206fills with fluid. In some examples, a spring wire barb1296or other metal protrusion forming a barb may be molded into or attached to rubber plunger seal1248. In some examples, the tips1298A, B of spring wire barbs1296may be angled rearward away from the Luer taper1213and compressed inward by the walls of the barrel of syringe1206. The rearward angle of spring wire barbs1296allow the rubber plunger seal1248with its attached or imbedded spring wire barbs1296to be pushed forward in a normal fashion by plunger1246, discharging the contents of the syringe1206.

In some examples, if fluid such as saline under pressure was attempted to be forced into the syringe1206from the Luer taper1213end forcing the plunger seal1248rearward, the tips1298A, B of spring wire barbs1296can gouge into the soft polymer or plastic (e.g., polyethylene or polypropylene) of the walls of the barrel of syringe1206and prevent a rearward movement of plunger seal1248. Therefore, when the syringe1206has discharged it contents, it cannot be reloaded or refilled. The spring wire barbs1296as shown inFIG.12are an example of using a barb or ratchet effect to allow movement of plunger seal1248in one direction and prevent movement of plunger seal1248in the other direction. Other barb or ratchet mechanisms that accomplish this same effect are anticipated.

In some examples, an enterprising drug thief could overcome the fact the syringe1206of this disclosure cannot be reloaded or refilled, by removing the contents of the syringe1206without depressing the plunger1246. This can be accomplished in prior art syringes by inserting a hypodermic needle attached to a second syringe, through the opening in the Luer taper1213connector and sucking out the contents of syringe1206. A third syringe filled with saline can then be used to refill syringe1206by inserting a hypodermic needle through the opening in the Luer taper1213connector and injecting the saline. Therefore, in some examples, it may be advantageous to make the syringe tamper-proof by adding a mechanical barrier on either end of the Luer taper connector1213that physically prevents a hypodermic needle from entering syringe1206.

In some examples, as shown inFIG.12, a mechanical barrier may be added in the form of needle blocking insert1291. In an example, the needle blocking insert1291may be a piece of molded polymer, plastic or rubber that can be inserted into the barrel of syringe1206and pushed down to the closed end. The needle blocking insert1291can include a small metal plate1293that is positioned directly in front of the opening in the Luer taper connector1213in order to prevent a hypodermic needle that may be inserted into the open end1294of the Luer taper1213connector from entering the barrel of syringe1206. Depending on the specifics of the design, without a metal plate1293, a sharp hypodermic needle may be able to be pushed through the polymer, plastic or rubber needle blocking insert1291and into the barrel of syringe1206. The piece of metal1293can be retained in a recess1293A in the needle blocking insert1291. Although the needle blocking insert1291is described as including metal plate1293, any suitable needle blocking insert that prevents a needle from being inserted into the open end of the Luer taper1213can be provided within the scope of this disclosure.

In some examples, as shown inFIG.12, the needle blocking insert1291may include transverse fluid channels1295and/or longitudinal fluid channels1297. The transverse and or longitudinal fluid channels1295,1297may be molded into needle blocking insert1291allowing the fluid in syringe1206to flow through needle blocking insert1291during a normal injection but preventing needle penetration, such as by a drug thief. In some examples, the needle blocking insert1291may be coupled by attachment1299to syringe1206in order to prevent dislodgement. The attachment1299between the needle blocking insert1291and the barrel of syringe1206may be a heat bond, an ultrasonic bond, and RF bond, an adhesive bond or other mechanical attachment such as a pressure fit.

FIG.13illustrates a longitudinal cross-sectional view of an example of a medication security syringe1306that can be used with the system100,200ofFIGS.1and2. In some examples, as shown inFIG.13, a hypodermic needle may be prevented from entering the open end1394of the Luer taper1313connector by adding a serpentine or zig-zag fluid channel1381to the open end1394of the Luer taper1313connector. In some examples, the serpentine or zig-zag fluid channel1381may be made of molded polymer or plastic that creates an extended Luer taper connector1383. The molded serpentine or zig-zag fluid channel1381may include a hub1385that mates with Luer taper1313connector and is connected to Luer taper1313connector by a heat bond, an ultrasonic bond, and RF bond or an adhesive bond. The serpentine or zig-zag fluid channel1381prevents a stiff hypodermic needle or even a flexible catheter from navigating the sharp corners of the fluid channel1381. In some examples, the molded components described herein can be alternately formed, such as by 3D printing.

By preventing the movement of plunger seal1248after the syringe has been discharged and preventing the insertion of a hypodermic needle through the open end1294,1394of the Luer taper1213,1313connector in order to suck out the drug and then reload the syringe1206,1306with saline, the syringes1206,1306ofFIGS.12and13are resistant to undetected drug theft.

In some examples as shown inFIGS.1and2, the safety and security system100,200of this disclosure may include a remote monitor with display187,287. The remote monitor may include a wired or wireless connection to the safety and security system100,200and may display some or all of the information shown on the electronic record display126,226, or other information generated by the safety and security system100. For example, the processing circuitry157,257can be in electrical communication with the remote display187,287and the processing circuitry157,257can send instructions to the remote display187,287to display the generated information.

The remote monitor may be in the next room or miles away. The remote monitor may allow remote supervision of healthcare delivery. For example, anesthesiologists frequently supervise up to four surgical anesthetics at once, each being delivered by a nurse anesthetist. In this case, the anesthesiologist carrying a wireless remote monitor187,287can have real-time data on each case under their supervision. Similarly, a nurse anesthetist working in a rural hospital may be supervised by an anesthesiologist who is 50 miles away.

In some examples, the remote monitor with display187,287can create a record for billing. For example, when an anesthesiologist is supervising multiple anesthetics at once, the payers may dispute the involvement in each case and refuse to pay. The remote monitor with display187,287may include an RFID reader that documents the close proximity of an RFID tag on the anesthesiologist's ID badge. Any other type of proximity sensor may be used in place of the RFID tag, including but not limited to GPS location sensing. Documenting that the anesthesiologist was carrying the remote monitor with display187,287throughout the time of the surgery is very good evidence that the anesthesiologist was actively participating in the care of the patient.

In some examples, the remote monitor with display187,287allows long-distance medical consultation. For example, an expert at the Mayo Clinic could consult with a physician halfway around the world in Dubai, responding to real-time patient data displayed on the remote monitor with display187,287.

FIG.14illustrates a side view of an example IV fluid identification and measurement system1430that can be used with the systems ofFIG.1-9, and the injection port cassette ofFIG.10. Some aspects ofFIGS.1-10and14are described together, however, the examples are merely illustrative and the features can be used in any suitable combination. In some examples, the safety and security system100,200of this disclosure includes a system for automatically measuring and recording the administration of IV fluids. To accomplish this, as shown inFIGS.1,2and14, the safety and security system100,200can include an IV fluid identification and measurement system130,230,1430. In some examples, the IV fluid identification and measurement system130,230,1430can be mounted onto module101.

Alternately, the IV fluid identification and measurement system130,230,1430may be mounted to an IV pole105or racking system independent from the module101. The system for automatically measuring and recording the administration of IV fluids is not limited to use in anesthesia or in the operating room, but has applicability for use throughout the hospital and other health care settings, including but not limited to the ICU, ER, wards, rehabilitation centers and long term care settings. In some examples, aspects of the IV fluid identification measurement system130,230,1430can be provided alone or together with other features of the safety and security system100,200including the medication identification and measurement system128,228.

