Patent Application
20100268380
The present invention relates to apparatus such as a kiosk for dispensing medicaments and, more particularly, to an automated apparatus for delivering a medicament to a patient/user which is adapted to be sited at a location remote from but connected a pharmacy support station.
In this specification, the term “medicament” encompasses drugs and any and all other materials dispensed subject to presentation of a prescription. The traditional means of dispensing prescribed medicaments involves a doctor meeting with a patient and prescribing a medicament based on a particular diagnosis, and then hand writing and signing a prescription for the patient to carry to a pharmacist at a pharmacy location for fulfillment. In recent years, two major advances have occurred in the field of medicament dispensing. The first is electronic prescription capturing methods, systems and apparatus, which improve the overall accuracy and patient record keeping associated with prescribing drugs. The second is the arrival of automated apparatus, typically configured as kiosks, which automatically dispense medication and are located for convenient patient access (for example, in doctors' offices and medical clinics) and are networked into a central computer system for inventory control and management. In this regard, reference may be made to PCT application no. PCT/CA2007/001220 (published on 17 Jan. 2008 under no. WO 2008/006203) for a method, system and apparatus for dispensing drugs, which application is specifically incorporated by reference herein.
More specifically, PCT application no. PCT/CA2007/001220 describes a networked system having a server, a database of patient information linked to the server, a first client having input means linked to the server and operable to generate a script for a medicament prescribed to a user, a second client comprising an automated apparatus for dispensing medicaments (referred to in said PCT application as a robotic prescription dispensary) operable to recognize a human and/or machine readable description in the script, and to provide validating cross-referencing between the description and patient information as a prelude to dispensing a medicament to the user on the basis of the input script. A doctor in a clinic can be a third client having input means linked to the server to input the appropriate prescription information, or accept certain prescription information from the database as being applicable in the particular case for a particular patient. Further, the doctor's client device can be operable to display patient information, e.g., drug history, insurance coverage, etc., and a printer module can print the script as a paper print-out.
The server and database enable storing, compiling and retrieval of patient data, including name, address, and diagnostic and drug history. Access to the database can be provided to both the doctor and the automated apparatus for dispensing medicaments via the server, via a secure connection, or via a link between the system and a clinic's existing clinic management system or patient database.
PCT application no. PCT/CA2007/001220 further describes a user interface, a teleconferencing or video-conferencing means enabling communication between the user and a human validation agent, and a scanning means for capturing an image of the script so that it, if needed, it can be viewed by a human validation agent, such as a licensed pharmacist communicating in the system and with the apparatus from a remote location to the apparatus, to approve a prescription. The user interface of the dispensary apparatus provides detailed and clear instructions to guide the user.
An authentication means confirms the identity of the patient, for example, by prompting for a personal identification number or by biometric means or by associating certain questions to answers provided by the patient that identify the patient to the apparatus, and cross-referencing this information with the patient information stored on the networked database. Once the patient is recognized, the dispensary apparatus prompts the user for a script and the apparatus processes the user-input script either by the above-mentioned human validation agent or by processing the machine readable description (which may be a bar code). This information can be verified with the server and the database. The apparatus may also interface with the server to adjudicate an insurance claim and determine the amount payable by the patient. The patient either accepts or rejects the transaction. If the transaction is accepted, the apparatus interfaces with the server to transact a payment, for example, by prompting the patient for credit card information. Prescription labels and receipts are printed. The apparatus confirms that the drug is correct and drops it into a dispensing area for retrieval by the user while retaining the script in a lock box, and verifies that the purchased drug product has been retrieved. Further, the apparatus may also print and/or provide to the user educational materials relevant to the particular prescribed drugs it dispenses to the user.
As described in PCT application serial no. PCT/CA2007/001220, the medicament dispensary kiosk may be located in a doctor's office or clinic. The interaction between a patient and the kiosk user interface coupled with access to the various networked functionalities means that a patient can obtain prescribed medicaments without having to attend a pharmacy or drug store.
To date, however, the utility of such known medicament dispensary apparatus has been restricted by the limited variety of medications that may be remotely stored or robotically dispensed by them. Therefore, patients, especially those requiring nonstandard dosing, multiple medications, medications requiring special storage or some form of pre-dispense preparation, are often faced with their medication requirements not being able to be fulfilled at such a known apparatus, thereby requiring a trip to a pharmacy for the balance of the prescription and negating the utility of such a dispensary apparatus.
In such a medicament dispensary, it is desirable that the first script ratio is high; i.e. that as many users as possible who present prescriptions with a view to obtaining medicaments will be able to fill their prescription at the kiosk without requiring a trip to the pharmacy.
