Abstract:
The medication delivery device provides patient access to medications prescribed to be available on an as-needed basis, but with a minimum time intervals between doses. The device permits access to a single dose of the medication after each minimum time interval has elapsed. When the drug dose is removed from the device, the medication tray locks until the next minimum dosage time interval has elapsed.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     This patent application is a continuation-in-part application claiming the benefit of the patent application assigned Ser. No. 10/247,427, filed on Sep. 19, 2002, which claims the benefit of the provisional patent application assigned Ser. No. 60/323,521 filed on Sep. 19, 2001. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The present invention relates generally to a medication dispenser, and more particularly to a time-controlled medication dispenser.  
       BACKGROUND OF THE INVENTION  
       [0003]     Fifty percent of post-operative patients report inadequate pain relief. Fifty percent of all cancer patients and ninety percent of advanced cancer patients experience pain. Pain is now defined as “the fifth vital sign” as part of the mandate by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to develop guidelines for pain management.  
         [0004]     Adequate pain control requires the appropriate medication for the pain level and type reported. In a hospital setting, pain medication can be obtained only by a physician&#39;s order. Pain medications such as narcotics and nonsteroidals (and anxiety medications such as tranquilizers) are frequently ordered on an as-needed basis (referred to as prn orders). This approach requires the patient to initiate a request for each prn drug dose. The nurse determines whether the appropriate time interval has passed between doses, according to the physician&#39;s order. If the required time interval has elapsed, the nurse transports the medication to the patient&#39;s bedside and administers the medication to the patient. In some dosing regimens the patient is given a time-release pain medication at the same time(s) each day, with as-needed (prn) medications for breakthrough pain. Again the patient must request the medication for each breakthrough pain episode. A common reported patient frustration is the need to issue a request for each and every dose of prn medication. Thus a busy nurse must determine that the ordered time has elapsed from the last dosage, locate the medication and transport it to the patient in response to each request. This must also be accomplished in a timely fashion, as patients in pain must be administered to as soon as possible.  
         [0005]     The as-needed approach to dosing provides the minimum amount of medication to adequately control symptoms, without the risk of abuse, overdosing and unnecessary side effects. Disadvantageously, in a hospital or institutional setting each medication that is dispensed on a prn basis requires nursing staff time and extra documentation by nursing and pharmacy staff, since the drugs can be administered only after the lapse of the predetermined time interval between doses. For example, a drug prescribed as needed every six hours may be given no more than four times in 24 hours. Such a drug may be administered from zero to four times in any given 24-hour period, depending upon patient dosage requests. If six hours have passed since the last administration of the drug, the medication is provided to the patient in response to the request. If six hours have not lapsed, the patient must wait the minimum time interval of six hours prior to receiving the next drug dose. In a home setting, the patient must remain aware of the restricted dosing schedule to safely self-administer these medications.  
         [0006]     An automated bedside dispensing cabinet, requiring the nurse to enter the cabinet at times to dispense medications, is known. As with all prn medications, this device requires the nurse to visit the patient&#39;s room, where the medication is removed from the cabinet for dispensing. Although such a device reduces medication errors compared to the conventional approach, it expends valuable nursing time and expense.  
         [0007]     It is also known that oral medications may be provided through the use of a sealed wrist pouch. The pouch is worn by the patient and filled with two medication doses. The pouch is refilled by a nurse at the patient&#39;s request. The patient reports the time of each self-administered dose and maintains a pain control diary. As in the other prior art devices, nursing staff time is required for refills and nursing staff availability may disrupt timely refilling of the pouch.  
         [0008]     Drug delivery devices that remind the patient to take a medication at preset time intervals are known. These devices provide the reminder through a variety of signaling indicators, such as audible alarms, and promote compliance to a scheduled dosing regimen, but do not control nor prevent patient access to the medications at intervals shorter than prescribed.  
         [0009]     Known PCA (patient controlled analgesia) intravenous pumps allow patients to self-medicate with pain medications. Using a PCA pump, under a physician&#39;s order, a patient receives a single dose of intravenous medication by activating a bedside button. The actuation starts a pump that delivers a measured dose of the intravenous drug (a narcotic, for example) at allowable time intervals. If the button is activated during a time interval in which an allowable dose has already been administered, the pump is “locked out” and unable to deliver the dose until the appropriate time interval has passed. This prevents the patient from taking more than a maximum allowable dose of medication during a measured time interval. The PCA device records the drug volume delivered over time. A nurse can query the device to chart the volume of drug delivered over a given time interval and the number of doses administered.  