In some examples, the IV fluid identification and measurement system130,230,1430may be configured to accommodate one or more bags of IV fluid132,232A, B and1432A, B. Each bag of IV fluid can include a drip chamber134,234A, B and1434A, B and IV tubing120,220A, B and1420A, B. IV flow rates may be controlled with the traditional manually operated roller clamp that variably pinches the IV tubing120,220A, B and1420A, B to control or even stop the flow of IV fluids. In some examples, IV flow rates may be controlled with the automatically operated electromechanical flow rate clamps1478that variably pinch the IV tubing1420A to control or even stop the flow of IV fluids. The automatically operated electromechanical flow rate clamps1478may be controlled by the processing circuitry157,257, such as an electronic anesthetic record computer in module101or by any other suitable processor including hardware processing circuitry that is in electrical communication with the IV fluid identification and measurement system130,230,1430and/or is located within the IV fluid identification and measurement system130,230,1430.

In some examples, the IV fluid identification and measurement system130,230,1430is configured to automatically measure and record the administration of IV medications and fluids. The system130,230can include one or more of a barcode reader and an RFID interrogator (such as1436A, B) for accurately and automatically identifying a fluid for IV administration. Because of the close proximity to the adjacent bags, barcode identification may be preferable in order to prevent an RFID interrogator from reading the RFID tag on a neighboring bag. In some examples, as shown inFIG.14, one or more barcode labels1405A, B may be applied to the IV bags1432A, B in a location where they can be read by a sensor such as a barcode reader or machine vision camera1436A, B, or another machine vision camera located in a suitable position to read the barcode. In some examples, a dedicated barcode reader or a machine vision camera may be positioned adjacent the barcode label1405A, B location, specifically for reading the barcode label1405A, B.

In some examples, the drip chamber234A, B and1434A, B of the IV set can be positioned adjacent the one or more machine vision cameras1436A, B. In some examples, a standard background1468A, B may be positioned on the opposite side of the drip chamber1434A, B from the machine vision cameras1436A, B. The standard background1468A, B may be a plain background or may be an advantageous color, pattern, color design or illumination that highlights each of the falling drops, for easier identification by the processing circuitry157,257(e.g.,1502,FIG.15). The machine vision software including instructions can be stored on one or more machine-readable mediums (such as1522inFIG.15) that when implemented on hardware processing circuitry (including but not limited to processing circuitry157,257) or in electrical communication with the system, can perform the functions described herein. An example of such electrical connection is shown by the connection of processor1502with mass storage1516inFIG.15.

In some examples, the processing circuitry157,257,1502can be configured to look for a fluid meniscus1464A, B in the drip chamber1434A, B. In this case “seeing” a fluid meniscus1464A, B indicates that there is fluid in the drip chamber1434A, B and therefore the IV bag1432A, B is not empty, and air is not inadvertently entering the IV tubing1420A,1420B.

In some examples, if the IV fluid identification and measurement system130,230,1430fails to “see” a fluid meniscus1464A, B meaning that the drip chamber1434A, B is empty and thus the IV bag1432A, B is empty, stop-flow clamps1460A, B can be automatically activated. For example, processing circuitry157,257can send an instruction to activate the stop-flow clamps1460A, B to compress the IV tubing1420A, B in order to prevent air from entering the IV tubing1420A, B. In some examples, the empty IV bag1432A, B condition detected by the processing circuitry157,257can cause an alert to be displayed to the caregiver on the anesthetic record display226, such as by sending an instruction to the display.

The combination of the machine vision camera1436A, B in electrical communication with processing circuitry (e.g.,157,257,FIGS.1and2) that executes instructions stored on a machine readable medium can count the number of drops of fluid per unit of time in a drip chamber1434A, B to calculate or to estimate the flow rate of an IV. The size of the drip chamber1434A, B inlet orifice determines the volume of liquid in each drop. The inlet orifices of standard drip chambers are sized to create drops sizes that result in 10, 12, 15, 20, 45 and 60 drops per ml. Given a particular drop volume (size), 10 drops per ml for example, the system130,230,1430(e.g., via sensors, processing circuitry and machine readable medium) can count the number of drops falling in a known period of time and use that data to calculate or to estimate the flow rate. If these estimates were attempted by a human, they may be less accurate at higher flow rates (higher drop counts) because the drops are so fast, it can be difficult to count the drops. Eventually, at even higher flow rates the individual drops become a solid stream of fluid and the flow rate cannot be visually estimated.

In some examples, the IV fluid identification and measurement system130,230,1430is configured to look for falling drops of fluid1462A, B within the drip chamber1434A, B. When drops1462A, B have been identified, the machine vision system (e.g., machine vision camera1436A or1436B operably coupled to processing circuitry157,257) may first measure the diameter of the drop1462A, B to determine which of the standard drop sizes or volumes it is counting. Most hospitals standardize on several infusion set sizes, 10, 20 and 60 drops per cc for example. Therefore, when these limited choices of infusion set brands and sizes have been programed into the computer, the machine vision system only needs to differentiate between these choices, which is much easier than accurately measuring the diameter of the drops. Unlike the human eye, the machine vision can accurately count the falling drops even at high flow rates to calculate an IV fluid flow rate.

In some examples, the machine vision system, including the machine vision cameras1436A, B and instructions1524(e.g., software) stored on a machine readable medium1522and implemented by hardware processing circuitry157,257does not “see” falling drops1462A, B. In this situation, either the fluid is flowing in a steady stream that is not identifiable or the fluid has stopped flowing. In some examples, these two opposite conditions can be differentiated by inserting a floating object1466A, B (hereinafter, “float”) into the drip chambers1434A, B. In some examples, the float1466A, B may be a ball-shaped float1466A, B. In some examples, the float may be patterned or multi-colored to more easily identify movement or spinning of the float. In some examples, if the machine vision system cannot identify falling drops1462A, B, it then looks to the float1466A, B for additional information. If the float1466A, B is not moving or spinning, the fluid flow has stopped. If the float1466A, B is moving or spinning and drops cannot be identified, the fluid is flowing in a steady stream and the flow rate cannot be measured by machine vision. In this situation, the system can determine fluid flow using an alternate method.

In some examples, the IV fluid identification and measurement system130,230,1430may be configured to accommodate one or more bags of IV fluid132,232A, B,1432A, B and each of these IV bags may be hanging from an electronic IV scale1472A, B (e.g., a weight, a physical characteristic sensor). The electronic IV scale1472A can measure the combined weight of the IV bag and fluid1432A, the drip chamber1434A and the IV tubing1420A. The electronic IV scale1472B can measure the weight or combined weight of one or more of the IV bag and fluid1432B, the drip chamber1434B, the IV tubing1420B and a pressure infuser1474. In both of these examples, the electronic IV scale1472A, B can accurately measure the change in combined weight that occurs due to the drainage of the IV fluid from the IV bag1432A, B. The change in weight per unit time can be converted to flow rates by processing circuitry157,257in electrical communication with the electronic IV scale1472A,1472B, for example, by the processing circuitry157,257,1502and displayed on the electronic record display126,226.

In some examples, the calculated flow rates for each IV bag1432A, B may also be displayed on one or more digital flow-rate displays1476A, B mounted on the IV fluid identification and measurement system1430. The digital flow-rate displays1476A, B may be small LED or LCD displays that conveniently tell the operator the flow rate while they are manually adjusting the flow rate near the IV bags1432A, B and drip chambers1434A, B. The digital flow-rate displays1476A, B are particularly convenient when the IV fluid identification and measurement system130,1430is a free standing entity mounted on an IV pole105for example while being used on the ward or ICU.

In some examples, when the falling drops1462A, B cannot be detected and yet the floats1466A, B are moving or spinning, the fluid is determined to be flowing in a steady stream and the flow rate cannot be measured by machine vision. In this case the electronic record computer may automatically query the change in weight per unit time as measured by the electronic IV scale1472A, B to determine the IV flow rate. At high flow rates, the change in weight per unit time as measured by the electronic IV scale1472A, B will most likely be more accurate than counting drops, in determining the IV flow rate.

