Patent Document

CROSS REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of commonly owned U.S. Provisional Patent Application Ser. No. 60/800,658 filed May 16, 2006 entitled “Computer Aided Nursing Devices and Methods,” which is incorporated herein by reference. 
     
    
     TECHNICAL FIELD 
       [0002]    This application relates to healthcare workstations for use by nurses and other healthcare providers in hospitals and other healthcare facilities and, more particularly, to a healthcare workstation with an RFID monitoring and alarm system. 
       BACKGROUND OF THE INVENTION 
       [0003]    In a study of more than 1000 hospitals in the U.S. reported in the Pharmacotherapy Journal in 2001, medication errors occurred in 5.07% of the patients admitted and 0.25% of the patients were seriously injured. On the average, each hospital committed one medication error every 22.7 hours. According to a report published by the American Institute of Medicine in 2006, the total cost for medication errors is more than $3.5 Billion/year, but this estimate does not include the cost for extended care. In a study of 36 hospitals and nursing homes in Colorado and Georgia reported in the Archives of Internal Medicine in September 2003, the most common drug error is giving hospitalized patients their medications at the wrong times or not at all. In 2001, the American Association of Critical-Care Nurses reported that distractions cause 36% of the reported medication errors in the U.S. 
         [0004]    Many patents have been issued for devices that automatically dispense pills, such as U.S. Pat. No. 5,405,011 issued to Haber, et al. in April 1995, U.S. Pat. No. 5,575,392 issued to Cutler in November 1996, U.S. Pat. No. 5,641,091 issued to Daneshvar in June 1997, and U.S. Pat. No. 5,609,268 issued to Shaw in March 1997. None of these inventions use RFID tags or barcode labels to identify the medication or the patient. 
         [0005]    U.S. Pat. No. 5,700,998 issued to Palti in December 1997, describes a simple concept of printing a linear or radial barcode label directly onto each pill. In another noteworthy invention, U.S. Pat. No. 5,564,803 issued to McDonald, et al. in October 1996 describes a “portable nursing center” attached to a cart with wheels. The data entry is via a keypad, barcode reader or touch screen; therefore, both the patient and the medications can be identified via barcode labels. The cart contains drawers that automatically open to access pills for an identified patient, and the cart computer also provides access to patient records. Some hospitals like this method for delivering medications, but it assigns most of the delivery workload to nurses, and the nurses are already overworked and understaffed. Furthermore, infectious organisms can be easily carried from room to room via the cart. 
         [0006]    Some hospitals believe it is more cost effective to store medications inside stationary locked cabinets at central locations, such as one cabinet on each nurses&#39; station, floor or wing of a hospital. U.S. Pat. No. 5,405, 048 issued to Rogers, et al. in April 1995 describes a medication storage cabinet with separate compartments for pills and a vacuum operated mechanism for individually dispensing pills into a cup. U.S. Pat. No. 5,883,806 issued to Meador, et al. in March 1999 describes a large drug dispensing cabinet with drawers that automatically open when a request is input via a keyboard. U.S. Pat. No. 6,975,922 issued to Duncan, et al. in May 2003 describes an instrumented cabinet with bins and a variety of drawers which contain supplies that could include medications. The configuration of the cabinet proposed by Duncan, et al. is not appropriate for a hallway in a large hospital, but it would be appropriate for a supply cabinet at a nurses&#39; station. A computer guides the worker in finding each requested item by turning on a light at the location in the cabinet where the item is stored. The light does not blink to indicate the number of medications needed for a pillbox. 
         [0007]    Most prescribed medications in hospitals are administered at standard times; therefore, the line at a central medication cabinet can get very long just before the standard medication times each day and evening. More important, this delivery scheme requires each nurse to collect all of the medications for several patients at the same time, which could add up to more than 50 medications. Missing pills and other medication errors are more likely to occur in this delivery scheme, but pharmacy workers like the idea of refilling a small number of locked cabinets in the hospital each day. It is important to remember that nurses are making the vast majority of the medication errors occurring in hospitals and nursing homes, and they need help. 
         [0008]    A point-of-care computer system is described in U.S. Pat. No. 7,154,397 issued to Zerhan, et al. in December 2006. The point-of-care computer and other electronics are contained inside a bedside frame. The computer controls bed motors, provides access to patient records, and receives data from diagnostic, treatment, and therapy devices. The point-of-care computer also interfaces with a barcode, RFID or other readers for identifying the patient, attendants and medications. When a caregiver brings a “locked medical box” to the patient&#39;s room, the patient and medications are scanned by the attendant to verify that the medications match the pharmacy records for the patient. The locked medical box can be attached to different described carts. 