         [0010]     Two other dosing devices are available using the same principal as the intravenous PCA. These include pumps that deliver narcotic medications subcutaneously and epidural catheters that deliver pain medications near the spinal canal. Cancer patients experiencing both acute and chronic pain use such intravenous PCA pumps.  
         [0011]     A randomized study of pain management in a post-operative setting using patient controlled analgesia (that is, the PCA pump) versus conventional pain therapy (CPT) (i.e., a request to the nurse for each administered dose), has been reported in the medical literature. Patient satisfaction for pain management in the PCA group was significantly better than that reported in the CPT group. Note, the only difference between the two study groups was the ability of the PCA group to easily and promptly self-control the medication dosing.  
         [0012]     Multiple factors prevent the timely dosing of pain medication and other as-needed medications to the patient bedside according to conventional pain therapy techniques. A national survey of pharmacy practice in acute care settings in 1999 indicated that 75% of pharmacies still practice centralized pharmacy distribution systems. In some situations, these centralized pharmacies extend the time required to deliver medications to each patient area. A future medication-delivery trend includes automated medication dispensing stations in each patient area. Although this is a trend for the future, it is not as yet reality except in large, sophisticated, primarily academic hospitals. Currently there is a shortage of pharmacists and the existing staffs are over-burdened, creating further delays in drug delivery to the patient bedside.  
         [0013]     In about 98% of the cases, nurses directly administer medications to patients. A time and motion study has reported that each prn oral medication delivered by a nurse to a hospital patient requires 18.42 minutes, which includes the unlocking of the narcotics cabinet to sign out the medication, transporting it to the patient&#39;s bedside, and documenting (charting) the time the dose is given. Like the pharmacy staff, nursing staffs are short-handed, while the number of complex hospitalized patients is growing. These patients have increasingly more complex diagnoses with more medication requirements.  
         [0014]     Improved patient pain control leads to better patient outcomes in the hospital setting. This has been well documented in the surgical literature in the post-operative setting, with fewer post-operative complications, earlier rehabilitation, and shorter hospital stays for patients with better pain management. Better pain management is also highly cost effective since earlier discharges and few complications save health care dollars and staff time.  
       BRIEF SUMMARY OF THE INVENTION  
       [0015]     According to one embodiment, the present invention comprises a medication dispenser for permitting administration of a medication dose to a patient only after a predetermined minimum dosing interval has elapsed. The medication dispenser comprises a medication tray comprising a plurality of compartments, wherein certain ones of the plurality of compartments contain a medication dose, a housing enclosing the medication tray, wherein the housing includes an opening and a controller for controlling the medication tray to align one of the plurality of compartments containing a medication dose with the opening after the minimum dosing interval has elapsed, thereby permitting the patient to access the medication dose through the opening.  
         [0016]     According to another embodiment, the present invention comprises a method for dispensing a medication dose from a medication dispenser to an authorized patient on an as-needed basis. The method comprises: (a) determining that a first predetermined time interval has elapsed since a previous medication dose was made available to the authorized patient; (b) activating an indicator when the predetermined time interval has elapsed; (c) determining that a person is the authorized patient; (d) causing a medication-containing compartment of the medication dispenser to align with an opening in the medication dispenser, (e) wherein the authorized patient can access the medication dose through the opening and after a second predetermined time interval from step (d), causing a compartment that does not contain a medication dose to align with the opening. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0017]     The foregoing and other features of the invention will be apparent from the following more particular description of the invention, as illustrated in the accompanying drawings, in which like reference characters refer to the same parts throughout the different figures. The figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.  
         [0018]      FIG. 1  is an exploded view of a medication on demand device constructed according to the teachings of the present invention.  
         [0019]      FIG. 2  is a block diagram of the control components of the medication on demand device of  FIG. 1 .  
         [0020]      FIG. 3  is another exploded view of a medication on demand device constructed according to the teachings of the present invention.  
         [0021]      FIGS. 4 and 5  are top and bottom views, respectively, of the medication on demand device of  FIGS. 1 and 2 .  
