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BACKGROUND OF THE DISCLOSURE
The present apparatus and method are directed to a means and procedure for
dispensing medications as typically occurs in nurse rounds in a large
hospital. In a typical situation, many patients, located in individual
rooms, large wards or both, are deployed at or near a nurse station. Every
morning and at other times during the day required nursing personnel begin
medication rounds at which time a cart loaded with appropriate medications
is pushed down the hallway from patient to patient (in rooms or wards) and
individual medications are administered. Each round of the medication cart
requires a rather complicated procedure. Individual orders for the various
patients from a multitude of treating physicians must be examined and the
cart loaded with the medications in advance. At the time of making the
medication round, individual patient chart orders must be then reviewed at
the cart so that prescribed medicine can be administered to each patient.
A patient may receive more than one medication with each round, and the
dispensing of such medications must be recorded with suitable verification
to assure that the orders have been carried out. This typically involves
multiple pieces of paper, one for the order from the treating physician,
dispensing of that particular medication and written verification that it
has been given to the patient. This is accomplished for every medication
that is required, including those that are optional such as open orders
where medication is prescribed on an "as needed" basis, meaning that the
patient may or may not get that medication depending on their particular
symptoms as dynamically determined. The foregoing is a tedious procedure
and involves generation of substantial paperwork including written
verification that the medications have been given which must be
subsequently mounted in the patient's medical record. The nurse station
normally collects individual medical records for each patient. The records
can accumulate over a period of time, and, for someone who has been ill
for some period of time, the record can become quite large. For people who
have been hospitalized for weeks or months, their bound medical records
can weigh many pounds.
The foregoing procedure is relatively complex, but an even more complex
procedure is involved in the dispensing of narcotics. By definition, they
are medications subject to prescription dispensing only. However, because
they are viewed as inherently dangerous and are regulated by various
Federal or State agencies, an extra sequence of steps is required in
dispensing narcotics. The medical cart does not leave the floor. For
medications other than narcotics an interchangeable rack of drawers is
brought to the floor by pharmacy personnel. Narcotics are brought to the
nursing station on the floor by specifically designated personnel. Prior
narcotic inventory sheets with amount of drugs given in 24 hours and
amount remaining are picked up by the pharmacy personnel once per day,
usually at an early hour. The sheets are carried to the pharmacy to
determine what stock to send by designated personnel who later deliver the
narcotics and stock the cart. This person has responsibility for narcotics
from the central pharmacy. The nurse accepts responsibility for the drugs
when they arrive on the floor. In an alternate reloading process, the
medication cart must be removed from the floor to be charged at the
hospital pharmacy with its needed narcotics. At the pharmacy, the
narcotics (in a locked vault or safe) are loaded onto the medicine cart.
In turn, the medicine cart must be a locked vehicle where the narcotics
are kept in a secure fashion. The narcotics are thus kept under lock and
key arrangement where the key is checked out by a particular person who
removes the cart after the cart has been loaded.
The cart must typically be charged with a specific number of narcotic
medications. It is not uncommon to place 20-30 different types of
narcotics in a cart, and the number of doses for each particular narcotic
can be as high as 50. The cart is thus loaded with the requisite number of
doses of the various narcotics and an inventory is then established. The
inventory at the time the cart is loaded with narcotics is compared with
the ending inventory minus the deletions which are administered to the
various patients during nurse rounds. This added layer of paperwork
creates significant delays in administering the medicines and narcotics.
In addition, however, each patient receiving narcotics is provided with a
written record at the time of dispensing so that the written record can
later be incorporated in the patient's chart. Again, this represents the
generation of an additional document which must be removed from the cart
and integrated into the chart for that particular patient. On a large
hospital floor with substantial patient census, the stacks of paperwork
accumulated after a round of dispensing medications (including narcotics)
is voluminous. It requires detailed record keeping at each step of the
way. All of this clerical work basically detracts from quality attention
to the patients; the nursing personnel must pay more attention to keeping
the paperwork than to the patients. These are also problems with the human
recorder, errors require time to resolve or remain unresolved.