The IV flow rate as determined by the change in weight per unit time can also be compared to the IV flow rates determined by counting drops to verify the accuracy of each method. Without interfering with or changing the healthcare providers normal or traditional IV routines, an unobtrusive machine vision camera and computer can “observe” the IV flow rates and automatically record them in the EMR.

The module or automated EMR system101,201of this disclosure may capture anesthetic event data but it must be noted that the same technologies described herein for capturing anesthetic event data can be used throughout the hospital or outpatient health care system to capture and record medication administration, IV fluid administration, vital signs and patient monitor inputs, provider events and other data. Non-operating room heath care locations are included within the scope of this disclosure. While this disclosure focuses on the totality of functions offered by module101,201, each of the individual functions can be offered independently of module101,201.

The use of the term Electronic Anesthetic Record (EAR) as defined herein can include any memory such as an electronic surgical record (ESR), or an electronic medical record (EMR), and is not limited to anesthetic or surgical applications. Aspects of the modules101,201described herein can also be employed in recovery, hospital room and long-term care settings.

In an example, the module201ofFIG.2, can include a housing299having a lower section299A and a tower-like upper section299B, wherein the lower section299A can be configured to house unrelated waste heat-producing electronic and electromechanical surgical equipment, and wherein the tower-like upper section299B can be located on top of the lower section299A. The module201can also include a cowling299C external or internal to the housing299that substantially confines waste heat generated by the unrelated waste heat-producing electronic and electromechanical surgical equipment. In addition, the module201can include a system for monitoring the administration of one or more IV medications and fluids228,230. As shown in the combination ofFIGS.2,4,5and14, the system228,230can include any of: a barcode436reader or an RFID438interrogator configured to identify the one or more IV medications or fluids; a machine vision digital camera436to capture an image of one or more of a syringe406or a drip chamber1434A, B; processing circuitry257operably coupled to the barcode reader436or the RFID interrogator438(or the machine vision digital camera436) to receive the identity of the one or more IV medications or fluids, the processing circuitry257operably coupled to the machine vision digital camera436to receive the captured image and determine a volume of medication administered from the syringe or fluid administered from an IV bag based on the image; and a display226operably coupled to the processing circuitry257, the display226configured to receive instructions from the processing circuitry257to output the identity and determined volume of medication administered from the syringe or fluid administered from an IV bag.

FIG.15illustrates an example electronic and/or electromechanical system1500of a medical system in accordance with some examples described herein. The system1500will be described with respect to the medical system20, but can include any of the features described herein to perform any of the methods or techniques described herein, for example, by using the processor1502. The processor can include processing circuitry157or257ofFIGS.1and2. In some examples, the processing circuitry1502can include but is not limited to, electronic circuits, a control module processing circuitry and/or a processor. The processing circuitry may be in communication with one or more memory and one or more storage devices. A single processor can coordinate and control multiple, or even all the aspects of the system1500(e.g., of modules101,201), or multiple processors can control all the aspects of the system1500. In some examples the storage device1516or memory1504,1506,1516can include at least a portion of the patient's anesthetic record saved thereon. The system1500can also include any of the circuitry and electronic and/or electromechanical components described herein, including but not limited to, any of the sensor(s) described herein (e.g., sensors1521), such as but not limited to, RFID barcode or QR codes sensors, machine vision cameras, retinal scanners, facial recognition scanners, fingerprint readers, actuators and position sensors described herein. The system1500may also include or interface with accessories or other features such as any of: a remote display or wireless tablet (e.g.,287,FIG.2), as well as any of the other systems described herein.

The processing circuitry1502can receive information from the various sensors described herein, make various determinations based on the information from the sensors, output the information or determinations from the information for output on the display or wireless tablet, output instructions to provide an alert or an alarm, power various components, actuate actuators such as clamps and flow managing devices, etc., or alert another system or user, as described herein. For the sake of brevity, select systems and combinations are described in further detail above and in the example sets provided in the Notes and Various Examples section below. Other embodiments are possible and within the scope of this disclosure.

Further,FIG.15illustrates generally an example of a block diagram of a machine (e.g., of module101,201) upon which any one or more of the techniques (e.g., methodologies) discussed herein may be performed in accordance with some embodiments. In alternative embodiments, the machine1500may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine1500may operate in the capacity of a server machine, a client machine, or both in server-client network environments. The machine1500, or portions thereof may include a personal computer (PC), a tablet PC, a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations.

Examples, as described herein, may include, or may operate on, logic or a number of components, modules, or like mechanisms. Such mechanisms are tangible entities (e.g., hardware) capable of performing specified operations when operating. In an example, the hardware may be specifically configured to carry out a specific operation (e.g., hardwired). In an example, the hardware may include configurable execution units (e.g., transistors, circuits, etc.) and a computer readable medium containing instructions, where the instructions configure the execution units to carry out a specific operation when in operation. The configuring may occur under the direction of the execution units or a loading mechanism. Accordingly, the execution units are communicatively coupled to the computer readable medium when the device is operating. For example, under operation, the execution units may be configured by a first set of instructions to implement a first set of features at one point in time and reconfigured by a second set of instructions to implement a second set of features.

Machine (e.g., computer system)1500may include a hardware processor1502(e.g., processing circuitry157,257, a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), a main memory1504and a static memory1506, some or all of which may communicate with each other via an interlink (e.g., bus)1508. The machine1500may further include a display unit1510, an alphanumeric input device1512(e.g., a keyboard), and a user interface (UI) navigation device1514(e.g., a mouse). In an example, the display device1510, an input device such as an alphanumeric input device1512and UI navigation device1514may be a touch screen display. The display unit1510may include goggles, glasses, or other AR or VR display components. For example, the display unit may be worn on a head of a user and may provide a heads-up-display to the user. The alphanumeric input device1512may include a virtual keyboard (e.g., a keyboard displayed virtually in a VR or AR setting.

The machine1500may additionally include a storage device (e.g., drive unit)1516, a signal generation device1518(e.g., a speaker), a network interface device1520, and one or more sensors1521, such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensor. The machine1500may include an output controller1528, such as a serial (e.g., universal serial bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to communicate or control one or more peripheral devices or actuators of the system. Peripheral devices can include but are not limited to any displays, controllers or memories in electrical communication with the system, and actuators can include but are not limited to: one or more stop-flow clamps1060A, B (FIG.10) and one or more flow rate clamps1478(FIG.14) of the system.

The storage device1516may include a machine readable medium1522that is non-transitory on which is stored one or more sets of data structures or instructions1524(e.g., software) embodying or utilized by any one or more of the techniques or functions described herein. The instructions1524may also reside, completely or at least partially, within the main memory1504, within static memory1506, or within the hardware processor1502during execution thereof by the machine1500. In an example, one or any combination of the hardware processor1502, the main memory1504, the static memory1506, or the storage device1516may constitute machine readable media that may be non-transitory.

While the machine readable medium1522is illustrated as a single medium, the term “machine readable medium” may include a single medium or multiple media (e.g., a centralized or distributed database, or associated caches and servers) configured to store the one or more instructions1524.