         [0022]      FIG. 6  is a top view of another embodiment of the medication on demand device.  
         [0023]      FIGS. 7, 8  and  9  illustrate various patient authentication devices for use with the medication on demand device of the present invention.  
         [0024]      FIG. 10  is a perspective view of another embodiment of a medication on demand device according to the teachings of the present invention.  
         [0025]      FIG. 11  is an exploded view of another embodiment of a medication on demand device constructed according to the teachings of the present invention.  
         [0026]      FIG. 12  illustrates a functional block diagram of the controlling and the controlled components according to one embodiment of the present invention. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0027]     Before describing in detail the particular medication dispenser in accordance with the present invention, it should be observed that the present invention resides primarily in a novel combination of hardware and software elements related to a medication dispenser. Accordingly, the elements have been represented by conventional elements in the drawings, showing only those specific details that are pertinent to the present invention, so as not to obscure the disclosure with structural details that will be readily apparent to those skilled in the art having the benefit of the description herein.  
         [0028]     A medication on demand device  10  constructed according to the teachings of the present invention is illustrated in the exploded view of  FIG. 1 , comprising an upper assembly  12  for mating with a lower assembly  14  and capturing a medication tray  16  there between. The medication tray  16  is received by an upper surface enclosure  17  of the lower assembly  14 . In one embodiment a motor (not shown in  FIG. 1 ) is located within the upper surface enclosure  17 . A gear  18  attached to a motor shaft protrudes from the vertical surface  19  of the upper surface enclosure  17  for drivingly mating with a circumferential gear track  21  disposed on an inner surface  22  of the medication tray  16 . Thus rotation of the gear in response to the application of electricity to the motor causes rotation of the medication tray  16 .  
         [0029]     The upper assembly  12  includes a passage  23  for receiving a door (not shown in  FIG. 1 ) providing access to one of a plurality of medication compartments  20  of the medication tray  16 . Once the patient has opened and closed the door to remove the medication, a timing sequence is initiated and during that sequence the medication tray  16  is locked in place. After the dosing interval has elapsed, the medication tray  16  is rotated, through action of the motor and associated gearing, through an arc segment to align the passage  23  with the next one of the plurality of medication compartments  20 . As described further below, the medication tray  16  is signaled to rotate, after a predetermined interval has elapsed since the last dosage, via entry of a patient code on a keypad of the device  10 . The patient can then remove the next dosage for self-administration.  
         [0030]     In the embodiment of  FIG. 1  each one of the plurality of equally-sized medication compartments  20  carries a medication dose for administration to the patient. Preferably, the upper assembly  12  is translucent or transparent and the lower assembly  14  is opaque to provide a color contrast, making the medication dose easily visible within the plurality of medication compartments  20 . In another embodiment a color-coded medication tray serves as an indicator of the drug type carried there within. In the pharmacy, the medication tray  16  can be loaded with medications, labeled to identify the patient and the minimum-dosing interval, and provided to the nurse attending the patient. While being transported, the medication tray  16  can be covered with a disposable cover.  
         [0031]     A controller  30  (see  FIG. 2 ) and its associated components control rotation of the medication tray  16  and allow patient access to the medications. In one embodiment the controller  30  is a microchip-based controller programmed to perform the various functions described herein. When the medication tray  16  is loaded into the device  10 , the nursing or pharmacy staff enters the physician ordered dosing interval via an input device  34 , comprising in one embodiment one or more manually operable switches. The controller  30  is responsive to the input device  34  for receiving and storing the dosing interval. The nursing staff also enters an authorization code, via the input device  34 , that is stored in the controller  30 , for later use to limit medication access only to the patient for whom the medications are intended.  
         [0032]     Although the description herein generally refers to a nursing staff as the party exercising control over the operation of the device  10 , this function can be performed by any third party ultimately controlling the patient&#39;s medication dosing, such as an in-home care giver, medical technician, pharmacy staff member, physician, etc.  