The first script coverage ratio really depends on how much variation there is in the population of prescriptions that will be presented at the kiosk and it depends on the range of medicaments available at the kiosk. With regard to range of medicaments, the ratio can be increased by increasing the number of different medicaments that can be dispensed at the kiosk. For example, if there are pills for suppressing headaches and there are pills of a different nature for easing rheumatic pain, then the first script coverage ratio is higher than if there were only either one or the other of the head ache pills and the rheumatic pain pills. Similarly, if there are a variety of medicament delivery mode capabilities such as pill delivery and liquid delivery, then the first script ratio is likely to be higher than if there were just one medicament delivery mode capability. Also if there are a variety of amount dispensing capabilities, such as the capability to dispense any number of pills between 1 and 50, then the first script ratio is likely to be higher than if there were just a single pill dispensing capability fixed at, say, 20 pills.
Clearly, if a kiosk is equipped to dispense every conceivable medicament, has every conceivable delivery mode capability and has every conceivable amount dispensing capability, the first script ratio may approach 100%. However, increasing the kiosk capabilities in this way may yield diminishing returns if the expense and complexity of product and operation are also markedly increased. Additionally, adding these capabilities in such a way as to add significantly to the kiosk volume or footprint may present further expense and logistical problems in the sense of readily obtaining convenient and competitively priced sites for such kiosks.
In view of these and other user requirements or preferences in the marketplace, an improved automated apparatus for dispensing medicaments is desirable.
According to one aspect of the invention, there is provided apparatus for delivering medicaments to users, the apparatus comprising a drug vault having a pre-packaged product storage container for containing pre-packaged medicament product, a bulk product storage container for containing bulk form medicament, and a control system operable to effect at least a part of a process to dispense bulk form medicament from the bulk product storage container, to pack as a dispensed packaged medicament product the dispensed bulk form medicament, and to pick and deliver medicament products to a delivery zone. Preferably, at least a part of the control system is commonly deployed in handling both the pre-packaged medicament products and the dispensed packaged medicament products whereby to limit the volume and footprint of the apparatus.
Preferably, the control system includes a medicament packaging module operable to dispense and package the bulk form medicament as a dispensed packaged medicament product that is one of a bottle, a box and a foil package. The apparatus can further comprise a metering module operable to meter a selected amount of the bulk form medicament and to deliver the selected amount from the bulk product storage container.
The medicament product can be stored in bulk form as individually dispensable items, with the metering module operable to meter the selected amount of the bulk form medicament as a metered plurality of individually dispensable items. The metering mechanism can further include a singulator successively to take items of the individually dispensable items and to deliver the taken items for packing, and a counter to count the number of items taken from the individually dispensable items and delivered for packing. Typically, the individually dispensable items are one or more of pills, lozenges and capsules.
The bulk form medicament may alternatively or additionally be stored in a bulk product storage container as a liquid. With such an arrangement, an alternative or additional metering mechanism is included that is operable to meter the bulk form medicament as a metered volume of the liquid. For certain liquid medicaments, the bulk storage container can be within a refrigerated zone, whereby liquid medicament stored therein is maintained at a lowered temperature to prevent heat-induced deterioration thereof.
The apparatus may further including a treatment mechanism operable to alter the bulk form medicament from an inventory state to a dispensing state prior to the bulk form medicament being dispensed and packaged as the dispensed packaged medicament product. For example, the treatment mechanism can be operable to effect at least one of mixing, reconstituting, agitating and diluting of the bulk form medicament.
Preferably, the apparatus further comprising a user-interface module configured to receive prescription information input from a user, a control module to interpret the prescription information and to issue commands to the control system on the basis of the received prescription information, thereby to cause the control system to select between picking and delivering the pre-packaged medicament product to a delivery zone, and picking and delivering the dispensed medicament product to the delivery zone. The apparatus may further comprise a network interface for connection of the apparatus into a network, the network interface operable to transmit state of the apparatus information onto the network and operable to receive command information from the network for control of the control system.
The drug vault may be configured for secure storage of the medicaments, and be connected to the user-interface module, with the user-interface forming a front end of the apparatus and the drug vault forming a back end of the apparatus.
The apparatus may further comprise a product labeling module configured for storing a stock of labels and for labeling a medicament product to be dispensed by the apparatus, the product labeling module operable to suspend a label from the stock of labels, and having an applicator for applying the label to the medicament product, the control system operable to transport the medicament product to the suspended label, and to align a front edge of the label with a pre-determined contact start point on the medicament product.
The apparatus may further comprise a validation unit operable within the network to validate the medicament products, the control system configurable to present medicament products to the validation unit for validation of the delivered products. For example, the validation unit may be operable effect one or more of weighing the medicament product presented thereto, monitoring a bar code on the medicament product presented thereto, and recording an image of the medicament product presented thereto.
Preferably, the automated apparatus communicates with a remote server linking the apparatus to a computer network, the apparatus having an identification unit to read and recognize a script for a prescribed medicament for a user of the apparatus. The apparatus is preferably configured for receiving through the computer network information regarding the user, the medicament and/or other apparatus of the network.