         [0009]    Most nurses like the concept of a medication workstation close to each patient room, but there are several problems with the Zerhan invention. If medications and medical supplies are kept inside the patient room, infectious organisms could be easily passed on to the next patient via the storage cabinet. Also, pharmacy workers would not like the idea of delivering a “locked medical box” to a workstation inside each patient room. The rooms could be congested or inaccessible, and any medical boxes left in the hallway could be stolen. If nurses deliver each medical box via a cart or other means, they would be reverting to the delivery methods described in the McDonald patent of 1996, except there would be a separate locked medical box for each patient. The additional workload for nurses would be unacceptable to nursing supervisors. 
         [0010]    Several of the above inventions mention RFID tags as an alternative to barcode labels and RFID is an important part of my invention. Passive RFID tags can be used to identify medication containers, supplies, equipment, patients and staff in hospitals. The recent shift from barcode to passive RFID is mostly driven by the fact that RFID transceivers operating at 13.56 MHz and higher frequencies are able to read a large number of tags at the same time, plus the additional advantage that a high-power RFID antenna can be located several feet away from an identified passive tag. If the RFID tag is active (i.e. powered by a battery), the distance between the antenna and the identified tag can be more than 10 feet. It is important to realize that any RFID tag can be easily shielded by wrapping aluminum foil around the tag; therefore RFID tags will never replace barcode readers at the checkout counter in Wal-Mart® stores. For the same reason, it is unlikely that RFID tags will be 100% effective in preventing theft of equipment, medications or babies in hospitals. 
         [0011]    Another important limitation of RFID is related to the frequencies of the RF signals transmitted and received by RFID antennas. Higher frequency RFID systems can read a large number of tags at the same time via frequency hopping and other schemes. But at higher frequencies, the smaller wavelengths are not able to go through or around large conductive objects. For example, metal shelves, carts and human bodies can easily block passive RFID readers designed to operate at 2.4 GHz; therefore line of sight communications may be required between a high-frequency RFID antenna and matching tags. RFID signals at 134 KHz are better able to pass around human bodies, but 134 KHz readers are easily jammed by multiple tags. 
         [0012]    At some time in the near future, the pharmaceutical industry will hopefully offer wrapped pills with RFID tags instead of barcode labels. More information can be written on an RFID tag, including secret codes that identify the pharmaceutical companies. The latter feature will help prevent counterfeit drugs. U.S. Pat. No. 7,156,305 issued to Swan, et al. in Jan 2007 presents several novel concepts related to RFID tags on medication containers, e.g. identifying counterfeit drugs, improper return of a medication, and supply chain abuses. 
         [0013]    U.S. Pat. No. 7,091,864 issued to Veitch, et al. in August 2006 describes a research application of attaching a large number of RFID tags to containers in pharmaceutical studies. In this application, details about each specimen are written on the RFID tag. This invention is not a system for monitoring patients, pillboxes or equipment in healthcare facilities, and hospitals would not like the concept of fabricating custom RFID tags for each patient. 
         [0014]    U.S. Pat. No. 7,175, 081 issued to Andreasson, et al. in Feb 2007 describes how a large number of medications with an RFID tag on each medication can be quickly identified using an RFID reader inside a locked “medication-dispensing unit” to determine which medications have been removed from the cabinet and when one of the medications needs to be replenished. Access to the locked cabinet requires the healthcare worker to be identified via an electronic card, PIN or RFID tag. It is then possible to identify if the worker has removed the correct medications for an identified patient or when a pharmacy worker has placed an incorrect medication in one of the compartments inside the cabinet. 
         [0015]    Unfortunately, there is a limit to the number of passive RFID tags that can be read at the same time. The current state of the art limits the number of passive RFID tags to a number much smaller than the typical number of medications stored in a medication-dispensing unit on each floor of a hospital. The above inventors solved this problem by providing a separate RFID antenna for each compartment inside the cabinet. This approach requires a large number of RFID antennas and associated equipment. 
       SUMMARY OF THE INVENTION 
       [0016]    The present invention meets the needs described above in a medication administration system that includes a system of pillboxes, a pharmacy workstation, and a system of attendant workstation. The pharmacy workstation reads RFID or barcode tags on the pillboxes and medication wrappers containing medication units as the medication units are checked into the pillboxes to ensure that the pillboxes are filled in accordance the appropriate prescription regimens. The attendant workstations read the RFID or barcode tags on the pillboxes and medication wrappers as the medication units are checked out of the pillboxes to ensure that the medications are administered in accordance the appropriate prescription regimens. The attendant workstations may activate alarms, which may include communicating the alarms to a central monitoring station or mobile communication devices assigned to healthcare providers, when the determine that a pillbox in not correctly filled, when a medication has been checked out of a pillbox improperly, or when a medication has not been checked out on time. 
         [0017]    The medication administration system may also assign two pillboxes to each patient, and providing an attendant workstation inside or close to the patient&#39;s room. One of the two pillboxes assigned to each patient will contain the patient&#39;s medications for the current day and will be stored in a locked compartment of the attendant workstation. The other pillbox will be located in the pharmacy department or at the nurses&#39; station, where it will be filled with the patient&#39;s medications for the next day. 