The term “machine readable medium” may include any medium that is capable of storing, encoding, or carrying instructions for execution by the machine1500and that cause the machine1500to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. Non-limiting machine readable medium examples may include solid-state memories, and optical and magnetic media. Specific examples of machine readable media may include: non-volatile memory, such as semiconductor memory devices (e.g., Electrically Programmable Read-Only Memory (EPROM), Electrically Erasable Programmable Read-Only Memory (EEPROM)) and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

The instructions1524may further be transmitted or received over a communications network1526using a transmission medium via the network interface device1520utilizing any one of a number of transfer protocols (e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), mobile telephone networks (e.g., cellular networks), Plain Old Telephone (POTS) networks, and wireless data networks (e.g., Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards known as Wi-Fi®, IEEE 802.16 family of standards known as WiMax®), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, among others. In an example, the network interface device1520may include one or more physical jacks (e.g., Ethernet, coaxial, or phone jacks) or one or more antennas to connect to the communications network1526. In an example, the network interface device1520may include a plurality of antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) techniques. The term “transmission medium” shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by the machine1500, and includes digital or analog communications signals or other intangible medium to facilitate communication of such software.

Method examples described herein may be machine or computer-implemented at least in part. Some examples may include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the examples. An implementation of such methods may include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code may include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code may be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media may include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), and the like.

Some of the benefits of the safety and security systems100,200ofFIGS.1and2and the subsystems described throughout this disclosure, and including the machine1500(FIG.15), can include features to help with monitoring medication, fluid and anesthesia delivery, as well as documenting medication, fluid and anesthesia delivery, as well as other functions. In general, doctors and nurses are not interested in replacing themselves and their jobs with automated drug delivery or automated anesthesia systems. However, there is great interest in automated record keeping. Virtually all healthcare providers would prefer the “old” paper record and a pen to the “new” computer records. Filling out the electronic medical record (EMR) using a computer keyboard, mouse and various menus is widely viewed as a slow, cumbersome and distracting process. The challenge with automated record keeping is automating the data input that documents the numerous activities, anesthesia related events, fluid, gas and medication administration, ventilator settings, pressure off-loading effectiveness, as well as outputs such as blood loss and urine output, that constitute an anesthetic experience.

A challenge in implementing the safety and security system and fluids100,200with an automated electronic anesthetic record (EAR) or electronic medical record (EMR) is to force as little change in the caregiver's routine as possible onto the clinicians using this system. Medical personnel tend to be creatures of habit and tradition and they generally do not like change. For example, IV medications are traditionally administered from a syringe and the dose is determined by the caregiver observing the plunger moving relative to a scale printed on the syringe. Maintaining this general technique of drug administration may have the highest probability of acceptance by healthcare users who are typically slow to embrace changes in their routine.

Further with regard to benefits of the modules, systems and machines described herein, the safety and security system200of module201can generate an automated electronic medical record (EMR) with the module201locatable proximate to the patient202. The module201can be a module for housing unrelated electronic and electromechanical surgical equipment. The module201need not necessarily be configured to house unrelated electronic and electromechanical surgical equipment in all examples, and other modules can include the system for generating an automated EMR.

The module201can be an automated EMR system that can include one or more systems (e.g.,200,228,230) configured to measure (e.g., monitor) and record one or more of functions involved in a surgical anesthetic environment, and can include life support functions. The one or more systems228,230can measure and record data automatically. However, in some examples, a user may initiate any of the systems described herein to measure and/or record data. These various measurements may be electronically recorded (such as on mass storage1516(FIG.15) and displayed on the electronic anesthetic record display226(e.g., display device1510,FIG.15). Inputs to the automated EMR system may be managed by the anesthetic record input component224(e.g., input device1512;FIG.15). The anesthetic record input component224(e.g., input device1512;FIG.15) can include a touch-screen display226that organizes all of the inputs to the EMR into easily accessed and utilized information. In some examples, and as shown inFIG.2, the identification and measurement system228of this disclosure may be located proximate the patient202. The control displays for the identification and measurement system228may include a dedicated display proximate the identification and measurement system228or may be shared space on the anesthetic record input component224or display226. In these locations, the information and controls of the identification and measurement system228can be viewed by the anesthesiologist or other user, in a single field of vision with the patient and surgical field.

Example methods of employing the systems, modules and machines disclosed herein are described throughout this disclosure and in the methods ofFIGS.16-21which are illustrative in nature. Other methods described herein may also be performed by the systems, modules and machines described herein, and the systems modules and machines described herein may be used to perform other methods.

FIGS.16-18show flow charts illustrating techniques for identification, measurement, monitoring, security and safety related to medications and/or IV fluids. The methods may be used with the systems, sub-systems and modules ofFIGS.1-15(e.g.,101,201,1500), but may also be used with other systems. Likewise, the systems, subsystems of modules ofFIGS.1-15may also be used with other methods. The techniques1600,1700,1800,1900,2000,2100,2300can be performed by at least one non-transitory machine-readable medium (e.g., computer readable) including instructions for operation of the systems described herein. Some steps of techniques may be performed by a provider. The systems can include processing circuitry (e.g.,157,257,1500, including one or more processors, processing circuitry hardware) for executing the instructions. The instructions, when executed by the processing circuitry can cause the processing circuitry to perform operations described inFIGS.16-21and23, and as described in the examples throughout this disclosure.

FIG.16is a flow chart illustrating an example technique1600of IV fluid identification and measurement. To start the technique, in operation1602a provider hangs an IV fluid bag and attached drip chamber on electronic scale hooks in an IV fluid identification and measurement unit (e.g.,FIG.14). In operation1604, a machine vision camera and software can identify the fluid and bag by the barcode label on the IV fluid bag. In operation1606, the machine vision camera and software can identify the individual drops in the drip chamber and measure the size of the drop to determine the fluid volume per drop and count the number of drops per unit time. In operation1608the machine vision camera and software can calculate the flow rate by multiplying the number of drops per unit time by the volume/drop. In operation1610, the fluid flow rate is displayed and document in the EMR.

In operation1612, if the machine vision camera and software fails to identify individual drops in the drip chamber, in operation1614the machine vision camera and software can look for a floating ball (e.g., float) that is located in the drip chamber to determine if the ball is floating and if the ball is moving. In operation1616, when the ball is not floating and/or moving, IV clamps are closed and the provider can change the empty IV bag if necessary. In operation1618, if the machine vision camera and software can determine that the ball is floating and moving, the system determines that the fluid flow is so fast that the fluid flow is constant or continuous such that individual drops cannot be measured. In operation1618, because individual drops cannot be determined, the system switches to measuring the fluid flow rate using an electronic IV scale (FIG.14) to determine the fluid flow rate. In operation1620, the fluid flow rate can be determined by monitoring the change in IV bag weight per time. In operation1622, the fluid flow rate can be displayed and documented in the EMR.

FIG.17is a second flow chart illustrating a technique1700including aspects of the technique1600of IV fluid identification and measurement from the perspective of processing circuitry (e.g.,257,FIG.2;1502,FIG.15). The technique1700may include an operation1702to receive IV fluid identification information from a first IV sensor (e.g., one or more sensors), such as an RFID or barcode reader to identify the fluid or other characteristics of an IV fluid bag as described herein. Operation1704can include saving the IV identification information to a storage device (e.g., one or more storage devices, memory, EMR). Operation1706can include to receive fluid drop information from a second IV sensor, such as a machine vision camera that detects, senses and measures an individual drop in a drip chamber to determine a fluid volume per drop and measure the number of drops per unit of time. While the illustrative example ofFIG.17includes the first IV sensor and the second IV sensor, in some examples the first IV sensor and the second IV sensor can be the same sensor or same one or more sensors. Operation1708can include to determine if a fluid drop was recognized by the second IV sensor. If in operation1708it is determined that a fluid drop was recognized, operation1710can include determining a fluid flow rate, such as by calculating the flow rate by multiplying the number of drops per unit time by the volume per drop. In some examples, the volume per drop is measured, while in other examples the volume per drop may be input by a user, or can be a value retrieved from a memory. Operation1712can include transmitting instructions to a display to cause a fluid flow rate to be displayed. Operation1714can include saving flow rate information to the storage device to document the fluid flow rate in the EMR. Any time a change is input or detected in the system, updated flow rate information can be displayed and saved.