The control system can be configured for communicating in the network and may comprise means for accessing the user-interface module and the drug vault module, the accessing means comprising a plurality of sensors for providing positional feedback information to the control system for controlling the accessing means, picking the medicament from the drug vault module and delivering the medicament to the user-interface module for delivery to the user. The user-interface module and the drug vault module are preferably dimensionally compatible for interconnectability of multiple user-interface modules and drug vault modules in multiple combinations. Preferably, the control system further comprises a state based machine configured to use a state table comprising states for controlling the control system, the states being associated with the positional feedback information provided by the sensors and based on behaviors to be applied by the accessing means to pick the medicament from inventory in the drug vault module. The control system may apply the behaviors according to increasing levels of aggressiveness to achieve success in picking the medicament from inventory, wherein the success is primarily defined to require no jamming of the control system.
The network may be a neural network comprising a dynamic knowledgebase of information, including learned information, pertaining to medicaments in inventory in the apparatus and on-going behaviors, and their results, of control systems in the network used for picking medicaments from inventory, and the computer-controlled control system may use the knowledgebase information for controlling the accessing means.
The user-interface module is preferably configured for staged security level access by a human operator whereby a first level security access is restricted to access pre-selected components of the front end user-interface module only and a second level security access includes access according to the first level security access and access to the control system and the drug vault module including the inventory thereof.
The drug vault may comprise a refrigerated storage module for storing medicaments in inventory in a controlled refrigerated environment, the refrigerated storage module having one or more temperatures sensors for monitoring the refrigerated environment and the apparatus communicates information from the temperature sensor(s) through the network for centralized action.
A secure transfer container can be provided for secure transfer of medicament product therein from a medicament distribution center to the automated apparatus. The secure transfer container can be configured for receipt by the control system and self-loading by the control system of the medicament product from the secure transfer container to placement of the medicament product into inventory in the drug vault module. The secure transfer container is configured to restrict access to the medicament product therein to only the distribution center and the control system whereby a common carrier may be used for transporting the secure transfer container. The secure transfer container may be insulated and refrigerated, comprising a solid state cooling device and means for temperature monitoring and configured for powering by means of an external power supply.
According to another aspect of the invention, there is provided a method of configuring a medicament dispensing kiosk for a predetermined population of issued prescriptions the method comprising storing at the medicament dispensing kiosk a first plurality of medicaments selected from a first larger set of medicaments, installing at the medicament dispensing kiosk a second plurality of medicament delivery mode capabilities selected from a second larger set of medicament delivery mode capabilities, and selecting a first combination of the first plurality of medicaments and the second plurality of medicament delivery mode capabilities to have at least a first predetermined fraction of the predetermined population of issued prescriptions fillable by said first combination.
The method of configuring may further include installing at the medicament dispensing kiosk a third plurality of amount dispensing capabilities selected from a third larger set of amount dispensing capabilities, the method further comprising selecting a second combination of the first plurality of medicaments, the second plurality of medicament delivery mode capabilities, and the third plurality of amount dispensing capabilities to have at least a second predetermined fraction of the predetermined population of issued prescriptions fillable by the second combination of the first plurality of medicaments, the second plurality of medicament delivery mode capabilities and the third plurality of medicament amount dispensing capabilities.
A description of certain embodiments of the invention are provided herein, by way of example only, with reference to the following drawings, in which like reference numbers refer to like elements throughout the description herein:
The invention provides an automated apparatus for dispensing medicaments which advantageously provides improved utility to expand the variety of medicaments that can be stored, prepared and dispensed. Its utility is enhanced by increasing the prescription coverage ratio offered a patient at an autonomous network device or drug dispensary apparatus. This utility of service provided by the apparatus may be viewed from the perspective of a patient (i.e. user) standing at the doctor's office with a prescription in hand and needing immediate medication. The distance the patient must travel and the frictions the patient must overcome to get the medication is the patient's utility function. Utility from the perspective of the drug dispensary, be it a pharmacy or a remote dispensary apparatus as provided by the present invention, means how many items on the patient's prescription could be filled, not requiring secondary actions, such as ordering the medication requiring the patient to return for pick up, or delivering the medication to the patient at a later time. Thus, for both the drug dispensary and the patient, maximum utility is determined by the ability to dispense all medications required, on the spot, at the time of the initial interaction.
Advantageously, the dispensary apparatus 10 of the invention is constructed from a pre-selected number and functional type of modular components, hereinafter referred to generally as modules. These modules include a front end user-interface module 20 (see
The front end user-interface module 20 is provided both as a half size and full size module allowing, for example, one large and two small user front ends to be attached to a back end module 200, or two, three or four front end modules to be attached to two back end modules. Within the back end module 200, several optional configurations may be assembled to accommodate product inventory as desired. For example, within a back end module 200 any combination of product storage modules may be selected. A controlled room temperature section 240 may be included together with a refrigerated temperature storage section 250, as shown in
The modularity of the components of the apparatus is defined in standardized manner to dictate dimensions, key contact points, power, network configuration points and mechanical features, to ensure interoperability for all components and their associated software, hardware and operational parameters.