The present invention is a method and apparatus for overcoming these
problems. It defines a medication cart which is equipped with an onboard
computer system having suitable input devices such as a card reader,
keyboard, and bar reader. The cabinet of the cart is divided into two
portions, one being a conventional cabinet and the other portion
constructed for enclosing narcotics. That portion is closed with a locked
door, and includes means for dispensing narcotics only when prompted. The
narcotics dispensing means has the improved form of a type of vending
machine which delivers the order from the supply while storing the supply
safely in the cabinet. Particular details of the present apparatus should
be noted. Narcotics are stored in a locked cabinet. A large door covers
over the locked cabinet. In addition, individual narcotics can be locked
in individual compartments with their separate lock and key arrangement
for each individual type of narcotic medication. It is not uncommon to
load as many as 40 different types of narcotic medications onto a cart,
each being provided with one or more units of dosage. For more popular
narcotics, the total dosage may be perhaps 50 individual doses. For such
popular narcotics, one approach is to load individual carpules into a
holder and dispense single units so that the carpules slide out through a
slot, administered in the fashion of a vending machine. The narcotic
dispensing mechanism cooperates with the packaged form of narcotics, i.e.
carpule or individual packets comprising a support card with a bubble or
blister pack over an individual pill, tablet or capsule, and they are
dispensed from the recesses of cabinetry so that only one dose is exposed
at an interval.
Beginning and ending narcotics inventory is much more readily accomplished.
For instance, narcotics which are stored within the cabinetry and which
are dispensed one unit at a time are never exposed. If 20 units were
initially loaded, the number actually dispensed is measured in memory and
the ending inventory for that particular medication is then calculated.
Furthermore, the apparatus sustains an inventory at all points of
dispensing along the nurse rounds. When the round has only been partly
finished, a precise count is known even then so that inventory aboard the
cart can be measured. In sum, narcotics inventory is obtained at all
times, from the beginning inventory stored in the cart, to the last
inventory. Moreover, painstaking hand counts or verification thereof can
be avoided. The present invention is, therefore an apparatus implementing
a method of operation whereby nurse rounds for dispensing medication (and
especially including narcotics) are expedited. This is accomplished by
providing a CRT or alternatively a printer on the cart which provides a
continuing output of patient medications in a particular sequence. The
sequence can be organized so that rounds proceed in the best sequence,
beginning perhaps with the closest patient room to the nurse station and
ending at the farthest or in some other sequence so that travel of the
cart is orderly, and where each stop adjacent a patient is sequential and
the medications are prompted to the nursing personnel in sequence. This is
achieved by collecting all the medication orders, inputting the orders,
sorting the orders into that sequence, collecting inventory to conform
with the orders, loading the cart with that inventory and then arranging
the patients medications in a particular queue. All medications including
narcotics can then be drawn from the cart and administered quicklY.
Moreover, as each medication is administered the personnel in charge of
medication can provide verification back to the cart mounted CPU and
ultimately obtain printed verification. This document is available by
patient for incorporation in the patient chart typically maintained at the
nurse's station. Dispensing errors could be reduced decreasing possibility
of patients overdosage and potential associated litigation. Another
problem that could be reduced is last medication charges; medication given
and not charted are an expense that must be absorbed by institutions.
The apparatus includes a wheel mounted cart with a number of cubicles for
storing medication. It includes a locked door which is released only by
inputting appropriate codes. Behind the door, various narcotics are
stored. Several narcotics are stored in individual cubicles or
alternatively, different types of dispensing mechanisms operating in the
fashion of coin operated vending machines deliver the various narcotics.
Thus, the narcotics can be locked behind a first door and individual
narcotics can be locked again, the looks being opened or the narcotics
dispensed in individual dosage by means of coded inputs. After a medicine
has been removed from the cart, it is packaged in an individual package
where a bar code reader (in the form of a wand) is used to read the code
to make verification that the dispensed medicine removed from the cart is
in fact the medicine specified in the order. For narcotics, it is
desirable to provide an extra step, namely identification of the nursing
personnel and for this purpose, a keyboard or card reader or both is used.
Personnel are normally provided with a badge which can be read by the card
reader; in the event the badge is lost, protection can be obtained by
inputting a personal identification number (PIN hereafter). Cart theft and
pilferage is prevented by incorporating an alarm system and a battery
monitor which provides alarm signals to personnel.
BRIEF DESCRIPTION OF THE DRAWINGS
So that the manner in which the above recited features, advantages and
objects of the present invention are attained and can be understood in
detail, a more particular description of the invention, briefly summarized
above, may be had by reference to the embodiments thereof which are
illustrated in the appended drawings.
It is to be noted, however, that the appended drawings illustrate only
typical embodiments of this invention and are therefore not to be
considered limiting of its scope, for the invention may admit to other
equally effective embodiments.
