Proposal MEDICATION TRACKING AND ALERT SYSTEM. ECE4007 Senior Design Project. Section L05, Pneumaniacs

Transcription

1 Proposal MEDICATION TRACKING AND ALERT SYSTEM ECE4007 Senior Design Project Section L05, Pneumaniacs Henry Bowden, Team Leader John Bowen Tyler Howell Kent Mustoe Laura Nguyen Robert Ussery Submitted February 4, 2009

2 TABLE OF CONTENTS Executive Summary... iii 1. Introduction Objective Motivation Background Project Description and Goals Technical Specifications Design Approach and Details Design Approach Central In Room Technical Critical Path Contingency Plans Codes and Standards Constraints, Alternatives, and Tradeoffs Schedule, Tasks, and Milestones Project Demonstration Component Testing Integration Testing Acceptance Testing Marketing and Cost Analysis Marketing Analysis Cost Analysis Summary References...22 Appendix A...24 Appendix B...26 Pneumaniacs (ECE4007L05) ii

3 EXECUTIVE SUMMARY Medication errors are common occurrences in hospitals and affect whether or not a patient is treated correctly. In some cases the errors affect whether a patient lives or dies. To minimize medication errors, the Pneumatic Medication Transport System will enable nurses and doctors to accurately, quickly, and securely deliver medications to all patients throughout a hospital. The system will be designed to work with an existing or newly constructed pneumatic tube transport system and is targeted towards small to medium sized hospitals to deliver medication to patient rooms. RFID readers will keep track of when the medication is sent, delivered, and administered to the patient. An alert system will send short message service alerts to the patient's caretakers if the medication is late. The demonstration will be of an RFID medication tracking system from a sending station to a receiving station. The system will record when the medication has been sent, delivered, and administered in a database. A locking mechanism will require identification before releasing the medication at the secondary station. If the medication is not taken out of the secondary station within a preset time limit, an SMS notification will be sent to a caretaker and to a website on the hospital's web server. This prototype and labor is estimated to cost $7,301. Pneumaniacs (ECE4007L05) iii

4 MEDICATION TRACKING AND ALERT SYSTEM 1. INTRODUCTION Medication errors occur in nearly one of every five doses given to patients in a typical hospital [1]. The Medication Tracking and Alert System will enable nurses and doctors to accurately, quickly, and securely deliver medications to all the patients throughout a hospital. When comparing the risks of utilizing a drug courier versus the risks of implementing a medication tracking and alert system, it is clear that hospitals should use this system to reduce medication errors and improve accuracy Objective The Medication Tracking and Alert System will accurately track medication from the pharmacy to the patient's room and will record when the medication is sent, delivered, and administered. This process will be achieved by RFID readers located at the sending and receiving stations, a database, and an alert system via SMS messages to the nurses' personal phones and LEDs on the receiving station Motivation With over 770,000 patients injured every year in American hospitals because of medication errors, changes need to be made in the method of delivering and administering drugs [2]. Some smaller hospitals have pneumatic tube systems in place, but there is no error checking involved when drugs are sent through these tubes. By applying RFID tags to the carriers and linking them to a database file associated with the patient, the Medication Tracking and Alert System will ensure that the correct medication arrives to the proper room and that the patient takes the medicine at the correct time, eliminating the major causes of delivery errors. Cost Pneumaniacs (ECE4007L05) 1

5 analyses by hospitals of all sizes also show that pneumatic tube delivery systems cost less over time than employee couriers [3] Background The concept of using a pneumatic tube system in a hospital is not a new one. There are already companies that specialize in the sale and installation of pneumatic tube systems in hospitals. One manufacturer, Aerocom, builds systems to send and receive "solid and liquid samples, sensitive electronic equipment, pharmaceuticals, IV solutions, and whole blood or plasma [4]." Companies have even established tracking devices for the carriers such as the Pevco Tracker which "provides a searchable real-time audit trail for patient-critical pneumatic tube system transactions, including pharmaceuticals, blood products and lab specimens [5]." Swisslog has developed a locking system, but theirs only ensures that the correct people can process transactions and does not restrict who is allowed access to medications [6]. 2. PROJECT DESCRIPTION AND GOALS A proof-of-concept model of this tracking and alert system will be designed and constructed. The system will be designed as an add-on for an existing or newly constructed pneumatic tube transport system. A pneumatic tube system will not be the goal of this project. The system will be constructed with the following goals: Prevent delivery of medications to the wrong patients. Ensure the administration of medication on the correct dosing schedule. Provide records of medication delivery times. Notify caregivers of late medication delivery through an alert system. Provide controlled access and custody verification for medications once they leave the pharmacy. Pneumaniacs (ECE4007L05) 2