The front end user-interface module 20 is independent from the back end drug vault module 200, whereby they may be co-located in a single chassis as a unified apparatus, or located in appropriate multiples to meet a particular service location requirement. Most commonly, multiple front end modules 20 are co-located with a single back end module 200 and both front ends (or multiple front ends) are serviced by a single control system 100 and back end drug vault 200. This is shown by
The control system 100 is improved to, inter alia, provide dispensing reliability of pre-packaged drugs which have a range of sizes, shapes, weight and weight distribution (e.g. a heavy dense glass vial on one side and light weight dropper on the other side of a package renders an uneven weight distribution for the package), slipperiness of packaging, tabs, stickiness, moisture (e.g. from absorption by cardboard), all of which create a plurality of handling problems for robotic systems. Also, drug companies frequently change packaging, so control algorithms may become ineffective when a package change alters an SKU (Stock Keeping Unit) which may be used by the robot to identify the package. Therefore, a robotic control algorithm that prescribes a handling method based on pre-recorded product package information (weight, size, etc) is subject to errors, simply because the packaging was not intended for automated dispensary, and there are currently more than four thousand package variants for common medications, that vary by region, manufacturer, re-packager, or distributor. To try to deal with this problem, some known systems create uniform over-packaging to assist in robotic dispensary reliability, but this adds additional handling and expense to the dispensary process, a significant increase in the opportunity for error, and additional waste stream burden to products already notorious for over packaging.
The control system 100 overcomes the foregoing problems of the prior art by using a “state based machine” based on controls, behaviours and sensors on the robotic pick head 50 (see
Humans can compensate instantly and intuitively to variations, changes and anomalies. Machines such as robotic dispensaries are not smart, and require a refined set of behaviors to compensate for common anomalies. As shown in
Intelligence is provided to the dispensary apparatus 10 to solve problems, this being achieved by pick head sensors 60, 70, product information, machine states, behaviors and behavior results. A state determination is made from sensors and product knowledge, determination of a state leads to a selection of behaviors, behaviors are executed in order of success and success of behaviors for particular states increases the intelligence (knowledge learned) of the apparatus and system.
The hardware of the control system 100 operates at a first layer of control, while the state machine operates at second layer. The hardware includes a set of behaviors, including jiggle pick, shelf recovery, and others. The state machine drives which of the behaviors the robot is to apply and a series of states are provided with a score. The states know whether one state is better than another. For example, an optimal state would be registered where a product is located at the correct identifier number with the sensors identifying it to be fully registered at the back of pick head measured against product specific information out of the system's database. At the time of a product pick by the control system 100, the product is known because it was measured and its length was recorded when the product was serialized and put into inventory in the apparatus. Also known by the control system 100 is the size, the weight, the shape, the moment arm, and other particulars pertaining to the location of the product to be picked.
The software driving robot knows what it is supposed to expect and the robot deduces what states should occur in order to be successful. It also deduces when it gets into a state relative to what the product is and by combining the product information and sensor information it deduces what to do next be successful. The control system 100 is controlled to do anything it can deduce to be successful.
A neural network is used by the system and each networked control system 100 to allow it to learn from previous actions and results. State transitions may provide learning knowledge to the control system 100. For example, if the robot achieved a particular state and used a particular behavior to get to that state, this is learned knowledge which is maintained by the control system 100 for future use. A collection of 25 different behaviors is applied by the robotic. If the robot is in a similar state as it was previously, and it previously tried a behavior which did not succeed, then it will not try the same behavior and, instead, will try another behavior. The control system is controlled to apply behaviors on the basis of risk levels, to become progressively more aggressive to achieve success. In a state table the states reflect this progression for control of the robot so that, for example, it will attempt 1 for, say, shift recovery, then attempt 2 for aggressive shift recovery, and then attempt 3 for maximum shift recovery.
The control system 100 is also controlled to do anything in its power to get unstuck, so it doesn't jam (since the apparatus is unattended). The primary rule applied by the robot is that it must not jam. For the robot, to not a make an error is a lesser rule (having lower priority) because the robot has access to a waste container 115 and a waste arm 110 which it uses to direct damaged product. If the control system 100 detects an error it transfers the product to the waste container. The robot applies it hardware, then state machine behaviors to achieve its primary directive of no jamming.
If after three attempts to pick a product it is not successful, it reverts to remote control mode by invoking a call center screen for a human agent who is alerted that an error occurred and manual recovery is required. The human agent can look at the screen through the network and can summon a technical person to commence a remote control application over the network which pilots the robot in real time, enabling the robot to service a user who is standing at the apparatus 10.
The control software of the control system 100 acts to try to correct errors when they occur. The robot picks a product from its storage location by bringing the pick head 50 to the storage location slot 207. The slot 207 has a gap in front to allow the pick head 50 to insert a tongue into the slot under the product. The pick head 50 has multiple belts (or wheels or fingers) to pull the product forward as the pick head moves up and onto a shelf of a storage container rack 205 while lifting the product up. This action picks up the first product on the storage shelf location, separating it from the remaining inventory, which is to (ideally) remain on the shelf. The pick head 50 then senses the size, shape, weight of the product it has picked to determine that it has picked a single product unit and determine that it has overcome three common errors, namely, a stuck pick (where the product sits in place due to slipperiness), double pick (where two products are either in close proximity, tangled together or stuck together) and multi pick (usually due to labels sticking together). The state machine, using sensors and a tables of information about the inventory product being dispensed, determines the error based on the physical parameters of dimension and weight and, for product containing RFID (Radio Frequency Identification) tags, by scanning and detecting the presence of more than one RFID tag, or more that one bar code if bar codes are presented in such a configuration as to make them visible.