         [0033]     The controller  30  is further bi-directionally responsive to a timer  36  for monitoring the time interval between permitted doses, and to a door sensor  38  (see  FIG. 1  for the physical location thereof) for determining the door position. From the door position information, the controller  30  determines the times when the door is opened and closed by the patient to receive the medication for self-administration. After the patient has sequenced the door through an open and close cycle to remove the medication dose, the controller  30  activates the timer  36  to begin a counting sequence representing the dosing interval. When the timer  36  times out, the dosing interval has elapsed and the patient is permitted to administer the next dose. In response thereto, the controller  30  illuminates an indicator  40  (see also  FIG. 1 ) indicating that the dosing interval has elapsed. In one embodiment the indicator  40  comprises a light emitting diode. The embodiment illustrated in  FIG. 1  includes a second indicator  41 , not required for proper operation of the device  10  that is illuminated during the time between permitted doses, serving as an indication that the patient is not permitted to administer the next medication dose.  
         [0034]     Returning to  FIG. 1 , note that the upper surface enclosure  17  further carries a keypad  42  comprising a plurality of user-operable keys for entering an authorization code. After the indicator  40  is illuminated, the patient uses the keypad  42  to enter a predetermined authorization code that is supplied as an input to the controller  30 . In one embodiment, the code comprises four digits and is followed by entry of an “enter” command on the keypad  42 . If the patient-entered code matches the stored authorized code (previously entered when the medication tray  16  was loaded into the device  10  as described above), in response thereto the controller  30  energizes a motor  44  to cause rotation of the medication tray  16 , as described above, such that the next medication compartment  20  is aligned with the passage  23 . The patient now has access to the next medication dose. In one embodiment the motor  44  comprises a stepping motor that when energized controllably rotates only through a predetermined number of turns such that the next medication compartment  20  and the passage  23  are aligned.  
         [0035]     The dosing timing cycle begins again when the door sensor  38  senses the opening and closing of the door, provides representative signals to the controller  30 , and the controller  30  activates the timer  36 .  
         [0036]     If the patient&#39;s pain has subsided and he thus does not require a medication dose at the prescribed minimum interval, i.e., when the indicator  40  is illuminated, the patient can elect not to enter the prescribed authorization code. The device  10  remains in a ready condition such that whenever the code is entered the medication tray  16  is rotated and the next dose is accessible. Only an open and closing cycle of the door restarts the timing cycle.  
         [0037]     The door open and close times determined as described above, are stored within the controller  30  and displayable on a clock  48  (disposed on the bottom surface of the lower assembly  14 ) in response to command queries entered into the input device  34 . In one embodiment, the clock  48  comprises a countdown clock that displays the time remaining until the next permitted dose. The clock  48  is reset after each dose is administered. Nursing staff can also query the controller  30  to control the clock  48  to display the dose administration times, which can then be manually entered in the patient&#39;s chart.  
         [0038]     In another embodiment where patient records are stored in a computing mechanism and associated storage media, the controller  30  is connected via a wired or wireless (RF or IR) network to the computing mechanism for automatically downloading these dose administration times and inputting them to the patient&#39;s record. According to such an embodiment, the controller  30  can also be programmed, with respect to the permitted dosing interval, authorization code authorized patient identification information, etc., through the wired (such as through a serial port included in the device  10 ) or the wireless network This feature avoids the need for a healthcare professional to physically visit the location of the device  10  to execute the programming function. Instead programming of a plurality of devices  10  is performed from a central location via a wired or wireless network that allows each device  10  to be individually accessed.  
         [0039]     In an alternative embodiment, the clock  48  is operable as a teal time clock in response to commands entered into the input device  34  by nursing staff members.  
         [0040]     Although the timer  36  is described herein as a separate component of the controlling mechanism of the device  10 , those skilled in the art recognize that the timing function can be incorporated within the controller  30 . Likewise, storage of the dosing interval, authorization code, etc., is described with reference to on-board storage in an internal memory within the controller  30 . In another embodiment the device  10  includes external memory responsive to the controller  30  for storing program code and such data.  
         [0041]      FIG. 2  further includes a key switch  50  for setting the operational mode for the device  10 . In one embodiment the key switch  50  comprises a three-position key switch. A mating key is required to set the position of the key switch  50 . Typically, this key would be accessible only to the nursing staff. In a first position the upper and lower assemblies  12  and  14  are separable for loading a new medication tray  16 . Typically, the device  10  would be loaded with new medications doses every 24-hour period. Other time periods may apply depending on the dosing interval and the number of medication compartments  20  within the medication tray  16 . In a second position the device  10  is locked and ready for patient use. In a third position the dosing interval, authorization code, etc., can be entered through the input device  34 , and the controller  30  can be queried as to the times when the door  65  (see  FIG. 3 ) was opened and closed.  