         [0018]    The pharmacy workstation is typically located in the pharmacy department or selected nurses&#39; station where the pillboxes are filled. The attendant workstations may also monitor a variety of RF antennas inside the patient&#39;s room and at other locations. Each attendant workstation can be mounted to a wall at a convenient location just outside the patient&#39;s room. This location reduces the likelihood of passing infectious organisms to the next patient, makes the pharmacy deliveries easier, and gives the attendants more privacy while reviewing and typing patient records. In nursing homes and assistive living centers, the patients are assigned to their rooms for longer periods, and the medications are handled differently. These institutions may prefer to mount each attendant workstation to a computer desk or to the patient&#39;s bed frame. In the bed frame version of the attendant workstation, the workstation cabinet can be modified to plug into existing slots for a trapeze frame, and the workstation can include a second monitor and wireless keyboard for the patient. A camera, microphone and speaker may also be attached to the workstation cabinet for video communications with the patient. 
         [0019]    In hospitals, each medication will be individually wrapped with a barcode or RFID tag attached to each medication wrapper. Each medication tag will identify the quantity and type of the medication. Each pillbox will be also identified by a barcode or RFID tag attached to the pillbox indicating an ID code previously assigned to the patient. The second pillbox assigned to each patient will be identified by the same or different ID code. The attendant workstation will contain a barcode reader plus one or more RFID readers for identifying each pillbox tag and for identifying each medication wrapper tag. If an RFID tag is attached to each medication wrapper, all of the medications inside the pillbox will be scanned at the same time by an RFID reader inside the attendant workstation to detect when an arriving pillbox contains incorrect or missing medications or when a nurse has removed a medication at the wrong time. 
         [0020]    Each attendant workstation will communicate with a pharmacy workstation configured to help pharmacy workers fill the pillboxes. The pharmacy workstation will include blinking cabinet lights that indicate the location and quantity of each medication needed for an identified pillbox. Pillbox lights will show the pharmacy personnel where to put each medication in the identified pillbox, and filling errors will be automatically detected. Blinking cabinet lights will also show the pharmacy workers which storage boxes contain missing medications and which storage boxes might contain the wrong medications. When pharmaceutical companies start labeling medications with RFID tags, an RFID antenna under each compartment of the pillbox will automatically verify that each RFID tagged medication is in the correct compartment of the pillbox. 
         [0021]    The attendant workstation computer will periodically communicate with the pharmacy computer to determine when a medication is late. A “late medication” alarm code will be first sent to a central monitoring station and if no acknowledgement occurs within a specified time period, the alarm code will be automatically transmitted to the appropriate attendant&#39;s wireless communication device. 
         [0022]    Each attendant workstation will also monitor a collection of RF antennas in the patient&#39;s room, which will detect a variety of other dangerous situations. One or more RF antennas inside or under the patient&#39;s mattress will be used to automatically read RFID tags on the patient&#39;s wrists and/or ankles. The ankle tags can be attached to non-skid socks at any location close to the top of each foot. The workstation computer will periodically identify the patient while lying on the mattress to detect medication errors. The workstation computer will also monitor antennas under floor coverings and under the shower tub to identify close proximity of either wrist tag, which will be interpreted as a possible fall. Bed egress will be detected when the mattress antenna(s) are unable to identify any wrist or ankle tag or when the floor antennas identify close proximity of either ankle or sock tag. Wandering will be detected via antenna(s) inside the door, door frame or floor covering close to the door, i.e. when these antenna(s) identify the proximity of any tag. 
         [0023]    Alternatively, the patient can wear small battery powered ID tags that periodically transmit an RF signal that identifies the patient and whether each tag is located on the patient&#39;s wrist or ankle. In this situation, the RF antennas inside the mattress, under the floor coverings, under the shower tub, inside the door or door frame, and at other locations do not transmit an RFID signal. Instead, they only receive the RF signals transmitted by the active RF tags. The power of each transmitted RF signal can be limited to achieve the desired detection range. For example, a detection range of 12 inches will be appropriate for ankle tags, and a detection range of 24 inches will be appropriate for wrist tags. Frequency hopping or other schemes will allow each RF antenna to read multiple active tags at the same time. 
         [0024]    When a patient is identified via a mattress, floor or doorway antenna, the workstation computer will automatically access the patient&#39;s records to determine if any wandering or bed restraints have been noted and to also determine the patient&#39;s preferred language. When an alarm situation has been identified, the workstation computer will send an appropriate alarm code to the central monitoring station and/or to the responsible attendant&#39;s wireless communication device. The workstation computer can also play prerecorded voice commands in the patient&#39;s preferred language, such as “Michael, please stay in your room.” 