Based on the foregoing information, the control system 100 determines with a high degree of accuracy whether the product is present, whether an error exists and, if so, the state of the error. Upon occurrence of an error, using the error state information the robot implements an escalating series of interventions in an attempt to resolve the error. If no product is present in the pick head 50 and the robot knows there is product in the slot 20, then machine state is a stuck pick. In this state, the robot implements a first level stuck pick resolution action called “Jiggle Pick”, for which a software control loop causes the robot to oscillate up and down within a range of motion and velocity determined to be appropriate for level one resolution range. With “Jiggle Pick”, distance is important for effectiveness and to minimize damage to the robot, storage shelf and product. Sensors on the pick head determine penetration into the shelf and maintain a safe distance from the surfaces to minimize the possibility of contact damage. “Jiggle Pick” causes the stuck product to unstick from the shelf, in much the same way that a vibratory conveyer overcomes friction to move goods.
Two products may stick together causing two products to be loaded into the pick head rather than one product. In the storage bin, the mean angle between the panels of each product box is shallow and this may cause two package boxes to mate when sitting next to each other with pressure or if cardboard and subject to humid conditions.
This increases the chance that when the pick head lifts one box, it may actually lift both, creating a double pick error. To resolve this, an escalation to a level two remedial action is implemented by the local control software creating a shift higher on the control head, to alter the angle the product is held at, thereby reducing the contact area between the first and second product, to create a separation angle, and create the contact point that disallows mating, therefore only pick one box.
A third common pick problem is multi pick, where several products are stuck together, typically due to the label or label glue affixing several packages together. The sensors and machine operating software are able to determine a multi pick error based on weight, moment arm of the load, dimensions of the load and load behaviour measured by parameters of acceleration and deceleration lag. If the multi pick error cannot be resolved by the foregoing resolution one or two, the local operating software escalates to resolution three, whereby an edge of a pick bin is used as a guillotine to wipe the redundant products from the picked product. As the wiped product may have been damaged or compromised by a level three intervention wiping action, any wiped product is placed in the waste container 115 and is not dispensed without prior confirmation of integrity.
A drug dispensary apparatus must be reliable, measured primarily in terms of availability for service. The ideal machine would be one that never fails, but the very nature of integrated communications, software and hardware, and variety of products and packaging that must be handled, invariably lead to an error rate greater than zero.
However, errors are probable and, therefore, error management, isolation and recovery are paramount to prevent failure. A core reliability algorithm used by the apparatus 10 of the invention is defined in terms of absolute parameters or edicts. Each edict overrides subordinate edicts, with edict one overriding all others. The edicts are the following:
Edict One is described in detail in the above-identified published PCT application (WO 2008/006203). Edict Two requires escalating procedures that do not require the machine or the drug vault to be opened. Edict Three requires that the escalating procedures be as succinct as possible to maintain an in service status and core utility of the apparatus.
The dispensary apparatus 10 is networked to a computer system so that any error occurring at the apparatus with respect to product (SKU) becomes a shared network experience and part of a common error record contributing to the accumulated knowledgebase of the system. Error parameters forming trends can be analyzed, such as, errors common to a specific machine, or specific machine configurations, or specific conditions, or specific packaging or product variants. As components of a neural network, each software controlled robot has pre-programmed autonomous actions, and being a state machine is able to adapt to changes to deliver the desired result under the control of a strictly applied rule set.
As stated, the robot's state machine in effect learns to recognize conditions and acquires knowledge in the form of a recorded history of the result of various solutions, thereby adding to the collective operation knowledgebase, to allow the robots of each of the networked dispensary apparatus 10 to learn from a successful outcome. For example, a product jam that entraps the pick head is a common reason for a dispensary apparatus to be out of service. The robot has a set of procedures to unstick itself. It knows its slot location and it knows the product SKU on the platen, but it may find that its X and Y axis movements are arrested.