6 The medication tracking system will be constructed such that it can be integrated with an existing pneumatic tube system by modifying or replacing the carrier send/receive stations. The system will consist of two terminals: a central sending station in pharmacy and a receiving station in each of the patient rooms. Central Station Description The master station will be located in the pharmacy and will allow the pharmacist to perform the following tasks: Associate a pneumatic tube carrier with a patient s dose of medication. Specify a dosing schedule for the medication. Identify the caregiver or set of caregivers who will be allowed to access the medication on the receiving end of the system. Host a patient and prescription database that specifies the correct dosing schedule for each patient s prescriptions. House a web server that will drive a notification system for the medicine tracking system. Send an SMS message to the proper caregiver in case of a dosing or delivery error. Update a webpage at the Nurses' Station with status information for each patient. In Room Station Description The receiving station located in each patient s room will have the following functionality: Send a timestamp and a room number to the master station when the carrier arrives. Send a timestamp when the carrier is removed from the station. Provide in-room notification of medication errors. Prevent access to the medicine by unauthorized persons via an electronic lock and identification card system. Pneumaniacs (ECE4007L05) 3

7 Target Market This medication notification system will be targeted toward small to medium sized hospitals which use pneumatic tubes to deliver medication to patient rooms. 3. TECHNICAL SPECIFICATIONS The project consists of four main systems which each require specific components to properly function. These systems are the Sending Unit, Receiving Unit, Database, and the Alert System. Each of these systems along with their components and corresponding operating requirements are shown in Table 1. Table 1. Overall Operating Requirements and Technical Specifications. Software Database Requirements A large portion of the design relies on the seamless integration of the database into the overall pharmaceutical delivery system. The features of the database are shown in Table 2 and represent only an overview of systems within the software not a complete feature listing. Pneumaniacs (ECE4007L05) 4

8 Table 2. Software Feature List for Database and Tracking Systems. 4. DESIGN APPROACH AND DETAILS 4.1 Design Approach The design of the medication delivery system will be approached as a set of separate subsystems with components that will be completed as independently as possible. As each component is completed, they will be integrated together. This method will prevent problems and complications in each component from affecting the others. The systems and components will be broken down as shown in Figure 1. Pneumaniacs (ECE4007L05) 5

9 Figure 1. Tracking and alert system components. The following components have already been completed or will be used off the shelf: Pneumatic tube and carrier RFID tags and reader Short Message Service (SMS) framework Pharmacy patient database Web server hardware and network framework Programmable Logic Device (PLD) hardware and programming language Pneumaniacs (ECE4007L05) 6

10 4.1.1 Central Back End Server The back end server will be comprised of four subcomponents. The MySQL database will have access to the hospital s computerized pharmacy database where it will know that an order has been placed for the patient, the patient s room, the time the medication will need to be administered, and phone number of the nurse(s) who are assigned to the patient. If the values for patient ID, room number, and time are not in the database, the value can be filled in by the pharmacy via the client server GUI. The client server will host a website that is accessible to the pharmacy. This website will serve as a front-end to the MySQL database, and will have a GUI similar to Figure 2. Figure 2. Client website with patient ID, room, time needed, RFID number and current time. Color will indicate the status of the medications Green for On- Time, Yellow for Late. Pneumaniacs (ECE4007L05) 7