         [0025]    Other features and advantages of the present invention will be readily appreciated upon review of the following detailed description when taken in conjunction with the accompanying drawing figures. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0026]      FIG. 1  is a diagram illustrating interconnections between an attendant workstation, a pharmacy workstation, an RF antenna located inside or under the patient&#39;s mattress, and an attendant&#39;s wireless communication device. 
           [0027]      FIG. 2  is a conceptual illustration of an RFID pillbox with separate compartments for medications, and a light under each compartment shows pharmacy workers where to insert each prescribed medication. 
           [0028]      FIG. 3  is a diagram illustrating the filling of RFID pillboxes at a pharmacy workstation. 
           [0029]      FIG. 4   a  is a side view of a wall-mounted attendant workstation cabinet containing a workstation computer, an RFID pillbox, and other electronics. 
           [0030]      FIG. 4   b  is a front view of the attendant workstation cabinet with the front doors removed. 
           [0031]      FIG. 4   c  is a front view of the top and bottom doors of the attendant workstation cabinet. 
           [0032]      FIG. 5  is a conceptual illustration of an attendant workstation cabinet configured as a computer desk with a separate computer monitor and keyboard for patients and their guests and an RFID pillbox located inside a locked compartment above the computer monitor. 
           [0033]      FIG. 6  is a conceptual illustration of an attendant workstation cabinet that plugs into sockets at the foot-end of a hospital bed, and this workstation includes a camera, microphone and speaker for video communications with the patient. 
       
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
       [0034]      FIG. 1  is a block diagram illustrating communications between an attendant workstation  120 , a pharmacy computer  110 , an RF antenna and transceiver circuit  135  inside or under the patient&#39;s mattress, and an attendant&#39;s wireless communication device  150 . Most institutions will also want hardwired communications with a nurses&#39; station or other central monitoring station computer, which is not shown. A computer associated with the workstation  120  also communicates with RFID devices inside the patient&#39;s room that detect medication errors, falls, bed egress and room egress (i.e. wandering). 
         [0035]      FIG. 2  illustrates an RFID pillbox  100  with separate compartments  201 - 208  for pills, and pillbox lights  220  under each compartment that show pharmacy workers where to insert each prescribed medication. 
         [0036]      FIG. 3  illustrates the pharmacy computer  110  helping pharmacy workers find a storage box  315 , where a prescribed medication is stored. A blinking cabinet light  325  indicates the quantity and location of the medication. 
         [0037]      FIG. 4   a  is a side view of a wall-mounted attendant workstation cabinet  120  containing a workstation computer  410 , a pillbox  100  and other electronics.  FIG. 4   b  is a front view of the workstation cabinet  120  with the front doors removed, and  FIG. 4   c  is a front view of the top door  420  and bottom door  430  of the workstation. 
         [0038]      FIG. 5  shows the workstation cabinet  120  configured as a computer nightstand with a separate computer monitor  122   b  and keyboard  435   b  for patients and their guests. The pillbox  100  is stored inside a locked compartment above the patient&#39;s computer monitor  122   b.    
         [0039]      FIG. 6  shows a workstation cabinet  120  attached to a frame  600  that plugs into sockets at the foot-end of a hospital bed. A second computer monitor  122   b  and wireless keyboard  435   b  can be used by the patient. A camera, microphone and speaker  605  are also shown attached to the frame  600  for video communications with the patient. 
         [0040]      FIG. 1  illustrates how a pillbox  100  is filled in a hospital pharmacy department using a pharmacy computer  110  programmed to oversee the process.  FIG. 3  shows how a blinking cabinet light  325  identifies the location and quantity of a prescribed medication.  FIG. 2  depicts pillbox lights  220  positioned under the pillbox  100 , which helps the pharmacy technician insert each identified medication into the correct compartment of the pillbox  100 . 
         [0041]    In this system, each patient is assigned unique RFID codes for a pillbox tag  102 , wrist tags  130  and  131  and optional ankle tags  132  and  133 . In an embodiment well suited for use in hospitals, the workstation cabinet  120  is mounted to wall studs just outside the patient&#39;s room. An RFID reader  121  inside the workstation cabinet  120  reads the pillbox Tag  102 , and an RFID reader  135  inside the patient&#39;s mattress periodically reads the patient&#39;s wrist tag  130  or  131 . The attendant workstation  120  communicates with both RFID readers  121  and  135  and identifies when the pillbox  100  has been delivered to the wrong patient. Details about any identified errors are displayed on the workstation monitor  122 . 
         [0042]    The patient&#39;s pillbox  100  is stored in a locked compartment inside the attendant workstation cabinet  120 . The pillbox compartment is unlocked when an attendant&#39;s RFID badge is detected by the RFID reader  121  followed by the attendant entering a pre-approved personal identification number (“PIN”) and/or password. The PIN and/or password inputs are registered using a Keypad  123  attached to the workstation  120 . 