FIG. 1 is a side view of a medicine cart for use in nurse rounds with a
portion broken away to show a set of internal medicine containers and
further including a locked door over the narcotics stored in the cart;
FIG. 2 is a sectional view along the line of 2--2 of FIG. 1 showing the
locked narcotics portion and in particular showing individual narcotic
dosage dispensing mechanisms which are operated on prompting from control
circuitry and which dispense individual servings of narcotics;
FIG. 3 is a schematic block diagram of the cart mounted control circuitry
including computer with input and output devices for prompting medicine
and narcotic dispensing;
FIG. 4 is a flow chart of activities relating to order preparation,
medicine and narcotic loading into the cart, and dispensing during
operation; and
FIG. 5 is a flow chart of actions undertaken by nursing personnel to
dispense medicines and narcotics during rounds.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
Attention is directed to FIG. 1 of the drawings where a medicine cart for
use in a hospital is illustrated. The cart 10 is supported on a set of
wheels 11 and has a door 12 which closes over a number of cubicles for
storage of medicine. Several cubicles are identified at 13. There are many
cubicles so that the cart can be loaded with the various medicines from
the hospital pharmacy. The medicines in the cubicles 13 do not include
narcotics and will be described hereinafter simply with the notations
"medicines" this being defined as those medicines which are administered
from the hospital pharmacy and for which entries are ordinarily made on
the chart of the patient. The cart is a large rectangular framework of
sufficient size to hold an adequate number of medicines for a complete
round. It is not uncommon to use the cart on two or three rounds during
the day, typically the first round occurring in the morning for dispensing
medicines to patients after breakfast. The same cart will be used for a
second trip just after the noon meal, etc. Reloading of the cart may occur
once per day, or more often if needed. Those medicines without narcotics
are thus located in the cubicles 13.
The cart includes a locked door 14 which is mounted on a hinge and which
covers storage containers or cubicles for the narcotics in the cart. The
term narcotics refers to any medication which includes narcotics and which
must ordinarily be handled in locked storage cabinetry, vaults, etc. all
in accordance with the appropriate state or federal regulations for
handling such narcotics. All types or grades of narcotics on board are
collectively grouped in this term, the narcotics being stored behind the
locked door 14 and typically stored in individual packages, carpules,
individual dose blister packs, etc. More will be noted concerning this
hereinafter. As shown in FIG. 2 of the drawings, the door 14 has a lock 15
on the interior, and the lock has a protruding hasp 16 which is shown in
dotted line in FIG. 1. The door is locked, and can not be opened with a
key, rather it is opened only with inputting a particular code at a
keyboard or through the use of a card reader as will be described. When
the proper signal has been input by the proper personnel, then the door 14
is unlocked and rotates on its hinge to permit access to the various
narcotics stored in the containers or cubicles behind the door 14.
FIG. 2 shows individual narcotics dispensing mechanisms. A single cubicle
17 having its own assigned locked door 18 is shown in FIG. 2. An
individual dosage in some suitable form is identified at 19 and is
received in the cubicle 17. This approach isolates the individual narcotic
19 so that a second locked door must be opened to get access to it.
For convenience, especially in administering those narcotics which are used
in quantity such as injectable morphine for pain reduction vending
machines are included which deliver such individual doses. Several
individual morphine carpules 20 are identified at 20. They are stored in a
magazine 21 which is deep within the recesses of the cart. The magazine 21
is not accessible through the door 14. Rather, it is loaded through a back
door 22 which is locked at the hospital pharmacy. A dispensing mechanism
23 dispenses single carpules of this particular narcotic. The dispensing
mechanism is operated by a drive means such as a motor or stepping motor
24. The motor is connected so that the dispensing mechanism drops the
single carpule out of the closed and sealed storage area and positions it
where nursing personnel can quickly remove the carpule for subsequent use.
The carpules are dispensed upon providing proper instructions to the
control circuitry and computer which will be described in FIG. 3.