If in operation1708it is determined that a fluid drop was not recognized, operation1616can include receiving float information from the second IV sensor or another IV sensor. The float information can include information about a float in the drip chamber including is the float still (e.g., not moving), moving, or is movement of the float slowing down. Operation1718can include determining if the float is moving. If the float is moving, Operation1720can include determining the fluid flow is constant. In such a scenario, the fluid is flowing but the fluid is flowing so quickly that individual drops of fluid cannot be distinguished because the fluid is flowing as a steady stream. Operation1720can further include determining the fluid flow rate by receiving IV bag physical characteristic information from a physical characteristic sensor, such as a weight sensor. The physical characteristic information can include weight information from the weight sensor (e.g., scale). Operation1722can include determining the fluid flow rate by calculating the change in IV bag weight over a period of time. In other examples, instead of weight information, the physical characteristic information can include a position of the IV bag that changes as a result of a change in weight, without the physical characteristic data corresponding directly to a weight measurement. Other physical characteristics and other physical characteristic sensors configured to monitor IV fluid delivery may be provided such that an automated, or at least partially automated EMR system is enabled.

If in operation1718it is determined that the float is not moving, operation1728can include determining that no fluid is flowing from the IV bag and transmitting one or more of: an instruction an actuator such as a clamp, to cause the actuator to inhibit fluid flow to the patient (e.g., close the clamp onto IV tubing to prevent flow); and transmit and instruction to an indicator (e.g., display, audible, tactile indicator) to cause an alert to be generated. Operation1730can include saving a no fluid event to the storage device.

FIG.18is a flow chart illustrating an example technique1800of medication identification and measurement. In operation1802a provider inserts a medication syringe into an injection portal (e.g.,411,FIG.4). In operation1804the medication can be identified by a sensor such as by at least one of the RFID, barcode or QR sensors described herein. In operation1806processing circuitry checks for medication errors by comparing the medication against one or more of: a doctor's orders, allergy history, medical history, other medications and current vital signs. In operation1808, the results of the medication error check can be displayed on an electronic record display. The results can indicate no error, the presence of an error, specific details about the error, or present a link to access information including additional details about the error. In operation1810, if a serious medication error is recognized, the error deploys (e.g., causes actuation of) IV tubing clamps (e.g.,1060A,1060B ofFIG.10) to prevent injection of the medication.

If in operation1812, such as when no errors are determined, the machine vision camera and software can measure the diameter of the syringe. In operation1814, an image of, or representation of the image of the syringe, is displayed on the electronic record display. In operation1816the provider squeezes the plunger of the syringe. In operation1818, the machine vision camera and software measure the distance traveled by the syringe's plunger seal (e.g.,548,FIG.5). In operation1820the processing circuitry calculates the volume injected by multiplying the syringe diameter times the distance of plunger travel. The processing circuitry can also calculate the dose by multiplying the volume injected by the concentration of the medication. In operation1822the injected dose and volume are displayed on the electronic record display. In operation1824the injected dose and volume are time stamped and recorded in the electronic medical record.

FIG.19is a second flow chart illustrating a technique1900including aspects of the technique1800of medication identification and measurement from the perspective of processing circuitry (e.g.,157,FIG.1;257,FIG.2;1502,FIG.15).

Technique1900can include an operation1902to receive medication identification information such as medication type, concentration, brand, lot number or amount, from a first medication sensor (e.g., RFID, barcode or QR reader). Operation1904can include saving medication identification information to a storage device (e.g., one or more storage devices, memory). Operation1906can include comparing medication identification information to at least one of a medication order, allergy history, medical history, other medications ordered for the patient, and vital signs (e.g., previously obtained vital signs or current vital signs of the patient via continuous monitoring). Operation1908can include determining if a medication error is present. Operation1910can include receiving syringe information from a second medication sensor (e.g., a sensor configured to measure diameter, such as a machine vision camera). Operation1912A can include receiving medication delivery information from the second medication sensor or another medication sensor. In some examples, the medication delivery information can include a distance of a syringe plunger travel.

Operation1912B can include transmitting instructions to a display to cause an image of the syringe (e.g., actual image or representation of the syringe) to be displayed. A representation of the syringe can include an image communicating information about the syringe that is not an image of the actual syringe or can be a modified image of the syringe, such as to highlight or point out aspects of the syringe or medication within the syringe

Using the medication delivery information obtained in operation1912A, operation1914can include determining a medication delivery amount. Operation1916can include transmitting instructions to a display (e.g., display226,FIG.2) to cause the medication delivery information or medication delivery amount to be displayed.

If in operation1908it is determined that a medication error is present, operation1920can include transmitting instructions including error information to the display or another display to cause the error information to be displayed. In some examples, any of the instructions described herein that are sent to the display can be sent to one or more displays. Such displays can be located locally or remotely (e.g., in a different part of a room, in a separate room, in another building, in another state, in another country), to alert multiple providers. For example, a provider such as a nurse anesthetist located adjacent to the patient can be alerted to and provided with the information via display226. In addition, a second provider, such as an anesthesiologist supporting the nurse anesthetist, and who may be supporting other nurse anesthetists working in different rooms, can also be alerted on a display of a mobile device, which may prompt them to check in with and potentially assist the nurse anesthetist. This concept can be applied outside the operating room to manage medication delivered by providers working in different rooms of a hospital or other care center, while a second provider such as a nurse manager, nurse practitioner, pharmacist or doctor oversees the work of the first provider. In operation1922the error information can be saved to one or more storage devices (e.g.,259,FIG.2;1516,FIG.15).

Also in response to determining that a medication error has occurred in operation1908, operation1924can include transmitting instructions to an actuator such as an IV tubing clamp to inhibit (e.g., prevent, reduce, limit) injection. In some examples, the actuator can reduce or limit the amount of the injection to a specified amount rather than completely inhibiting or preventing administration of the medication. Operation1926can include saving an inhibit injection event information to a storage device, such as any of the one or more storage devices (e.g.,259,FIG.2;1516,FIG.15). The inhibit injection event information can include information such as the time of the event and the action taken to inhibit injection and how much the injection was inhibited (e.g., partially inhibited, completely inhibited, or amount of medication inhibited from injection).

If in operation1908it is determined that a medication error has not occurred, operation1910can include receiving syringe information including a syringe diameter from a sensor such as a machine vision camera. In some examples, the sensor can be the first medication sensor or can be a second medication sensor. Operation1912A can include receiving medication delivery information from a sensor such as from the first medication sensor, the second medication sensor or another sensor. The medication delivery information can include a distance of plunger travel relative to a syringe body. Operation1912B can include transmitting instructions to one or more displays such as, display226,FIG.2, to cause an image of the syringe or representation of the syringe to be displayed.

Operation1914can include determining a medication delivery amount, such as a volume or dose injected. For example, the volume injected can be calculated by multiplying the syringe diameter by the distance of plunger travel. The dose injected can be calculated by multiplying the volume injected by the concentration of the medication.

Operation1916can include transmitting instructions to the one or more displays to cause the medication delivery information to be displayed. Operation1918can include saving medication delivery information to the storage device (e.g., EMR). In some examples, the medication delivery information can include, but is not limited to, volume, dose, time of the injection, or time period of the injection.

FIG.20is a flow chart illustrating an example of a second technique of IV fluid identification and measurement including safety and security measures. Aspects of technique2000can be similar or the same as techniques1800and1900, however, technique2000is particularly well-suited to the challenges of maintaining safety and security with controlled drugs such as narcotics. Technique2000can include operation2002of identifying a medication (e.g., a controlled drug) and identifying a health care provider, such as by RFID, barcode or QR code reader, retinal scanner, facial recognition, or fingerprint. Operation2002can occur at the time a provider checks out a drug from a pharmacy or a medication dispensing machine. The medication can include a narcotic in a tamper-proof, non-refillable syringe.