         [0042]      FIG. 2  further includes a network interface  52  providing a wired or wireless connection to a remote computing device, such as a laptop or tablet computer or a personal digital assistant device. Various information collected by the controller  30 , such as patient&#39;s dosing times and the minimum-dosing interval, is supplied to the remote computing device via the network interface  52 .  
         [0043]     A more detailed exploded view of the medication on demand device  10  is illustrated in  FIG. 3 , wherein the upper assembly  12  comprises a housing  60 , for receiving a cover  62 . A first region  63  of the passage  23  is formed within the housing  60  and a second region  64  thereof is formed within the cover  62 . A door  65  provides access to the passage  23 . A medication dose  66  rests in a medication compartment of  20  of the medication tray  16 . Although the medication dose  66  comprises an orally administered dose, the teachings of the invention can be applied to other medication types, and thus such other medication types can be held within the compartment  20 .  
         [0044]     The lower assembly  14  further comprises a housing  70  carrying a circuit board  72  on which the controller  30  (not shown in  FIG. 3 ) and its associated components are mounted. The motor  44 , powered by batteries  76 , is mounted within a housing  80 . The key switch  50  passes through a notch  82  in the circuit board  72  and a notch  84  in the housing  80 . The key switch  50  is electrically connected to the controller  30  as described in conjunction with  FIG. 2 .  
         [0045]      FIG. 4  is a top view of the medication on demand device  10  illustrating certain ones of the previously discussed components.  
         [0046]     Although the patient authorization process described above comprises the entry of numeric or alphabetic characters via the keypad  42  to determine that the user is that authorized patient, other identification techniques for determining if the patient is authorized to receive the medication dose  66  can be employed, including fingerprint and voice print identification. These techniques, as known by those skilled in the art, prompt the user to enter a fingerprint or a voiceprint that is compared with a stored fingerprint or voiceprint of the authorized patient. If a match is indicated, the patient is provided with access to the next medication dose  66 . The promptings and comparison functions can be performed by a suitable augmented controller  30 , as known by those skilled in the art.  
         [0047]     According to another embodiment, the device  10  comprises a bar code reader  90  (see  FIG. 4 ) for reading a unique bar code  92  (see  FIG. 7 ) assigned to the patient and printed on a patient&#39;s wristband  94  (see  FIG. 7 ). If the stored bar code in the reader  90  matches the scanned bar code  92  and the minimum dosing interval has elapsed, the medication tray  16  is rotated under control of the controller  30 , as described above, to provide patient access to the next medication dose. The implementation details associated with bar codes and bar code readers are known in the art.  
         [0048]     In yet another embodiment, an RFID (radio frequency identification) reader  100  (see  FIG. 4 ) is included in the medication on demand device  10 . The RFID tag reader  100  communications with a unique RFID code tag  102  incorporated into a patient&#39;s wristband  104  as illustrated in  FIG. 8 . The technology associated with RFID tags is known by those skilled in the art. Any of the known RFID technologies (magnetic or electromagnetic) can be used in conjunction with the medication on demand device  10  and the RFID reader  100  and tag  102 .  
         [0049]     In still another embodiment, a patient is provided with a smart card  106  (see  FIG. 9 ) for reading by a smart card reader  107  (see  FIG. 4 ) within one embodiment of the device  10 . Use of the smart card  106  and corresponding reader  107  offers another technique for determining that the user is the authorized patient.  
         [0050]     Other person identification techniques are known in the art and can be incorporated into an embodiment of the medication on demand device of the present invention. The use of any such techniques are considered within the scope of the present invention.  
         [0051]      FIG. 5  is a bottom view of the medication on demand device  10  illustrating several of the previously described components of the device  10 . A guide wire  110  for securing the medication on demand device  10  to a patient&#39;s bed, bedside table or tray passes through a loophole  111 . The input device  34  and the clock  48  are also shown in the bottom view of  FIG. 5 .  