Other types of narcotics, typically having the form of pills, capsules or
tablets are delivered in the form of a blister pack on a card. A single
dosage is typically mounted on a card by means of a bubble or blister
pack. The card is of specified rectangular dimensions and is joined to an
adjacent card with a set of perforations. Several such cards are spooled
on a drum 26, the individual cards 25 being serially connected. They
extend through a narrow slot at 27 and can be torn from the spool one dose
at a time. The spool is rotated by means of a drive motor 28 which again
is operated by the control circuitry shown in FIG. 3. Thus, the motors 24
and 28 are periodically operated and each will dispense a single dose for
each operation. This enables the card 25 to be pulled from the dispensing
slot, or the carpule 20 to be removed by nursing personnel. The sequence
in which the dispensed narcotics doses are used will be described in
detail hereinafter.
Going now to FIG. 3 of the drawings, the computer system aboard the cart is
illustrated and is located within the dotted line. Certain equipment
located outside the dotted line will be described first because it relates
to the procedure for obtaining various prescription medications including
narcotics. Briefly, as illustrated in FIG. 3, for aIl patients which are
located contiguous to a nurse station, whether in wards, private or
semiprivate rooms, the various treating physicians write medical orders
which include prescription requirements. The orders are collected. This is
indicated generally at 30. The several orders for the various patients are
collected and input to a pharmacy computer 31. The pharmacy computer reads
the orders, converts the orders into a listing where the patients are
sorted in a particular sequence. That sequence conforms to the travel
route for the medicine cart 10. This may be in room order sequence, or any
other sequence as appropriate; whatever the choice, the particular
sequence is derived from the various orders for those patients and are
then listed in that sequence. The sequential medicine orders are then
transferred to a memory 32 on the cart which lists the patients by name in
the desired sequence and also lists the medicine and narcotic orders. That
is, the particular medications including narcotics are listed by patient
name, room number, patient number as appropriate, particular medication,
and size or dosage and other specific instructions necessary for the
patients. That is stored in memory at 32. The pharmacy computer 31 also
prepares an inventory of required narcotics and medicines indicated at 33.
The inventory 33 is output for the pharmacist. In addition, it is input to
the cart memory 34 which represents the beginning inventory of medicine
including narcotics aboard the cart. Thus, the pharmacist is provided with
the hard copy of the inventory and the inventory required for the cart is
likewise located in memory. This provides suitable directions and
instructions to personnel at the pharmacy for loading the cart.
Conveniently, a pharmacy keyboard 35 is likewise included to enable input
of the supervening instructions into memory so that changes in the
medications loaded onto the cart can be recorded. For instance, the orders
may specify a particular set of medications, but the pharmacist may know
from experience that certain medications dispensed on a PRN basis should
also be loaded into the cart. These additional inventory entries are made
as the cart is loaded prior to return of the cart to the nurse station.
The pharmacy has a precise list of medications loaded onto the cart (for
billing and inventory purposes) and the cart itself is provided with the
memory 34 with an accurate list of the medications including narcotics
aboard the cart.
At this point, the cart can then be removed from the pharmacy to the nurse
station preparatory to the first round of the day, typically just after
breakfast. The cart at this point is equipped with a sorted patient list
with aIl medicine and narcotic orders on the list, this being identified
at the memory 32. The memory 34 is a separate cart inventory, the
beginning inventory of all medications aboard the cart. This inventory
will be decremented as deliveries are made out of the cart in the
procedure described below.
Other details of the cart computer system should be noted. A CPU 36 is
included. An inertial switch 37 is incorporated to indicate when the cart
is moving. There are times when the cart is stationary, and indeed,
movement may be totally undesirable. The inertial switch is useful with an
alarm system 38 to indicate that the cart is being moved at the wrong
moment. This can be incorporated to serve as a safety or theft alarm to
prevent untimely movement of the cart. The alarm is switched on by the
inertial switch should the cart be moved at the wrong time. However, the
cart is intended for movement, and suitable operator encoding can be
provided to permit the operator to override the inertial switch so long as
the cart is under the personal control and jurisdiction of the proper
nursing personnel. A clock 38 is likewise included and provides timing
signals for the CPU. The cart also includes a program memory 39, it being
understood that separate memories have been indicated at 32, 34 and 39
where in common application a single memory device will be used with
separate memory fields. The system utilizes a CRT 40 to provide visible
output prompts for the operator. Alternatively, a printer 41 can be used
as an output device. Many of the transactions described below require a
hard copy record and to this end, a printer 41 is preferably included. The
printer, however, can be located remote from the cart and the cart
connected with the printer temporarily after dispensing medications to the
several patients whereupon the printer 41 is connected to the CPU by means
of a convenient plug and socket to form the necessary hard copies to be
placed in patient charts.