11 A list of medication orders will be listed on the client GUI. When an entry is clicked on the GUI, the fields for the order can be changed; clicking the Enter button will cause the change to be committed to the MySQL database. The RFID field is filled in by scanning the RFID tag for the carrier containing the patient s medication. The pharmacy will have the ability to delete an entry if the system should not delete the entry automatically. A web server will be used to communicate with the receiving station. The receiving station will employ a PIC microcontroller using TCP/IP to communicate with the central web server. The web server will use PHP to interact with the database and to serve web and SMS notifications of overdue medication. Pharmacy Computer A computer will be placed in proximity to the pneumatic tube system at the sending station in the pharmacy. This computer will run Microsoft Windows, will have access to the internet, and will have at least one USB port. The computer will render the client GUI on a web browser. The RFID reader will be connected to the computer via USB. RFID Tagged Pneumatic Carrier Each pneumatic tube carrier will be tagged with a unique RFID tag. The tag will be located inside the carrier such that it can be read by the RFID reader regardless of the orientation in which the carrier arrives. Pneumatic Tube Sending Station with RFID Reader The pneumatic tube sending station will be located at the pharmacy. The station will accept input to specify the destination room for the carrier, and will house the RFID reader. The reader will be integrated with the station as shown in Figure 3. Pneumaniacs (ECE4007L05) 8

12 Figure 3. RFID reader location in the pneumatic tube sending station.. The RFID reader will emulate a keyboard entry on the pharmacy computer, entering the RFID tag ID into the RFID Number field on the client GUI. Since the RFID reader can only read the tag once it is in the pneumatic tube, there is little possibility that the carrier will be misplaced in the pharmacy between entering the RFID number and sending the carrier. Once the RFID number has been entered, a time stamp for the carrier entering the pneumatic tube system will be recorded. After the RFID number and destination room have been entered, the carrier will be transported to the patient s room where the in-room system will take over In Room System Pneumatic Tube Receiving Station with Lockable Housing The receiving station for the pneumatic tube system will have access security and an RFID reader built in. Access security is ensured by a locking mechanism on the door that can only be opened when appropriate identification is provided to the RFID badge reader. The Pneumaniacs (ECE4007L05) 9

13 locking mechanism will be a solenoid that is activated to unlock the door to the housing. The receiving housing, shown in Figure 4, will contain the PIC microcontroller, RFID tag reader, RFID badge reader, door lock mechanism, and status LEDs. Figure 4. Receiving housing for the pneumatic tube system with lockable door. PIC Microcontroller The PIC Microcontroller will perform all the intelligent functions of the receiving station. The PIC will communicate to the web server via TCP/IP over the hospital s internal Ethernet network. Information on RFID tag presence, badge ID, and status of an order will be communicated with the central web server and MySQL database. Pneumaniacs (ECE4007L05) 10

14 The microcontroller will have input/output ports for communicating with the RFID readers, locking mechanism, and status LEDs. The locking mechanism will be controlled by the PIC which will activate the solenoid when an authorized RFID badge is presented to the RFID badge reader. If the badge presented has authorization, the badge ID and time will be collected and transmitted to the MySQL database for clerical purposes. RFID Badge Reader The RFID badge reader will read an RFID enabled badge used by hospital staff and pass the badge ID to the PIC. The PIC will transmit the ID to the central web server. The web server will check to see if the badge is authorized to access the carrier, and will respond with an authorization signal if so. The PIC will receive this signal and activate the solenoid to grant access to the carrier. RFID Carrier Reader The RFID reader will be used to check for the presence of the carrier in the in-room housing. The reader will be connected to the PIC via a serial connection. LED Indicators The LED indicators will visually indicate the status of the medication in the tube. The following notification scheme will be used: None no carrier and medication present Solid green carrier present, medication is waiting to be administered Solid yellow carrier present, medication is overdue Blinking green access granted to badge presented Blinking yellow access not granted to badge presented Blinking green and yellow system error Pneumaniacs (ECE4007L05) 11

15 Technical Critical Path The technical critical path is shown in Figure 5 on the following page. The most critical path is the web server to the backend server to the computer client to the pneumatic tube system. This path will most likely take the longest to implement due to unknowns in creating the database and integrating them all together with the in-room system. As seen in the figure above, the components of each system are developed in parallel to the greatest extent possible. This prevents complications in one component from affecting the development of the others. Pneumaniacs (ECE4007L05) 12

16 Figure 5. Critical Path chart for the Pneumatic Medication Tracker Contingency Plans If parts of the system prove hard or impossible to develop, alternative ways to complete the part will be investigated. The system allows for multiple ways to develop each part. For example the web server can be programmed in a different language, the PIC can be replaced with a more costly but simpler personal computer, and a number of alternative RFID reader Pneumaniacs (ECE4007L05) 13