If the database has no prior occurrence of this specific problem, the software begins the following resolution sequence, starting with the least destructive behavior: jiggle gently, yes/no resolution; escalate to jiggle intensely, yes/ no resolution; escalate to jiggle intensely while puffing back the platen, reversing the pickup belts and while applying X axis up, to force the product free, sacrificing the product to the discard bid (this action will discard one product SKU), yes/no resolution; escalate to ramming the platen forward into the slot and elevating the contents of the slot, then dropping them into the waste container (this action will discard all remaining product SKU's in the slot, but if successful, frees the robot to pick and dispense from the remaining slots), yes/no resolution; revert to shut down, call for help center technical intervention, open a remote pilot session, whereby the multiple cameras within the apparatus allow a technician at a remote repair center location to see inside the apparatus and to take over remote piloting of the robot to resolve the issue (this action avoids on site intervention and the apparatus is not opened so no security issues arise with this intervention), yes/no resolution; escalate to local call out whereby a qualified local technician who is certified to enter security level one (front of machine) is dispatched to the site, opens the front of the machine and can repair the problem if it is external to the drug vault, yes/no resolution; lastly, escalate to truck roll whereby a senior technician is called out, and the senior technician is authorised to security level two (drug vault access) and can resolve the issue by opening the back end drug vault module(s).
The foregoing staged error resolution process, by which the dispensary apparatus 30 determines when an error state occurs and is able to resolve the error which has been detected, serves to maximize the in-service time of the apparatus, maximize patient utility, provide a rapid response to an error, provide a low service cost structure and optimize security for the machine and the drug inventory.
The physical security of the dispensary apparatus 10 is enhanced by a staged access configuration of the apparatus as illustrated by
Access level two is illustrated by
A network video camera confirms the identity of the technician, that the technician's credentials are current and authorize the technician to access the machine at that time and that there is a work order created to track time and activity at the dispensary apparatus. In the event that a network connection cannot be established by the apparatus due to network interruption or prolonged power failure beyond the hold up time of an internal UPS, a controlled access key can be used for access to the level one interior space to restore power or network connectivity. Access to the level two controlled regions of the apparatus, such as the drug vault module, can only be achieved with network confirmation.
To optimize the user's utility in relation to the dispensary apparatus and serve a high traffic level, the apparatus must provide a high level of prescription coverage. An obstacle to doing so is that some medications, like insulin for diabetics, eye drops for glaucoma and several pediatric medications, require refrigeration for storage and such medications can be rendered ineffective if stored outside of their temperature range (e.g. if outside such range by two to eight degrees Celsius). On the other hand, some medications such as syrups require room temperature storage which is defined as fifteen to twenty-nine degrees Celsius.
Advantageously, the dispensary apparatus 10 of the invention overcomes this obstacle by providing an isolated refrigerated section 250 in the drug vault module 200 that can store medications at controlled refrigerated temperatures in combination with a controlled room temperature section 240 in the drug vault module 200 to store medications at room temperature, as shown by
As in the known medication dispensary apparatus, the apparatus 10 of the invention is able to dispense only pre-packaged product, being single unit items referred to as “standard dosage” items or packages. Pre-package products indicate that the items are appropriate for use in the dispensary and for dispensing to users but the actual number of pills, capsules, etc., contained in a given standard dosage package will vary based on the drug and dosing regimen. This regimen is derived from information provided by the drug manufacturer and the common dosing practices for the drug in question. However, from the perspective of utility function for the user, the dispensary apparatus is non-functional if the prescription requires 10 pills and the apparatus only stocks 8 pills standard dosage packages. The apparatus 10 solves this common problem by providing in its back end drug vault module 200 a bulk medication storage area 215 and pill counters 270 integrated into bulk storage containers for pill/capsule products 230.
A common problem encountered in autonomous pill counting is reliable, secure and clean handling of medication without cross contamination. The apparatus 10 includes a larger bulk pill/capsule storage container 230 that allows medication to be securely stored in bulk and sealed, and only touched by dedicated handling equipment until dropped into a dispensary package and dispensed to the user. This conforms to a no touch technique SOP to eliminate the possibility of cross contamination. The storage container 230 has specific dimensions to allow it to be stored in a standard storage slot, and specific features to enable reliable handling by robot. It also has specific security features to make it tamper resistant in transit.
The bulk pill/capsule storage container 230 is shown in
In one embodiment of pill dispenser, a vibratory scroll feeder (not shown) aligns the medication from the hopper, before it passes to the counting unit which counts the number of pills or capsules directed by the robot. When the product count is reached, a flap mechanism (not shown) diverts the pill flow back to the bulk storage container 230.
Another embodiment of pill dispenser is shown in
As shown in
In operation, a prescription is read and interpreted as previously described and instructions are sent to a pill dispenser control module indicating that a prescribed number of pills of a certain type are to be dispensed from an inventory store of such pills contained in a selected one of the bulk storage containers 402. As a result of the instruction, drive is provided to the selected pill dispenser to cause its drive gear to start the disc 414 spinning. A further drive is applied to move the limiter 408 to a predetermined position at which the size of the annular exit region 410 is appropriate to allow successive pills 404 to fall under gravity at a metered rate through the exit region 410 and onto the disc upper surface. The limiter position is set so that the rate at which pills pass through the exit region is not so large as to overload subsequent pill counting and pill packaging stages of the apparatus, but is also not so small small as to result in jamming of the pills in the exit region 410. Once the pills fall onto the disc upper surface, the disc surface, the fins 418 and the wiper guide 420 interact to drive the pills in a spiral path towards the barrier wall. Pills driven towards the outer edge of the disc tend to become distributed and to be driven in arcuate paths next to the wall barrier 422. Ideally, the pills are strung out and pass successively through the opening in the separator 424. If however multiple pills adhere together owing to static friction or other surface condition, the separator 424 allows passage of only one of the adhering pills at time with any adhering pill being stripped away and subsequently presented to the separator by the spinning disc.