Several input devices are connected to the CPU. One is a bar code reader
44, another is a card reader 46, and another is the keyboard 48. The
medications are preferably dispensed as individual doses, wrapped in
protective film typically mounted on the card 25 as previously
illustrated. The card is preferably printed with bar code identification
so that the wand 45 can be used to read the bar code. Alternatively, a
magnetic strip in a card is read by the card reader 46. This is the same
device which is used for reading magnetic strips in credit cards or badges
used for controlled access to factories and the like. The nursing
personnel preferably use a card reader so that personnel identification is
accomplished easily. The alternate third input is the keyboard 48 which
can either be an alphanumeric keyboard, or can be provided only with
numeric data. As will be explained hereinafter, certain instructions are
input (the PIN number) so that security for the narcotics is assured and
suitable documentation is generated while the person actually dispensing
the medications is identified in conformance with regulatory statutes.
FIG. 3 further discloses an operator for the main narcotic vault lock 15.
It is preferably electrically operated so that the hasp 16 is retracted
when prompted by the CPU 36. A similar electrical signal is provided from
the CPU 36 to open the lock 18 illustrated in FIG. 2. FIG. 2 also shows
electrically powered motors 24 and 28 which function in individual
narcotic dispensers. The system also includes a battery 50 periodically
tested by a monitor 51 to provide indications of battery discharge. The
battery 50 provides all the power necessary for operation of the
equipment. Operation of certain of the equipment should be noted. The cart
is equipped with a suitable mating plug and socket combination connected
with an RS 232 terminal for inputting data. Data is input into the
memories 32 and 34 through conventional techniques believed well known in
the art. Data is additionally input through the bar code reader 44 by
moving the wand 45 over medication packages to read the bars. As mentioned
earlier, the packages can come in the form of flat cards with bars printed
thereon. An alternative is bar markings on carpules, other containers,
bottles, disposable pouches, etc. The card reader 46 normally reads a card
which is pushed through a slot to form an input employee identification
number or alternatively, identification of a particular dose affixed to
the card. The keyboard 48 is a third optional input mechanism for
receiving coded symbols representative of doses and particular medicines.
The operator of the cart receives data including instructions and prompts
by means of the CRT 40 or the printer 41. In response to these, the
operator performs the next step in delivery of the medications to the
various patients under charge of the particular operator.
FIG. 4 of the drawings is a flow chart listing certain steps that must be
undertaken and begins with the first step 55 of writing patient orders.
This is normally carried out by the treating physicians. These orders are
then collected and input for sorting, and from the orders, the collected
narcotics and medicines are then grouped as a listing 56. This step is
involved in the data generated for the memory 32. This step typically
involves identification of the patients by name and room or bed location,
patient number according to the hospital records, date and time,
particular medications including narcotics and the doses required for such
medications. In addition, the treating physician is identified. This list,
after sorting, can be conveniently converted into a collective inventory
as exemplified at 33 in FIG. 3. In any event, the next step is to load the
cart 10 with the various medicines and narcotics. It is physically loaded
by placing the various medicine containers in cubicles in the cart 10.
Simultaneously, the memory 34 is loaded with the beginning inventory.
Simultaneously, the sorted patient orders at 32 are loaded into memory. At
this juncture, the cart is normally removed from the pharmacy under
control of proper personnel. In fact, cart movement can be defeated by the
alarm system which sounds an alarm if the cart is moved by unauthorized
personnel. Movement by the proper personnel requires inputting personnel
identification through the card reader 46 and keyboard input of the PIN
number. This is stored so that the memory knows what particular person
removed the cart along with the various medicines and narcotics on the
cart.
After the cart has been loaded, the next step is to print out a beginning
narcotic inventory as shown at 59. If desired, this can be verified with a
hand-count as the cart is removed from the pharmacy. Perhaps, one sequence
is to compile a list of the narcotics necessary for the cart, draw the
narcotics from the supply in the vault at the pharmacy, load the cart with
such narcotics, and then utilize the beginning narcotics inventory from
the step 59 to assure that proper counting has occurred. Counting need not
be difficult. For instance, the cards 25 shown in FIG. 2 are numerically
labeled. This avoids the need to count all the cards, rather, the cards
are supplied on a spool so that the last card showing provides the number
of cards. It is not uncommon to load between 20 and 40 cards, the cards
being serially connected at tear-away perforations so that card
verification is quickly accomplished.