         [0043]    Each day or night, a second pillbox  101  with the same RFID tag  102  is filled with medications prescribed for the next day. At a specified time, pillbox  101  is delivered to the patient&#39;s workstation cabinet  120  and exchanged for pillbox  100 . The following day or night, pillbox  100  is refilled and exchanged for pillbox  101 . 
         [0044]    The attendant workstation  120  computer communicates with the pharmacy computer  110  to determine all of the medications prescribed for the patient and a deadline for each medication. When a medication is late, a “late medication” message or alarm code is displayed on the attendant workstation monitor  122  and/or central workstation monitor. The message can be also transmitted to a wireless communication device  150  carried by the responsible attendant. The wireless communication device  150  can be also configured with a barcode reader  151  for reading barcode labels on patient&#39;s ID bracelets and for reading barcode labels on medication wrappers. 
         [0045]    In a preferred embodiment of the invention, the “late medication” message or code is first displayed on the central workstation monitor listing the patient&#39;s name, room number, and other details. The attendant at the central workstation must press a special function key within a specified period of time to acknowledge the message. If no response is detected by the central workstation computer, then a similar wireless message is automatically transmitted by the central workstation computer to the responsible attendant&#39;s wireless communication device  150 . The central workstation monitor can be located at the responsible nurses&#39; station. 
         [0046]    The wireless communication device  150  can be also used for other text, audio and video communications, e.g. displaying other alarm codes, displaying distorted video images of floor areas where patient falls have been detected and seeing a clear video image of the patient during nurse call communications. These video options must be pre-approved by the patient during the admissions process. The wireless communication device  150  can be a PDA, a cell phone, or a small laptop computer. 
         [0047]    If pharmaceutical companies switch from barcode labels to RFID tags on medication wrappers, the same RFID reader  121  inside the attendant workstation cabinet  120  can be used to read all of the RFID medication tags inside the pillbox  100  and can thereby detect when a medication has been removed from the pillbox  100  at the wrong time. The RFID reader  121  can also identify when any medications are missing at the time the pillbox  100  arrives at the attendant workstation  120  or when an arriving medication or dosage is incorrect. The attendant workstation computer can be programmed to display these error messages on the workstation monitor  122  and to also report these delivery errors to the pharmacy computer  110 . In some applications, the RFID tag  102  on the pillbox  100  may be designed to operate at a different frequency than the RFID tags on wrapped medications. In this situation, a different RFID reader inside the workstation  120  will read the medication tags. 
         [0048]    Most hospital patients will be expected to wear both RFID wrist tags  130  and  131 , which will improve the accuracy for detecting medication errors, falls, bed egress and room egress. Patients with a history of wandering will also wear ankle tags  132  and  133  attached to ankle bracelets or socks. RF antennas under hallway flooring coverings will identify ankle tags  132  and  133  and will detect when a patient with a history of wandering has entered an unsafe area. 
         [0049]    The computer associated with the attendant workstation  120  will monitors the interfacing circuits connecting to RF antennas under floor coverings inside the patient room and under the shower tub to detect when either wrist tag  130  or  131  remains close to the floor at these locations, which will be interpreted as a patient fall. Bed egress will be indicated when neither wrist tag  130  nor  131  is detected by an RF antenna  135  inside or under the mattress. Room egress will be detected when an RF antenna inside the entry door or door frame detects close proximity of either wrist tag  130  or  131 . Bed egress can be also indicated when either ankle tag  132  or  133  is detected by a floor antenna next to the bed, and room egress can be identified when either ankle tag  132  or  133  is detected by a door antenna, door frame antenna or floor antenna next to the door. 
         [0050]      FIG. 2  shows more details about pillbox  100 . A passive RFID tag  102  is attached . to the pillbox  100 . When the RFID tag  102  is triggered to transmit, it conveys an alphanumeric code which is assigned to the patient during the admissions process. The pillbox  100  has separate compartments  201 ,  202 ,  203 ,  204 ,  205 ,  206  . . . for holding medications which are scheduled for delivery to the patient at marked standard times, e.g. 6 AM, 10 AM, 2 PM, 6 PM, 10 PM, 2 AM, etc. Additional compartments  207 ,  208  are for medications prescribed as needed or at non-standard times. Each patient is assigned two identical pillboxes  100  and  101  (pillbox  101  is not shown). An identical RFID tag  102  number is attached to both pillboxes  100  and  101 , thereby identifying that the pillboxes  100  and  101  are both assigned to the same known patient. 
         [0051]      FIG. 3  shows how the pharmacy computer  110  helps a pharmacy technician refill pillbox  100  and other pillboxes assigned to other patients. The patient&#39;s name, allergies, preferred language, room number and other information are determined via the RFID tag  102  and associated patient records. The pharmacy technician uses an RFID reader  305  to read the RFID tag  102 . The pharmacy computer  110  then looks up the patient&#39;s prescriptions, and the computer monitor  310  displays a drawing of the pillbox  100  and other details about the patient. 