17 technologies are available. If the SMS notification alert system is not feasible, that notification system will be replaced with a single LED outside of the patient's door that flashes if the medication is late. If the updating webpage on the nurses' station is deemed impractical, we will continue to consult with nurses to determine a more practical central notification method. 4.2 Codes and Standards Some components in the design will require codes or standards in order to work properly and to adhere to local, state and federal standards [8]. The RFID tags and reader both have standards and regulations depending on what frequency they operate at and what application they are being used in [9]. For badge-based security, ISO [10] will be used. This standard deals with proximity cards used for identification which are defined by the ISO 7810 standard [11]. For the unique ID tag, ISO has been established for the numbering system, the identification procedure, and the implementation of the RF tag in an integrated circuit. The ISO standard will be used for air interface commutations. For communication between the in-room controller and the web server, TCP/IP will be used. This protocol will allow the PIC to communicate with the server from any network that implements the TCP/IP standard [12] Constraints, Alternatives, and Tradeoffs Table 3. Constraints, alternatives, and tradeoffs of medication delivery system. Topic Constraint Alternative Tradeoff 1 RFID System Orientation of carrier in tube, shape of carrier, proximity, ease of use Bar codes Barcode requires human scanning, requires proper orientation of the carrier in the tube. Pneumaniacs (ECE4007L05) 14

18 2 SMS System Cost to implement systems, ability to get nurse s attention, complexity, required infrastructure 3 Client GUI Using a webbased GUI allows for a limited amount of data entering abilities 4 LED Indicators LED Indicator could possibly annoy the patient alerts, light alert Visual Basic or C++ GUI Use sound based or LED Indicator at the nurses station Nurse will not be able to check all the time. A light alert could be easily missed by a busy nurse. The web-based GUI is very easy to program for and works across a broad range of computers. LED at nurses station would require more hardware. No indication in the room to the patient if the medication is late. 5. SCHEDULE, TASKS, AND MILESTONES. The design team has been separated into groups by systems within the project, and each of these systems will be approached concurrently when possible. Weekly updates are due for each group member including their current task and status on upcoming personal deliverables. See Appendix A for a complete Gantt Chart. 6. PROJECT DEMONSTRATION The demonstration of the project will be in Van Leer in late April showing the process described in Figure 6. Two group members will act as a pharmacist and a nurse to fulfill the personnel aspect of the system. Pneumaniacs (ECE4007L05) 15

19 Figure 6. Medication alert and notification system process. Pneumaniacs (ECE4007L05) 16

20 6.1 Component Testing As the design progresses and is implemented, each critical element will be tested individually. Table 4 explains the objectives that must be met by each component. Subsystem Carrier Identification System Table 4. Component Testing Objectives Testing Objective! Read the unique identifier of the carrier via RFID.! Generate an Ethernet packet containing the carrier ID.! Generate an Ethernet packet when the carrier RFID tag is no longer in range Access Control System! Lock the secondary station carrier access door via an electronic lock.! Receive and decode an Ethernet packet containing the designated caregiver s unique identifier.! Read an employee badge and verify the unique identifier with the badge ID.! Unlock the door if and only if the badge ID matches the caregiver ID. Nurse Notification System! When invoked, generate a warning of a medication error containing the patient name, medication, and prescribed time of administration.! Automatically display this warning on a website accessible via computer or portable device.! Send an SMS message containing the warning. Ethernet Communications System Patient Notification System 6.2 Integration Testing! Send packets both ways between the master and secondary stations.! Illuminate a warning light in the patient s room when medication has not been administered on time. Once each of the individual subsystems has been validated by testing, each must be tested in the context of its interactions with the rest of the system. Integration testing will use the same testing objectives as acceptance testing, with the caveat that all of the testing objectives may not necessarily be achieved simultaneously as they must be for acceptance testing. Integration testing will identify problems with the overall system and provide a means of verifying that project milestones are achieved on schedule. Pneumaniacs (ECE4007L05) 17