Operation2004can include identifying a provider such as by RFID, barcode or QR code reader, retinal scanner, facial recognition, or fingerprint at a patient's bedside, such as at an injection portal (e.g.,411,FIG.4). The provider can be the same or a different provider as the provider in operation2002. In operation2006, the provider inserts the medication syringe into the patient's injection portal. In operation2008, the controlled drug is identified, such as by an RFID, barcode or QR code reader associated with the injection portal. Operation2010can include processing circuitry checking for medication errors by comparing the medication against doctor's orders, allergy history, medical history, other medications and vital signs. Operation2012can include displaying medication error check results on a display, such as display226,FIG.2. If the medication error is of a serious nature, the error can cause IV tubing clamps to prevent injection. Operation2016can include machine vision camera and software measuring the diameter of the syringe. Operation2018can include an image, or an image representing the syringe being displayed on a display, such as display226,FIG.2. Operation2020can include a provider squeezing the plunger of the syringe. Operation2022can include the machine vision camera and software measuring the distance traveled by the syringe's plunger seal (e.g.,548,FIG.5). Operation2024can include processing circuitry determining the volume of medication injected by multiplying the syringe diameter by the distance of plunger travel or determining the dose of medication injected by multiplying the volume of medication injected by the concentration of the medication. Operation2026can include displaying the injected volume or dose on a display, such as display226,FIG.2.

Operation2028can include saving the injected volume or dose along with a timestamp to the EMR. Operation2030includes repeating the operations of technique2000as necessary until the machine vision camera and software documents an empty syringe. Operation2032includes completing the “chain of custody” for a specific syringe of controlled medication. The operations of technique2000can be repeated as necessary for other syringes, thereby completing the “chain of custody” for each syringe.

FIG.21is a second flow chart illustrating a technique2100including aspects of the technique2000of IV fluid identification and measurement including safety and security measures from the perspective of processing circuitry, such as, but not limited to, processing circuitry157,FIG.1;257,FIG.2;1502,FIG.15. The technique may involve processing circuitry2202B, such as may be part of a medication vending system as shown inFIG.22.FIG.22illustrates generally an example of a block diagram of vending system and a medication delivery system ofFIGS.1-21and23upon which any one or more of the techniques (e.g., methodologies) discussed herein may perform in accordance with some embodiments.FIGS.21and22are described together.

In some examples, operations2102and2104can be part of a vending system (2202,FIG.22) for managing medication withdrawal from a pharmacy or other vending system. Operations2110-2136can be part of a medication delivery system (e.g., can be used with the bedside patient systems and modules shown and describe inFIGS.1-15; medication delivery system2210,FIG.22). Operation2138can tie information, including data generated by the vending system2202and the medication delivery system2210together to facilitate tracking a “chain of custody” for a specific syringe of controlled medication from the pharmacy until the medication is completely injected into the patient. Chain of custody information can be stored to one or more of: the vending system storage2202A, the medication delivery storage2216, and chain of custody storage device (e.g.,2206,FIG.22) and the EMR. Any of the storage described herein can include one or more storage devices or memory as described herein and can include other storage devices in electrical communication with the vending system or the medication delivery system.

Operation2102of the vending system can include receiving withdrawing provider identification information from a medication dispensing sensor2202C, such as a first RFID or barcode reader that reads a badge of a provider and reads the medication identification information from a syringe or other medication container, or any other type of suitable sensor described herein. Operation2104can include associating and saving the medication identification information and the withdrawing provider identification information to a vending system storage device (e.g.,2202A,FIG.22).

Operation2110can include receiving medication identification information from a first identification sensor (e.g., RFID, QR, barcode reader, or machine vision camera reads information about a medication) and receiving delivery provider identification information from the first identification sensor or another identification sensor (e.g., a second identification sensor, another RFID, QR or barcode reader, machine vision camera, retinal scanner, facial recognition sensor or fingerprint reader). In some examples, patient identification information can also be obtained from one of the first identification sensor, second identification sensor or another identification sensor, such as by scanning patient identification information on a hospital wristband. In some examples receiving the medication identification, the provider identification information or the patient identification can cause the processing circuitry to send an instruction to a display to prompt the user for the other of the medication identification information, the provider identification information or the patient identification information.

Operation2112can include comparing the received identification information to one or more of: a medication order, allergy history, medical history, other medications and current vital signs. Operation2114can include determining if a medication error is present. If it is determined that a medication error is present, operation2116can include transmitting instructions including error information to a display to cause the error information to be displayed. Operation2118can include saving the error information to one or more storage devices. Further, if in operation2114it is determined that a medication error has occurred, operation2120can include transmitting inhibit injection instructions to an actuator such as, but not limited to, an IV tubing clamp (e.g.,1060A,1060B;FIG.10) to inhibit injection. Operation2122can include saving an inhibit injection event information to one or more storage devices.

Operation2124can include receiving syringe information from a second medication sensor (e.g., syringe diameter including syringe inner diameter, outer diameter, or wall thickness from a machine vision camera). Operation2124can include receiving syringe size information from a data storage device, the syringe size information provided by the syringe manufacturer that supplies the specific syringes used by the specific healthcare facility. Operation2126can include transmitting instructions to a display to cause an image of the syringe or a representation of the syringe to be displayed. Operation2128can include receiving syringe movement information from the second medication sensor or another sensor. Syringe movement information can include, for example, a distance of travel of the syringe plunger relative to the syringe barrel.

Operation2130can include determining medication delivery information based on the syringe movement information. Medication delivery information can include, for example, a volume or dose of medication delivered to the patient (e.g., ejected from the syringe). In some examples, the volume of medication delivered (e.g., ejected from the syringe) can be calculated by multiplying the syringe inner diameter by the distance of plunger travel. Likewise, the dose of medication delivered can be calculated by multiplying the calculated volume by a concentration of the medication. Operation2132can include saving medication delivery information to one or more storage devices. In other words, operation2132can include documenting volume, dose and time in an EMR, in some cases automatically without intervention from a provider.

Operation2134can include transmitting instructions to one or more displays described herein to cause the medication delivery information to be displayed. Operation2136can include determining that a syringe is empty and saving “chain of custody” complete for the specific syringe of medication (e.g., controlled drug) to one or more storage devices.

To complete and document the chain of custody, thereby ensuring the medication was delivered to the patient, operation2138can include one or more of receiving, associating and saving to one or more chain of custody storage devices (e.g.,2206,FIG.22), information from both the pharmacy vending system2202(FIG.22) and the bedside medication delivery system2210(FIG.22)(e.g.,1516;FIG.15). In some examples the one or more chain of custody storage devices is not necessarily separate from the vending system storage2202A or the medication delivery storage2216, but rather can reside with one or the other systems, a different system, multiple systems or can be included as a single storage device.

FIG.23illustrates and example technique2300for assessing physiological events. In some examples, the EMRs created by the safety and security system100,200,400,600,800can provide the most accurate and temporally correlated information about the relationship between any injected medication and the resulting physiologic response. In some examples, this is uniquely accurate dose-response data can be used as a final check of the chain of custody for controlled medications or any medication. The processing circuitry157,257may include or be in electrical communication with artificial intelligence (AI) and/or machine learning that can compare the measured physiologic response in the several minutes after a medication is injected, to the expected physiologic response for that dose of that medication. For example, if the injected medication was a narcotic, it would be expected that the heart rate and blood pressure of the patient would decrease quickly after the injection.