         [0052]     The bottom surface of the device  10  further includes a low-battery indicator  114  and a recess  116  for receiving, for example, patient identification information, the medication type and dosage, and the minimum interval between doses. Typically, this information is recorded on adhesive-backed material received within the recess  116 . The device  10  includes a stacking ring  117  for mating with a receiving recess in the upper assembly  12  of a second device  10 , thus allowing several devices  10  to be transported and stored in an efficient and stable configuration.  
         [0053]     In another embodiment of the present invention, the door  65  is lockable and controllable by operation of the controller  30 , such that a door lock  120  in  FIG. 6  is released only after the minimum dosing interval has elapsed. In this embodiment, rotation of the medication tray  16  by operation of the motor  44  under control of the controller  30  can occur at any time during the dosing interval, as the patient cannot gain access to the medication dose  66  until the door  65  is unlocked by operation of the lock  120 .  
         [0054]      FIG. 10  illustrates an embodiment of a medication on demand device  150  including an opening  152 . Unlike the embodiments described above, the embodiment of  FIG. 10  lacks the locking door  65 . Instead, the motor  44  under control of the controller  30 , rotates a medication-containing compartment  154  into alignment with the opening  152  after the minimum dosing interval has elapsed and after the user has been identified (according to one of the identification techniques described above) as the authorized patient, permitting the patient to remove a medication dose  66  from the compartment  154  through the opening  152 .  
         [0055]     The patient has a predetermined time in which the medication dose  66  is accessible through the opening  152 . After this time has elapsed (in one embodiment, about 25 seconds, which should be a sufficient time for the patient to remove the medication dose  66 ), the medication tray  16  is rotated by action of the motor  44  under control of the controller  30 , such that an empty compartment  159  is aligned with the opening  152 . The medication on demand device  150  remains in this configuration until the timer  36  determines that the minimum dosing interval has elapsed, at which time the indicator  40  is illuminated, indicating that the minimum dosing interval has elapsed. The medication tray  16  is then rotated (subject to patient authorization) such that another compartment  154  containing a medication dose  66  is aligned with the opening  152 . The medication tray  16  remains in this position for the predetermined time after which another timing cycle begins. To accommodate this embodiment, the medication tray  16  comprises alternating empty compartments  159  and medication-carrying compartments  154 . Any of the above described or otherwise available identification techniques can be employed to provide patient authorization.  
         [0056]     According to another embodiment as further illustrated in  FIG. 10 , the medication on demand device  150  further comprises a tray  170  locked into a closed position within the device  150  and releasable therefrom into an open or extended position as illustrated in  FIG. 10 . According to various embodiments, the tray  170  comprises a display  176  and/or user-activated keys  178  for use in combination or independently to program the medication on device  150  as described above. In particular, the device  150  must be programmed with a physician-ordered dosing interval and patient identification information from which an authorized patient is determinable.  
         [0057]     In yet another embodiment, the device  150  is programmed using a stylus or pen interacting with the display  176  as is known in the art. After the device is programmed, the tray  170  is returned to the closed/locked position within the device  150 . Various mechanical locking devices are known for locking the tray  170  in position while permitting convenient release of the lock when it is desired to program the device  150 . The display  176  and the keys  178  can also be used to query the device  150 , for example to determine when the medication doses  66  have been self-administered.  
         [0058]     In yet another embodiment, in lieu of using the components of the tray  170  to program the device  150 , the device  150  comprises wireless communications equipment (not illustrated in  FIG. 10 ) for receiving and processing radio frequency signals to program and/or query the device  150 . The signals can be transmitted from a nurse&#39;s station to devices  150  in the area in use by patients, from a medication cart that is used by a nurse to deliver medications to patients, and/or from a central pharmacy responsible for supply the medication tray  16  having the medication dose contained therein.  
         [0059]     In certain use scenarios for the device  150 , the nurses and/or the central pharmacy program the device  150  to establish the minimum dosing interval and query the device  150  to determine when it is necessary to provide a new medication tray  16 , as the patient has self-administered all the available medication doses  66 . Querying of the device  150  by the pharmacy or the attending nurse also reveals when the patient has self-administered a medication dosage, information that is then included on the patient&#39;s medical record and invoiced against the patient&#39;s financial record. Every administered medication dose is also tracked by a pharmacy inventory system such that when a dose is administered it is deleted from inventory.  