         [0052]    The pillbox  100  is then inserted into a refill tray  210  with a different edge  215  at one corner which matches one corner of the pillbox  100 , thereby forcing the pillbox  100  into a preferred orientation inside the refill tray  210 . Alternatively, hinges  225  and  226  can be used that only fit into the refill tray  210  when properly aligned. Many other alignment schemes can be employed. A collection of pillbox lights  220 ,  221 ,  222 ,  223 ,  224  . . . are mounted at the bottom of the refill tray  210  with each pillbox light able to project light through the bottom surface of one of the compartments of the pillbox  100 . 
         [0053]    All of the stock medications are stored in a collection of storage boxes  315  positioned on shelves of an Instrumented cabinet  320 . When the pharmacy computer  110  determines all of the medications prescribed for the patient, the pharmacy computer  110  turns on a cabinet light  325  under each of the storage boxes  315  containing medications which have been prescribed for the patient. Each cabinet light  325  blinks a number of times that indicates the number of pills which need to be inserted into the pillbox  100  for the identified patient. After blinking, each cabinet light  325  remains off for a short period of time, and then automatically repeats the sequence of blinks. The pharmacy technician must walk along each shelf and collect the correct number of pills from each storage box  315 , as indicated by the blinking light below each storage box  315 . In an alternative design, the cabinet lights  325  can be mounted above the storage boxes  315 . Also, a small 2-digit display can be mounted under or over each storage box  315  to show the number of pills needed. Other liquid medications and supplies can be selected via the same scheme. 
         [0054]    The pharmacy worker must next use a barcode reader  330  to read the barcode label on each wrapped medication. The barcode reader  330  can be built into the pharmacy computer  110  or it can be a handheld barcode reader (not shown). The pharmacy computer  110  then looks up the patient&#39;s prescription records and displays an Arrow  340  or other indicator on the pharmacy monitor  310 , showing the pharmacy technician where to put the medication in the pillbox  100 . To assist the technician, a pillbox light  222  under the pillbox  100  turns on to further indicate where the medication should be placed in the pillbox  100 . The pillbox light  222  remains on until the next medication barcode label is read. A sound is triggered each time a medication label is successfully read. A different sound is triggered each time a medication label is detected but not identified. 
         [0055]    When all of the barcode labels have been read, any missing medications are listed on the computer monitor  310 , and the corresponding cabinet lights  325  on the Instrumented cabinet  320  blink to show the pharmacy technician the location and quantity of the remaining medications needed. The pharmacy worker must again use the barcode reader  330  to read each of the remaining medication labels. The pharmacy monitor  310  and appropriate pillbox light show the pharmacy worker where to place each of the missing medications. If any medications are wrong, the pharmacy computer  110  will help the pharmacy worker identify the storage boxes  315  which may contain the wrong medications. The pharmacy monitor  310  will display a warning message instructing the pharmacy technician to check each of the suspected storage boxes  315  marked by a rapidly blinking cabinet light  325 . The cabinet lights  325  will blink rapidly one at a time, and the pharmacy monitor  310  will list the medication that should be in the identified storage box. 
         [0056]    If pharmaceutical companies shift from barcode labels to RFID tags on wrapped medications, the RFID reader  305  can be used to read each medication tag. Alternatively, a separate RFID antenna could be mounted around each of the pillbox lights  220  to read all of the medication tags inside each pillbox compartment  201 . The pillbox  100  could be fabricated with a clear plastic bottom, a metal lid, and metal sides around each compartment  201 . This design would shield the tags in adjacent compartments. 
         [0057]    Each pillbox  100  is stored inside a locked attendant workstation cabinet  120 , exemplified as a wall-mounted cabinet in  FIGS. 4   a ,  4   b , and  4   c . This cabinet design is recommended for hospitals. The wall-mounted cabinet  120  is designed to fit between wall studs and protrude out of the wall as little as possible.  FIG. 4   a  shows a side view of the cabinet and contents;  FIG. 4   b  shows a front view with both the top and bottom doors removed; and  FIG. 4   c  shows the top and bottom doors with several electronic devices attached to each door. On the first day, the pillbox  100  is filled and delivered by the pharmacy department with medications prescribed for the first day. The pillbox  101  is filled and exchanged for the pillbox  100  before the morning of the second day. 
         [0058]    The hospital version of the attendant workstation cabinet  120  can be located inside or just outside the patient&#39;s room. A wall-mounted cabinet just outside the patient&#39;s room will have significant advantages of (1) giving the nurses more privacy when reading or typing patient records and preparing each medication delivery; (2) making it easier for pharmacy technicians to deliver the pillboxes without losing site of their delivery cart; (3) keeping the medications and supplies away from infectious organisms inside the patient&#39;s room; and (4) displaying alarm codes and email messages on the workstation monitor at a more visible location that will be less likely to frighten the patient. 