21 6.3 Acceptance Testing The final demonstration of the system will verify that the project is complete and fulfills all of the project objectives. Following is the acceptance test procedure: 1) Accept carrier into system and associate with patient. a. Create a patient record in the patient database with a patient room ID associated with the secondary station and with suitable medication information and a dosing schedule. b. Place carrier on RFID reader of master station. c. Associate patient record with carrier ID via the master station interface. d. Convey carrier to secondary station. 2) Acknowledge receipt of carrier in patient s room. a. Verify that database is updated with time of arrival of carrier in patient s room. 3) Release carrier to designated caregiver. a. Read caregiver s badge into secondary station b. If the badge belongs to the correct caregiver, release the carrier. Otherwise, deny access to the carrier. c. Verify that no medication error notifications are generated if the carrier is retrieved on schedule. 4) Generate notifications when medication error occurs. a. Repeat steps 1 and 2 with a room ID not associated with the secondary station. b. Verify that a medication error notification is generated on the system monitor webpage due to incorrect delivery. c. Repeat steps 1 and 2, but do not retrieve carrier within the time specified by the dosing schedule. d. Verify that webpage, caregiver SMS, and patient display notifications are generated. Pneumaniacs (ECE4007L05) 18

22 This procedure will verify that the system objectives are achieved. Specifically, the system will generate warnings if medication errors occur, will generate records of medication delivery, and will prevent access to medications by unauthorized persons. 7. MARKETING COST AND ANALYSIS 7.1. Marketing Analysis There are several companies selling pneumatic tube systems specifically for hospitals. These systems can connect to patient rooms, labs, or even multiple buildings [6]. Modern pneumatic tube systems can handle up to 500 different termination points [4]. The pneumatic tube delivery device proposed contains key differences from currently marketed systems. First of all, current systems do not utilize RFID technology. Most tracking is barcode based [5]. Barcode systems introduce another variable into the process: a staff member must scan barcodes at both the initiation and termination points. With RFID, a staff member can load the RFID-labeled delivery capsule with medication at the central station. At the receiving station, an RFID receiver scans for an incoming RFID-labeled capsule. As with other systems, a nurse can use a hospital identification tag or personal identification number to gain access to the delivered medication [13]. Another unique advantage of the proposed system is the alert system. Any confirmations via an RFID-wireless network interface to a central web database. If any medications are not confirmed or delivered on time, alerts are sent via the network via SMS, to the nurse station, and to LEDs at the termination point. Pneumaniacs (ECE4007L05) 19

23 Following are the major enhancements to current systems: RFID for initialization point o Logs medication as sent. RFID for termination point o Logs medication as delivered. Automated alert system o Alert provided if capsule is not sent or delivered on time. o Real-time web and SMS alerts provided 7.2. Cost Analysis The total cost of the project material is predicted to be $389. This is comprised of RFID readers and tags which are 40% of cost, a PIC microcontroller and ethernet which are 31% of cost, the construction of capsule, initialization and termination points which are 27% of cost, and other accessories that are 2% of cost. References for material costs are included in Appendix B. The total predicted man-hours for the completion of the project is 192 hours. An additional 528 hours will come from lectures, reports, and group planning meetings resulting in 720 total working hours. The breakdown per task is outlined in Appendix B. Using an estimated $30.00 an hour as an engineer s salary, and adding 20% in fringe benefits, the total cost per hour is $ This amounts to a total labor cost of $25, Also included in Appendix B is a cost breakdown for implementation in 25 hospitals over five years. Distributing the costs over 25 customers reduces the price per system to 47% of the development cost for the initial system. A cost overview is outlined in Table 5 on the following page. Table 5. Total Cost Estimates Pneumaniacs (ECE4007L05) 20

24 Costs: Value: Proposal Project 40 Bed Hospital Engineer Salary $30 per hour Benefits 20% of Salary ($6) Total Salary $36 per hour $25,920 $1, per hospital* Material Cost $ $11, Preliminary Cost $26, $12, Sales Expense 10% of project cost $2, $1, Cost to Manufacture $28, $13, Recommended Profit Margin: 15% Total Cost to Customer: $33, $15, * Accounts for engineering price over 25 hospitals (5 hospitals a year for five years). 8. SUMMARY The Pneumatic Medication Delivery System is currently at the end of the design stage and the beginning of the production stage. Final decisions are being made about the subsystems, and vendors are being confirmed for the parts needed to construct the system. A complete parts list is being compiled to be ordered so that construction and development of the system can begin. Progress on the medication delivery system can begin as soon as proposed idea has been approved. Pneumaniacs (ECE4007L05) 21