Under a solenoid drive (not shown) from the control module, the gate 426 is held in an open, pill passing position as long as a full count of the pills to be dispensed has not been reached. After the pills are discharged through the gate by the disc drive, they fall through a count zone 428 into a previously positioned empty pill bottle. In the count zone, the pills drop past an array of photodiodes and associated photodetectors (not shown). The photodetectors are set to record a pill count as each pill drops into the pill bottle. Software control is applied to close the gate when the number of pills counted matches the number of pills prescribed on the prescription.
Prior to the pills being dispensed through the count zone, an empty pill bottle is brought to the selected pill dispenser and lodged in a position where the pills dispensed from the bulk storage container drop into the bottle. The pill bottles are retrieved and moved by the control system which, as previously described with respect to the picking and delivery of pre-packaged medicament products, can be driven on X and Y axes to range over the full vertical area of the medicament vault. The control system can also be moved to a bottle zone where an array of empty bottles of various shapes and size, together with an array of matching caps, are stored. The control system incorporates a pick head described previously with respect to picking the prepackaged medicament products, the pick head having a finger and hook with the finger being reciprocable along the Z-axis. In operation, at the bottle zone, the finger is driven in the Z-axis direction to a position under a slot in the base of a container into which the bottle is dropped following previous software controlled selection and release from a bottle storage bandolier. As in the case of the prepackaged medicament product manipulation, the finger is moved upwardly in the slot to support the empty bottle. As the finger is withdrawn along the Z-axis, the hook engages the bottle to withdraw it from the container.
Also mounted on the control system is a platen. An articulator mechanism forming part of the control system grips the empty bottle and moves it onto the platen and into an upright position where it is locked relative to the platen. The control system is then operated to deliver the platen to a position where the standing bottle is positioned to receive pills that drop from the selected pill dispenser.
The control system also includes a cap pick and placement module. Following the dispensing of the desired number of pills into the bottle as previously described, the cap pick and placement module places a selected cap on the on the open neck of the bottle and a levering mechanism applies downward pressure on the cap to snap it over the neck. The control system is then driven to deliver the bottle containing the dispensed pills to a delivery zone accessible by the kiosk user.
It will be understood that
Both in the pill dispensing and the liquid dispensing arrangements, care is taken to avoid contamination of the medicament being dispensed. Thus, where possible mechanical control elements are encapsulated and contained to avoid the escape of dust and vapours. In addition, where possible, dust, liquid and vapur seals and barriers are installed at locations where elements of the dispensing mechanism move relative to one another.
The prescribed medication is then transferred to a medication packaging module 280 (see
Optionally, the apparatus 10 may be configured so that the bulk pill/capsule storage container 230 can only dispense medication when inserted into a dispensary module under control of the robot. Such a configuration allows for tight batch and inventory control and maintenance of the drug pedigree. The prescribed counted medication is loaded into a hopper 290 of the packaging module 280 and is packaged by a bottle or foil packager 300, 310 of the packaging module 280. Optionally, the medication count may be verified optically during the transfer between the counter unit and the packaging module. The hopper 290, vibratory conveyer and counting unit (and optionally the transfer port) are optically inspected to confirm that no medication remains at those locations (i.e. no medication was left behind), before the bulk medication container 230 is cleared for the next use. The mediation packaging module 280 is configured for packaging medication in two ways. Firstly, it can bottle medication, insert sterile bulking material and apply a cap. A cap spinner (not shown) applies a known torque, the removal torque is tested to verify cap function and re-torqued to the original torque setting. A drug pedigree certificate produced by the system adds to the pedigree a “cap good” notation. Secondly, the medication packaging module 280 can load medication into sterile foil seal pouches, apply a foil seal and verify seal via visual inspection. Standard dosage packaging also presents an obstacle for liquid medications, especially paediatric medications and maintenance drugs where dosage can vary 26 widely. To resolve this obstacle the dispensary apparatus 10 of the invention provides a bulk storage container for liquid product 220 with an integrated pouring unit 226 as shown by
As previously indicated, each package has to be labelled. It would be of value to have a labelling apparatus and method, which are versatile in the sense of being applicable to such a range of package shapes and sizes. For medicament dispensing kiosks, medicament package labels are typically of a standard shape and size to enable them to be passed through a printer, and must contain critical patient and medication information in conformance with industry standards and offering little scope for variation in shape, size or materials. Such labels are typically applied by running pressure sensitive adhesive back coated labels on a peal-away carrier through a label printer and transferring the printed label to the medicament container such as a bottle or box. Known label transfer methods have used sponges, vacuum, sponges and vacuum in combination, transfer media, transfer roller and pressure pads. There is a need for reliable accurate placement and adhesion of standard flat labels to dispensed medicament products.