         [0059]    In  FIG. 4 , the RFID reader  121  is used to read the RFID tag  102  attached to each pillbox  100 ,  101  and to also read each attendant&#39;s RFID badge. The attendant can access the locked workstation  120  by swiping his/her RFID badge close to the RFID reader  121  and by next inputting a pre-approved PIN and/or Password using the Keypad  123 . A biometric reader (e.g. fingerprint reader, palm reader, or face recognition camera) can be provided with the attendant workstation  120  to add another level of security. Most biometric readers are expensive; therefore, this option is not shown in  FIG. 4 . Three levels of security can be created by requiring each attendant to first swipe an RFID badge near the RFID reader  121  and to next input a long-term PIN followed by a second short-term PIN. The short-term PIN could be changed each week or month at any workstation  120 . 
         [0060]    As previously described in the context of  FIG. 1 , RFID tags  130 ,  131 ,  132  and  133  remain close to each patient&#39;s body, for example on wristbands and attached to nonskid socks or ankle bracelets. Some institutions may not require all patients to wear ankle tags  132  and  133 , but these RFID tags can be hidden inside non-skid socks and will prevent wandering and falls at minimal cost to the institution. RF antennas under floor coverings or floor mats in hallways, bathrooms and next to the bed identify when the patient is standing or walking at these locations. The workstation computer  410  can be programmed to first identify the patient and then access patient records to determine whether any wandering limits or bed egress restrictions have been imposed for the patient. The workstation computer  410  can then respond accordingly via alarm codes or prerecorded voice commands to the patient in the patient&#39;s preferred language. 
         [0061]    An RFID antenna and transceiver  135  inside or below the patient&#39;s mattress are used to periodically read the patient&#39;s wrist tags  130  or  131 . The workstation computer  410  periodically communicates with the RFID transceiver  135  (shown in  FIG. 1 ) to identify the patient while lying in the bed. When a pillbox RFID tag  102  (shown in  FIG. 1 ) is identified by the workstation RFID reader  121 , the workstation computer  410  verifies that the patient is receiving the correct pillbox  100 . Any errors are displayed on the attendant workstation monitor  122  mounted to the upper door  420  of the workstation cabinet  120 . 
         [0062]    Fans  421 ,  422 , and  423  are mounted to the upper door  420  to cool the computer  410  and workstation monitor  122 . A back-up batter power supply  424  is mounted above or below the workstation computer  410  for short periods of power loss. Hospital generators will supply power to the workstation  120  during prolonged periods of power loss. The upper door  420  has a vertical hinge  425 , allowing the upper door  420  to swing outward to access the computer  410  and other electronics. 
         [0063]    An attendant can unlock the lower door  430  to access the storage compartment  431  by first swiping a pre-authorized RFID badge close to the RFID reader  121  and by next inputting a pre-approved PIN and/or Password using the Keypad  123 . The hinge  432  for the lower door  430  is horizontal, allowing this door  430  to swing downward and remain in a horizontal position. A keyboard  435  is then positioned at a comfortable location for accessing patient records and typing email messages or patient records. 
         [0064]    Each wrapped medication inside the pillbox  100  is marked with a distinctive barcode label. A barcode reader  440  mounted inside the storage compartment  431  is used to read the barcode label on each medication before the medication is delivered to the patient. The attendant workstation computer  410  communicates with the pharmacy computer  110  and with the mattress RFID transceiver  135  to identify any medication errors, e.g. incorrect medications, incorrect dosages, missing medications, or timing errors. Error messages are displayed on the workstation monitor  122  and reported to the pharmacy computer  110 . 
         [0065]    When the patient is out of the bed, a wireless barcode reader near the patient&#39;s bed can be used to read either barcode label printed on both of the patient&#39;s ID bracelets, i.e. next to the RFID tags  130  and  131 . Some institutions may prefer to provide each attendant with a wireless communication device  150  configured with a barcode reader  151 . 
         [0066]    The workstation computer  410  communicates with the pharmacy computer  110  at periodic intervals to determine prescribed medications and deadlines for medication deliveries for the identified wrist tag  130  or  131 . Whenever a critical medication has not been identified by the barcode reader  440  or  151  before the prescribed deadline indicated by the pharmacy computer  110 , a “late medication” message is sent to a central monitoring station, and the message can be optionally forwarded to the responsible attendants wireless communication device  150 . If the workstation computer  410  does not identify that the late medication has been delivered in a specified period of time, the “late medication” alarm code is sent again and repeated at specified intervals until the medication is identified. 