25 9. REFERENCES [1] K. N. Barker, E. A. Flynn, G. A. Pepper, PhD, D. W. Bates, R. L. Mikeal. (2002, Sep. 9). Arch Intern Med: Medication errors observed in 36 health care facilities. [Online] Available: [2] Cardinal Health. Statistics. [Online]. Available: [3] Pevco. Pneumatic Tube Systems 101. [Online]. Available: [4] Aerocom. Application: Hospitals. [Online]. Available: [5] Pevco. Pevco Tracker. [Online]. Available: [6] C. Warren. (2008, Dec.). Swisslog Introduces WhoTube Card Swipe Technology for Pneumatic Tube Systems. Swisslog. Denver, CO. [Online]. Available: [7] Modtronix Engineering. "Single board computer for 44 pin PLCC PICs." SBC45EC datasheet. [Online]. Available: [8] RFID Gazette., RFID Gazette. RFID regulations by FCC. [Online] Dec. 7, [Cited: Jan. 30, 2009.] [9] RFID Journal., "A Summary of RFID Standards." s.l. : RFID Jounal, [10] Inernational Organization for Standardization., dentification cards -- Contactless integrated circuit cards -- Proximity cards -- Part 1: Physical characteristics. ISO.org. [Online] Jan [Cited: Jan. 30, 2009.] Pneumaniacs (ECE4007L05) 22

26 3. ISO [11] International Organization for Standardization., Identification cards -- Physical characteristics. ISO. [Online] Oct [Cited: Jan. 30, 2009.] ISO [12] Microsoft., TCP/IP Protocol Architecture. [Online] [Cited: Jan. 30, 2009.] vsm.mspx?mfr=true. [13] Express Healthcare. Reducing Medication Errors. [Online]. Available: Pneumaniacs (ECE4007L05) 23

27 Appendix A: Project Gantt Chart Pneumaniacs (ECE4007L05) 24

28 Pneumaniacs (ECE4007L05) 25

29 Appendix B: Detailed Cost Analysis with Component Sources Pneumaniacs (ECE4007L05) 26

30 JB= John Bowen TH= Tyler Howell KM= Kent Mustoe HC= Henry Bowden LN = Laura Nguyen RU= Robert Ussery Initiation Point Material Cost* Hourly Cost JB HC TH LN KM RU Initiation Pad 2 Wood/Plastic $10 2 Nails/Glue $5 4 Acrylic Tubing (3') $22 RFID Receiver 1 $45 Nurse's Station (Central Console) Central Computer $0 Pharmaceutical Tracking Timer $0 8 Web Based User Interface $ RFID Integration $ Patient Database $0 16 Alert System/Software Real-Time Web Notification $0 24 SMS Notifications $0 8 Medication Capsule Programmable RFID Tags Assembly 8 Programmable RFID Tags Assembly $20 Capsule $30 8 Integration Testing $ Termination Point Termination Pad Wood/Plastic $10 2 Nails/Glue $5 2 Acrylic Tubing (3') $22 4 RFID Receiver 2 $45 RFID Receiver 3 $45 PIC Microcontroller Setup Pic Microcontroller $60 Ethernet $60 16 LEDs $10 8 RFID Interface $ Class Lectures Lab Lectures Pneumaniacs (ECE4007L05) 27

31 All prices include incidental costs. List continued on the following page. Reports Technical Report Proposal Draft Project Summary Final Project Report Group Meetings Total Costs $ List of Component Sources Component Price/unit Source RFID Readers (Several within price range) $45 PIC Microcontroller (with Ethernet) $60 Ethernet $60 Trossen Robotics ( RFID-Readers.aspx) Coridium ( XTOR from Semiconductor Store( t/pc/viewprd.asp?idproduct=122) Acrylic Tubing $10.48/ft U.S. Plastics ( Nails/Wood/Plastic $30 Home Depot Pneumatic Tube Transport Manufacturers Company Website Pevco Swisslog Aerocom pitals.shtml Pneumaniacs (ECE4007L05) 28