A package labeling module of the apparatus is shown in
As shown in greater detail in
The labelling module is used to apply a label to a medicament product container or package 538 which is transported to the labelling module 512 using the pick head 522. In use, label stock 526 is pulled off the supply reel 528 by a drive wheel 540 in the printer 524. Within the printer, the label stock is halted and desired medicament identifying data is printed onto a presented label before the printer wheel 540 further advances the label stock 526 in preparation for the printed label 536 to be applied to the container 538. As the label stock 526 exits the printer 524, the printed label 536 continues to adhere to liner 534, and the take-up reel 530 and tensioner device 534 pull the liner around a small diameter roller 544 so as to take up the liner 534 at a rate related to the throughput of the printer 524.
The label 536 is made from paper or plastic that is stiffer than the liner 534 to which it adheres on the supply reel 528. This results in the label 536 separating from the liner 534 as a result of its movement around the small diameter roller 544. The label 536 is also sufficiently stiff that it adopts a suspended position as shown in
The pick head 522 is then driven to pick a medicament container 538 to be dispensed by the apparatus and to raise the container to a desired level where a platen 548 forming part of the pick head and supporting the container moves in a horizontal direction to bring the container to the position shown in
In a subsequent stage of the labelling process, the pick head 522 drives the package upwardly against a conformable cylindrical tamp block 554 of polyurethane foam, this movement acting both to initiate a “tacking” of the self-adhesive label 536 to the package 538 and to dislodge the last part of the suspended label 536 from the liner 534. The medicament container 538, with label attached, is further raised by the pick head 522 to bring the container with the label side up, into contact with a second tamp block 556 formed from conformable polyurethane foam, the second tamp block being shown in
In use, the package container 538 with label 536 tacked to at least a central part of the container surface is brought against a cross-piece 560 of the U tamp block as shown in the operational sequence of
Dimensions and materials are selected so as to direct pressure to contact the label to all intended parts of the package and to apply sufficient pressure to activate the contact sensitive adhesive. Because the size and shape of the package are known to the pick head control means, accurate label placement is possible with this method, with high reliability and repeatability.
It will be appreciated that the first and second tamp blocks, 54 and 56 respectively, can be combined if desired, whereby a first part of the movement of the container 38 relative to the combination tamp block is to tack the label 36 to the package, and then a subsequent part of the movement is to effect the label wrapping and application described previously. It will be appreciated also that alternatives to the U form of tamp block are possible. Thus O-form and H-form blocks can, for example, be configured to provide the relative translational movement and the block deformation to apply the label to the front and sides of a package.
In addition, while, conveniently, the tamp block is formed of a single cut or moulded piece of material, the parts of the tamp block that are used respectively for the front tamp and the side tamp can be separate but joined by a mechanical articulation. It will be appreciated that in the preferred embodiment, the movement of the product container relative to the tamp block to apply an adherent label to the front and sides of a package is a single unidirectional movement of the container. However, the movement can alternatively be affected as intermittent actions. For example, a first translational movement of the tamp block or container to apply a label to the front of the package can be followed by a second movement where a combination of translational movement and twisting are used to apply parts of the label against the side walls.
In addition, it will be realized that the movement need not be unidirectional in nature. In a further alternative arrangement, the tamp block is moved while the product container, is maintained in a fixed position for the label application, or both the tamp block and the container are moved to effect the label application. It will be further appreciated that whereas the nature of the deformation of the tamp block to effect the pressure against the sides of the container occurs by the tamp block being squeezed between a clamping fixture at one side of the tamp block and the medicament package at the other side of the tamp block, other external fixtures can be positioned so as to limit the locations into which parts of the tamp block can be deformed to those required for the effective application of the label where required on the container and to the effective application of pressure at the contact locations.
The apparatus 10 can include a further improvement for product labeling in the form of an optical scribe 330 that writes directly to a product package (container) to be dispensed.
It will be understood that in dispensing inventory pre-packaged products and inventory bulk medicament in such a way as to have a high first script ratio, a prevailing problem is the corresponding demand for a kiosk which has a high volume/footprint to accommodate a wide variety of medicaments, a wide variety of dispensing methods and a wide range of amount dispensing capabilities. It will be appreciated that the networked arrangement according to one aspect of the invention permits certain of these activities to be conducted at a location remote from the kiosk which permits some reduction in volume/footprint of the kiosk. In addition, in the control system for medicament products containing dispensed bulk medicaments (either pill type medicaments or liquid medicaments) and for dispensing pre-packaged products, the kiosk volume and footprint is reduced by having certain elements of the control system commonly used in multiple stages of the dispensing process. This means that the dispensing of the wide variety of medicaments, by a wide variety of dispensing methods to achieve a wide range of dispensed amounts does not mandate a tailored plurality of control sub-systems.
| Number | Date | Country | |
|---|---|---|---|
| 61170642 | Apr 2009 | US |