In some examples, if the expected physiologic response does not occur, the AI software of the safety and security system100,200,400,600,800may electronically “flag” that injection as suspicious. For example, if there is no physiologic response after injecting what was supposed to be a narcotic, it is possible that the drug had been stolen and replaced by saline. On the other hand, no response may simply mean that the patient is addicted to and tolerant of narcotics and that too is worth noting. An unpredicted response does not prove anything but multiple unpredicted responses in multiple patients can be suspicious. Therefore, aggregating or analyzing data over time for a particular patient or provider can alert management to issues. If any individual provider traverses a threshold number of flags (e.g., too many “flags”) for unexpected physiologic responses (including no response), the safety and security system100,200,400,600,800can generate an alert to notify management and an investigation of that provider may be warranted. Knowing that AI is “watching” the patients' response to a healthcare providers' injected medications, can be a significant deterrent to tempted drug thieves.

Technique2300can include determining if one or more unexpected physiological events has occurred, analyzing saving, aggregating and displaying such information, in any order. The method can be performed by processing circuitry157,257,1502, including other processing circuitry, memories and databases in electrical communication with processing circuitry157,257,1502to one or more of: receive physiologic data, analyze physiologic data, determine physiologic data is unexpected, create and send instructions to cause an alert to the provider or another user, or save a physiological event information to a storage device1516which may include a database. The physiological event information can include, but not limited to data generated by the various sensors and equipment described herein, including one more of: physiological information, patient information, provider information, medication information, time information, location information, facility information, equipment information, aggregated physiological event information and analyzed physiologic event information.

Operation2302can include receiving physiologic data from a physiologic sensor, Operation2304can include analyzing the physiologic data. Operation2304can include comparing the physiologic data to expected physiologic responses. Based on the outcome of the analysis in operation2304, in operation2306, the processing circuitry can determine if the physiologic data is unexpected, and if so, operation2308can include saving unexpected physiologic event information to one or more storage devices, or can include sending instructions to one or more displays to display unexpected physiologic event information.

Operation2310can include aggregating or analyzing physiologic event information from a plurality of unexpected physiological events and generating aggregated or analyzed physiologic event information. In some examples, aggregating can include aggregating a number of physiological events by counting the number of physiological events for a given provider, patient, group of patients, medical facility, type of medication, or any other suitable assessment. Operation2312can include saving aggregated or analyzed physiologic event information to one or more storage devices or sending instructions to one or more displays to display aggregated or analyzed physiologic event information. In some examples, the physiologic event information can include any type of physiologic event that occurs, including expected or desirable physiologic events.

The operations of technique2300can help provide safer care for patients, including providing narcotic medications when helpful, while keeping a close eye on drug abuse by providers or patients. Taken at a high level, technique2300can help medical facilities evaluate which medications are most often abused by patients or stolen by providers, and to mitigate risk for insurers.

Any operations of the various methods described herein can be used in combination with or separately from one another, depending on the desired features and in consideration of constraints such as financial, space, material and manufacturing availability.

The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. The terms approximately, about or substantially are defined herein as being within 10% of the stated value or arrangement.

The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other examples can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed example. Thus, the following claims are hereby incorporated into the Detailed Description as examples or examples, with each claim standing on its own as a separate example, and it is contemplated that such examples can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

NOTES AND VARIOUS EXAMPLES

Each of these non-limiting examples may stand on its own, or may be combined in various permutations or combinations with one or more of the other examples. The examples are supported by the preceding written description as well as the drawings of this disclosure.

Example 1 is a system for intravenous (IV) medications to deliver a medication from a syringe, the system comprising: a provider identification sensor configured to identify (e.g., sense) provider identification information; an injection portal configured to receive the syringe; one or more medication sensors configured to identify medication identification information that is coupled to the received syringe when the received syringe is located in the injection portal and configured to capture an image of the received syringe; one or more displays; one or more storage devices; and processing circuitry that is in electrical communication with the provider identification sensor, the one or more medication sensors, the one or more displays and the one or more storage devices, wherein the processing circuitry is configured to receive the provider identification information and to store the provider identification to at least one of the one or more storage devices, wherein the processing circuitry is configured to send instructions to at least one of the one or more displays to output a visual image or representation of the received syringe on the at least one display, wherein the processing circuitry is configured to determine a volume of medication dispensed from the received syringe based on an image of the syringe captured by the one or more medication sensors, and wherein the processing circuitry is configured to at least one of: save the volume of medication dispensed to the one or more storage devices or send instructions to at least one of the one or more displays to output the volume of medication dispensed on the at least one display.

In Example 2, the subject matter of Example 1 includes, wherein the injection portal further comprises: an injection port that is configured to fluidly couple to IV tubing; and at least one orienting member configured to guide the received syringe having a diameter that is a first diameter of a plurality of different diameters, to mate with the injection port.

In Example 3, the subject matter of Examples 1-2 includes, wherein at least one of the one or more medications sensors is located to capture an image of an inside of the injection portal, and wherein the processing circuitry is configured to receive a captured image of the received syringe and to calculate the volume of medication dispensed from the received syringe from the captured image by determining an internal diameter of the syringe and measuring a distance a plunger of the received syringe moves to calculate an injected volume.

In Example 4, the subject matter of Examples 1-3 includes, wherein at least one of the one or more medication sensors is an RFID interrogator, and wherein the medication identification information is an RFID tag.

In Example 5, the subject matter of Examples 1-4 includes, wherein at least one of the one or more medication sensors is configured to read the medication identification information and transmit a medication identity to the processing circuitry.

In Example 6, the subject matter of Examples 1-5 includes, wherein at least one of the one or more medication sensors is a machine vision digital camera.

In Example 7, the subject matter of Examples 1-6 includes, wherein when the provider identification sensor is configured to read the provider identification information and to generate provider identification data, and wherein the processing circuitry is configured to receive the generated provider identification information and to compare the generated provider identification information to withdrawing provider information, wherein the withdrawing provider information includes an identity of the provider who withdrew the syringe from a vending source.

In Example 8, the subject matter of Example 7 includes, wherein the provider identification sensor is a barcode reader, an RFID interrogator, a retinal scanner, a facial recognition scanner, or a fingerprint reader.

In Example 9, the subject matter of Examples 1-8 includes, wherein the processing circuitry is configured to send instructions to at least one of the one or more displays to output one or more of: a brand name of a drug, a generic name of a drug, a drug concentration, a dosage of a drug, a dosage delivered, a fluid flow rate, a fluid volume delivered, a patient allergy, an over-dosing alert, a drug allergy alert and a drug interaction alert.

In Example 10, the subject matter of Examples 1-9 includes, wherein the processing circuitry is configured to transmit dispensing information to one or more of: an electronic anesthetic record (EAR) and an electronic medical record (EMR), to automatically record dispensing information about the medication dispensed from the received syringe to the EAR or the EMR.

In Example 11, the subject matter of Examples 1-10 includes, an injection port located in the injection portal that is configured to fluidly couple the received syringe to IV tubing; and at least one clamp in electrical communication with the processing circuitry, wherein the processing circuitry is configured send an instruction to actuate the at least one clamp positioned one or more of upstream or downstream from the injection port, and wherein the processing circuitry is configured to send instructions to the at least one clamp to inhibit dispensing of the medication or an IV fluid when an adverse condition is determined by the processing circuitry.