The next step shown in FIG. 4 is the step 60 of dispensing the medicines
and narcotics as required. Step 60 is carried out by moving the cart from
bed to bed or for all the patients under the responsibility of the
particular nurse administering the medications and narcotics. As mentioned
earlier, this typically starts when the nurse moves the cart from the
nurse's station to the first patient's location. The patients are listed
in memory in this sequence. That is, the memory preferably stores the
patients in a sequence which is convenient and easy for the nurse. The
medicine cart is thus transferred from the pharmacy back to the nurse
station and the round can begin immediately so that the first patient is
immediately prompted for the nurse. Such prompts can be output either
through the CRT or the printer. As medicine is delivered to the patient,
the delivery beginning with removal from the cart, the instructions for
that particular dose can be prompted to the nurse and the nurse can
thereafter perform a verification input.
Consider an easy example. Assume that the first patient is prompted on the
screen and only a single medication need be administered. That particular
medication is prompted onto the screen, and the nurse then draws that
particular medication from the cart in the indicated dosage. Assume that
the particular medication is supplied in card form where the pill, tablet
or capsule is in the blister or bubble pack. The card has a bar code
identification number. The wand 45 is passed over the bar code. This
indicates to the computer that the particular card has been withdrawn from
inventory on the cart. Thus, the nurse is able to read visually on the
card the particular medicine removed from the cart. Verification is
bolstered by the bar code reading step which matches the bar code on the
card with the instructions prompting the nurse. This interlocking approach
assures proper verification. Once the medicine has been verified, the
nurse can then leave the cart, step to the bed of the patient (typically
only a few feet away), give the medicine to the patient, and then return
to the cart. A suitable entry (such as PIN number) is then performed by
the nurse to indicate that that transaction has been completed, meaning
that the right medicine from the order has been dispensed from the cart,
verified, administered to the patient, then reverified as having been
delivered to the patient in the prescribed manner. This step 60 thus
assures quality medical care to the patient in that confusion as to
medication, misreading of labels and other mishaps in medication do not
occur. The foregoing procedure is used both for narcotics and medicines.
To remove narcotics from the cart, additional steps are required. This
will be discussed with FIG. 5.
As the nurse makes the patient rounds, certain exceptions may arise.
TYpical exceptions are discharge of a patient so that no medication is
administered. Another exception may occur where the patient has been
removed from that particular bed or room and transferred to another health
care facility, for an example, an intensive care unit (ICU). There may be
discretion for the nurse in administering some drugs such as PRN
instructions, and in that event, it may be necessary for the nurse to
verify back to the computer that such exceptions were implemented. The
step 60 contemplates transfer back into the equipment of the exception
events. In a typical medicine round where 50 patients are attended, it is
not uncommon for five or ten changes or alterations to occur.
After the cart has traversed the patient area and has been returned to the
nurse station, the step 61 is operated so that all the changes or omitted
medications are listed. The step 61 serves primarily as a limited set of
corrections to be implemented into various medical charts. It is
important, however, that every medical chart receive a hard copy entry
verifying that the orders were actually administered, and to this end, the
step 62 describes printing of each patient's chart entry. This is the step
of printing a hard copy for each patient which reflects the actual
medication administered including all the support data such as particular
medication identification, dosage and amount, the time at which the
medicine was administered, name of the treating physician, name of the
nurse personnel who administered the medicine and any other data which
might be necessary. It may be appropriate for the nurse to input data in a
variety of circumstances accomplished through the use of the keyboard, and
which is stored momentarily until hard copy is made. If 50 patients were
involved in the rounds, this step would typically print 50 separate pages
so that each page can be placed in the respective patient charts. The
entries on the various chart pages can be as simple or as complex as they
have been when prepared by hand.
The step 63 relates to inventory of the narcotics. Part of this is to print
the total narcotics transactions during the rounds, that is, to list all
the narcotics prescribed and administered to the patients on the round.
This represents removal of narcotics from cart inventory, and after that
is done, the ending inventory is prepared. As desired, it can be verified
by actual count. Counting, however, is made much easier by the spooled
cards which can be visually counted simply by looking at the last card. If
the spooled cards initially counted to card 40, and the number showing is
25, then 15 units were dispensed, and 25 remain on the spool or on
inventory.
Beginning with the inventory loaded on the cart and with the decremented
entries for the various patients, hospital costing to the chart can also
be readily accomplished so that total charges are compiled easily.
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