         [0060]      FIG. 11  illustrates yet another embodiment of a medication on demand device  200  comprising a housing  204  for receiving a removable drug tray  202  further comprising compartments  20 / 154 / 159  therein. A tray indexing switch  208  detects movement of the tray  202  for recording by control components mounted on a printed circuit board  210 . Rotation of the tray  202  as detected by the indexing switch  208 , indicates when medication doses have been self-administered, from which it can be determined when the tray  202  is empty. As described above this information is useful for both the patient&#39;s medical and financial records. The device  200  further comprises an indicator  212  for indicating that the device is ready to provide access to another medication dose  66 .  
         [0061]     A dome  213 , comprising a transparent (in one embodiment) hemispherical or flat cover, overlies the drug tray  202  and defines an opening  214  therein. As descried above, the drug tray  202  is rotated to allow the opening  214  to align with one of the compartments  154 / 159 . The tray  202  is configured in either an open position with the medication dose  66  accessible by the patient through the opening  214  or in a closed position with a blank or empty compartment  159  aligned with the opening  214 . The dome  213  is removable to replace the tray  202  with a new tray  202  properly loaded with medication doses  66  for the patient. In another embodiment the dome  213  is pivotally attached to the housing  204 .  
         [0062]     The device  200  further comprises a solenoid  215  that engages the dome  213  to prevent unauthorized tampering with or removal of the dome  213  to access the medication doses  66 . The solenoid  215  is disengagable when it is necessary to load a new tray  202  into the housing  204 . According to the embodiment including the solenoid  215 , the commands entered through the user interface (the key pad  42  of  FIG. 1  or any wired or wireless network as described above) comprise: unlock the dome  213  by disengaging the solenoid  215 , setting the dispensing interval and providing identification information for the authorized user.  
         [0063]     According to the embodiment of  FIG. 11 , the tray  202  is caused to rotate by a planetary gear  216  driven by the motor  44 .  
         [0064]     According to yet another embodiment, a nurse or physician can override the dosing interval as programmed into the device  10 / 150 / 200 , permitting immediate rotation of the medication tray  16 / 202  into a position where a dose is accessible of patient administration. The override can be accomplished using the keypad  42 , the bar code reader  90 , the RFID tag reader  100  or the smart card reader  107  or programming components associated with the tray  170 .  
         [0065]      FIG. 12  illustrates a block diagram of one embodiment of a controller  300  and controlled components of a medication on demand device according to one embodiment of the present invention. The controller  300  comprises an access controller  302  responsive to a reader  304 , further comprising the bar code reader  90 , the RFID reader  100  and/or the smart card reader  107  described above, or another device for identifying a person as an authorized patient. A motor controller  308  controls the motor  44  as described above. A stop switch  310  determines that the tray  16 / 202  has stopped rotating and in response to a lock controller  312 , the solenoid  214  is engaged.  
         [0066]     A configuration interface  320  interfaces with the programming mechanism, such as the laptop/tablet computer  322  illustrated (or any of the other programming techniques and apparatuses described herein) to program the controller  300  with respect to the various programmable features, e.g., dosing interval, identification information.  
         [0067]     A timer controller  328  controls the various time-driven components of the device. An annunciator controller  334  controls a display  336  (including the clock  48  described in conjunction with  FIG. 5 ) to display real time or the time remaining until the next dose is permitted, i.e., accessible through the opening  152 / 214 . The controller  334  also controls a buzzer/beeper  338  to provide an audible indication when the next medication dose is permitted. Power is supplied to the device via a power supply  340 , comprising the batteries  76  in the embodiment of  FIG. 3  or another power source as desired.  
         [0068]     As known by those skilled in the art, the various components of the controller  300  illustrated in  FIG. 12  are in communications with other components thereof to effectuate control of the features and functions of the medication on demand device.  
         [0069]     While the invention has been described with reference to preferred embodiments, it will be understood by those skilled in the art that various changes may be made and equivalent elements may be substituted for elements thereof without departing from the scope of the present invention. The scope of the present invention further includes any combination of the elements from the various embodiments set forth herein. In addition, modifications may be made to adapt the teachings of the present invention to a particular application without departing from its essential scope thereof. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the appended claims.