         [0067]    Some institutions may want their attendants to carry a wireless PDA  150 , which can be easily configured with a barcode reader  151 . The attendant can use the wireless PDA  150  and attached barcode reader  151  to read barcode labels in the patient&#39;s room, to receive and transmit text or audio messages, and to also see a video image of a patient. If an institution is not able or willing to provide wireless PDA&#39;s  150  for their attendants, alarm codes can be transmitted to responsible attendants using less expensive telephone pagers. For example, a telephone pager message of “042-0891” could signify that a Code “042” (decoded as a late medication) has been detected by the workstation computer  410  at room “0891.” Other number codes could be used to indicate patient falls, wet sheets, bed egress, room egress, and when weight-shifts are needed. 
         [0068]    In hospitals and nursing homes with more than one bed per room, a larger compartment inside the workstation cabinet  120  can be provided for multiple pillboxes. When a pillbox is identified and the patients inside the room are identified via an RFID antenna and transceiver inside or below each mattress  135 , the workstation monitor  122  displays a drawing of the room, an optional photograph of the patient and indicates which bed the patient is residing. In this situation, a second barcode check inside the patient room is particularly important, i.e. reading the barcode label on the patient&#39;s ID bracelet and the barcode label on each medication. 
         [0069]    The attendant workstation cabinet  120  can be attached to a wall as described above or contained inside a computer desk as depicted in  FIG. 5 . This design will be less appealing to most hospitals for the reasons described above, but may be more appealing to assistive living centers and nursing homes.  FIG. 5  shows a workstation computer  410  and back-up battery supply  424 , two keyboards  435   a  and  435   b,  two workstation monitors  122   a  and  122   b,  one RFID reader  121 , three storage compartments  431   a,    431   b,  and  431   c,  a locked cabinet door  430  with a horizontal hinge  432 , and pillbox  100 . The lowest storage compartment  431   c  can also contain an optional refrigerator for intravenous bags. The workstation computer  410  can be set up to allow patients to use the desktop keyboard  435   b,  computer monitor  122   b  and middle storage Drawer  431   b.  The other two storage compartments  431   a  and  431   c  can be locked, requiring a pre-approved RFID badge and PIN to access these compartments. The upper keyboard  435   a  slides outward toward the attendant for inputting the attendant&#39;s PIN and accessing patient records. The upper cabinet door  430   a  has two square holes (not shown) for accessing the RFID reader  121  and for viewing the upper computer monitor  122  when the cabinet door  430   a  is in a locked position. The cabinet door  430   a  rotates upward to access the pillbox  100  and upper storage compartment  431   a.    
         [0070]      FIG. 6  shows another configuration of the attendant workstation cabinet  120  mounted to the foot-end of a hospital bed, e.g. plugging the workstation frame  600  into the sockets provided on most hospital beds for an over-bed trapeze frame. A second computer monitor  122   b  is mounted to the workstation frame  600  to allow the patient to see the monitor  122   b  while lying in the bed, and a wireless keyboard and mouse pad  435   b  is available to the patient and guests for a variety of computer applications including Internet access. 
         [0071]    A digital camera, microphone and audio speaker  605  can be attached to the frame  600  or enclosed with the computer monitor  122   b  for audio and video communications with attendants, physicians and family members. A multi-lead electrical connector  610  will need to be installed near the headwall with appropriate electrical connections for the workstation computer  410  and other electronics provided with the workstation  120 . A mobile version of the bed frame workstation  120  could be offered with the workstation frame  600  attached to a stand that rolls under the foot-end of the bed. 
         [0072]    The workstation computer  410  in each of the above configurations monitors RF antennas at different locations in the patient&#39;s room, for example (1) the RF antenna(s)  135  inside the mattress for reading either wrist tag  130  or  131  at periodic intervals to detect medication errors; (2) the same RF antenna(s)  135  inside the mattress for identifying when neither wrist tag  130  nor  131  are close to the mattress which will be interpreted as bed egress; (3) the RF antenna(s) under floor coverings or floor mats for identifying prolonged proximity of either wrist tag  130  or  131  which will be interpreted as a patient fall; (4) the RF antenna(s) under a shower tub for identifying prolonged proximity of either wrist tag  130  or  131  which will be interpreted as a patient fall in the shower tub; (5) the RF antenna(s) inside the entry door or door frame for identifying close proximity of either wrist tag  130  or  131  which will be interpreted as room egress; and (6) the RF antenna(s) under floor coverings or floor mats in hallways, at doorways next to the bed, next to the toilet and at other locations for identifying close proximity of either ankle tag  132  or  133 . These RF antennas and tags will be used to detect wandering outside the patient&#39;s room and will also detect when a patient gets out of the bed and when the patient has entered the bathroom. If the patient is wearing RFID tags, the antennas transmit and receive RFID signals via transceiver circuits. If the patient is wearing battery powered RF tags that automatically transmit an RF signal at periodic intervals, then the antennas are only used to receive the RF signals, and receiver circuits amplify the signals. It should be understood that the foregoing relates only to the exemplary embodiments of the present invention, and that numerous changes may be made therein without departing from the spirit and scope of the invention as defined by the following claims.

Technology Category: 3