Example 12 is a system for intravenous (IV) medications to deliver a medication from a syringe, the system comprising: a provider identification sensor configured to identify (e.g., sense) a provider; an injection portal configured to receive the syringe; one or more medication sensors configured to identify medication information that is coupled to the received syringe when the received syringe is located in the injection portal, wherein at least one of the one or more medication sensors is located to capture an image of an inside of the injection portal; one or more displays; one or more storage devices; and processing circuitry that is in electrical communication with the provider identification sensor, the one or more medication sensors, the one or more displays, and the one or more storage devices, wherein the processing circuitry is configured to receive the provider identification information and to store the provider identification to at least one of the one or more storage devices, wherein the processing circuitry is configured to send instructions to at least one of the one or more displays to output a visual image or representation of the received syringe on the at least one display, wherein the processing circuitry is configured to receive a captured image of the received syringe and to calculate a volume of medication dispensed from the received syringe from the captured image by determining an internal diameter of the syringe and measuring a distance a plunger of the received syringe moves to calculate an injected volume, and wherein the processing circuitry is configured to at least one of: save the volume of medication dispensed to the one or more storage devices or send instructions to at least one of the one or more displays to output the volume of medication dispensed on the at least one display.

In Example 13, the subject matter of Example 12 includes, wherein the injection portal further comprises: an injection port that is configured to fluidly couple to IV tubing; and at least one orienting member configured to guide the received syringe having a diameter that is a first diameter of a plurality of different diameters, to mate with the injection port.

In Example 14, the subject matter of Examples 12-13 includes, wherein at least one of the one or more medication sensors is an RFID interrogator, and wherein the medication identification information is an RFID tag.

In Example 15, the subject matter of Examples 12-14 includes, wherein at least one of the one or more medication sensors is configured to read the medication identification information and transmit a medication identity to the processing circuitry.

In Example 16, the subject matter of Examples 12-15 includes, wherein the processing circuitry is configured to send instructions to at least one of the one or more displays to output one or more of: a brand name of a drug, a generic name of a drug, a drug concentration, a dosage of a drug, a dosage delivered, a fluid flow rate, a fluid volume delivered, a patient allergy, an over-dosing alert, a drug allergy alert and a drug interaction alert.

In Example 17, the subject matter of Examples 12-16 includes, wherein the processing circuitry is configured to transmit dispensing information to one or more of: an electronic anesthetic record (EAR) and an electronic medical record (EMR), to automatically record dispensing information about the medication dispensed from the received syringe to the EAR or the EMR.

In Example 18, the subject matter of Examples 12-17 includes, an injection port located in the injection portal that is configured to fluidly couple the received syringe to IV tubing; and at least one clamp in electrical communication with the processing circuitry, wherein the processing circuitry is configured send an instruction to actuate the at least one clamp positioned one or more of upstream or downstream from the injection port, and wherein the processing circuitry is configured to send instructions to the at least one clamp to inhibit dispensing of the medication or an IV fluid when an adverse condition is determined by the processing circuitry.

Example 19 is a tamper-resistant, non-refillable syringe comprising: a cylindrical syringe barrel extending from a first end having an opening configured to receive a movable plunger to a second end adjacent a Luer taper connector; a tamper-resistant hypodermic needle-blocking obstruction proximate the Luer taper connector to prevent receiving of a hypodermic needle through the Luer taper connector and into the syringe barrel; and a plunger seal coupled to the plunger, the plunger seal having one or more angled barbs that allow the plunger to be moved in a direction towards the Luer taper connector, and wherein the angled barbs inhibit movement of the plunger in a direction away from the Luer taper connector to prevent refilling a syringe.

In Example 20, the subject matter of Example 19 includes, wherein a coupling interface between the plunger and the plunger seal is configured to disengage when the plunger is moved in a direction away from the Luer taper connector.

In Example 21, the subject matter of Examples 19-20 includes, wherein the plunger seal includes one or more spring wires molded into the plunger seal having barb tips formed by cut ends of the spring wires protruding outward from the plunger seal to poke into an inner surface of the syringe barrel.

In Example 22, the subject matter of Example 21 includes, wherein the one or more spring wires are angled toward the syringe barrel opening to allow movement of the plunger seal toward the Luer taper connector while inhibiting movement of the plunger seal in an opposite direction by the one or more spring wires poking into an inner surface of the syringe barrel when the plunger is moved away from the Luer taper connector.

In Example 23, the subject matter of Examples 19-22 includes, wherein the needle-blocking obstruction includes a polymer insert that is sized to fit against an inside surface of the syringe barrel proximate the Luer taper connector, the needle-blocking obstruction further including a solid central portion that directly opposes the opening to the Luer taper connector and one or more tortuous fluid channels that allow fluid flow in a longitudinal direction through the polymer insert and then in a transverse direction toward the opening to the Luer taper connector.

In Example 24, the subject matter of Example 23 includes, wherein the needle-blocking obstruction includes a metal plate that is located opposite the opening to the Luer taper connector by the polymer insert, and wherein the metal plate is configured to block the insertion of a hypodermic needle through the Luer taper connector and into the syringe barrel.

In Example 25, the subject matter of Examples 23-24 includes, wherein the polymer insert is sized to fit snuggly against the inside of the syringe barrel proximate the Luer taper connector, and wherein the polymer insert is bonded to the syringe barrel by one or more of a heat bond, ultrasonic bond, RF bond, adhesive bond or friction fit.

In Example 26, the subject matter of Examples 19-25 includes, wherein the needle-blocking obstruction proximate the Luer taper connector includes a zig-zag fluid channel located between the first end of the syringe barrel and a distal end of the Luer taper connector.

Example 27 is a system for delivering intravenous (IV) fluids from an IV bag fluidly that is coupled to a drip chamber and IV tubing, the system comprising: an IV scale configured to receive and support the IV bag; one or more sensors, wherein at least one of the one or more sensors is configured to identify an IV fluid in the IV bag hanging on the IV scale and wherein at least one of the one or more sensors is located adjacent to the received drip chamber and is configured to capture an image of the drip chamber; one or more displays; one or more storage devices; and processing circuitry that is in electrical communication with the IV scale, the one or more sensors, the one or more displays and the one or more storage devices, wherein the processing circuitry is configured to receive a medication identity and a captured image of the drip chamber from the one or more sensors, and wherein the processing circuitry is configured to determine a fluid flow rate by analyzing an image of fluid drops falling in the drip chamber including determining a size of drops and a number of drops per unit time; wherein the processing circuitry is configured to at least one of: save the fluid flow rate to one or more storage devices or send instructions to at least one of the one or more displays to output the fluid flow rate on at least one of the one or more displays.

In Example 28, the subject matter of Example 27 includes, wherein the IV scale includes a hanger configured to support the IV bag, and wherein the IV scale is configured to measure a combined weight of the IV bag, the IV drip chamber, the IV tubing and the fluids in the IV bag, and wherein the processing circuitry is configured to determine a reduction in a measured combined weight over time to determine a weight of the fluid removed from the IV bag and to convert the measured combined weight over time to a fluid flow rate and an infused fluid volume.

In Example 29, the subject matter of Examples 27-28 includes, a float located in the IV drip chamber, wherein when the processing circuitry determines from the captured image that the fluid drops in the drip chamber cannot be distinguished from one another and that the float is moving, the processing circuitry is configured to measure the fluid flow rate by determining a reduction of a combined weight of the IV bag, the IV drip chamber, the IV tubing and fluid in the IV bag over time.

In Example 30, the subject matter of Examples 27-29 includes, one or more electromechanical clamps that is in electrical communication with the processing circuitry, wherein the processing circuitry is configured to determine from the captured image that no fluid meniscus is present in the drip chamber, the processing circuitry sends an instruction to cause at least one of the one or more electromechanical clamps to compress the IV tubing to inhibit fluid flow prior to air entering the IV tubing.

Example 31 is at least one machine-readable medium including instructions that, when executed by processing circuitry, cause the processing circuitry to perform operations to implement of any of Examples 1-30.

Example 32 is an apparatus comprising means to implement of any of Examples 1-30.

Example 33 is a system to implement of any of Examples 1-30.

Example 34 is a method to implement of any of Examples 1-30.